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Pooka1
12-18-2008, 09:06 PM
http://www.ncbi.nlm.nih.gov/pubmed/17728687?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&logdbfrom=pubmed

Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review.

Dolan LA, Weinstein SL.

Department of Orthopaedics and, Rehabilitation, University of Iowa Healthcare, Iowa City, IA, USA. lori-dolan@uiowa.edu

STUDY DESIGN.: Systematic review of clinical studies. OBJECTIVES.: To develop a pooled estimate of the prevalence of surgery after observation and after brace treatment in patients with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA.: Critical analysis of the studies evaluating bracing in AIS yields limited evidence concerning the effect of TLSOs on curve progression, rate of surgery, and the burden of suffering associated with AIS. Many patients choose bracing without an evidence-based estimate of their risk of surgery relative to no treatment. Therefore, such an estimate is needed to promote informed decision-making. METHODS.: Multiple electronic databases were searched using the key words "adolescent idiopathic scoliosis," "observation," "orthotics," "surgery," and "bracing." The search was limited to the English language. Studies were included if observation or a TLSO was evaluated and if the sample closely matched the current indications for bracing (skeletal immaturity, age <15 years, Cobb angle between 20 degrees and 45 degrees ). One reviewer (L.A.D) selected the articles and abstracted the data, including research design, type of brace, minimum follow-up, and surgical rate. Additional data concerning inclusion criteria and risk factors for surgery included gender, Risser, age and Cobb angle at brace initiation, curve type, and dose (hours of recommended brace wear). RESULTS.: Eighteen studies were included (observation = 3, bracing = 15). All were Level III or IV clinical series. Despite some uniformity in surgical indications, the surgical rates were extremely variable, ranging from 1 surgery of 72 patients (1%) to 51 of 120 patients (43%) after bracing, and from 2 surgeries of 15 patients (13%) to 18 of 47 patients (28%) after observation. When pooled, the bracing surgical rate was 23% compared with 22% in the observation group. Pooled estimates for surgical rate by type of brace, curve type, Cobb angle, Risser sign, and dose were also calculated. CONCLUSION.: Comparing the pooled rates for these two interventions shows no clear advantage of either approach. Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in AIS. This recommendation carries a grade of D, indicating that the use of bracing relative to observation is supported by "troublingly inconsistent or inconclusive studies of any level." The decision to brace for AIS is often difficult for clinicians and families. An evidence-based estimate of the risk of surgery will provide additional information to use as they weigh the costs and benefits of bracing.

LindaRacine
12-19-2008, 12:08 AM
Interesting, but I'd be curious about what the real brace experts think. There is a LOT of variation in bracing, based on the skill and experience of the MD and the orthotist. Many TLSO bracing studies were based on off-the-shelf braces as opposed to custom made orthotics.

Lacking any other evidence, if I had a child who fit the profile of successfully braced patients (25-40 degrees with the appropriate Risser), I'd definitely want to give bracing a chance.

--Linda

Pooka1
12-19-2008, 08:18 AM
It's so interesting how different folks see data.

I look at the same studies and would not put my child in a brace. My one braced daughter chose to try it. It is failing as I type. In hindsight at least, that wasn't the correct decision. I think the literature supports that outcome though.

LindaRacine
12-19-2008, 10:31 PM
I know a lot of kids who have been successfully braced and whom have avoided surgery, even in the long term. The best example is probably Joe O'Brien, President of the National Scoliosis Foundation, was not braced, and has had to have several surgeries for scoliosis. His brother was braced, and has avoided surgery well into adulthood. We both know, however, that anecdotal evidence is pretty useless.

With that said, if I had a kid who was super rebellious about wearing the brace, I probably wouldn't push it.

--Linda

Pooka1
12-19-2008, 10:34 PM
How do you know the success in avoiding surgery was over and above the natural history without good controlled studies which apparently don't exist yet for the most part?

leahdragonfly
12-19-2008, 11:20 PM
Hi Sharon,

Thanks for the interesting article. It's even harder for parents like myself with a young JIS child to make informed decisions, since there are even fewer articles about treatment of JIS. In addition to Dr Betz we have seen two other pediatric spine specialists, one in particular who seemed very pro-bracing, and both told me clearly that "we don't even know if bracing works."

