The Use of Systematic Reviews to Justify Orthopaedic Clinical Trials- an Analysis of Research Waste

Abstract

Objective As much as 85% of biomedical research is estimated to be wasted or of little use. This has led to $170 billion of wasteful research spending annually worldwide. One method to combat research waste by avoiding duplicative or unnecessary studies is to conduct randomized controlled trials (RCTs) only when a systematic review (SR) suggests more data are needed. The primary aim of this study is to evaluate the use of SRs as justification in conducting RCTs in orthopaedic literature. Methods All RCTs published between January 01 2015 and November 31, 2018 in 5 high impact Journals chosen for analysis based on the most recent 2018 Google h5-index rankings were analyzed and screened by at least 2 authors. We recorded the number of SRs cited in each RCT and analyzed for justification in conducting the trial. Results Of the 390 trials retrieved, 320 were included. The data extraction process identified 777 total SR citations in the 320 included trials. Overall, 74.4% (238/320) of trials referenced a SR while 25.6% (82/320) had no references to a SR. Analysis of the 320 trials showed that 35.6% (114/320) cited at least one SR as justification for conducting the trial, with most such citations found in the introduction (86/114). Ultimately, 64.4% (206/320) made no reference of SR guiding the design of the RCT. Conclusion Based off of our findings, we recommend that efforts be taken to reduce research waste by using SRs as justification for conducting RCTs.