Abstract
BackgroundEvidence Based Medicine (EBM) is increasingly being applied to inform clinical decision-making in orthopaedic surgery. Despite the promotion of EBM in Orthopaedic Surgery, the adoption of results from high quality clinical research seems highly unpredictable and does not appear to be driven strictly by randomized trial data. The objective of this study was to pilot a survey to determine if we could identify surgeon opinions on the characteristics of research studies that are perceived as being most likely to influence clinical decision-making among orthopaedic surgeons in Canada.MethodsA 28-question electronic survey was distributed to active members of the Canadian Orthopaedic Association (COA) over a period of 11 weeks. The questionnaire sought to analyze the influence of both extrinsic and intrinsic characteristics of research studies and their potential to influence practice patterns. Extrinsic factors included the perceived journal quality and investigator profiles, economic impact, peer/patient/industry influence and individual surgeon residency/fellowship training experiences. Intrinsic factors included study design, sample size, and outcomes reported. Descriptive statistics are provided.ResultsOf the 109 members of the COA who opened the survey, 95 (87%) completed the survey in its entirety. The overall response rate was 11% (95/841). Surgeons achieved consensus on the influence of three key designs on their practices: 1) randomized controlled trials 94 (99%), 2) meta-analysis 83 (87%), and 3) systematic reviews 81 (85%). Sixty-seven percent of surgeons agreed that studies with sample sizes of 101–500 or more were more likely to influence clinical practice than smaller studies (n = <100). Factors other than design influencing adoption included 1) reputation of the investigators (99%) and 2) perceived quality of the journal (75%).ConclusionAlthough study design and sample size (i.e. minimum of 100 patients) have some influence on clinical decision making, surgeon respondents are equally influenced by investigator reputation and perceived journal quality. At present, continued emphasis on the generation of large, methodologically sound clinical trials remains paramount to translating research findings to clinical practice changes. Specific to this pilot survey, strategies to solicit more widespread responses will be pursued.
Highlights
There is an increasing awareness and application of evidence-based medicine (EBM) to guide clinical practice and enhance patient care in many medical and surgical specialties - and orthopaedic surgery is no exception (Dijkman de SA et al SpringerPlus (2015) 4:62“High-quality evidence”, often cited as the requirement for orthopaedic surgeons to consider changing clinical practice (Khan et al 2013), is not always successful in effecting changes
While previous reports suggest that 90% of surgeons used randomized-controlled trial (RCT) to guide practice (Matzon et al 2013), that number is much lower in orthopaedic surgery - with only 25% and 46% of surgeons finding RCTs “extremely” and “somewhat” helpful, respectively (Khan et al 2013)
Demographics The initial e-mail asking for respondent participation was sent out to the 841 active Canadian Orthopaedic Association (COA) members with a listed e-mail address
Summary
There is an increasing awareness and application of evidence-based medicine (EBM) to guide clinical practice and enhance patient care in many medical and surgical specialties - and orthopaedic surgery is no exception (Dijkman de SA et al SpringerPlus (2015) 4:62“High-quality evidence”, often cited as the requirement for orthopaedic surgeons to consider changing clinical practice (Khan et al 2013), is not always successful in effecting changes. While previous reports suggest that 90% of surgeons used RCTs to guide practice (Matzon et al 2013), that number is much lower in orthopaedic surgery - with only 25% and 46% of surgeons finding RCTs “extremely” and “somewhat” helpful, respectively (Khan et al 2013) The reasons for this are likely multi-factorial, with studies demonstrating surgeon preference (LeBlanc et al 2014), increasing patient education/pressure (McKinlay et al 2014), and challenges unique to practice setting and resource allocation (Farias-Kovac et al 2014) as critical in determining patient treatment – independent of sound evidence.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
