The Statistical Fragility of Management Options for Acute Achilles Tendon Ruptures – A Systematic Review of Randomized Control Trial with Fragility Analysis

Doyle, Tom R.; Davey, Martin S.; Hurley, Eoghan T.

doi:10.1016/j.jisako.2022.04.003

Cited by 8 publications

(3 citation statements)

References 90 publications

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“… 4 While a previously published analysis of 12 surgical fragility analyses found the median FI to be 3 and FQ to be 0.039. 8 For the purpose of a more focused comparison, we conducted a search for fragility analyses which focus primarily on shoulder surgery. This returned 6 reviews and they report a median FI of 4 (4-4).…”

Section: Discussionmentioning

confidence: 99%

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The statistical fragility of the management options for reverse shoulder arthroplasty: a systematic review of randomized control trial with fragility analysis

Doyle¹,

Hurley²,

Davey³

et al. 2023

JSES Reviews, Reports, and Techniques

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Section: Discussionmentioning

confidence: 99%

“… 2 , 39 A limitation of this review is that it includes fewer RCTs than some other previously published analyses. 8 , 11 , 21 , 37 However, this is an accurate reflection of RSA evidence pool that is currently available. The primary limitation of fragility analyses is that only dichotomous variables may be included.…”

Section: Discussionmentioning

confidence: 99%

The statistical fragility of the management options for reverse shoulder arthroplasty: a systematic review of randomized control trial with fragility analysis

Doyle¹,

Hurley²,

Davey³

et al. 2023

JSES Reviews, Reports, and Techniques

Self Cite

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“…Statistical fragility is poorly understood, with no consensus on cut-offs to determine whether a study is significantly fragile or robust. However, multiple studies have shown high fragility in the medical literature (3,7,8).…”

Section: Discussionmentioning

confidence: 99%

A Comparative Analysis of Unit Fragility and the Relative Risk Index

Heston

2023

Preprint

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BACKGROUND: In biostatistics, evaluating fragility is crucial for understanding their vulnerability to miscategorization. One proposed measure of statistical fragility is the unit fragility index (UFI), which measures the susceptibility of the p-value to flip significance with minor changes in outcomes. Although the UFI provides valuable information, it relies on p-values, which are arbitrary measures of statistical significance. Alternative measures, such as the fragility quotient (FQ) and the percent fragility index, have been proposed to decrease the UFI’s reliance on sample size. However, these approaches still rely on p-values and thus depend on an arbitrary cutoff of p < 0.05. Instead of quantifying fragility by relying on p-values, this study evaluated the effect of small changes on relative risk. METHODS: Random 2x2 contingency tables associated with an initial p-value of 0.001 to 0.05 were evaluated. Each table’s UFI and relative risk index (RRI) were calculated. A derivative of the RRI, the percent RRI, was also calculated along with the FQ. The UFI, FQ, RRI, pRRI, initial p-value, and sample size were compared. RESULTS: A total of 15000 cases were tested. The correlation between the UFI and the p-value was the strongest (r = -0.807), and the correlation between the pRRI was the weakest (r = -0.395). The RRI had the strongest correlation with the sample size (r = 0.826), and the UFI had the weakest correlation (r = 0.3904). The coefficient of variation for the average RRI was the smallest at 28.3%, and for the FQ, it was the greatest at 57.0%. The correlation between the UFI, FQ, and p-value is significantly greater than the correlation between the RRI, pRRI, and p-value (for all comparisons, p < 0.001). CONCLUSION: The RRI and pRRI are significantly less correlated with the p-value than the UFI and FQ, indicating relative independence of the RRI and pRRI from p-values.

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The fragility of statistical significance in distal femur fractures: systematic review of randomized controlled trials

Megafu

Mian

Megafu

et al. 2022

Eur J Orthop Surg Traumatol

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The Statistical Fragility of Management Options for Acute Achilles Tendon Ruptures – A Systematic Review of Randomized Control Trial with Fragility Analysis

Cited by 8 publications

References 90 publications

The statistical fragility of the management options for reverse shoulder arthroplasty: a systematic review of randomized control trial with fragility analysis

The statistical fragility of the management options for reverse shoulder arthroplasty: a systematic review of randomized control trial with fragility analysis

A Comparative Analysis of Unit Fragility and the Relative Risk Index

The fragility of statistical significance in distal femur fractures: systematic review of randomized controlled trials

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