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Dynamic Splinting for Hallux Limitus and Valgus

Discussion in 'Foot Surgery' started by NewsBot, Aug 5, 2011.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Dynamic Splinting for Postoperative Hallux Limitus: A Randomized, Controlled Trial
    Mathew M. John, Stanley Kalish, Stephen V. Perns and Buck Willis
    JAPMA July/August 2011 vol. 101 no. 4 285-288
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Lets play a game:
    Who can see why the data does not support the conclusion?
    Who trusts the results?
    Why have JAPMA done this to us yet again?
     
  3. phil

    phil Active Member

    I'm not too good at these games, cause I though stats was too boring and irrelevant at uni. Wishing I listened now though!

    Anyway, I'll try questions 2- Who trusts the results? Not me! It's associated with Dynasplint Systems Inc, which sounds like a company making the splints. I know that doesn't automatically make the research invalid, but it might.
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Like many papers in JAPMA recently this one falls woefully short of the minimum reporting standard that should be expected of a clinical trial (see this eg on Neuromas and shockwave which actually showed the opposite of what they claimed they found; and this one from one of the same authors above: Plantar Fasciopathy Treated with Dynamic Splinting). The accepted standard for the reporting of clinical trials is the CONSORT statement, which JAPMA even reproduced previously.

    Anyone reading this paper and the CONSORT statement can see how far short it falls in its reporting.

    In addition there are so many other issues, that its next to impossible to believe the results:
    Lets start:
    - no details on how the randomization was done
    - if it was a proper randomization the probability of getting exactly 25 in each group (which they did) is low, but can still happen
    - no info on how they measured the ROM, let alone anything on if the measurements were reliable (and we all know about how unreliable these type of measurements are); for eg, how many people did the measurements to ensure reliability; no data on the intertester and intratetser reliability of the measurements. Are you prepared to trust the measurements without this data?
    - no stats test to confirm the baseline characteristics between the experimental and control group were the same (look at the graph and there seems to be big differences in the baseline characteristics of ROM!!!!)
    - the actual means and SD's of the ranges before and after in each group are not even reported!!!!! ... we have no idea what they are (you could guesstimate it from the graph!)
    -an ANOVA was done, but I can't see why you would do that when there are only two groups to compare; they need to justify that decision (stating is was done by a "biostatstics professor" is not good enough)
    -even if ANOVA was suitable, it should had been a CANOVA to account for the baseline differences between the two groups
    - "two people withdraw" - their data should still have been included in the analysis - 'intention to treat' is the gold standard for analysis in clinical trials.
    - they claim a "mean improvement of 250% in ROM" - looking at the graph, it appears the experimental group went from about 16 degrees to 44 degrees and the control group when from about 21 degrees to 35 degrees (notice the baseline differences they did not account for in the analysis). While there may have been a 250% improvement in the experimental group, the endpoint differences between the groups of 35 degrees and 44 degrees, is not that great and given the baseline differences and no formation given on the SD's.....what do you think of that?

    Anyone want to trust the results?
     
  5. DaVinci

    DaVinci Well-Known Member

    Isn't this the job of the editor and reviewers to sort this before publication or reject it?
    No
     
  6. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Short term results of dynamic splinting for hallux valgus – a prospective randomized study
    ChristianPlaassaAnnikaKarchbArminKochbVivienWiederhoeftaSarahEttingeraLeifClaassenaKiriakosDaniilidisacDaiweiYaoaChristinaStukenborg-Colsmana
    Foot and Ankle Surgery; 1 January 2019
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A comparison of the hallux valgus angle, range of motion, and patient satisfaction after use of dynamic and static orthoses
    NasrinMoulodiMojtabaKamyabMaedeFarzadi
    The Foot; 25 June 2019
     
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The effect of combined exercise-bandage protocol on hallux valgus angle in women with hallux valgus deformity
    Biravar Khandani et al
    University of Tehran
     
  9. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Hallux valgus orthosis characteristics and effectiveness: a systematic review with meta-analysis
    Mei-Ying Kwan et al
    BMJ Open 2021;11:e047273. doi: 10.1136/bmjopen-2020-047273
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The immediate effects of hallux valgus orthoses: A comparison of orthosis designs
    Mei-YingKwan et al
    Gait & PostureVolume 90, October 2021, Pages 283-288
     
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