Level of evidence of clinical spinal research and its correlation with journal impact factor

The level of evidence in prosthodontics in relation to author's characteristics: An analysis of three leading prosthodontics journals

Purpose

The purpose of this study was to examine the level of evidence (LOE) characteristics and associated factors that change over time in three leading prosthodontics journals.

Materials and methods

Articles published in The Journal of Prosthetic Dentistry (JPD), International Journal of Prosthodontics (IJP), and Journal of Prosthodontics (JP) in 2013 and 2020 were reviewed by eight independent reviewers. After applying exclusion and inclusion criteria, the number of authors, the corresponding author's educational degree, corresponding author's origin in each clinical research article were recorded. The included articles were rated by reviewers according to the level of evidence criteria and proposed level of evidence-associated factors. Descriptive statistics, univariable, and binary logistic regression analysis were performed to investigate dependent variables and potentially associated factors. All independent variables with a significant effect were analyzed by using a multivariable test. The entry and exit alpha level were set at αE = 0.15. The statistical significance was set at α = 0.05.

Results

A total of 439 articles from 3 selected journals for the years studied met the inclusion criteria. The percentages of level 1, 2, 3, 4, and 5 articles were 2.7 %, 11.4 %, 9.6 %, 13.4 % and 62.9 %, respectively. Univariable analysis results demonstrated significant associations related to the number of authors (P = 0.005), the corresponding author's educational degree (P = 0.022), and the corresponding author's geographic origin (P = 0.042). Multivariable analysis results demonstrated significant associations related to the number of authors (P = 0.002), and the corresponding author's geographic origin (P = 0.014).

Conclusions

The number of authors, CA degree, and CA origin had a significant association with the LOE of included prosthodontic studies. Although there was an increase in the number of publications from 2013 to 2020, the level of evidence trend shows no improvement over the years.

Methodological quality of systematic reviews on sepsis treatments: A cross-sectional study

OBJECTIVE

Systematic reviews (SRs) offer updated evidence to support decision-making on sepsis treatments. However, the rigour of SRs may vary, and methodological flaws may limit their validity in guiding clinical practice. This cross-sectional study appraised the methodological quality of SRs on sepsis treatments.

METHODS

We searched MEDLINE, EMBASE, and Cochrane Database for eligible SRs on randomised controlled trials on sepsis treatments with at least one meta-analysis published between 2018 and 2023. We extracted SRs' bibliographical characteristics with a pre-designed form and appraised their methodological quality using AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2. We applied logistic regressions to explore associations between bibliographical characteristics and methodological quality ratings.

RESULTS

Among the 102 SRs, two (2.0%) had high overall quality, while respectively four (3.9%), seven (6.9%) and 89 (87.3%) were of moderate, low, and critically low quality. Performance in several critical methodological domains was poor, with only 32 (31.4%) considering the risk of bias in primary studies in result interpretation, 22 (21.6%) explaining excluded primary studies, and 16 (15.7%) applying comprehensive searching strategies. SRs published in higher impact factor journals (adjusted odds ratio: 1.19; 95% confidence interval: 1.05 to 1.36) was associated with higher methodological quality.

CONCLUSIONS

The methodological quality of recent SRs on sepsis treatments is unsatisfactory. Future reviewers should address the above critical methodological aspects. More resources should also be allocated to support continuous training in critical appraisal among healthcare professionals and other evidence users.

Ten-Year Trends in Level of Evidence in Hand Surgery

BACKGROUND

The purposes of this study were to analyze the trends in Oxford level of evidence (LOE), LOE of most-cited articles, and association between LOE and journal impact factor (IF) and SCImago Journal Rank (SJR) over a 10-year period (2009-2018) in 3 prominent hand surgery journals, specifically HAND, Journal of Hand Surgery (American Volume) (JHS), and Journal of Hand Surgery (European Volume) (JHSE).

METHODS

All articles published from 2009 to 2018 in HAND, JHS, and JHSE were reviewed for assigned or available LOE. Data were pooled and analyzed for trends in LOE; relationship among IF, SJR, and LOE; and citation density.

RESULTS

A total of 3921 total publications were tabulated from 2009 to 2018, with the majority of studies being level V (1700, 43%) and fewer studies being level I (146, 4%). Over the 10-year study period, there was no significant change in frequency of level I studies for any journal. HAND trended significantly toward higher LOE, JHS trended toward higher LOE, and JHSE trended toward decreased LOE without significance. Among all journals, the annual number of articles and the average LOE were independent significant predictors of IF and SJR. Statistically significant correlations were found between citation density and LOE for JHS and HAND.

CONCLUSIONS

Higher quality evidence is becoming more prevalent in the hand surgery literature over the past 10 years. Annual articles, average LOE, and level I and II and level IV articles were significant predictors of increasing IF and SJR.

Level of evidence analysis of the Saudi Dental Journal: A bibliometric analysis of publications from 2012 to 2021

Objectives

The Level of Evidence (LOE) ranking system is used to measure the methodological quality of research. This study aimed to analyze and evaluate the trends of LOEs in articles published in the Saudi Dental Journal (SDJ) between 2012 and 2021.

