Statistical Fragility and the Role of P Values in the Sports Medicine Literature.

IF 2.6 2区医学 Q1 ORTHOPEDICS

Journal of the American Academy of Orthopaedic Surgeons Pub Date : 2019-04-01 DOI:10.5435/JAAOS-D-17-00636

Robert L Parisien, David P Trofa, Jesse Dashe, Patrick K Cronin, Emily J Curry, Freddie H Fu, Xinning Li

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引用次数: 33

Abstract

Introduction: Comparative trials evaluating categorical outcomes have important implications on surgical decision making. The purpose of this study was to examine the statistical stability of sports medicine research.

Methods: Comparative clinical sports medicine research studies involving anterior cruciate ligament, meniscus, and knee instability were reviewed in two journals between 2006 and 2016. The statistical stability for each study outcome was determined by the number of event reversals required to change the P value to either greater or less than 0.05. The number of patients lost to follow-up was also determined.

Results: Of the 1,505 studies screened, 102 studies were included for analysis, 40 of which were randomized controlled trials. There were 339 total outcome events, with 98 significant and 241 not significant. The Fragility Index, or the median number of events required to change the statistical significance of the overall study, was five (interquartile range, 3 to 8) or 5.4% of the total study population. In addition, the average number of patients lost to follow-up was 7.9, which is greater than the number needed to change the significance of each study arm and the entire study population.

Conclusion: Results in the comparative sports medicine literature may not be as stable as previously thought, with only a small percentage of outcome events needed to change study significance. Outcomes research based on a single discreet P value cutoff may be misleading.

查看原文本刊更多论文

统计脆弱性和P值在运动医学文献中的作用。

评价分类结果的比较试验对手术决策具有重要意义。本研究的目的是检验运动医学研究的统计稳定性。方法:回顾2006 - 2016年两篇期刊关于前交叉韧带、半月板和膝关节不稳定的比较临床运动医学研究。每个研究结果的统计稳定性取决于将P值改变为大于或小于0.05所需的事件逆转次数。失访患者的数量也被确定。结果:在1505项研究中，102项研究被纳入分析，其中40项为随机对照试验。共有339个结局事件，其中98个显著，241个不显著。脆弱性指数，或改变整个研究的统计显著性所需事件数的中位数，为5(四分位数范围，3至8)或总研究人群的5.4%。此外，平均失去随访的患者人数为7.9人，这大于改变每个研究组和整个研究人群的意义所需的人数。结论:比较运动医学文献的结果可能不像以前认为的那样稳定，只有一小部分结果事件需要改变研究意义。基于单个离散P值截止值的结果研究可能会产生误导。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Academy of Orthopaedic Surgeons 医学-整形外科

CiteScore

6.10

自引率

6.20%

发文量

529

审稿时长

4-8 weeks

期刊介绍： The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues. Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.