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Evidence-based Recommendations for Pediatric Orthopaedic Practice.

Kishore Mulpuri1,2, Emily K Schaeffer1,2, H Kerr Graham3

  • 1Department of Orthopaedic Surgery, BC Children's Hospital.

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|April 22, 2017
PubMed
Summary
This summary is machine-generated.

Two pediatric orthopaedic randomized controlled trials (RCTs) showed no significant difference in outcomes. Further noninferiority trials are needed to guide clinical practice changes.

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Area of Science:

  • Pediatric Orthopaedics
  • Evidence-Based Medicine
  • Clinical Research Methodology

Background:

  • Evidence-based medicine (EBM) integrates research evidence with clinical expertise for optimal patient care.
  • Study methodology quality is crucial for reliable interpretation of clinical results in EBM.
  • This review assesses pediatric orthopaedic studies to determine their impact on clinical practice.

Purpose of the Study:

  • To analyze the methodological design and clinical findings of published pediatric orthopaedic studies.
  • To determine the ability of these studies to influence or change clinical practice.
  • To provide an evidence-based review of current pediatric orthopaedic research.

Main Methods:

  • Review of randomized controlled trials (RCTs) in pediatric orthopaedics published 2013-2014.
  • In-depth methodological review by orthopaedic surgeons with research expertise.
  • Clinical impact assessment by clinical experts, followed by panel consensus.

Main Results:

  • One RCT on physical therapy for supracondylar humeral fractures had sound design but did not warrant a practice change.
  • A second RCT on Botulinum Toxin A for idiopathic toe-walking had a small sample size, precluding definitive conclusions.
  • Neither study provided sufficient evidence to recommend changes in clinical practice.

Conclusions:

  • Both reviewed RCTs were superiority studies with non-significant findings.
  • Caution is advised when interpreting superiority studies with nonsignificant results.
  • The need for more noninferiority trials in pediatric orthopaedics is highlighted to better compare treatment options.