Methodology

The bibliometric details of all articles published from 2012 to 2021 were extracted from the SDJ website. All articles, expect editorials, were included in the analysis. The articles were divided based on LOEs, dental specialties, number of authors, and centers. The citation metrics were obtained from Google Scholar, and the statistical analysis was performed using JMP Pro 15.2.0 software.

Results

Five hundred twenty-two articles were selected for analysis. They had an average of 21.19 citations per article, and a growing trend in the number of articles was observed. Authors from 40 countries contributed to the articles, with the most contributions from the Kingdom of Saudi Arabia. Most articles (n = 269; 51.53%) were LOE IV and V, while a low proportion (5.56%) were LOE I articles. Aside from miscellaneous articles, periodontics composed most of the LOE I studies, followed by endodontics, and oral and maxillofacial Surgery (OMFS). Orthodontics had the highest number of LOE II studies, pediatric dentistry had the most LOE IV, and prosthodontics had the most LOE V studies. No significant correlations were found between LOE and the number of authors or centers. However, a significant correlation was found in the distribution of LOE contributed by academic institutes.

Conclusion

The study results highlight that most articles were LOE IV and V, whereas nominal LOE I articles were found. Furthermore, there is a need to encourage dental scientists to carry out high-quality evidence studies. Professional dental societies can play a pivotal role in this regard.

Publication Speed Across Neurosurgery Journals: A Bibliometric Analysis

OBJECTIVE

Many factors influence an author's choice for journal submission, including journal impact factor and publication speed. These and other bibliometric data points have not been assessed in journals dedicated to neurosurgery.

METHODS

Eight leading neurosurgery journals were analyzed to identify original articles and reviews, collected via randomized, stratified sampling per published issue per year from 2016 to 2020. Bibliometric data on publication speed were gathered for each article. Journal impact factor, article processing fees, and open access availability were determined using Clarivate Journal Citation Reports. Correlation analysis and a linear regression model were used to estimate the effect of impact factor and publication year on publication speed.

RESULTS

Across the 8 neurosurgery journals, 1617 published articles were reviewed. The mean (standard deviation) time from submission to acceptance (SA) was 131 (101) days, from acceptance to online publication was 77 (61) days, and from submission to online publication was 207 (123) days. Higher impact factors correlated with longer publication times for all metrics. Later years of publication correlated with longer times from SA and submission to online publication. For each point increase in a journal's impact factor, multivariate regression modeling estimated a 19.2-day increase in time from SA, a 19.7-day increase in time from acceptance to online publication, and a 38.9-day increase in time from submission to online publication (P < 0.001 for all).

CONCLUSIONS

Publication speeds vary widely among neurosurgery journals and appear to be associated with the journal impact factor. Time to publication increased over the study period.

Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions

OBJECTIVE

Cervical disc arthroplasty (CDA) has been recognized as a popular option for cervical radiculopathy or myelopathy caused by disc problems that require surgery. There have been prospective randomized controlled trials comparing CDA to anterior cervical discectomy and fusion (ACDF) for 1- and 2-level disc herniations. However, the indications for CDA have been extended beyond the strict criteria of these clinical trials after widespread real-world experiences in the past decade. This article provides a bibliometric analysis with a review of the literature to understand the current trends of clinical practice and research on CDA.

METHODS

The PubMed database was searched using the keywords pertaining to CDA in human studies that were published before August 2022. Analyses of the bibliometrics, including the types of papers, levels of evidence, countries, and the number of disc levels involved were conducted. Moreover, a systematic review of the contents with the emphasis on the current practice of multilevel CDA and complex cervical disc problems was performed.

RESULTS

A total of 957 articles published during the span of 22 years were analyzed. Nearly one-quarter of the articles (232, 24.2%) were categorized as level I evidence, and 33.0% were categorized as levels I or II. These studies clearly demonstrated the viability and effectiveness of CDA regarding clinical and radiological outcomes, including neurological improvement, maintenance, and preservation of segmental mobility with relatively low risks for several years postoperation. Also, there have been more papers published during the last decade focusing on multilevel CDA and fewer involving the comparison of ACDF. Overall, there was a clustering of CDA papers published from the US and East Asian countries. Based on substantial clinical data of CDA for 1- and 2-level disc diseases, the practice and research of CDA show a trend toward multilevel and complex disease conditions.

CONCLUSIONS

CDA is an established surgical management procedure for 1- and 2-level cervical disc herniation and spondylosis. The success of motion preservation by CDA-with low rates of complications-has outscored ACDF in patients without deformity. For more than 2-level disc diseases, the surgery shows a trend toward multiple CDA or hybrid ACDF-CDA according to individual evaluation for each level of degeneration.

Level of evidence and characteristics of clinical studies published in leading prosthodontics journals

STATEMENT OF PROBLEM

Data on the level of evidence and the characteristics of studies published in peer-reviewed prosthodontic journals are lacking.

PURPOSE

The purpose of this study was to investigate the characteristics and level of evidence (LOE) scores of studies published in 3 leading peer-reviewed prosthodontic journals.

