The Journal of Bone and Joint Surgery has
introduced a new section entitled "Evidence-Based Orthopaedics"
in this volume. The Journal has always taken a
leadership role in promoting the use of randomized clinical trials
in orthopaedic surgery1, and this
new section will apprise orthopaedic surgeons of important advances
in a constructive and timely manner. Sackett et al. defined evidence-based
medicine as "the conscientious, explicit, and judicious use of current
best evidence in making decisions about the care of individual patients.
The practice of evidence based medicine means integrating individual
clinical expertise with the best available external clinical evidence
from systematic research."2 This
definition emphasizes the need to balance the best evidence with
clinical experience when making decisions with and for patients.
Randomized clinical trials are thought to provide the highest-quality
evidence and, when available, should influence clinical decision-making.
Randomized clinical trials will form the main contributions to
Evidence-Based Orthopaedics. Future installments will include diagnostic
test evaluations, meta-analyses, prognostic studies, and economic
analyses. Each section will include three, four, or five structured
abstracts. A commentary written by an experienced clinician will accompany
each abstract. The commentators will scrutinize the articles for
quality, place the research into context, and include recommendations on
how the study should influence clinical practice.
The sections will be created in numerous stages. First, with
the help of Dr. R. Brian Haynes and Cindy Walker-Dilks of the Health
Information Research Unit at McMaster University, forty orthopaedic
and other specialty journals will be reviewed each month to identify
randomized clinical trials and other studies of interest to orthopaedic
surgeons. All articles that pass a preliminary methodological evaluation
will be reviewed by the Associate Editor for Evidence-Based Orthopaedics
(J. G. W.). The final selection of articles will be performed in
conjunction with the Deputy Editor for Outcome Studies (M. F. S.). The
focus of this selection process is to choose those articles on studies
performed with the highest methodological standards3 deemed to be clinically relevant
to practicing orthopaedic surgeons. Commentaries will be solicited
from clinicians who are experts in their field, many of whom will
have experience in clinical epidemiology, health sciences, or outcomes
research. The Journal initially plans to publish
the section on a quarterly basis.
This section is specifically devoted to busy clinicians with
real-world questions; the hope is that the abstracts will help to
improve the quality of orthopaedic practice. Clearly, not all issues
in surgery are amenable to randomized clinical trials4. Furthermore, these abstracts and
commentaries are intended to guide, but not replace, clinical judgment
in choosing appropriate care for patients. We anticipate that future
sections will include trials that compare two or more surgical treatments
or that compare operative with nonoperative treatments for orthopaedic
problems. We look forward to your comments on this and future sections,
and we hope to receive suggestions on how to improve the section
for readers of The Journal.