Evidence hierarchies relating to hand surgery: current status and improvement. A bibliometric analysis study

ABSTRACT BACKGROUND: Hierarchy of evidence is an important measurement for assessing quality of literature. Information regarding quality of evidence within the Brazilian hand surgery setting is sparse, especially regarding whether research has improved in either quality or quantity. This study aimed to identify and classify hand surgery studies published in the two most important Brazilian orthopedics journals based on hierarchy of evidence, with comparisons with previously published data. DESIGN AND SETTING: Bibliometric analysis study performed in a federal university. METHODS: Two independent researchers conducted an electronic database search for hand surgery studies published between 2010 and 2016 in Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia. Eligible studies were subsequently classified according to methodological design, based on the Haynes pyramid model (HP) and the JBJS/AAOS levels of evidence and grades of recommendations (LOR). Qualitative and quantitative data were gathered regarding all studies. Previous data were considered to assess whether the proportion of high-quality studies had improved over time (2000-2009 versus 2010-2016). RESULTS: The final analysis included 123 studies, mostly originating from the southeastern region (78.8%) and private institutions (65%), with self-funding (91.8%). Methodological assessment showed that 15.4% were classified as level I/II using HP and 16.4% using LOR. No significant difference in proportions of high-quality studies was found between the two periods of time assessed (5% versus 12%; P = 0.13). CONCLUSION: Approximately 15% of hand surgery studies published in two major Brazilian journals were likely to be classified as high-quality through two different systems. Moreover, no trend towards quality-of-evidence improvement was found over the last 15 years.

背景：证据等级体系（hierarchy of evidence）是评估文献质量的重要指标。目前巴西手部外科领域中，有关证据质量的相关信息较为匮乏，尤其是在研究的质量与数量是否均有所提升这一问题上，相关数据更是稀缺。本研究旨在依据证据等级体系，对发表于巴西两大顶尖骨科期刊的手部外科研究进行识别与分类，并与既往发表的数据开展对比分析。
设计与研究地点：本研究为在某联邦大学开展的文献计量学分析。
方法：由两名独立研究者对2010年至2016年间发表于《Acta Ortopédica Brasileira》与《Revista Brasileira de Ortopedia》的手部外科研究进行电子数据库检索。随后依据海恩斯金字塔模型（Haynes pyramid model，HP）以及JBJS/AAOS证据等级与推荐意见分级（JBJS/AAOS levels of evidence and grades of recommendations，LOR），按照研究方法学设计对符合纳入标准的研究进行分类。收集所有研究的定性与定量数据，并结合既往数据，以评估2000-2009年与2010-2016年两个时间段内高质量研究的占比是否有所提升。
结果：最终纳入分析的研究共123项，其中大部分来自巴西东南部地区（78.8%），由私立机构开展（65%），且为自筹经费（91.8%）。方法学评估结果显示，依据海恩斯金字塔模型（HP），15.4%的研究被归类为I/II级证据；依据JBJS/AAOS证据等级与推荐意见分级（LOR），该比例为16.4%。所评估的两个时间段间，高质量研究占比未发现显著差异（5% vs 12%；P=0.13）。
结论：在巴西两大顶尖骨科期刊发表的手部外科研究中，约15%可通过两种不同的分级体系被归类为高质量研究。此外，近15年间未观察到证据质量存在提升趋势。