MATERIAL AND METHODS

Clinical studies published in the Journal of Prosthetic Dentistry (JPD), the Journal of Prosthodontics (JP), and the International Journal of Prosthodontics (IJP) in 2013 and 2020 were included in the analysis. Abstracts, letters to the editor, book reviews, and animal and laboratory studies were excluded from the investigation. For each study, design, type and LOE scores (Levels 1 to 5), publication year, impact factor (IF) of the journals, geographic origins of the first and corresponding authors, and funding status were recorded. Level 1 and Level 2 were defined as high evidence (HE), and Level 3, Level 4, and Level 5 were defined as low evidence (LE). Descriptive statistics and logistic regression analysis were performed (α=.05).

RESULTS

Among the 439 studies included in the analysis, the proportion of HE and LE studies was 14.1% and 85.9%, respectively. According to univariate and multivariate analysis results, year of publication (P=.010 and P=.029), geographic origin of the corresponding author (P<.001), and funding status (P<.001 and P=.002) were significantly associated with the LOE of a study. However, the journal IF was not associated with LOE (P=.328).

CONCLUSIONS

Although the number of HE studies in 3 leading prosthodontic journals has increased over time, the total number was still limited compared with LE studies. A further improvement in the overall LOE of clinical studies in prosthodontics is needed.

Level of Evidence of Dental Research in Saudi Arabia (2000-2020)

Objectives

The level of evidence (LOE) of Saudi dental research from 2000 to 2020 was evaluated, and factors associated with the LOE were determined.

Methods

This study was a systematic review. PubMed, Web of Science, and Medline databases were utilized to retrieve available dental articles published in English between January 2000 and May 2020. The inclusion criteria consisted of clinical studies conducted in Saudi Arabia with at least one Saudi dental affiliation. The retrieved eligible articles were evaluated independently by two reviewers using a modified Oxford LOE scale. The LOE of the studies was compared between the last two decades.

Results

Of the 7237 articles identified, 1557 articles met the inclusion criteria. Approximately 78% of the published articles reported Level IV evidence. A higher trend toward Level I, II, and III publications has occurred in recent years (i.e., 2010-2020). However, no statistically significant difference existed in LOE proportions between the two decades. The presence of international collaboration and high journals' impact factor was significantly associated with a higher LOE.

Conclusion

Most published dental research studies were low LOE studies (i.e., Level IV). National and international collaboration is highly encouraged as this is a factor, according to our findings, that would be a positive addition toward publishing dental research of a higher LOE in Saudi Arabia.

A bibliometric analysis of the spine journals

BACKGROUND

Spine is a rapidly growing branch with fully-dedicated peer-reviewed journals. Journal impact factor (JIF), speed of publication, and readership are some critical factors affecting the author's choice for submission. This study aimed to find the bibliometric data of spine journals.

METHOD

Fourteen Spine journals in NCBI (National centre for Biotechnology information, USA) database, meeting the inclusion criterion were analyzed for original articles, collected via stratified sampling from each issue of the journal. The dates to submission (DS), acceptance (DA), and publication (DP), study design, corresponding author's details like-subject specialization and country of affiliation were recorded for each original article. Data on JIF, number of issues/years, open access availability (OA), article processing charges (APC) were also retrieved. Correlation and geographic plot were used to display the findings.

RESULTS

The median (interquartile range) time for submission to publication/total time (TT) in spine journals was 175 (120-313) days with a submission to acceptance time of 107 (66-168) days and acceptance to publication time of 54 (20-170). Fifty-seven percent of the journals had APC, and all had options for OA. A significant correlation was noted between all determinants of publication speed and the Scimago Journal rankings (SJR) (AT: r = 0.238, PT: r = 0.074, TT: r = 0.288, p < 0.001). Amongst the author affiliations, the USA (37.5%) and Japan (18.6%) had the maximum contributions. Furthermore, 57.4% of authors were orthopaedicians, and 14.4% were neurosurgeons. Retrospective and prospective cohort studies were the standard study designs (48% vs. 20.9%), while clinical trials accounted for 5.8%.

CONCLUSION

Spine journals had comparable publication speed with other biomedical journals; all spine journals had OA options. Observational study dominates the pattern in spine research. The contribution is mainly from orthopaedician, but the trend is changing towards collaborative research with neurosurgeons.

Assessment and Trends in the Methodological Quality of the Top 50 Most Cited Articles in Shoulder Instability

Background:

Citation counts have often been used as a surrogate for the scholarly impact of a particular study, but they do not necessarily correlate with higher-quality investigations. In recent decades, much of the literature regarding shoulder instability is focused on surgical techniques to correct bone loss and prevent recurrence.

Purpose:

To determine (1) the top 50 most cited articles in shoulder instability and (2) if there is a correlation between the number of citations and level of evidence or methodological quality.

Study Design:

Cross-sectional study.

Methods:

A literature search was performed on both the Scopus and the Web of Science databases to determine the top 50 most cited articles in shoulder instability between 1985 and 2019. The search terms used included “shoulder instability,” “humeral defect,” and “glenoid bone loss.” Methodological scores were calculated using the Modified Coleman Methodology Score (MCMS), Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS) score.

Results:

The mean number of citations and mean citation density were 222.7 ± 123.5 (range, 124-881.5) and 16.0 ± 7.9 (range, 6.9-49.0), respectively. The most common type of study represented was the retrospective case series (evidence level, 4; n = 16; 32%) The overall mean MCMS, Jadad score, and MINORS score were 61.1 ± 10.1, 1.4 ± 0.9, and 16.0 ± 3.0, respectively. There were also no correlations found between mean citations or citation density versus each of the methodological quality scores.

