HAND & WRIST
Most positive hand surgery RCTs have very fragile results
J Hand Surg Am. 2019;44(8):698. doi: 10.1016/j.jhsa.2018.10.005. Epub 2018 Nov 9The Fragility Index is an important concept when assessing the strength of findings from a positive RCT - essentially, the Fragility Index asks how many patients it would take with an opposite outcome in order for the overall trial results to become non-significant. In this paper, the authors apply this concept to RCTs in hand surgery. They include 5 RCTs with positive findings on a dichotomous primary outcome. They found that four of the five RCTs had a fragility index of 4 or less, with a median of 3 (range 0-26). Overall, this suggests that most hand surgery RCTs have very fragile results and should be interpreted with caution.
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