Evidence Based Orthopaedics and Orthopaedic Informatics

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If Orthopaedic Informatics is about "the utility of orthopaedic information as it pertains to the treatment of patients", then Evidence Based Orthopaedics (EBO) is the heart of OI. Fortunately it is also the subjectwhich attracts the most attention from mainstream orthopaedics. Reviews and meta-analyses are frequently published and constitute a higher level of evidence.

The Cochrane Collaborationis the group with the highest reputation and is dedicated to "Preparing, maintaining and promoting the accessibility of systematic reviews of the effects of health care interventions". This site contains abstracts of the meta-analyses prepared by different focus groups. Table 1 shows the numbers of reviews of relevance to orthopaedics in Dec 2007. There is a small amount of overlap between groups.

Table 1. Cochrane Musculoskeletal Focus Groups (as of Jan 2008)

Name of Group

Total Number of Reviews

Number Withdrawn

Back

41

10

Bone, Joint and Muscle Trauma

76

1

Musculokeletal

25

0

Wounds

102

7

Pain, Palliative and Supportive Care

35

0

The stringent methodology of these reviews and the difficulty of undertaking randomized trials in surgical subjects means that Cochrane reviews frequently conclude that the evidence for commonly employed orthopaedic procedures is "insufficient". This is not to belittle the process but to encourage orthopaedic surgeons to carry out more rigorous research which will meet the EBO standards. 300 topics on which the evidence has been stringently examined is a manageable number. Each review summarizes the main conclusions in a few lines. One could visit all these summaries in a few hours, assimilate this level of evidence and obtain an overview of the state of the evidence in orthopaedics.

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