Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review

Background: The Fragility Index (FI) and Reverse Fragility Index are powerful tools to supplement the P value in evaluation of randomized clinical trial (RCT) outcomes. These metrics are defined as the number of patients needed to change the significance level of an outcome. The purpose of this stud...

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Autores principales:	Carl L. Herndon, MD, Kyle L. McCormick, MD, Anastasia Gazgalis, MD, Elise C. Bixby, MD, Matthew M. Levitsky, MD, Alexander L. Neuwirth, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Total joint arthroplasty Fragility index Randomized controlled trials Statistical significance Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/67f1a271d1ca4f5c8c7b007a29d3248e
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spelling	oai:doaj.org-article:67f1a271d1ca4f5c8c7b007a29d3248e2021-11-14T04:34:07ZFragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review2352-344110.1016/j.artd.2021.08.018https://doaj.org/article/67f1a271d1ca4f5c8c7b007a29d3248e2021-10-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S235234412100159Xhttps://doaj.org/toc/2352-3441Background: The Fragility Index (FI) and Reverse Fragility Index are powerful tools to supplement the P value in evaluation of randomized clinical trial (RCT) outcomes. These metrics are defined as the number of patients needed to change the significance level of an outcome. The purpose of this study was to calculate these metrics for published RCTs in total joint arthroplasty (TJA). Methods: We performed a systematic review of RCTs in TJA over the last decade. For each study, we calculated the FI (for statistically significant outcomes) or Reverse Fragility Index (for nonstatistically significant outcomes) for all dichotomous, categorical outcomes. We also used the Pearson correlation coefficient to evaluate publication-level variables. Results: We included 104 studies with 473 outcomes; 92 were significant, and 381 were nonstatistically significant. The median FI was 6 overall and 4 and 7 for significant and nonsignificant outcomes, respectively. There was a positive correlation between FI and sample size (R = 0.14, P = .002) and between FI and P values (R = 0.197, P = .000012). Conclusions: This study is the largest evaluation of FI in orthopedics literature to date. We found a median FI that was comparable to or higher than FIs calculated in other orthopedic subspecialties. Although the mean and median FIs were greater than the 2 recommended by the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines to demonstrate strong evidence, a large percentage of studies have an FI < 2. This suggests that the TJA literature is on par or slightly better than other subspecialties, but improvements must be made. Level of Evidence: Level I; Systematic Review.Carl L. Herndon, MDKyle L. McCormick, MDAnastasia Gazgalis, MDElise C. Bixby, MDMatthew M. Levitsky, MDAlexander L. Neuwirth, MDElsevierarticleTotal joint arthroplastyFragility indexRandomized controlled trialsStatistical significanceOrthopedic surgeryRD701-811ENArthroplasty Today, Vol 11, Iss , Pp 239-251 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Total joint arthroplasty Fragility index Randomized controlled trials Statistical significance Orthopedic surgery RD701-811
spellingShingle	Total joint arthroplasty Fragility index Randomized controlled trials Statistical significance Orthopedic surgery RD701-811 Carl L. Herndon, MD Kyle L. McCormick, MD Anastasia Gazgalis, MD Elise C. Bixby, MD Matthew M. Levitsky, MD Alexander L. Neuwirth, MD Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review
description	Background: The Fragility Index (FI) and Reverse Fragility Index are powerful tools to supplement the P value in evaluation of randomized clinical trial (RCT) outcomes. These metrics are defined as the number of patients needed to change the significance level of an outcome. The purpose of this study was to calculate these metrics for published RCTs in total joint arthroplasty (TJA). Methods: We performed a systematic review of RCTs in TJA over the last decade. For each study, we calculated the FI (for statistically significant outcomes) or Reverse Fragility Index (for nonstatistically significant outcomes) for all dichotomous, categorical outcomes. We also used the Pearson correlation coefficient to evaluate publication-level variables. Results: We included 104 studies with 473 outcomes; 92 were significant, and 381 were nonstatistically significant. The median FI was 6 overall and 4 and 7 for significant and nonsignificant outcomes, respectively. There was a positive correlation between FI and sample size (R = 0.14, P = .002) and between FI and P values (R = 0.197, P = .000012). Conclusions: This study is the largest evaluation of FI in orthopedics literature to date. We found a median FI that was comparable to or higher than FIs calculated in other orthopedic subspecialties. Although the mean and median FIs were greater than the 2 recommended by the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines to demonstrate strong evidence, a large percentage of studies have an FI < 2. This suggests that the TJA literature is on par or slightly better than other subspecialties, but improvements must be made. Level of Evidence: Level I; Systematic Review.
format	article
author	Carl L. Herndon, MD Kyle L. McCormick, MD Anastasia Gazgalis, MD Elise C. Bixby, MD Matthew M. Levitsky, MD Alexander L. Neuwirth, MD
author_facet	Carl L. Herndon, MD Kyle L. McCormick, MD Anastasia Gazgalis, MD Elise C. Bixby, MD Matthew M. Levitsky, MD Alexander L. Neuwirth, MD
author_sort	Carl L. Herndon, MD
title	Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review
title_short	Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review
title_full	Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review
title_fullStr	Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review
title_full_unstemmed	Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review
title_sort	fragility index as a measure of randomized clinical trial quality in adult reconstruction: a systematic review
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/67f1a271d1ca4f5c8c7b007a29d3248e
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Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review

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