Socioeconomic Status and Race Are Rarely Reported in Randomized Controlled Trials for Achilles Tendon Pathology in the Top 10 Orthopaedic Journals: A Systematic Review

Grayson M Talaski; Anthony N Baumann; Natasha Salmen; Deven P Curtis; Kempland C Walley; Albert T Anastasio; Cesar de Cesar Netto

doi:10.1177/24730114231225454

Socioeconomic Status and Race Are Rarely Reported in Randomized Controlled Trials for Achilles Tendon Pathology in the Top 10 Orthopaedic Journals: A Systematic Review

Foot Ankle Orthop. 2024 Jan 28;9(1):24730114231225454. doi: 10.1177/24730114231225454. eCollection 2024 Jan.

Authors

Grayson M Talaski¹, Anthony N Baumann², Natasha Salmen², Deven P Curtis², Kempland C Walley³, Albert T Anastasio⁴, Cesar de Cesar Netto⁴

Affiliations

¹ Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.
² College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
³ Department of Orthopedic Surgery, University of Michigan/Michigan Medicine, Ann Arbor, MI, USA.
⁴ Department of Orthopedic Surgery, Duke University, Durham, NC, USA.

Abstract

Background: Randomized controlled trials (RCTs) are crucial in comparative research, and a careful approach to randomization methodology helps minimize bias. However, confounding variables like socioeconomic status (SES) and race are often underreported in orthopaedic RCTs, potentially affecting the generalizability of results. This study aimed to analyze the reporting trends of SES and race in RCTs pertaining to Achilles tendon pathology, considering 4 decades of data from top-tier orthopaedic journals.

Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and used PubMed to search 10 high-impact factor orthopaedic journals for RCTs related to the management of Achilles tendon pathology. The search encompassed all articles from the inception of each journal until July 11, 2023. Data extraction included year of publication, study type, reporting of SES and race, primary study location, and intervention details.

Results: Of the 88 RCTs identified, 68 met the inclusion criteria. Based on decade of publication, 6 articles (8.8%) reported on SES, whereas only 2 articles (2.9%) reported on race. No RCTs reported SES in the pre-1999 period, but the frequency of reporting increased in subsequent decades. Meanwhile, all RCTs reporting race were published in the current decade (2020-2030), with a frequency of 20%. When considering the study location, RCTs conducted outside the United States were more likely to report SES compared with those within the USA.

Conclusion: This review revealed a concerning underreporting of SES and race in Achilles tendon pathology RCTs. The reporting percentage remains low for both SES and race, indicating a need for comprehensive reporting practices in orthopaedic research. Understanding the impact of SES and race on treatment outcomes is critical for informed clinical decision making and ensuring equitable patient care. Future studies should prioritize the inclusion of these variables to enhance the generalizability and validity of RCT results.

Keywords: Achilles tendon pathology; race; randomized controlled trial; socioeconomic status; systematic review.

Publication types

Review