Conclusion:

The list of top 50 most cited articles in shoulder instability comprised studies with low-level evidence and low methodological quality. Higher-quality study methodology does not appear to be a significant factor in whether studies are frequently cited in the literature.

Clinical Level of Evidence Presented at the Cervical Spine Research Society (CSRS) Annual Meeting Over 10 Years (2008-2017): A Systematic Review

STUDY DESIGN

Systematic review.

OBJECTIVE

We systematically reviewed the level of clinical evidence presented at Cervical Spine Research Society annual meetings from 2008 through 2017.

SUMMARY OF BACKGROUND DATA

The Cervical Spine Research Society is dedicated to advancing knowledge of the cervical spine to promote evidence-based care. Research presented at these meetings impacts clinical practice.

METHODS

A total of 774 paper abstracts presented at Cervical Spine Research Society (CSRS) annual meetings were independently assessed by two reviewers. Reviewers designated a clinical level of evidence (LOE) to each included abstract from level I to level IV based on criteria set forth by the Oxford Centre for Evidence-Based Medicine. Reviewer agreement was assessed using Cohens Kappa coefficient (k) and disagreements were discussed until a consensus was reached. Wilcoxon rank sum test was used to assess for differences in LOE grades. Chi-squared testing was used to assess nonrandom changes in level of evidence and in excluded studies.

RESULTS

A total of 583 abstracts were included. Over the last 10 CSRS meetings, 5.15% of presentations were level I, 27.8% level II, 27.4% level III, and 39.6% level IV. The average LOE from 2008 to 2017 was 3.02 (median = 3). Additionally, 49.7% were therapeutic studies, 37.6% prognostic studies, and 12.7% diagnostic studies. When comparing the first 5 years (2008-2012) to the last 5 years (2013-2017), we observed a significant increase in Level II (P = 0.007) evidence and a corresponding decrease in level IV evidence (P < 0.001). The average LOE improved from 3.14 (2008-2012) to 2.91 (2013-2017); there was a significant improvement in LOE between the two periods (P = 0.001).

CONCLUSION

Emphasis on evidence-based medicine within cervical spine research has positively influenced the clinical level of evidence disseminated at CSRS annual meetings between 2008 and 2017. Continued focus on higher quality Level I studies is warranted.

LEVEL OF EVIDENCE

4.

Levels of Evidence in Small Animal Dentistry and Oral Surgery Literature Over 40 Years

Veterinary dentistry and oral surgery are relatively new clinical disciplines that have rapidly evolved in the last few decades. Although clinical standards of care are supported by a growing body of literature, the extent to which peer-reviewed, evidence-based studies have contributed to advancing the practice of dentistry and oral surgery has not been assessed. The purpose of this study was to survey literature on the clinical practice of small animal dentistry and oral surgery published over the past 40 years to evaluate the levels of evidence over time, authorship affiliation, funding, and clinical subdisciplines within the field. A literature search was conducted in PubMed and the identified articles were screened for inclusion. A total of 1,083 articles were included for final analysis. Three reviewers independently assessed and assigned each article to one of nine predetermined study design categories. Systematic reviews and meta-analyses were considered the highest level of evidence, whereas expert opinion and experimental (ex vivo, in vitro, or in silico) studies were deemed the lowest levels of evidence. For statistical analysis and interpretation, study type was dichotomized into high evidence designs from which causal inference and/or associations could be derived, and low evidence designs which were purely descriptive or non-clinical experiments. No statistically significant difference in the distribution of study type was seen over time, with the majority of research in the last 5 years being largely at high risk of bias and descriptive in nature: 80.6% of articles published between 2014 and 2019 were assigned to the low evidence design tier. The type of study was found to differ by author affiliation: high evidence study designs were found more often than expected when author affiliation was multi-institutional or industrial, whereas private practice authorship was underrepresented in the high evidence design tier. To meet the increasing demand for evidence-based studies on the practice of dentistry and oral surgery in dogs and cats, researchers are encouraged to consider study design when testing hypotheses to improve the quality of research.

The level of evidence, scientific impact and social impact of clinical studies in periodontology: A methodological study

AIMS

To analyse the level of evidence (LOE) of clinical studies in the field of periodontology, and to investigate whether LOE is a predictor of scientific impact and social impact.

MATERIALS AND METHODS

Clinical studies published in five leading periodontal journals during 2015-2019 were identified. The LOE of included studies were assessed with a modified LOE classification system based on Oxford 2009 LOE, Oxford 2011 LOE and GRADE guidelines. Citation counts were harvested from Web of Science and Scopus. Altmetric Attention Scores (AAS) were obtained from Altmetric Explorer. Multivariable generalized estimation equation (GEE) analyses were used to investigate association between LOE and citation count, as well as between LOE and AAS.

RESULTS

Among 768 studies included, the proportion of level-1, level-2, level-3 and level-4 was 10.4%, 44.8%, 13.7% and 31.1%, respectively. In the multivariable GEE analyses, high LOE was a significant predictor of higher average citation count (p = .010) and higher AAS (p < .001).

