Levels of evidence in foot and ankle surgery: progress over the last decade?

BackgroundThe focus on evidence-based medicine has led to calls for increased levels of evidence in surgical journals. The purpose of the present study was to review the levels of evidence in articles published in the foot and ankle literature and to assess changes in the level of evidence over a decade.MethodsAll articles from the years 2000 and 2010 in Foot and Ankle International, Foot and Ankle Surgery, and all foot and ankle articles from JBJS A and JBJS B were analysed. Animal, cadaveric, basic science, editorials, surveys, letters to Editor and correspondence were excluded. Articles were ranked by a five-point level of evidence scale, according to guidelines from the Centre for Evidence Based Medicine.ResultsA total of 379 articles were analysed from a total of 42 different countries. The kappa value for the inter-observer reliability showed very good agreement between the reviewers for types of evidence (κ = 0.785 (P< 0.01)) and excellent agreement for levels of evidence (κ = 0.846 (P< 0.01)). Bet...