To The Editor:
I want to thank Drs. Wright and Swiontkowski and the Editor of The
Journal for producing the new section called "Evidence-Based
Orthopaedics." I have grown immensely frustrated with research
articles published in orthopaedic journals. So many of the articles
are retrospective, based on numbers insufficient to support adequate
conclusions, limited by short durations of follow-up, and oriented
toward treatment of the disease and not the patient. I discovered POEMS
(patient-oriented evidence that matters) in my search for a source
that would filter the literature and give me nuggets of information
from reliable research. I hoped to see the advent of orthopaedic
POEMS. Please keep up the good work.
Reviews of topics of clinical interest appear in The Journal
in the form of "Current Concepts Reviews," "Instructional
Course Lectures," and other features. These reviews never
give any indication of the nature and quality of the research covered.
This makes the reviews subject to the biases and prejudices
of the reviewers. While the reviewers are often considered experts
in the area, I wonder how many have a solid grounding in scientific
methodology and statistics in order to judge which articles are
most worthwhile.
In my search for filtered summaries to answer clinical questions,
I discovered the Cochrane Collaboration and the Cochrane Library
(www.cochranelibrary.com). This is an international collaboration
that seeks to answer important clinical questions by searching for
research that is well done, methodologically sound, and statistically
strong. The collaborators look for double-blind, controlled studies
that can address clinical questions. They often synthesize the information
from multiple articles with use of meta-analysis. When there are
only a few articles that are germane to the question, they simply
cite the articles in a summary fashion. However, the Cochrane Library does
not have much that is relevant to orthopaedics. I wonder if some
sort of international collaborative database similar to the Cochrane
Library could be set up to act as a central clearinghouse and idea
exchange for the development of systematic reviews of the literature
on any given topic in orthopaedic surgery.
—Kenneth C. Peacock, MDLaurel Orthopedic
Evaluations
Moorestown Office Center, Suite 305
110 Marter Avenue
Moorestown, NJ 08057
E-mail address: kcp@bellatlantic.net
J.G. Wright and
M.F. Swiontkowski reply:
We thank Dr. Peacock for his letter supporting the new section
of "Evidence-Based Orthopaedics" in The Journal.
We hope to provide the reader the
benefit of the highest-quality clinical research published in other
peer-reviewed journals on topics of interest to the orthopaedic
surgeon. We are in full agreement regarding the critical differences between
a review article, which relies on the author’s individual
perspective, and a systematic literature review or meta-analysis,
such as that provided by the Cochrane Collaboration. The Cochrane
web site includes a section on musculoskeletal conditions (focusing
on osteoporosis, arthritis, etc.) and a section on musculoskeletal
injuries (involving both bone and soft-tissue trauma). Recent reviews
are identified in both sections, and one may search using these
terms on the home page. One of us (M.F.S.) is, in fact, on the editorial
board of the Cochrane Musculoskeletal Injuries Group within the
Cochrane Collaboration (a bias that should be identified in this
letter). We thank Dr. Peacock again for his support of The Journal’s
efforts to supply our readers with the best scientific information
available on musculoskeletal conditions.
—James G. Wright, MD
Marc F. Swiontkowski, MD Corresponding author: James G.
Wright, MD
The Hospital for Sick Children
555 University Avenue, Room S-107
Toronto, ON M5G 1X8, Canada
E-mail address: jgwright@sickkids.on.ca