CONCLUSION

The LOE of clinical studies in the periodontal field is relatively high in general, although it varies significantly in different journals. Studies with high LOE tend to have greater scientific impact and social impact than low LOE studies.

Clinical Level of Evidence Presented at the Lumbar Spine Research Society (LSRS) Annual Meeting Over 10 Years (2008-2017): A Systematic Review

STUDY DESIGN

A systematic review.

OBJECTIVE

The Lumbar Spine Research Society (LSRS) is dedicated to advancing knowledge of the lumbar spine to promote evidence-based care. We sought to systematically review the level of clinical evidence presented at LSRS annual meetings from 2008 through 2017.

SUMMARY OF BACKGROUND DATA

Improvements in clinical evidence have been reported at similar bone and joint scientific meetings.

METHODS

A total of 458 paper abstracts presented at LSRS annual meetings were independently assessed by two reviewers. Only clinical studies being included for analysis. Reviewers designated a clinical level of evidence (LOE) to each included abstract from level I to level IV based on criteria set forth by the Oxford Centre for Evidence-Based Medicine. Reviewer agreement was assessed using Cohens Kappa coefficient (k). Student t test was used to assess for differences in mean LOE grades. Chi-squared testing was used to assess nonrandom changes in LOE.

RESULTS

A total of 299 abstracts met inclusion criteria. Over the last 10 LSRS meetings, 2.68% of the presentations were level I, 22.4% were level II, 37.1% were level III, and 37.8% were level IV. We found the average LOE from 2008 to 2017 to be 3.10 (median = 3). In addition, 63.9% presentations were Therapeutic Studies, 30.1% were Prognostic Studies, and 6.02% were Diagnostic studies. When comparing the first 5 years (2008-2012) to the last 5 years (2013-2017), we observed a significant increase in Level II (P < 0.05) and Level III (P < 0.05) evidence along with a corresponding decrease in level IV evidence (P < 0.01). The average LOE improved significantly from 3.28 (2008-2012) to 2.88 (2013-2017) (P < 0.001).

CONCLUSION

Emphasis on evidence-based medicine within spine surgery, specifically pertaining to the lumbar spine, has positively influenced the clinical LOE disseminated at LSRS annual meetings between 2008 and 2017.

LEVEL OF EVIDENCE

4.

Publication characteristics of studies published in The Spine Journal from 2005 to 2015

There is a growing demand for evidence- based practices and informed clinical decision making supported by reliable, high-quality research. The aim of the study is to analyze trends in the level of evidence of publications and to evaluate the publication characteristics that influence the quality of research in The Spine Journal (TSJ). This is a comprehensive publication assessment that reviews and analyses all studies published in TSJ from the years 2005, 2007, 2009, 2011, 2013, and 2015. Level of evidence, study type, funding source, author country, author department, number of citations were considered as the outcome measures. Multivariable logistic regression, multivariable linear regression analyses, and chi square tests were used to analyze the trends of published studies level of evidence, study type, the specialties of authors, author countries, number of citations, and funding sources. A total of 1456 articles were evaluated. There was a decrease in the percentage of high-level evidence (level 1 and 2) studies from 73.6% in 2005 to 49.8% in 2015 (P=0.0045). There was a significant increase in the percentage studies with reporting funding support (P<0.0001). Funded studies were more likely to have a higher level of evidence (P<0.0001). The percentage of studies from international authors increased from 17.8% in 2005 to 69.1% in 2015 (P<0.0001). The percentage of studies with orthopedic authors decreased from 67% in 2005 to 44.9% in 2015 with a corresponding increase in the percentage of studies with neurosurgeon authors from 14.4% in 2005 to 23.2% by 2015, as well as an increase in the percentage of studies with a collaboration of authors from both specialties from 5.1% in 2005 to 8.7% in 2015 (P=0.0007). Orthopedic and neurosurgery collaboration in authorship did not affect the level of evidence of the studies nor the number of citations of the studies (P=0.7583). Earlier studies had a higher Scopus citation number but were not affected by the level of evidence (P=0.2515) nor the department of the author(s) (P=0.9107). We can conclude that the publication characteristics of articles in TSJ have evolved between 2005 and 2015 with a 3.9-fold increase in international authorship and a 32% decrease in the proportion of Level I and Level II studies. Inter-departmental collaboration, funding source, and country of origin may affect level of evidence and number of citations. Continued efforts to increase level of evidence should be considered.

Citation Analysis of Articles about Hand Surgery Published in Orthopaedic and Hand Surgery Journals

BACKGROUND

To date, little is known about the characteristics of highly cited studies in hand surgery compared with other orthopaedic subspecialties. We aimed to assess the position of hand surgery within the orthopedic surgery literature.

METHODS

We conducted a bibliographic analysis using the Web of Science database to review 1,568 articles published between January 2012 and December 2012 in 4 relevant general orthopedic and 2 hand surgery journals. We used the number of citations within 3 years of publication to measure the impact of each paper. To analyze prognostic factors using logistic regression analysis, we extracted data on orthopedic subspecialty, published journal, location of authorship, and type of study for all articles. For clinical studies, we also recorded details on study design and sample size.

