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Evidence based practice
Original research
Randomised controlled trials in hand surgery: a scoping review
  1. Juuso Heikkinen1,
  2. Soumen Das De2,
  3. Jarkko Jokihaara3,
  4. Kati Jaatinen4,
  5. Rachelle Buchbinder5,
  6. Teemu Karjalainen6
  1. 1Orthopedic and Traumatology, Oulu University Hospital, Oulu, Finland
  2. 2Department of Hand & Reconstructive Microsurgery, National University Hospital, Singapore
  3. 3Department of Hand Surgery, Faculty of Medicine and Life Sciences, Tampere University Hospital, Tampere, Finland
  4. 4University of Jyväskylä, University of Jyväskylä, Jyvaskylä, Finland
  5. 5Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  6. 6Unit of Hand Surgery, Department of Surgery, Central Finland Central Hospital, Jyvaskyla, Finland
  1. Correspondence to Dr Juuso Heikkinen; juuso.heikkinen{at}fimnet.fi

Abstract

Objectives To identify the evidence gaps that exist regarding the efficacy or effectiveness of hand surgery.

Setting A scoping review. We systematically searched MEDLINE, Embase and CENTRAL databases to identify all hand surgical randomised controlled trials from inception to 7 November 2020.

Results Of the 220 identified randomised controlled trials, none were fundamental efficacy trials, that is, compared surgery with placebo surgery. 172 (78%) trials compared the outcomes of different surgical techniques, and 143 (65%) trials were trauma related. We identified only 47 (21%) trials comparing surgery with non-operative care or injection.

Conclusion The evidence supporting use of surgery especially for chronic hand conditions is scarce. To determine optimal care for people with hand conditions, more resources should be aimed at placebo-controlled trials and pragmatic effectiveness trials comparing hand surgery with non-operative care.

PROSPERO registration number CRD42019122710.

  • surgery
  • hand & wrist
  • plastic & reconstructive surgery

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (JH), upon reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2022-062773

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    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (JH), upon reasonable request.

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    Footnotes

    • Twitter @JuusoHeikkinen2, @TeemuVKarjalain

    • Contributors All the authors gave substantial contribution for this work. JH, TK, JJ and SDD extracted and double-checked the data, JH, TK, RB, JJ and SDD interpreted the results and created the manuscript. KJ created the figures and assisted with the design of the work. JH is responsible for the overall content as the guarantor. All authors read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.