Levels of Evidence is important for Orthopaedic clinical research…..all of them!
We have made great progress in increasing the quality of evidence on which to make practice decisions in Orthopaedic surgery over the last 30 years. JBJS publishes 10-12% level 1 manuscripts annually which is slowly increasing but will never dominate. RCT’s are valuable in this regard but are not always useful and we will discuss the move to large practical trials to improve the utility as well as issues of trial fragility. Because of the practicalities of our surgical field Level 3 and Level 4 cohort studies are always going to provide value to clinicians faced with decision making. Level 5 expert opinion adds value as well but the limitations therein should be highlighted.
Insights from our discussion will uncover
- Level 1 and 2 studies are very valuable but have inherent limitations
- Level 3 and 4 studies are appropriate because of the realities of the field of Orthopaedic Surgery
- Level 5 studies are also valuable with caveats
Marc Swiontkowski, MD
Orthopaedic Trauma Surgeon
Professor, Department of Orthopaedic Surgery
University of Minnesota Medical School
Editor-In-Chief of The Journal of Bone and Joint Surgery
Deborah Bohn, MD
Orthopaedic Surgeon- Hand
Clinical Educator, Health Partners Minnesota
Hand Fellowship Clinical Educator, University of Minnesota
Orthopaedic Surgery Residency Program