RESULTS

Of eligible hand surgery articles (n = 307), the majority (62%) were case reports/series. Only 19% were comparative studies, comprising a significantly smaller proportion of comparative studies from other subspecialties in general orthopedic journals. Systematic reviews/meta-analyses generated a significantly higher number of average citations, whereas educational reviews were consistently cited less frequently than other study types (14.9 and 6.1 average citations, respectively). Being published in the Journal of Bone and Joint Surgery, American volume, having authorship in North America or Europe and Australia, focusing on subspecialties like hip & knee, sports, or shoulder, utilizing a comparative or randomized clinical trial study design, and having a larger sample size increased the odds of receiving more citations.

CONCLUSIONS

Clinical studies related to hand surgery published in general orthopedic journals are most often of lower quality study design. Having a larger sample size or using a comparative study or randomized clinical trial design can improve the quality of study and may ultimately increase the impact factor of hand surgery journals.

Comparison of Impact Factor, Eigenfactor Metrics, and SCImago Journal Rank Indicator and h-index for Neurosurgical and Spinal Surgical Journals

BACKGROUND

In academic specialties such as neurosurgery, bibliometrics are often used to guide readers, academic institutes, and researchers to make objective assessment of journals. Recently, new indices have been developed to overcome the shortcomings of the widely used Impact Factor. The objective of our study was to investigate the correlations among 6 of the commonly used bibliometric indices (Impact Factor, SCImago Journal indicator, SCOPUS h-index, Google h-index, Eigenfactor, Article Influence Score) in neurosurgical and spinal surgical journals.

METHODS

A list of all neurosurgical and spinal surgical journals was compiled using the databases of SCOPUS, Clarivate Analytics (Thomson Reuters), and National Library of Medicine Catalog. Journals that are not surgically oriented, non-English journals, and nursing journals were excluded. Bivariate Spearman ranking correlation tests were performed.

RESULTS

Fifty-four journals were included, of which 14 were spine themed. High positive correlations were obtained among the bibliometric indices of neurosurgical (nonspinal) journals (P < 0.05 in all pairs). Median values were 1.54, 0.66, 53, 25, 0.0035, and 0.46 for Impact Factor, SCImago Journal rank indicator, SCOPUS h-index, Google h-index, Eigenfactor, and Article Influence Score, respectively. However, the correlations for spinal surgical journals were more variable, likely because of the small sample size.

CONCLUSIONS

Despite the different mathematical basis among the citation-based bibliometric indices studied, they have strong correlations in ranking neurosurgical journals. This study provides evidence that the newer indices may be used interchangeably with the Impact Factor in this context, and they may, theoretically, mitigate some the shortcomings of the Impact Factor.

Evidence hierarchies relating to hand surgery: current status and improvement. A bibliometric analysis study

BACKGROUND

Hierarchy of evidence is an important measurement for assessing quality of literature. Information regarding quality of evidence within the Brazilian hand surgery setting is sparse, especially regarding whether research has improved in either quality or quantity. This study aimed to identify and classify hand surgery studies published in the two most important Brazilian orthopedics journals based on hierarchy of evidence, with comparisons with previously published data.

DESIGN AND SETTING

Bibliometric analysis study performed in a federal university.

METHODS

Two independent researchers conducted an electronic database search for hand surgery studies published between 2010 and 2016 in Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia. Eligible studies were subsequently classified according to methodological design, based on the Haynes pyramid model (HP) and the JBJS/AAOS levels of evidence and grades of recommendations (LOR). Qualitative and quantitative data were gathered regarding all studies. Previous data were considered to assess whether the proportion of high-quality studies had improved over time (2000-2009 versus 2010-2016).

RESULTS

The final analysis included 123 studies, mostly originating from the southeastern region (78.8%) and private institutions (65%), with self-funding (91.8%). Methodological assessment showed that 15.4% were classified as level I/II using HP and 16.4% using LOR. No significant difference in proportions of high-quality studies was found between the two periods of time assessed (5% versus 12%; P = 0.13).

CONCLUSION

Approximately 15% of hand surgery studies published in two major Brazilian journals were likely to be classified as high-quality through two different systems. Moreover, no trend towards quality-of-evidence improvement was found over the last 15 years.

Quality of Spine Surgery Research from the Arab Countries: A Systematic Review and Bibliometric Analysis

Purpose. The purpose of our study is to evaluate the level of evidence (LOE) of spine surgery publications in the Arab countries and compare it with standard international literature in spine surgery and to determine the stand of the Arab nations academic production with that of the global one. Methods. An online search using "PubMed" and "Google Scholar" was carried out, using search terms related to spine surgery such as "Spine surgery," "Scoliosis," "Herniated disc." Each article was reviewed and graded by two reviewers using Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence scale. Results. We have identified 434 articles that met the inclusion criteria; 56% were level IV studies. The most common study design was case reports (42%). The number of Arab countries with publications in spine surgery was 18 countries. The country with the highest rate of publications was Egypt (26%). The quantity of the published studies increased from 151 in (2000-2008) to 283 in (2009-2015). There is statistical significance between high and low LOE articles (p = 0.0007). Conclusion. We have observed that LOE has not changed significantly over the period of 15 years and that much of the publications are of a low LOE (levels III and IV). We, herein, emphasize the need for spine surgeons in the Arab countries to conduct studies of higher LOE.

