This Article Full Text Full Text (PDF) CME: Take the activity for this article: CME 1: January, February, March 2010 ... [Supporting data] [Commentary] Letters to the Editor: Submit a response Letters to the Editor: View responses Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Rights and Permissions Citing Articles Citing Articles via Google Scholar Sign up for keyword alerts Google Scholar Articles by Dijkman, B. G. Articles by Bhandari, M. Search for Related Content PubMed PubMed Citation Articles by Dijkman, B. G. Articles by Bhandari, M. Related Collections Basic Science Social Bookmarking                   What's this?

Twenty Years of Meta-Analyses in Orthopaedic Surgery: Has Quality Kept Up with Quantity?

¹ Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 2X2, Canada. E-mail address for M. Bhandari: bhandam{at}mcmaster.ca
² Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Postbus 95500, 1090 HM Amsterdam, the Netherlands
³ Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
⁴ Department of Orthopaedic Surgery, Boston University Medical Center, 850 Harrison Avenue, Boston, MA 02118

A commentary by Elena Losina, PhD, and Jeffrey N. Katz, MD, MSc, is available at www.jbjs.org/commentary and as supplemental material to the online version of this article.

Investigation performed at Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. One of the authors receives salary support, in part, from a Canada Research Chair, McMaster University.

Methods We conducted, in duplicate and independently, a systematic review of published meta-analyses in orthopaedics in the years 2005 and 2008 and compared them with a previous systematic review of meta-analyses from 1969 to 1999. A search of electronic databases (MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews) was performed to identify meta-analyses published in 2005 and 2008. We searched bibliographies and contacted content experts to identify additional relevant studies. Two investigators independently assessed the quality of the studies, using the Oxman and Guyatt index, and abstracted relevant data.

Results We included forty-five and forty-four meta-analyses from 2005 and 2008, respectively. While the number of meta-analyses increased fivefold from 1999 to 2008, the mean quality score did not change significantly over time (p = 0.067). In the later years, a significantly lower proportion of meta-analyses had methodological flaws (56% in 2005 and 68% in 2008) compared with meta-analyses published prior to 2000 (88%) (p = 0.006). In 2005 and 2008, respectively, 18% and 30% of the meta-analyses had major to extensive flaws in their methodology. Studies from 2008 with positive conclusions used and described appropriate criteria for the validity assessment less often than did those with negative results. The use of random-effects and fixed-effects models as pooling methods became more popular toward 2008.

Conclusions Although the methodological quality of orthopaedic meta-analyses has increased in the past twenty years, a substantial proportion continues to show major to extensive flaws. As the number of published meta-analyses is increasing, a routine checklist for scientific quality should be used in the peer-review process to ensure methodological standards for publication.

CiteULike    Connotea    Del.icio.us    Facebook    Technorati    Twitter    What's this?

Letters to the Editor:

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.