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Levels of Evidence in Research Published in The Journal of Bone and Joint Surgery (American Volume) Over the Last Thirty Years
Shane Hanzlik, MS1; Raman C. Mahabir, MSc, MD, FRCSC2; Richard C. Baynosa, MD1; Kayvan T. Khiabani, MD, MSc, FRCSC1
1 University of Nevada School of Medicine, 2040 West Charleston Boulevard, Suite 301, Las Vegas, NV 89102
2 Division of Plastic Surgery, Scott and White Memorial Hospital, 2401 South 31st Street, Temple, TX 76508. E-mail address: rmahabir@swmail.sw.org
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Division of Plastic Surgery, University of Nevada School of Medicine, Las Vegas, Nevada

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Feb 01;91(2):425-428. doi: 10.2106/JBJS.H.00108
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Background: The recent emphasis on evidence-based medicine has led to increasing levels of evidence being published in surgical journals. The purpose of the present study was to review the levels of evidence in reports published in The Journal of Bone and Joint Surgery (American Volume) over the last thirty years.

Methods: We reviewed all of the articles published in The Journal in the years 1975, 1985, 1995, and 2005. Cadaver studies, animal studies, basic-science studies, review articles, Instructional Course Lectures, and correspondence were excluded. Articles were scored according to The Journal's levels of evidence for a primary research question.

Results: A total of 1058 articles were reviewed. Of these, 134, 123, 120, and 174 articles met the inclusion criteria for the years 1975, 1985, 1995, and 2005, respectively, and were ranked according to level of evidence. The number of articles for each level of evidence rating was then expressed as a percentage of the total number of articles meeting the inclusion criteria for that year. There was a significant trend toward higher levels of evidence, with the combined percentage of Level-I, II, and III studies increasing from 17% to 52% (p < 0.01). The percentage of Level-I studies increased from 4% in 1975 to 21% in 2005. The average level of evidence rating improved from 3.72 to 2.90 during the study period.

Conclusions: The level of evidence in The Journal has improved significantly over the last thirty years.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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