Hip surgery and its evidence base: progress over a decade?

BACKGROUND

The burden of traumatic and elective hip surgery is set to grow. With an increasing number of techniques and implants against the background of an aging population, the emphasis on evidence-based treatment has never been greater. The purpose of this study was to assess changes in the levels of evidence in the hip literature over a decade.

MATERIALS AND METHODS

Articles pertaining to hip surgery from the years 2000 and 2010 in Hip International, Journal of Arthroplasty, Journal of Bone and Joint Surgery and The Bone and Joint Journal were analysed. Articles were ranked by a five-point level of evidence scale and by type of study, according to guidelines from the Centre for Evidence-based Medicine.

RESULTS

531 articles were analysed from 48 countries. The kappa value for the inter-observer reliability showed excellent agreement between the reviewers for study type (κ = 0.956, P < 0.01) and for levels of evidence (κ = 0.772, P < 0.01). Between 2000 and 2010, the overall percentage of high-level evidence (levels I and II) studies more than doubled (12 to 31 %, P < 0.001). The most frequent study type was therapeutic; the USA and UK were the largest producers of published work in these journals, with contributions from other countries increasing markedly over the decade.

CONCLUSIONS

There has been a significant increase in high levels of evidence in hip surgery over a decade (P < 0.001). We recommend that all orthopaedic journals consider implementing compulsory declaration by authors of the level of evidence to help enhance quality of evidence.

LEVEL OF EVIDENCE

Level 2: economic and decision analysis.

Strategies to improve the credibility of meta-analyses in spine surgery: a systematic survey

BACKGROUND CONTEXT

Meta-analyses are powerful tools that can synthesize existing research, inform clinical practice, and support evidence-based care. These studies have become increasingly popular in the spine surgery literature, but the rigor with which they are being conducted has not yet been evaluated.

PURPOSE

Our primary objectives were to evaluate the methodological quality (credibility) of spine surgery meta-analyses and to propose strategies to improve future research. Our secondary objectives were to evaluate completeness of reporting and identify factors associated with higher credibility and completeness of reporting.

STUDY DESIGN

This study is based on a systematic survey of meta-analyses.

OUTCOME MEASURES

We evaluated credibility according to the Users' Guide to the Medical Literature and completeness of reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

METHODS

We systematically searched MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently assessed eligibility, credibility, and completeness of reporting. We used multivariable linear regression to evaluate potential associations. Interrater agreement was quantified using kappa and intraclass correlation (ICC) coefficients.

RESULTS

We identified 132 eligible meta-analyses of spine surgery interventions. The mean credibility score was 3 of 7 (standard deviation [SD], 1.4; ICC, 0.86), with agreement for each item ranging from 0.54 (moderate) to 0.83 (almost perfect). Clinical questions were judged as sensible in 125 (95%), searches were exhaustive in 102 (77%), and risk of bias assessments were undertaken in 91 (69%). Seven (5%) meta-analyses addressed possible explanations for heterogeneity using a priori subgroup hypotheses and 24 (18%) presented results that were immediately clinically applicable. Investigators undertook duplicate assessments of eligibility, risk of bias, and data extraction in 46 (35%) and rated overall confidence in the evidence in 24 (18%). Later publication year, increasing Journal Impact Factor, increasing number of databases, inclusion of Randomized Controlled Trials, and inclusion of non-English studies were significantly associated with higher credibility scores (p<.05). The mean score for reporting was 18 of 27 (SD, 4.4; ICC, 0.94).

CONCLUSIONS

The credibility of many current spine surgery meta-analyses is limited. Researchers can improve future meta-analyses by performing exhaustive literature searches, addressing possible explanations of heterogeneity, presenting results in a clinically useful manner, reproducibly selecting and assessing primary studies, addressing confidence in the pooled effect estimates, and adhering to guidelines for complete reporting.

Hierarchy of evidence referring to the central nervous system in a high-impact radiation oncology journal: a 10-year assessment. Descriptive critical appraisal study

CONTEXT AND OBJECTIVE

To the best of our knowledge, there has been no systematic assessment of the classification of scientific production within the scope of radiation oncology relating to central nervous system tumors. The aim of this study was to systematically assess the status of evidence relating to the central nervous system and to evaluate the geographic origins and major content of these published data.

DESIGN AND SETTING

Descriptive critical appraisal study conducted at a private hospital in São Paulo, Brazil.

METHODS

We evaluated all of the central nervous system studies published in the journal Radiotherapy & Oncology between 2003 and 2012. The studies identified were classified according to their methodological design and level of evidence. Information regarding the geographical location of the study, the institutions and authors involved in the publication, main condition or disease investigated and time of publication was also obtained.

RESULTS

We identified 3,004 studies published over the 10-year period. Of these, 125 (4.2%) were considered eligible, and 66% of them were case series. Systematic reviews and randomized clinical trials accounted for approximately 10% of all the published papers. We observed an increase in high-quality evidence and a decrease in low-quality published papers over this period (P = 0.036). The inter-rater reliability demonstrated significant agreement between observers in terms of the level of evidence.

