The limited impact of randomized controlled trials on the management of greater trochanteric pain syndrome as demonstrated by fragility Indices: A citation analysis
Bibliographic record
Abstract
IMPORTANCE: Greater trochanteric pain syndrome (GTPS) is a chronic condition commonly defined as pain in the lateral hip joint that can be severely limiting to activities of daily living, sleep, and overall quality of life. It encompasses numerous disease states causing pain in the region of the greater trochanter of the femur. Noninvasive management approaches for GTPS include corticosteroid injections and physiotherapy, preferred as first-line interventions prior to surgical interventions. Understanding the impact of randomized control trials (RCTs) can enhance the understanding of treatment paradigms. OBJECTIVE: To identify factors and study characteristics associated with the impact, as measured by the citation density of RCTs in the management of GTPS. EVIDENCE REVIEW: MEDLINE, EMBASE, CENTRAL, SCOPUS, and Web of Science were searched from database inception to September 5, 2023 for RCTs evaluating conservative and surgical interventions for GTPS. The inclusion criteria for this systematic review were level I evidence, assessment of at least two different approaches to the management of GTPS, published in English, and featuring human subjects. Pertinent study characteristics were extracted from the included trials after title/abstract and full-text screening. Citation metrics were obtained from the Clarivate Web of Knowledge database on September 28, 2023. The fragility index (FI) and continuous fragility index (CFI) were calculated for primary outcomes across all included RCTs. Univariate regression models were used to assess correlations between citation density and a variety of study characteristics. A sub-analysis by category of intervention (injectable modalities, non-invasive modalities, and surgical modalities) was also performed, with an ANOVA of study and bibliometric characteristics. FINDINGS: Twenty-one studies published from 2009 to 2023 comprising 1683 patients (1690 hips) met inclusion criteria and were eligible for analysis. Treatments ranged from non-invasive (n = 8), injectable (n = 12), to surgical modalities (n = 1). Eleven different countries were represented amongst the included RCTs; 71.4 % were from the United States or Europe, with the remaining 28.6 % originating from Australia. The median journal impact factor of published studies was 3.4 (IQR 2.4-4.8). The mean citation density across all three intervention categories were injectable modalities (4.37 ± 3.39), noninvasive modalities (3.27 ± 1.77), and surgical modalities (1, not applicable). The median CFI was 2 (IQR 0-12). Correlation analysis demonstrated a statistically significant correlation to year published (R = -0.473, p = 0.03) and study sample size (R = 0.735, p < 0.01). CONCLUSIONS AND RELEVANCE: RCTs assessing the management of GTPS demonstrate a varied range of clinical uptake, as evidenced by citation density. An array of different healthcare disciplines is involved in GTPS management, signified by the diversity of journals publishing RCTs on the topic. The median CFI is low compared to other citation analyses in orthopedics, demonstrating that the collective conclusions drawn by these studies are limited by fragility. Additionally, RCTs on surgical treatments for cases refractory to nonsurgical management are notably underrepresented, highlighting the necessity for further evaluation. LEVEL OF EVIDENCE: I.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.186 | 0.638 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.024 | 0.032 |
| Bibliometrics | 0.035 | 0.036 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.010 | 0.010 |
| Open science | 0.004 | 0.005 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".