I read one article about AIS recently that suggested that 70% of AIS patients who were braced wouldn't have progressed to surgical levels anyway, hence they were treated with a brace unnecessarily. That haunts me to no end, since I was personally braced and HATED it. If it were a benign treatment it would be different...

txmarinemom
12-20-2008, 01:30 AM
Linda,

You obviously haven't seen the results of the current bracing studies. Bracing is a crapshoot at best (sorry ... no matter *what* type of brace for initial onset JIS/AIS).

I'm really surprised you haven't seen this same data. BTW ... who do you consider the "real brace experts"? LMAO ... THE brace experts in modern day are determining braces are iffy.

Personally, like Gayle, having BEEN a braced child, I'd never consider it.

Pooka1
12-20-2008, 09:18 AM
Hi Sharon,

Thanks for the interesting article. It's even harder for parents like myself with a young JIS child to make informed decisions, since there are even fewer articles about treatment of JIS. In addition to Dr Betz we have seen two other pediatric spine specialists, one in particular who seemed very pro-bracing, and both told me clearly that "we don't even know if bracing works."

I read one article about AIS recently that suggested that 70% of AIS patients who were braced wouldn't have progressed to surgical levels anyway, hence they were treated with a brace unnecessarily. That haunts me to no end, since I was personally braced and HATED it. If it were a benign treatment it would be different...

The situation with AIS is more straightforward in terms of waiting and then fusion.

The situation with JIS is just harrowing as far as I can tell. It seems the best hope at the moment are the non-fusion surgical procedures like Ti ribs, growth rods, and stapling. That's what I would be looking at if I were in that situation.

That appears to be the state of the art at the moment.

In re bracing, it is rational to conclude most/all of the present studies suffer from fatal design flaws and are certainly well within the issue for most research results being false. That's why we have orthopods watching and waiting and not bracing. They are just being ethical.

Pooka1
12-20-2008, 09:55 AM
I don't really understand the reference to real brace experts. The closest thing we have to bracing experts are the orthopods publishing studies. As Pam stated, those are the ones pointing out the flaws in previous studies. The lack of a control group is the tip of the iceberg (though it is singly the hugest Achilles heel in the earlier studies).

There are NON-experts when it comes to bracing. Listed in this column are:

1. chiros
2. orthothists

Our orthotist claimed only 2 out of a few hundred patients he braced over several years ever went on to need surgery IIRC. Now I like the guy and I'm not saying he is lying. I AM saying he is misinformed or delusional as an absolute fact.

And I doubt anyone is using off-the-shelf bracing as opposed to custom bracing for the later studies. What is the evidence for that claim? I don't think that can be the reason for lack of positive bracing results.

leahdragonfly
12-20-2008, 10:18 AM
I am also very puzzled by Linda's comment about "the real bracing experts." Who do you mean Linda? The pro-bracing ortho I referenced above is the inventor of a mainstream night brace, and even he told me "we don't know if bracing works."

I believe that cognitive dissonance plays a large part in the bracing debate. (Read up on it if you're not sure what it is). How could these orthotists and orthopedists live with themselves knowing they had subjected hundreds of children and teens to the misery of bracing, only to suspect that it doesn't work! Cognitive dissonance makes them too uncomfortable psychologically (even unconsciously) and so they come to believe that studies be damned, bracing MUST work!

I find it just another thing about scoliosis that is so hard to deal with: we don't know how our child's situation will unfold, we don't have a strong body of valid scientific evidence, and we as parents are left to make terribly difficult decisions for our children. I know the only thing that keeps me sane in the event Leah has progression is the promise of VBS.

Pooka1
12-20-2008, 10:25 AM
I hear you Gayle.

Although there aren't long-term studies, I think the surgical procedures are very promising. And they don't appear to be dangerous or risky over and above generic surgical concerns but I haven't researched them in depth.

I predict all the present surgical interventions will eventually be shown to have a higher success rate for JIS than any brace.

There, I'm on record. :D

There is reason for hope here.

sharon

ps. I think you are correct about the cognitive dissonance. That explains a lot of things that go on in society (e.g., faith versus evidence), not just this aspect of medical research. It's one of the reasons why most published scientific results are false.

concerned dad
12-26-2008, 09:47 AM
This is a continuation of a related topic discussed in a thread titled "Scoliosis Specialists". other thread (http://www.scoliosis.org/forum/showthread.php?t=8136) I think this thread is a more appropriate place to continue the chat.

