ArticleClinical orthopaedics and related research2013
Have levels of evidence improved the quality of orthopaedic research?
Article in Clinical orthopaedics and related research, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed.
- Hybrid versus cemented implants for total hip replacement: a randomised feasibility study with embedded qualitative research.BMC musculoskeletal disorders · 2026Trial
- Not Ready for Prime Time: Limitations of a Retrieval-Augmented Generation Large Language Model in Assessing Risk of Bias in Observational Studies.Journal of the Pediatric Orthopaedic Society of North America · 2026Article
- The top 50 cited publications relating to femoral shaft fractures - A bibliometric analysis of the literature.Journal of orthopaedics · 2025Article
- Tibial shaft fractures: A bibliometric analysis of the top 50 most cited publications.Journal of orthopaedics · 2025Article
- Ten-Year Trends in Level of Evidence in Hand Surgery.Hand (New York, N.Y.) · 2024Article
- Clinical investigations to evaluate high-risk orthopaedic devices: a systematic review of the peer-reviewed medical literature.EFORT open reviews · 2023Article
- Validation of a Smartphone-Based Institutional Electronic Data Capture System for Thumb Carpometacarpal Joint Arthroplasty.Hand (New York, N.Y.) · 2023Article
- Validation of a Novel Smartphone-Based Electronic Data Capture System Following Surgical Fixation of Distal Radial Fractures.Hand (New York, N.Y.) · 2023Article
- Impact of Large Database Studies on Orthopedic Surgery Literature: Are We Advancing the Field?HSS journal : the musculoskeletal journal of Hospital for Special Surgery · 2023Article
- Assessment of 30 Years of Randomized Controlled Trials inOrthopaedic journal of sports medicine · 2023Review
- Trends in Level of Evidence of Systematic Reviews in Sports Medicine, 2010-2020 : A Systematic Review and Meta-analysis.Orthopaedic journal of sports medicine · 2022Review
- A systematic analysis of preprints in Trauma & Orthopaedic surgery.Bone & joint open · 2022Review
- Acute Versus Delayed Surgical Intervention in Multiligament Knee Injuries: A Systematic Review.Orthopaedic journal of sports medicine · 2021Review
- Opinion leaders in the medical community attract more attention than randomized controlled trials in shoulder surgery.International orthopaedics · 2021Article
- Level of Evidence and Industry Sponsorship Associated with Favorable Outcomes in Publications on Platelet-Rich-Plasma Therapy in Musculoskeletal Disorders.Revista brasileira de ortopedia · 2020Article
- Assessing the level of evidence in the orthopaedic literature, 2013-2018: a review of 3449 articles in leading orthopaedic journals.Patient safety in surgery · 2020Article
- The extent of pediatric orthopaedic research in low- and middle-income countries and the impact of academic collaboration on research quality: a scoping review.Pediatric surgery international · 2019Article
- CORR InsightsClinical orthopaedics and related research · 2017Article
- Has the Level of Evidence of Podium Presentations at the Musculoskeletal Tumor Society Annual Meeting Changed Over Time?Clinical orthopaedics and related research · 2017Article
- Impact of academic collaboration and quality of clinical orthopaedic research conducted in low- and middle-income countries.SICOT-J · 2017Article
Corrections and comments
- Commented on by
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSince 2003 many orthopaedic journals have adopted grading systems for levels of evidence (LOE). It is unclear if the quality of orthopaedic literature has changed since LOE was introduced. QUESTIONS/PURPOSES: We asked three questions: (1) Have the overall number and proportion of Level I and II studies increased in the orthopaedic literature since the introduction of LOE? (2) Is a similar pattern seen in individual orthopaedic subspecialty journals? (3) What is the interobserver reliability of grading LOE?
methodsWe assigned LOE to therapeutic studies published in 2000, 2005, and 2010 in eight major orthopaedic subspecialty journals. Number and proportion of Level I and II publications were determined. Data were evaluated using log-linear models. Twenty-six reviewers (13 residents and 13 attendings) graded LOE of 20 blinded therapeutic articles from the Journal of Bone and Joint Surgery for 2009. Interobserver agreement relative to the Journal of Bone and Joint Surgery was assessed using a weighted kappa.
resultsThe total number of Level I and II publications in subspecialty journals increased from 150 in 2000 to 239 in 2010. The proportion of high-quality publications increased with time (p < 0.001). All subspecialty journals other than the Journal of Pediatric Orthopaedics and the Journal of Orthopaedic Trauma showed a similar behavior. Average weighted kappa was 0.791 for residents and 0.842 for faculty (p = 0.209).
conclusionsThe number and proportion of Level I and II publications have increased. LOE can be graded reliably with high interobserver agreement. The number and proportion of high-level studies should continue to increase.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.