title: Has the Level of Evidence of Podium Presentations at the Musculoskeletal Tumor Society Annual Meeting Changed Over Time?
abstract: BACKGROUND
  Level of evidence (LOE) framework is a tool with which to categorize clinical studies based on their likelihood to be influenced by bias. Improvements in LOE have been demonstrated throughout orthopaedics, prompting our evaluation of orthopaedic oncology research LOE to determine if it has changed in kind.
  
  
  OBJECTIVE
  (1) Has the LOE presented at the Musculoskeletal Tumor Society (MSTS) annual meeting improved over time? (2) Over the past decade, how do the MSTS and Orthopaedic Trauma Association (OTA) annual meetings compare regarding LOE overall and for the subset of therapeutic studies?
  
  
  METHODS
  We reviewed abstracts from MSTS and OTA annual meeting podium presentations from 2005 to 2014. Three independent reviewers evaluated a total of 1222 abstracts for study type and LOE; there were 577 abstracts from MSTS and 645 from OTA. Changes in the distributions of study type and LOE over time were evaluated by Pearson chi-square test.
  
  
  RESULTS
  There was no change over time in MSTS LOE for all study types (p = 0.13) and therapeutic (p = 0.36) study types during the reviewed decade. In contrast, OTA LOE increased over this time for all study types (p < 0.01). The proportion of Level I therapeutic studies was higher at the OTA than the MSTS (3% [14 of 413] versus 0.5% [two of 387], respectively), whereas the proportion of Level IV studies was lower at the OTA than the MSTS (32% [134 of 413] versus 75% [292 of 387], respectively) during the reviewed decade. The proportion of controlled therapeutic studies (LOE I through III) versus uncontrolled studies (LOE IV) increased over time at OTA (p < 0.021), but not at MSTS (p = 0.10).
  
  
  CONCLUSIONS
  Uncontrolled case series continue to dominate the MSTS scientific program, limiting progress in evidence-based clinical care. Techniques used by the OTA to improve LOE may be emulated by the MSTS. These techniques focus on broad participation in multicenter collaborations that are designed in a comprehensive manner and answer a pragmatic clinical question.
authors.affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Lerman
authors.affiliation: Sarcoma Services, Primary Children's Hospital & Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.|Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Cable
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University, HHS Hamilton General Hospital, 711 Concession Street Hamilton, Hamilton, ON, L8V 1C3, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Thornley
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University, HHS Hamilton General Hospital, 711 Concession Street Hamilton, Hamilton, ON, L8V 1C3, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Evaniew
authors.affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Slobogean
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University, HHS Hamilton General Hospital, 711 Concession Street Hamilton, Hamilton, ON, L8V 1C3, Canada.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.affiliation: Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Healey
authors.affiliation: Sarcoma Services, Primary Children's Hospital & Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.|Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: R Lor
authors.initials: RL
authors.lastname: Randall
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University, HHS Hamilton General Hospital, 711 Concession Street Hamilton, Hamilton, ON, L8V 1C3, Canada. ghert@hhsc.ca.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ghert
mesh_terms: D035843:Biomedical Research / Q000639:trends*; D001859:Bone Neoplasms / Q000175:diagnosis / Q000628:therapy; D016009:Chi-Square Distribution; D003226:Congresses as Topic / Q000639:trends*; D019317:Evidence-Based Medicine / Q000639:trends*; D006801:Humans; D008495:Medical Oncology / Q000639:trends*; D019042:Muscle Neoplasms / Q000175:diagnosis / Q000628:therapy; D009985:Orthopedics / Q000639:trends*; D013060:Speech; D013997:Time Factors