The Dolan paper (abstract posted at the beginning of this thread) is very interesting. It is a systematic review of a whole bunch of prior studies. The authors used strict criteria for selecting published papers on bracing and statistically analyzed the pooled results. Their conclusions can be summed up as follows

Comparing the pooled rates for these two interventions shows no clear advantage of either approach. Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in AIS.

As a father who has decided to brace his daughter, these conclusions are obviously troubling. So, I decided to dig into this paper and see what I could learn (I do NOT have a background in biology or medicine).
The first thing that jumped out at me from the Dolan paper is the small sample size of UNBRACED patients. You add them ALL up and you come up with 139 kids. (As opposed to their BRACED pool which totaled 1814). The authors, in their discussion make the following comment:

there is less evidence for the observation pooled rate since only 3 studies, representing just 2 institutions, were available for this review.

Wow, just two institutions? Which ones? They are the ones in Puerto Rico and Ireland.
OK, they go on to say:

This lack of confidence is amplified by the fact that the rates differ greatly between the (observation pooled) studies.

Well, so not only do they have a small sample size from just 3 studies, but the data “differ greatly”. Just how much do they differ?

Without the Fernandez-Feliberti et al data, the observation surgical rate would be 13%, which is significantly lower than that following bracing. An obviously erroneous conclusion would be that
bracing causes an excess risk of surgery. (Emphasis added is mine).

Yep, that is troubling. They excluded just one study (The Puerto Rico study) and showed that bracing causes an excess risk of surgery. It makes you wonder about the other study. It sure would be nice to see what happens to the numbers if they excluded the other study (Ireland). Unfortunately they don’t provide the calculation but I can tell you it would sway it the other way (it would show that bracing causes a decreased risk). The abstracts for the Puerto Rico study and the Ireland study are both posted in the other thread.

Also troubling, in the Dolan paper there is a table summarizing the previous research. In that table (Table 2) they say the following about the Puerto Rico Study. They (Dolan) claims that the main conclusion of the PR study was

“Nonintervention is equivalent to bracing in surgical rate”

Now, That is troubling because I read the abstract of the Puerto Rico paper and it concludes

the control group had a threefold increase in the odds of ending with surgery compared to the treatment group (OR = 3.24, 95% CI, 1.09-9.60). The curve was more likely to progress >40 in the control group (OR = 2,83, 95% CI, 0.98-8.17)

Just what paper were they reading? This makes NO sense – is it equivalent or is it 3 times more likely? The data from the only control group opposing the control data from Ireland is misinterpreted? EDIT after looking at this again, I think there was a problem with my PDF of the paper and this comment that they made was in reference to the Goldberg paper and not the PR paper.

Sharon posted a link to a paper that claims that “most published research results are false”. (a very interesting paper we should discuss relative to the specifics of scoliosis bracing – but perhaps on a different thread)
Isn’t it possible that here we have an example of a false result in the Dolan paper?

And is this the paper that the “anti bracing “ folks are embracing to support their argument? (well, it’s not just this one, also cited is the Ireland paper, but we discussed the problems with that on the other thread).

The call for a large randomized controlled study isn’t going to help us here and now. There are a lot of challenges (ethical and logistical) involved with doing a study like that. We have to look (with a discerning eye) at what data we have available now.

Dolan in the above 2007 paper says

The few studies that have compared bracing to observation have demonstrated some decreased risk of curve progression (generally defined as >5 change). Of these, the study by Nachemson and Peterson is the only prospective, multicenter controlled study (Level 2b).

Dolan also says the Nachemson paper is the “most rigorous to date”. What does the Nachemson paper conclude?

“Treatment with a brace was associated with a success rate of 74 percent at four years; observation only with a success rate of 34 percent.”

Note that Dolan did not include the Nachemson data in their “systematic review” because it failed an “inclusion criteria” of providing information concerning surgical rates. And, just to put the Nachemson study in perspective, it was performed by the Brace Study group of the Scoliosis Research Society (it was a multicenter study).

I don’t intend to sound harsh here. I am just trying to give a voice to the other viewpoint.
There are a lot of brave kids out there diligently following their doctors and parents advice and wearing their brace. I would not want them to come to the conclusion after reading a thread like this that bracing is somehow scientifically shown to be a waste of time. Comments such as “I look at the same studies and would not put my child in a brace” and “Bracing is a crapshoot at best” from obviously very smart and respected posters warrant a response from an opposing view. And here you have it.

