title: Trends in the Level of Evidence in Clinical Hand Surgery Research.
abstract: BACKGROUND
  The application of evidence-based medicine (EBM) to the practice of hand surgery has been limited. Production of high-quality research is an integral component of EBM. With considerable improvements in the quality evidence in both orthopedic and plastic and reconstructive surgery, it is imperative that hand surgery research emulates this trend.
  
  
  METHODS
  A systematic review was performed on all hand surgery articles published in 6 journals over a 20-year period. The journals included Plastic and Reconstruction Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, Journal of Hand Surgery-European Volume, Journal of Hand Surgery-American Volume, Journal of Bone & Joint Surgery, and the Bone & Joint Journal. The level of evidence of each article was determined using the Oxford level of evidence. The quality of methodology of randomized controlled trials (RCTs) was assessed using Jadad scale. Statistical analysis involved chi-squares and Student t test (P < .05).
  
  
  RESULTS
  A total of 972 original hand surgery research articles were reviewed. There was a significant increase in the average level of evidence of articles published between1993 and 2013. High-quality evidence only accounted for 11.2% of evidence published, with a significant increase over the study period (P = 0.001). Quantitative evaluation of the 26 published RCTs, using Jadad scale, revealed a progressive improvement in study design from 0.3 in 1993 to 3.33 in 2013.
  
  
  CONCLUSIONS
  Hand surgery research has mirrored trends seen in other surgical specialties, with a significant increase in quality of evidence over time. Yet, high-quality evidence still remains infrequent.
authors.affiliation: St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Conor M
authors.initials: CM
authors.lastname: Sugrue
authors.affiliation: St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Cormac W
authors.initials: CW
authors.lastname: Joyce
authors.affiliation: St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Sugrue
authors.affiliation: St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Carroll
keywords: hand surgery; levels of evidence; randomized controlled trials