Improving Evidence in Hand and Wrist Surgery: A Systematic Assessment of Randomized Controlled Trials Quality and Impact.
Cameron O'Brien, Alexandra Shumard, David Mitchell et al.
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In 30 seconds
This systematic assessment evaluated the clinical usefulness and transparency of 88 randomized controlled trials of surgical, perioperative, or nonoperative interventions in hand and wrist surgery, published from 2000 to 2025. Trials were assessed using a validated 13-item framework. Although 99% addressed a clinically important question, only 11% achieved a usefulness score of 75% or greater. Pragmatic designs were uncommon, and patient-centered outcomes and data sharing were limited. The findings indicate that the presence of a randomized design alone does not ensure evidence that is readily applicable to clinical decision-making.
Key findings
- Of 88 trials, 99% addressed a clinically important question, but only 13% used a pragmatic design.
- Patient-centered outcomes appeared in 52% of trials; validated patient-reported outcome measures were used in 39%.
- Although 47% of trials were pre-registered, only 5% shared raw data.
- Only 11% of trials achieved a usefulness score of 75% or greater on the 13-item framework.
Why it matters
Randomized trials can provide strong evidence, but their value for clinical decisions also depends on design, relevant outcomes, and transparency. This assessment highlights gaps in those features across hand and wrist surgery research. Addressing them could make future trial findings more applicable to real-world care and easier to evaluate and use.
What to keep in mind
The assessment covers trials identified through Medline and Embase and evaluates usefulness using a 13-item framework; the abstract does not report whether the framework captures every dimension of clinical relevance.