All of the above is just my current opinion and subject to change.

Pooka1
12-26-2008, 02:32 PM
As a father who has decided to brace his daughter, these conclusions are obviously troubling. So, I decided to dig into this paper and see what I could learn (I do NOT have a background in biology or medicine).

I also have no background in biology or medicine (though I have had some college-level bio and some grad-level microbio). But that said, I am SO not a biologist.


The first thing that jumped out at me from the Dolan paper is the small sample size of UNBRACED patients. You add them ALL up and you come up with 139 kids. (As opposed to their BRACED pool which totaled 1814). The authors, in their discussion make the following comment:

there is less evidence for the observation pooled rate since only 3 studies, representing just 2 institutions, were available for this review.

This is just reiterating the comment that there are few controlled bracing studies.


Wow, just two institutions? Which ones? They are the ones in Puerto Rico and Ireland.
OK, they go on to say:

This lack of confidence is amplified by the fact that the rates differ greatly between the (observation pooled) studies.

Well, so not only do they have a small sample size from just 3 studies, but the data “differ greatly”. Just how much do they differ?

Without the Fernandez-Feliberti et al data, the observation surgical rate would be 13%, which is significantly lower than that following bracing. An obviously erroneous conclusion would be that
bracing causes an excess risk of surgery. (Emphasis added is mine).

Try to keep an open mind to all possibilities. This is not obviously erroneous if somehow the brace results in lost muscle tone that somehow accelerates or allows more curvature when the brace is removed. Now I'm not saying this explanation is likely. I think a more likely explanation is that bracing does not increase surgical rates and that the sample size is too small to say anything one way or the other.


Yep, that is troubling. They excluded just one study (The Puerto Rico study) and showed that bracing causes an excess risk of surgery. It makes you wonder about the other study. It sure would be nice to see what happens to the numbers if they excluded the other study (Ireland). Unfortunately they don’t provide the calculation but I can tell you it would sway it the other way (it would show that bracing causes a decreased risk). The abstracts for the Puerto Rico study and the Ireland study are both posted in the other thread.

I wouldn't sweat the meaning of considering one or the other of these studies. I think both are most likely flawed. We need higher quality studies going forward. I think the best we can say now is that bracing might be measurably efficacious over and above natural history but it has to be shown. I would characterize the bracing advocates as being in the category of, "Everybody knows it but nobody shows it" as a colleague of my says. Well, I'm waiting for someone to show it despite the case that some folks seem to know it.


Also troubling, in the Dolan paper there is a table summarizing the previous research. In that table (Table 2) they say the following about the Puerto Rico Study. They (Dolan) claims that the main conclusion of the PR study was

“Nonintervention is equivalent to bracing in surgical rate”

Now, That is troubling because I read the abstract of the Puerto Rico paper and it concludes

the control group had a threefold increase in the odds of ending with surgery compared to the treatment group (OR = 3.24, 95% CI, 1.09-9.60). The curve was more likely to progress >40 in the control group (OR = 2,83, 95% CI, 0.98-8.17)

Just what paper were they reading? This makes NO sense – is it equivalent or is it 3 times more likely? The data from the only control group opposing the control data from Ireland is misinterpreted?

It could just be a simple error that got by the reviewers. Or it could be that Dolan re-crunched the Puerto Rican data. Or it could be something else. Taking surgery as a criteria is clearly out to lunch anyway. And the sample size is too small to rule out non-random reasons for progression beyond 40* being related to brace or not.

Either way, not enough there for me to get excited about either way.


Sharon posted a link to a paper that claims that “most published research results are false”. (a very interesting paper we should discuss relative to the specifics of scoliosis bracing – but perhaps on a different thread)
Isn’t it possible that here we have an example of a false result in the Dolan paper?

No I think that's a simple error or a re-crunching using more robust criteria. The paper discussing why most published results are false is not referring to these types of errors but rather much more fundamental ones as far as I know. That is, the data presented in the papers are not made up and they can be interpreted in the way the authors do. But they are still wrong for many other reasons.


And is this the paper that the “anti bracing “ folks are embracing to support their argument? (well, it’s not just this one, also cited is the Ireland paper, but we discussed the problems with that on the other thread).

I think it goes far beyond any one paper. I think it's also years of personal experience bracing by orthopods and them noting the results though not publishing them necessarily. You get a sense if something is working or not if you brace kids and many still go on to surgery.


