Evidence-based orthopaedics or ‘superstition in the pigeon’

Summary

Pigeon behavioural conditioning methods are similar to the processes that orthopaedic surgeons use to evaluate new surgical procedures. Alternatively, evidence-based orthopaedics is a tool for surgeons to evaluate procedures in a systematic, patient-centred way that is less instinctive than pigeon behaviour. The objective of this article is to describe evidence-based orthopaedics, and then propose changes to surgical culture with the aim of refining the interpretation of the current literature and improving the quality of future research. The proposals are ‘institutional’ changes rather than calls for increased funding and more randomised controlled trials.

Keywords

Orthopaedics - evidence-based medicine - study design

• References

• 1 Skinner BF. Superstition in the pigeon. J Exp Psychol 1948; 38: 168-172.
• 2 Sackett DL, Rosenberg WM, Gray JA. et al. Evidence based medicine: what it is and what it isn&t. Brit Medical J 1996; 312: 71-72.
• 3 Budsberg S. Evidence for the use of nutraceuticals in osteoarthritis. American College of Veterinary Surgeons Symposium, October 23–25. 2008
• 4 Guyatt G, Rennie D. User&s guide to the medical literature: Essentials of Evidence-based clinical practice. Chicago: AMA press; 2002: 9
• 5 Bhandari M, Swiontkowski MF, Einhorn TA. et al. Interobserver agreement in the application of levels of evidence to scientific papers. J Bone Joint Surg 2004; 86A: 1717-1720.
• 6 Hollis S, Campbell F. What is meant by intention to treat analysis? Survey of published randomized controlled trials. Brit Medical J 1999; 319: 670-674.
• 7 Sumner-Smith G. &What is conservatism?. Is it not adherence to the old and tried, against the new and untried?& Vet Comp Orthop Traumatol 2007; 20: 1
• 8 El-Hai J. The Lobotomist, 2005, Hoboken. John Wiley and Sons. 2005: 167
• 9 Goodman B, Maggio J. The American Experience: The lobotomist (program), PBS website. Available at. http://www.pbs.org/wgbh/amex/lobotomist/program/.