How Reliable Is the Data?

Concern has been raised regarding the quality of foot and ankle research. Authors have eloquently highlighted inherent biases in study design, effects on data presentation, as well as statistical manipulation i.e. “P-hacking.” Some have even called for statistical significance to be moved from P <0.05 to P <0.005.

Catch the biases if you can

Continuing the critical appraisal of the data is the recently published “The Statistical Fragility of Operative vs. Nonoperative Management for Achilles Tendon Rupture: A Systematic Review of Comparative Studies,” by Nathan P. Fackler et al.

Using the Fragility Index, the researchers showed that in 17 studies, including 10 randomized level controlled studies and over 40 outcome variables, the efficacy of operative versus nonoperative treatment of Achilles ruptures is not as statistically stable as previously predicted.

In other words, like so many other foot and ankle controversies, the debate continues.