The call for a large randomized controlled study isn’t going to help us here and now. There are a lot of challenges (ethical and logistical) involved with doing a study like that. We have to look (with a discerning eye) at what data we have available now.

Dolan in the above 2007 paper says

The few studies that have compared bracing to observation have demonstrated some decreased risk of curve progression (generally defined as >5 change). Of these, the study by Nachemson and Peterson is the only prospective, multicenter controlled study (Level 2b).

Dolan also says the Nachemson paper is the “most rigorous to date”. What does the Nachemson paper conclude?

“Treatment with a brace was associated with a success rate of 74 percent at four years; observation only with a success rate of 34 percent.”

Note that Dolan did not include the Nachemson data in their “systematic review” because it failed an “inclusion criteria” of providing information concerning surgical rates. And, just to put the Nachemson study in perspective, it was performed by the Brace Study group of the Scoliosis Research Society (it was a multicenter study).

I will await some more controlled studies.


I don’t intend to sound harsh here. I am just trying to give a voice to the other viewpoint.
There are a lot of brave kids out there diligently following their doctors and parents advice and wearing their brace. I would not want them to come to the conclusion after reading a thread like this that bracing is somehow scientifically shown to be a waste of time. Comments such as “I look at the same studies and would not put my child in a brace” and “Bracing is a crapshoot at best” from obviously very smart and respected posters warrant a response from an opposing view. And here you have it.

All of the above is just my current opinion and subject to change.

I don't think anyone has said bracing is a waste of time. I think it has been said, and is fair to say, bracing hasn't been shown to be particularly efficacious over and above watching and waiting.

If folks want to take a shot with bracing then they should be able to do so.

sharon

leahdragonfly
12-27-2008, 11:45 AM
Hi Concerned Dad,

I wanted to start by saying that I respect your choice in selecting a treatment for your daughter's scoliosis. I would never judge another parent for choosing to brace or not brace or opt for surgery. We all are trying to do what we think is best for our kids, of that I am sure!

I have been following this thread (and the other one linked to it-thanks). I have some additional interest in the topic of bracing because I wore a Boston brace very miserably for two years, and I don't think I ever fully "got over it." It was incredibly difficult to say the least. My young daughter wore a brace for 5 months earlier this year and it was not a happy time for our family. Some other families are luckier I guess because some kids seems to tolerate bracing better than others. Not having a sound scientific base to guide treatment choices with is a huge concern for me. If bracing were a benign treatment it would be different and easier, I think.

Anyway, enough rambling! Concerned Dad, the study that was mentioned but not named is the BrAIST Study. Here is a link:
http://clinicaltrials.gov/ct2/show/NCT00448448

It is a fully randomized trial. The participants do not get to self-select the treatment. You can find quite a bit about the study online.

Best regards,

ecnw
12-27-2008, 04:15 PM
First, thank you for summarizing those papers, I can never get through them (the one thing I don't have patience to do).
I do think that the paper you mentioned has results that are skewed, major differences in sizes and different countries use different methods, as we have read on this forum. I'd be more interested in US studies.
My personal opinion is to use any non-invasive method first, before one thinks of surgery. There seems to be more brace choices that are less showing than the older ones, that should be investigated.
When it comes to the results of surgery after bracing, there are many factors that can lead to this. Such as for my daughter, we knew surgery would eventually be neccessary, we were just trying to prolong it. As for my son, we keep our fingers crossed that as he goes on major growth spurts the curve won't decide to increase. Of course in his case, during the summer when it is hot, it's uncomfortable to wear, right now it helps to keep him warm. The inconsistancy of wear might do him in.
I don't know how the studies deal with those types of situations, or if they even mention it, but that would hold more standing for me.

Emily

concerned dad
12-29-2008, 09:21 AM
Thanks for the replies Emily, Gayle and Sharon.

Sharon, you make some very good points. There is still much to learn. Time is not on my side though. This whole thing reminds me of a Mark Twain Quote: There is something fascinating about science. One gets such wholesale returns of conjecture out of such a trifling investment of fact.

Gayle, Thank you for the link to the BRAist Study. I guess I've heard it referred to but never saw the actual information. It is interesting to read that there seems to be an independent panel evaluating preliminary results. I may be reading more into this than I should, but since this study has been going on for 2 years, I assume that had there been a clear preference for bracing they would have stopped the study and offered it to all.

