Level of Evidence in Spine Compared to Other Orthopedic Journals

Abstract

Spine publishes clinical studies with levels of evidence comparable to the 2 orthopedic journals with similar impact factors.

Have Levels of Evidence Improved the Quality of Orthopaedic Research?

“…An accurate identification rate (77% and 83%), with a low incidence of misclassification (4% to 5% leading to an inappropriate increase in quality) indicates that LOE is a concept with which faculty and residents are conversant. Our results are consistent with those of other studies that show substantial or better agreement when grading LOE, regardless of experience [2,4,17,32]. In contrast, Schmidt et al [21] found substantial inconsistency and poor agreement between different observers when grading the LOE of presentations at the 2007 AAOS Annual Meeting.…”

“…However, while the proportion of these studies has improved significantly with time, there remains a predominance of Level III and IV studies. This finding is consistent with results from other studies in the orthopaedic literature [4,17,27,32]. Although there is value in these lower-quality studies, higher-quality studies generally are better at removing bias, isolating confounders, and providing reliable data for further clinical practice.…”

“…Errors made by these observers could be reflected in the counts of articles analyzed for the study data. Based on the high interobserver reliability in our study and others [2,4,17,32], it is unlikely that this had a significant effect on our conclusions. Third, not all of the journals behaved similarly.…”

“…Efforts to evaluate the quality of therapeutic studies published in medical and surgical specialty journals have been reported [3,5,11,17,24,32]. The primary purpose of our study was to quantitatively analyze the orthopaedic subspecialty literature before, around, and after the introduction of LOE to orthopaedics to determine if the overall number and proportion of high-quality publications (Levels I and II) had improved.…”

“…Using weighted kappa values, we found that residents and attendings had a substantial or better agreement with the LOE grading performed by the journal. It generally is accepted that kappa values greater than 0.5 indicate a high level of agreement [17,21,32]. An accurate identification rate (77% and 83%), with a low incidence of misclassification (4% to 5% leading to an inappropriate increase in quality) indicates that LOE is a concept with which faculty and residents are conversant.…”