CC2022: The Fragility of Statistical Significance in Patellofemoral Instability Research: A Systematic Review (November 2022)-The Fragility of Statistical Significance in Patellofemoral Instability Research: A Systematic Review (November 2022)

The Fragility of Statistical Significance in Patellofemoral Instability Research: A Systematic Review (November 2022)

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This systematic review explored the fragility of reported results in the patellofemoral instability (PFI) literature. The fragility index (FI) and fragility quotient (FQ) were calculated for outcomes reported in 22 comparative studies on PFI management. The analysis revealed a lack of robustness, with only a few outcome events needed to alter the statistical significance of the results. The overall FI was 3, indicating that changing the outcomes of just a few patients could reverse the significance of all included studies. Additionally, 27% of the included studies reported loss to follow-up greater than the overall FI, suggesting that maintaining the follow-up may have resulted in the reversal of significance. The study recommends the triple reporting of the p-value, FI, and FQ to aid in the interpretation of the statistical integrity of future comparative trials in the PFI literature. <br /><br />The fragility of statistical significance is a pervasive issue in medical and orthopaedic literature and has been shown to occur in studies of various areas, including orthopaedic trauma and spine surgery. The concept of fragility analysis, which evaluates the stability of study results, provides insight into the robustness of statistical findings. The FI, which represents the number of reversals of outcome events required to alter the significance of a result, and the FQ, which divides the FI by the sample size to generate relative fragility, are informative measures used in fragility analysis. The fragility analysis of the PFI literature suggests that caution should be exercised in interpreting the statistical significance of reported outcomes as they may be subject to instability.

Keywords

fragility

PFI literature

fragility index

fragility quotient

comparative studies

statistical significance

follow-up

interpretation

orthopaedic literature

fragility analysis