The last large study (Nachemson) took about 10 years between the start of the study (1985) and publishing the data (1995).

We are going to give the SpineCor a try with Dr. Rivard.

Pooka1
12-29-2008, 09:28 AM
Well, even if there is a clear result to date, if the number of subjects is too small, nobody should be halting anything. Large numbers are needed... this is a very variable condition (even between identical twins :D).

concerned dad
12-29-2008, 09:43 AM
Well, even if there is a clear result to date, if the number of subjects is too small, nobody should be halting anything. Large numbers are needed... this is a very variable condition (even between identical twins :D).

The "clearer" the result, the fewer the patients needed to demonstrate it. Nachemson has a table where they compare the different rates of curve progression with the number of patients required to detect a difference at the 5 percent significance level. Purely a statistical argument.
The extreme limit on the table shows that if the difference between observation and bracing where 30% curve progression (observation) and 5% (bracing) they could detect the difference with only 47 patients.
But, if the difference were only 30% curve progression (observation) and 20% (bracing) they would need almost 400 patients to detect it.

I was also interested to see in the link Gayle shared that the braces are fitted with temperature sensors to measure actual compliance.

And, Gayle offered a perspective on bracing that few parents can appreciate having actually worn a brace herself. Thank you for sharing.

Pooka1
12-29-2008, 10:06 AM
Well, I have my doubts.

I am of the (admittedly small) school of thought that if you need fancy statistics to interpret your data then you should consider a better experimental design. :D It takes lots of training and experience be able to design a good study in my opinion.

You can flip a coin 30 times and get 25 heads some (small) percentage of the time. In fact you can calculate what percentage of time you would get 25 of 30 being heads. Doesn't mean the true frequency isn't 0.5 heads.

There was an article discussing this very thing within the context of scientific studies in my field several years ago.

concerned dad
12-29-2008, 10:25 AM
Well, I have my doubts.

I am of the (admittedly small) school of thought .....

Well, it's not that small of a school, I would have to agree with you. I feel like quoting smart people today, and here's another one (somewhat related but not directed at any particular study).

'He uses statistics as a drunken man uses lamp-posts- for support rather than illumination.' A. Lang sometime in the 1800's

But, I dont think Nachemson was using fancy statistics. They were just trying to determine how many people they needed for their study to come up with a result that was statistically significant. It was part of their attempt to design a good study.

And my "reading between the lines" of this current ongoing study guesses that perhaps, if the preliminary results were dramatic, they would have halted the study and braced (or unbraced) all the kids.

Pooka1
12-29-2008, 11:51 AM
Concerned Dad, you have some pertinent quotes. :)

It is not out of the question to suggest that bracing efficacy might never be nailed down in my opinion. The problem with people agreeing to randomized trials combined with improvements in non-fusion and fusion surgery may make bracing obsolete before it can be a proven modality.

concerned dad
02-17-2009, 05:03 PM
Table 2 from Dolan in Spine 2007 was bothering me. I mentioned it earlier in this thread. I was going to post a question on the other (UK) forum asking her to clarify it.
I took a better look at the issue and I think it is either a typo or a problem with my PDF.
Table 2 is a 2 page table. On my PDF it has a different total row height on page 1 of the table than on page 2 of the table. I think their comment that I interpreted to be about the Puerto Rico paper was really meant to summarize the Ireland paper. I edited my post above in this thread and figured I would also make a post here (in case it was bothering anyone like it bothered me.... ) just to set the record straight.

Pooka1
02-24-2009, 07:31 AM
Thanks for correcting that.

Always remember that despite your best efforts and the best efforts of the researchers, most research results are still false. :eek:

FixScoliosis
02-24-2009, 10:15 AM
...most research results are still false.

Hi Sharon.
I know that you have experience in research, so could you please explain a bit more in detail, how it is that most result/conclusions are false?
I know that many things can be twisted with statistics, is that what you are referring to?

I'm just want keen to learn something new.

will

Pooka1
02-24-2009, 11:13 AM
most results are false (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1182327)

Why Most Published Research Findings Are False

John P. A. Ioannidis

John P. A. Ioannidis is in the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece, and Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States of America. E-mail: jioannid@cc.uoi.gr

Abstract

Summary

There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. In this essay, I discuss the implications of these problems for the conduct and interpretation of research.

FixScoliosis
02-24-2009, 10:29 PM
Sharon, Thank you!

This is very good, I will read it all. :)