Impact of academic collaboration and quality of clinical orthopaedic research conducted in low- and middle-income countries.

Hao-Hua Wu,Theodore Miclau,David W Shearer,Amber M Caldwell,Wes Turner,Max Liu,Ralph Richard Coughlin,Jesse C Hahn,Lincoln Baltus,Saam Morshed,Kushal R Patel

doi:10.1051/sicotj/2016042

Abstract

Background: Little is known about the quality of orthopaedic investigations conducted in low- and middle-income countries (LMICs). Academic collaboration is one model to build research capacity and improve research quality. Our study aimed to determine (1) the quality of clinical orthopaedic research conducted in LMICs, (2) the World Bank Regions and LMICs that publish the highest quality studies, (3) the pattern of collaboration among investigators and (4) whether academic collaboration between LMIC and non-LMIC investigators is associated with studies that have higher levels of evidence. Methods: Orthopaedic studies from 2004 to 2014 conducted in LMICs were extracted from multiple electronic databases. The World Bank Region, level of evidence and author country-affiliation were recorded. Collaboration was defined as a study that included an LMIC with non-LMIC investigator. Results: There were 958 studies that met inclusion criteria of 22,714 searched. Ninety-seven (10.1%) of included studies achieved Level 1 or 2 evidence, but case series (52.3%) were the most common. Collaboration occurred in 14.4% of studies and the vast majority of these (88.4%) were among academic institutions. Collaborative studies were more likely to be Level 1 or 2 (20.3% vs. 8.4%, p < 0.01), prospective (34.8% vs. 22.9% p = 0.04) and controlled (29.7% vs. 14.4%, p < 0.01) compared to non-collaborative studies. Conclusions: Although orthopaedic studies in LMICs rarely reach Level 1 or 2 evidence, studies published through academic collaboration between LMIC and non-LMIC investigators are associated with higher levels of evidence and more prospective, controlled designs.

Highlights

There is increasing recognition of the importance of musculoskeletal disease as a global health issue, as it relates to injury
265 (27.6%) of clinical orthopaedic research studies conducted in low- and middle-income countries (LMICs) were epidemiologic or qualitative and had no level of evidence (LOE)
The percentage of high-quality global orthopaedics being conducted in LMICs annually has been stagnant over time (Figure 2), even though the number of LMIC orthopaedic studies has steadily increased over the same time period

Summary

Introduction

There is increasing recognition of the importance of musculoskeletal disease as a global health issue, as it relates to injury. An estimated 1.2 million deaths and 50 million nonfatal injuries occur each year due to road traffic accidents alone [1], with traumatic injuries contributing to more global disability than human immunodeficiency virus (HIV), tuberculosis and malaria combined [2, 3]. The burden of injury is greatest in low- and middle-income countries (LMICs), where resource-limited orthopaedic surgeons face a daunting volume of musculoskeletal disease [2, 4].

Methods

Results

Discussion

Conclusion