CONCLUSIONS

Increases in high-level evidence and in the total number of central nervous system papers were clearly demonstrated, although the overall number of such studies remained relatively small.

An analysis of references used for the Orthopaedic In-Training Examination: what are their levels of evidence and journal impact factors?

BACKGROUND

Although the references recommended for the Orthopaedic In-Training Examination (OITE) have been evaluated in certain subspecialty domains, suggested reference level of evidence (LOE), impact factor, and citation age have not been evaluated comprehensively to our knowledge.

QUESTIONS/PURPOSES

We present an analysis of all references cited in the OITE recommended readings for each test question including the duration of time between their initial publication and their use in the OITE, which we defined as citation age, LOE, and the impact factor of the journals referenced.

METHODS

We evaluated all references for the 2010 to 2012 OITE administrations (three examinations; 825 questions total). Publication characteristics, including citation age, were noted. The LOE for each journal article and the impact factor of each journal were determined; differences in LOE and impact factor were compared between test sections. A total of 1817 references were cited in the 825 questions we evaluated; this denominator was used in all calculations that follow.

RESULTS

The recommended reading references included 1337 journal article references (74%), 469 text references (26%), and 11 multimedia sources (0.6%; eg, websites, instructional DVDs). The three most commonly recommended journals were general orthopaedic journals, The Journal of Bone and Joint Surgery (American Volume), Journal of American Academy of Orthopaedic Surgeons, and Clinical Orthopaedics and Related Research. The majority (72.2%) of the cited journal references were published within 10 years of the test date, with a mean ± SD citation age of 8.3 ± 7.4 years. The majority of the cited journal articles were Levels IV and V evidence (mean, 4.16 ± 1.1). The Spine section had higher LOE (3.74; p < 0.001), although the practical relevance of such a difference is questionable, as all but two sections' LOE rounded to Level IV evidence. The Spine and Basic Science sections were published in journals with a larger mean impact factor (Basic Science, 7.16 ± 12.67; Spine, 5.73 ± 12.08; p < 0.001).

CONCLUSIONS

Our data show that the majority of the recommended readings for the OITE stem from higher impact general orthopaedic and major subspecialty journals. Furthermore the observed mean LOE of the recommended readings shows a preponderance of Levels IV and V research. These data may suggest that test-takers may find benefit in the review of high-level general orthopaedic journals, and review articles in particular while preparing for the OITE, although further study is necessary to determine optimal test preparation strategies. Finally, our study provides a baseline analysis of the study designs of OITE recommended references, and may provide insight for educators designing resident educational curricula.

Does source of funding and conflict of interest influence the outcome and quality of spinal research?

BACKGROUND/CONTEXT

There has been longstanding controversy surrounding the influence of funding source on the conduct and outcome of medical research. In 2011, a systematic review of the use of recombinant bone morphogenetic protein-2 revealed underreporting of unfavorable outcomes in some industry-sponsored trials. We hypothesize that Industrial funding and the presence of potential conflict of interest will be associated with low levels of evidence (LOE) and greater proportions of favorable outcomes in spinal research.

PURPOSE

The aim of this study is to investigate the association between funding source and potential conflict of interest on the LOE and study outcome in the current spinal research.

STUDY DESIGN/SETTING

Systematic review of all the spinal publications in five leading spinal, orthopedics, neurosurgery, and general medical journals during 2010 (print and online). Supplements were included.

OUTCOME MEASURE

Outcome and the LOE of research papers.

METHODS

Two reviewers independently assessed all publications. Commentaries, editorials, letters, open operating theatres, case reports, narrative reviews, and study protocols were excluded. The self-reported potential conflict of interest and type of funding was extracted from each paper. Funding type was classified as foundation, industry, public, intramural, multiple (including industry), multiple (without industry), and unfunded. The outcome of each study was classified as favorable, unfavorable, equivocal, or not applicable. Clinical publications were ranked using the LOE guidelines produced by the Oxford Center for Evidence-Based Medicine.

RESULTS

Overall, 1356 papers were analyzed, out of which 864 were suitable for LOE grading. There was good interobserver reliability for assignment of LOE grade, κ=0.897 (p<.01) and study outcome κ=0.804 (p<.01). A significant association was found between LOE and source of funding (p<.01). Industry-funded studies had the greatest proportion of level IV evidence (65%). There was a significant association between the funding source and study outcome (p=.01). The proportion of industry-funded studies with favorable outcomes (88%) was higher than that of publicly and foundation-funded studies (73% and 74%, respectively). The associated odds ratio for reporting favorable outcomes in industry-funded studies compared with studies with public and foundation funding was 2.7 (95% confidence interval [CI], 1.4-5.3), and 2.6 (95% CI, 1.3-5.2), respectively. A significant association between LOE and study outcome (p<.01) was also identified. Level I studies had the highest proportions of unfavorable (14%) and equivocal (23%) outcomes. Level IV studies had the highest proportion of favorable outcome (85%). There was no association between self-reported conflict of interest and LOE (p=.83) or study outcome (p=.25).

CONCLUSION

We demonstrated a significant association between source of funding, study outcome, and LOE in spinal research. A large proportion of industry funded research was shown to provide level IV evidence and report favorable outcome.