Impact of the PROFHER trial findings on surgeons’ clinical practice

Jefferson, Laura; Brealey, Stephen; Handoll, Helen; Keding, Ada; Kottam, Lucksey; Sbizzera, Illary; Rangan, Amar

doi:10.1302/2046-3758.610.bjr-2017-0170

Cited by 27 publications

(18 citation statements)

References 11 publications

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“…RCTs have an influence on medical practice as demonstrated with the PROFHER study. In it, half of the surgeons stated that they did fewer operations on PROFHER-eligible fractures after the publication of the PROFHER study in response to an online questionnaire via emails through the British Orthopedic Association [5]. Nevertheless, a randomized study demonstrated that opinion leaders influence the medical community to implement practice guidelines more effectively than audits and feedback [1].…”

Section: Discussionmentioning

confidence: 99%

Opinion leaders in the medical community attract more attention than randomized controlled trials in shoulder surgery

Torrens

Santana

Miquel

2020

International Orthopaedics (SICOT)

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Purpose The objective of this study was to determine whether opinion leaders in the medical community attract more attention than randomized controlled trials (RCT) in shoulder surgery. Methods A PubMed search to retrieve all therapeutic and diagnosis RCT shoulder studies was carried out. Three opinion leaders were chosen from among the last ten presidents of the European Shoulder and Elbow Society based on the number of publications. Their studies were also retrieved from PubMed. The metrics of the studies were determined through ResearchGate and Web of Science. The year of publication, impact factor of the journal, level of evidence, number of citations, number of reads, research interest, and reported conflicts of interest were recorded for every study. Results Two-hundred forty-five shoulder RCTs and 236 opinion leader studies met the inclusion criteria. The opinion leader studies were read significantly more times than the RCTs (p = 0.04). The mean impact factor for RCT studies was 2.84 (SD 3.9) while it was of 1.99 (SD1.14) in the opinion leader group (p < 0.001). Most of the studies of the opinion leaders were level IV (73.3%), while only 6.3% of their papers were categorized as levels I-II. Conflict of interest was present in 19.6% of the RCTs and in 32.2% of the opinion leader studies (p < 0.001). Conclusion The medical community pays more attention to opinion leader studies in shoulder surgery than to RCT studies even though RCTs are published in higher impact factor journals and opinion leader studies are mainly level IV evidence studies.

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Section: Discussionmentioning

confidence: 99%

Opinion leaders in the medical community attract more attention than randomized controlled trials in shoulder surgery

Torrens

Santana

Miquel

2020

International Orthopaedics (SICOT)

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“…In recent years, there has been a cultural shift in orthopedic surgery with a growing number of successful randomized clinical trials that have reduced uncertainty and influenced both practice and policy. [7][8][9][10][11][12] However, this has predominately involved adult orthopaedic surgery and is yet to be realized within children's orthopaedics.…”

Section: Cite This Article: Bone Joint J 2018;100-b:680-4mentioning

confidence: 99%

A consensus exercise identifying priorities for research into clinical effectiveness among children’s orthopaedic surgeons in the United Kingdom

Perry

Wright

Cooke

et al. 2018

The Bone & Joint Journal

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AimsHigh-quality clinical research in children's orthopaedic surgery has lagged behind other surgical subspecialties. This study used a consensus-based approach to identify research priorities for clinical trials in children's orthopaedics. MethodsA modified Delphi technique was used, which involved an initial scoping survey, a tworound Delphi process and an expert panel formed of members of the British Society of Children's Orthopaedic Surgery. The survey was conducted amongst orthopaedic surgeons treating children in the United Kingdom and Ireland. ResultsA total of 86 clinicians contributed to both rounds of the Delphi process, scoring priorities from one (low priority) to five (high priority). Elective topics were ranked higher than those relating to trauma, with the top ten elective research questions scoring higher than the top question for trauma. Ten elective, and five trauma research priorities were identified, with the three highest ranked questions relating to the treatment of slipped capital femoral epiphysis (mean score 4.6/ 5), Perthes' disease (4.5) and bone infection (4.5). ConclusionThis consensus-based research agenda will guide surgeons, academics and funders to improve the evidence in children's orthopaedic surgery and encourage the development of multicentre clinical trials.

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“…Several studies are starting to quantify the change in orthopaedic clinical practice following published level 1 evidence. Early attempts include the distal radius acute fracture fixation trial12 and proximal fracture of the humerus: evaluation by randomisation (PROFHER)13 randomised control trials. A review of the English Hospital Episode Statistics demonstrated that surgeons appeared to change their practice pattern for distal radius fractures after a large randomised control trial.…”

Section: Introductionmentioning

confidence: 99%

Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns?

et al. 2019

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ObjectivesTo determine if level 1 evidence from a landmark trial changed practice patterns for treatment of patients with displaced midshaft clavicle fractures.DesignRetrospective cohort study.SettingTwo level 1 trauma centres.ParticipantsDisplaced midshaft clavicle fractures.Results686 patients met inclusion criteria. The pretrial cohort (n=108) was 68.5% male, with a mean age of 37.7 (±13.9) years. The post-trial cohort (n=578) was 76.1% male, with a mean age of 41.9 (±12.7) years. There was nearly a 10-fold increase in the patients treated with openreduction and internal fixation (ORIF) in the post-trial cohort (34.1%) compared with the pretrial cohort (3.7%) (p<0.001). Patients in the post-trial cohort were more likely to undergo ORIF if they were <40 years (OR=2.2; 95% CI 1.53 to 3.10), if their Injury Severity Score was >9 (OR=1.6; 95% CI 0.89 to 2.99) or if they were treated at a centre that participated in theCanadian Orthopaedic Trauma Society (COTS)trial (OR=5.2; 95% CI 3.31 to 8.21).ConclusionsThis study demonstrated a significant shift towards more frequentORIFfor displaced midshaft clavicle fractures following the COTS trial. Quantifying changes in practice pattern following publication of level 1 evidence is important to further our understanding of the impact largerandomisedclinical trailsare having on clinical practice.

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Impact of the PROFHER trial findings on surgeons’ clinical practice

Cited by 27 publications

References 11 publications

Opinion leaders in the medical community attract more attention than randomized controlled trials in shoulder surgery

Opinion leaders in the medical community attract more attention than randomized controlled trials in shoulder surgery

A consensus exercise identifying priorities for research into clinical effectiveness among children’s orthopaedic surgeons in the United Kingdom

Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns?

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