Unattainable equipoise in randomised controlled trials: staff views of a feasibility study of surgical treatments for segmental tibial fractures
<p><strong>Aims:</strong> To explore staff’s experience of a multi-centre pilot randomised controlled trial (RCT) comparing intramedullary nails and circular frame external fixation for segmental tibial fractures.</p> <p><strong>Patients and Methods:</strong&g...
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| Fformat: | Journal article |
| Iaith: | English |
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British Editorial Society of Bone and Joint Surgery
2021
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| _version_ | 1826290731076026368 |
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| author | Phelps, EE Tutton, E Costa, ML Hing, CB STIFF-F research collaborators |
| author_facet | Phelps, EE Tutton, E Costa, ML Hing, CB STIFF-F research collaborators |
| author_sort | Phelps, EE |
| collection | OXFORD |
| description | <p><strong>Aims:</strong> To explore staff’s experience of a multi-centre pilot randomised controlled trial (RCT)
comparing intramedullary nails and circular frame external fixation for segmental tibial fractures.</p>
<p><strong>Patients and Methods:</strong> A purposeful sample of 19 staff (nine surgeons) involved in the study
participated in an interview. Interviews explored participants’ experience and views of the study and
the treatments. The interviews drew on phenomenology, were face-to-face or by telephone and
were analysed using thematic analysis.</p>
<p><strong>Results:</strong> The findings identify that for the treatment of segmental tibial fractures equipoise was a
theoretical ideal that was most likely unattainable in clinical practice. This was conveyed through
three themes i) the ambiguity of equipoise, where multiple definitions of equipoise and a belief in
community equipoise were evident, ii) an illusion of equipoise, created by strong treatment
preferences and variation in collective surgical skills and iii) treating the whole patient, where the
complexity and severity of the injury required a patient-centred approach and doing the best for the
individual patient took priority over trial recruitment.</p>
Conclusion: Equipoise can be unattainable for rare injuries such as segmental tibial fractures, where
there are substantially different surgical treatments requiring specific expertise, high levels of
complexity and a concern for poor outcomes. Surgeons are familiar with community equipoise.
However, a shared understanding of factors that limit the feasibility of RCTs may identify instances
where community equipoise is unlikely to translate into practice. |
| first_indexed | 2024-03-07T02:48:40Z |
| format | Journal article |
| id | oxford-uuid:acea482d-c8c6-4f21-a6df-680e152bf5f6 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:48:40Z |
| publishDate | 2021 |
| publisher | British Editorial Society of Bone and Joint Surgery |
| record_format | dspace |
| spelling | oxford-uuid:acea482d-c8c6-4f21-a6df-680e152bf5f62022-03-27T03:32:05ZUnattainable equipoise in randomised controlled trials: staff views of a feasibility study of surgical treatments for segmental tibial fracturesJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:acea482d-c8c6-4f21-a6df-680e152bf5f6EnglishSymplectic ElementsBritish Editorial Society of Bone and Joint Surgery2021Phelps, EETutton, ECosta, MLHing, CBSTIFF-F research collaborators<p><strong>Aims:</strong> To explore staff’s experience of a multi-centre pilot randomised controlled trial (RCT) comparing intramedullary nails and circular frame external fixation for segmental tibial fractures.</p> <p><strong>Patients and Methods:</strong> A purposeful sample of 19 staff (nine surgeons) involved in the study participated in an interview. Interviews explored participants’ experience and views of the study and the treatments. The interviews drew on phenomenology, were face-to-face or by telephone and were analysed using thematic analysis.</p> <p><strong>Results:</strong> The findings identify that for the treatment of segmental tibial fractures equipoise was a theoretical ideal that was most likely unattainable in clinical practice. This was conveyed through three themes i) the ambiguity of equipoise, where multiple definitions of equipoise and a belief in community equipoise were evident, ii) an illusion of equipoise, created by strong treatment preferences and variation in collective surgical skills and iii) treating the whole patient, where the complexity and severity of the injury required a patient-centred approach and doing the best for the individual patient took priority over trial recruitment.</p> Conclusion: Equipoise can be unattainable for rare injuries such as segmental tibial fractures, where there are substantially different surgical treatments requiring specific expertise, high levels of complexity and a concern for poor outcomes. Surgeons are familiar with community equipoise. However, a shared understanding of factors that limit the feasibility of RCTs may identify instances where community equipoise is unlikely to translate into practice. |
| spellingShingle | Phelps, EE Tutton, E Costa, ML Hing, CB STIFF-F research collaborators Unattainable equipoise in randomised controlled trials: staff views of a feasibility study of surgical treatments for segmental tibial fractures |
| title | Unattainable equipoise in randomised controlled trials: staff views of a feasibility study of surgical treatments for segmental tibial fractures |
| title_full | Unattainable equipoise in randomised controlled trials: staff views of a feasibility study of surgical treatments for segmental tibial fractures |
| title_fullStr | Unattainable equipoise in randomised controlled trials: staff views of a feasibility study of surgical treatments for segmental tibial fractures |
| title_full_unstemmed | Unattainable equipoise in randomised controlled trials: staff views of a feasibility study of surgical treatments for segmental tibial fractures |
| title_short | Unattainable equipoise in randomised controlled trials: staff views of a feasibility study of surgical treatments for segmental tibial fractures |
| title_sort | unattainable equipoise in randomised controlled trials staff views of a feasibility study of surgical treatments for segmental tibial fractures |
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