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Impact of the PROFHER trial findings on surgeons’ clinical practice: An online questionnaire survey
Open accessAbstract
Objectives: To explore whether orthopaedic surgeons have adopted the Proximal Fracture of the Humerus: Evaluation by Randomisation (PROFHER) trial results routinely into clinical practice. Methods: A questionnaire was piloted with six orthopaedic surgeons using a ‘think aloud’ process. The final questionnaire contained 29 items and was distributed online to surgeon members of the British Orthopaedic Association and British Elbow and Shoulder Society. Descriptive statistics summarised the sample characteristics and fracture treatment of respondents overall, and grouped them by whether they changed practice based on PROFHER trial findings. Free-text responses were analysed qualitatively for emerging themes using Framework Analysis principles. Results: There were complete responses from 265 orthopaedic and trauma surgeons who treat patients with proximal humeral fractures. Around half (137) had changed practice to various extents because of PROFHER, by operating on fewer PROFHER-eligible fractures. A third (43) of the 128 respondents who had not changed practice were already managing patients non-operatively. Those who changed practice were more likely to be younger, work in a trauma unit rather than a major trauma centre, be specialist shoulder surgeons and treat fewer PROFHER-eligible fractures surgically. This group gave higher scores when assessing validity and applicability of PROFHER. In contrast, a quarter of the non-changers were critical, sometimes emphatically, of PROFHER. The strongest theme that emerged overall was the endorsement of evidence-based practice. Conclusion: PROFHER has had an impact on surgeons’ clinical practice, both through changing it, and through underpinning existing non-operative practice. Although some respondents expressed reservations about the trial, evidence from such trials was found to be the most important influence on surgeons’ decisions to change practice. Cite this article: L. Jefferson, S. Brealey, H. Handoll, A. Keding, L. Kottam, I. Sbizzera, A. Rangan. Impact of the PROFHER trial findings on surgeons’ clinical practice: An online questionnaire survey. Bone Joint Res 2017;6:590–599. DOI: 10.1302/2046-3758.610.BJR-2017-0170.
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93% of orthopaedic surgeons who treat PHFs are reportedly aware of ProFHER's findings.
“with 93% of orthopaedic surgeons who treat PHFs reportedly aware of ProFHER's findings.”
From Quotation errors related to the Proximal Fracture of the Humerus Evaluation by Randomization (ProFHER) study (2021) · cites this paper as [9]
Since ProFHER's publication, its findings have guided treatment and further research.
“Nevertheless, since ProFHER's publication, its findings have guided treatment and further research.”
From Quotation errors related to the Proximal Fracture of the Humerus Evaluation by Randomization (ProFHER) study (2021) · cites this paper as [9]
The low ProFHER quotation error rate may be explained by the ProFHER study being a large and well-known trial and by high awareness among orthopaedic surgeons.
“A possible explanation for the low ProFHER quotation error rate was that the ProFHER study is a large and well-known trial with 93% of orthopaedic surgeons who treat PHFs reportedly aware of ProFHER's findings.”
From Quotation errors related to the Proximal Fracture of the Humerus Evaluation by Randomization (ProFHER) study (2021) · cites this paper as [9]
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Metadata
- Authors
- Jefferson, L., Brealey, S., Handoll, H., Keding, A., Kottam, L., Sbizzera, I., & Rangan, A.
- Affiliations
- University of York (GB)
- Teesside University (GB)
- James Cook University Hospital (GB)
- South Tees Hospitals NHS Foundation Trust (GB)
- Corresponding author
- Brealey, S.
- Venue
- Bone & Joint Research
- Published
- 2017-10
- Volume
- 6
- Issue
- 10
- Pages
- 590-599
- ISSN
- 2046-3758 (ISSN-L)
- PMC
- PMC5670363
- OpenAlex
- W2766402037
- Cited by
- 33
- References
- 13
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 7 · 2018: 4
- FWCI
- 4.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Bone and Joint Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Funders
- National Institute for Health and Care Research (06/404/53, 06/404/502)
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Surgery › Shoulder Injury and Treatment
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- proximal humerus fracture, clinical practice change, evidence-based practice, conservative treatment, trauma surgeons, trial validity
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