Department of Orthopaedic Surgery

Internet Versus Mailed Questionnaires: A Randomized Comparison (2)

Fri, 24 Sep 2004 00:00:00 GMT

Internet Versus Mailed Questionnaires: A Randomized Comparison (2) Leece, Pam; Bhandari, Mohit; Sprague, Sheila; Swiontkowski, Marc F; Schemitsch, Emil H; Tornetta, Paul; Devereaux, PJ; Guyatt, Gordon H BACKGROUND Low response rates among surgeons can threaten the validity of surveys. Internet technologies may reduce the time, effort, and financial resources needed to conduct surveys. OBJECTIVE We investigated whether using Web-based technology could increase the response rates to an international survey. METHODS We solicited opinions from the 442 surgeon–members of the Orthopaedic Trauma Association regarding the treatment of femoral neck fractures. We developed a self-administered questionnaire after conducting a literature review, focus groups, and key informant interviews, for which we used sampling to redundancy techniques. We administered an Internet version of the questionnaire on a Web site, as well as a paper version, which looked similar to the Internet version and which had identical content. Only those in our sample could access the Web site. We alternately assigned the participants to receive the survey by mail (n=221) or an email invitation to participate on the Internet (n=221). Non-respondents in the mail arm received up to three additional copies of the survey, while non-respondents in the Internet arm received up to three additional requests, including a final mailed copy. All participants in the Internet arm had an opportunity to request an emailed Portable Document Format (PDF) version. RESULTS The Internet arm demonstrated a lower response rate (99/221, 45%) than the mail questionnaire arm (129/221, 58%) (absolute difference 13%, 95% confidence interval 4%-22%, P<0.01). CONCLUSIONS. Our Internet-based survey to surgeons resulted in a significantly lower response rate than a traditional mailed survey. Researchers should not assume that the widespread availability and potential ease of Internet-based surveys will translate into higher response rates.

Thoracolumbar Injury Classification and Severity Score: A New Paradigm for the Treatment of Thoracolumbar Spine Trauma

Mon, 01 Aug 2005 00:00:00 GMT

Thoracolumbar Injury Classification and Severity Score: A New Paradigm for the Treatment of Thoracolumbar Spine Trauma Lee, Joon Y.; Vaccaro, Alexander R.; Lim, Moe R.; Öner, F.C.; Hulbert, R. John; Hedlund, Rune; Fehlings, Michael G.; Arnold, Paul; Harrop, James; Bono, Christopher M.; Anderson, Paul A.; Anderson, D. Greg; Harris, Mitchel B.; Brown, Andrew K.; Stock, Gordon H.; Baron, Eli M. BACKGROUND Contemporary understanding of the biomechanics, natural history, and methods of treating thoracolumbar spine injuries continues to evolve. Current classification schemes of these injuries, however, can be either too simplified or overly complex for clinical use. METHODS The Spine Trauma Group was given a survey to identify similarities in treatment algorithms for common thoracolumbar injuries, as well as to identify characteristics of injury that played a key role in the decision-making process. RESULTS Based on the survey, the Spine Trauma Group has developed a classification system and an injury severity score (thoracolumbar injury classification and severity score, or TLICS), which may facilitate communication between physicians and serve as a guideline for treating these injuries. The classification system is based on the morphology of the injury, integrity of the posterior ligamentous complex, and neurological status of the patient. Points are assigned for each category, and the final total points suggest a possible treatment option. CONCLUSIONS The usefulness of this new system will have to be proven in future studies investigating inter- and intraobserver reliability, as well as long-term outcome studies for operative and nonoperative treatment methods.

Cox-2: Where Are We in 2003? - The Role of Cyclooxygenase-2 in Bone Repair

Mon, 21 Oct 2002 00:00:00 GMT

Cox-2: Where Are We in 2003? - The Role of Cyclooxygenase-2 in Bone Repair Einhorn, Thomas A Prostaglandins are important mediators of bone repair, and cyclooxygenases are required for prostaglandin production. Data from animal studies suggest that both non-specific and specific inhibitors of cyclooxygenases impair fracture healing but that this is due to the inhibition of COX-2 and not COX-1. Although these data raise concerns about the use of COX-2-specific inhibitors as anti-inflammatory or anti-analgesic drugs in patients undergoing bone repair, clinical reports have been inconclusive. Because animal data suggest that the effects of COX-2 inhibitors are both dose-dependent and reversible, in the absence of scientifically sound clinical evidence it is suggested that physicians consider short-term administration or other drugs in the management of these patients.

How good is the orthopaedic literature?

Tue, 01 Apr 2008 00:00:00 GMT

How good is the orthopaedic literature? Chaudhry, Harman; Mundi, Raman; Singh, Ishu; Einhorn, Thomas A.; Bhandari, Mohit Randomized trials constitute approximately 3% of the orthopaedic literature Concerns regarding quality of the orthopaedic literature stem from a widespread notion that the overall quality of the surgical literature is in need of improvement. Limitations in surgical research arises primarily from two pervasive issues: 1) A reliance on low levels of evidence to advance surgical knowledge, and 2) Poor reporting quality among the high level surgical evidence that is available. The scarcity of randomized trials may be largely attributable to several unique challenges which make them difficult to conduct. We present characteristics of the orthopaedic literature and address the challenges of conducting randomized trials in surgery.