The Journal of Bone and Joint Surgery (American). 2008;90:595-601.
doi:10.2106/JBJS.G.00279
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Publication Bias in Orthopaedic Research: An Analysis of Scientific Factors Associated with Publication in The Journal of Bone and Joint Surgery (American Volume)

Kanu Okike, MD, MPH1, Mininder S. Kocher, MD, MPH2, Charles T. Mehlman, DO, MPH3, James D. Heckman, MD4 and Mohit Bhandari, MD, MSc5

1 Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail address: okike{at}post.harvard.edu
2 Department of Orthopaedic Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115
3 Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229
4 The Journal of Bone and Joint Surgery, 20 Pickering Street, Needham, MA 02492-3157
5 Department of Orthopaedic Surgery, Hamilton General Hospital, 7 North, Suite 727, Barton Street East, Hamilton, ON L8L 2X2, Canada

Investigation performed at Harvard Medical School and Children's Hospital, Boston, Massachusetts, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, and Hamilton General Hospital, Hamilton, Ontario, Canada

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the Department of Orthopaedic Surgery at Children's Hospital Boston. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (The Journal of Bone and Joint Surgery). A commercial entity (DePuy Spine) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Background: Positive outcomes are common in the orthopaedic literature, and there are many who believe it may be due to the preferential publication of studies with positive findings—a phenomenon known as publication bias. The purpose of this investigation was to determine whether positive findings rendered a manuscript submitted to The Journal of Bone and Joint Surgery (American Volume) more likely to be accepted for publication.

Methods: A total of 1181 manuscripts submitted to The Journal of Bone and Joint Surgery between January 1, 2004, and June 30, 2005, for publication as scientific articles were analyzed, with 855 meeting the inclusion criteria. The direction of the study findings (positive, neutral, or negative) was independently graded by three blinded reviewers. The final disposition (acceptance or rejection) was recorded, as was information on the scientific characteristics plausibly related to acceptance or rejection. Logistic regression was used to identify factors associated with acceptance for publication.

Results: The overall acceptance rate was 21.8% (186 of 855 studies). The study outcome was positive for 72.5% (620) of the manuscripts. The acceptance rate for the 235 manuscripts with nonpositive findings was 23.0% (fifty-four studies) compared with 21.3% (132) of the 620 studies with positive findings (crude odds ratio, 1.10 [95% confidence interval, 0.77 to 1.58]; p = 0.593). After controlling for all covariates, the adjusted odds ratio was 0.92 (95% confidence interval, 0.62 to 1.35; p = 0.652). In the multivariate analysis, the only factor significantly associated with acceptance for publication was level of evidence (p = 0.001).

Conclusions: We found no evidence of publication bias in the review of manuscripts for publication by The Journal of Bone and Joint Surgery, as positive and nonpositive studies were accepted at similar rates. The dearth of nonpositive studies in the orthopaedic literature is of concern, and may be due largely to investigator-based factors. Orthopaedic researchers should submit negative and neutral studies for publication, confident that the likelihood of acceptance will not be influenced by the direction of study findings.


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K. Okike, M. S. Kocher, C. T. Mehlman, J. D. Heckman, and M. Bhandari
Nonscientific Factors Associated with Acceptance for Publication in The Journal of Bone and Joint Surgery (American Volume)
J. Bone Joint Surg. Am., November 1, 2008; 90(11): 2432 - 2437.
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