Tag Archive | Robert Marx

Revised JBJS LOE Table Improves Clinical Usefulness and Transparency

Since 2003, JBJS has assigned level-of-evidence (LOE) ratings to all clinical articles, based on a system developed by the UK’s Centre for Evidence-Based Medicine (CEBM). The CEBM updated its rating system in 2011, and The Journal has revised its LOE guidance in ways that largely but not entirely reflect the CEBM update.

In an editorial in the January 7, 2015 JBJS, Editor-in-Chief Dr. Marc Swiontkowski and Associate Editor for Evidence-Based Orthopaedics Dr. Robert Marx note that the revised JBJS LOE table still divides studies by type and that “much of the ranking criteria remain the same.” However, the rows and columns have been transposed and a column focused on specific clinical questions has been added. The clinical-question column—which poses queries such as “Does this treatment help?”—can guide busy clinicians quickly and efficiently to the best available evidence about their immediate situation.

In addition, guidance in the new table’s footnotes permits flexibility to grade studies upward if there is a dramatic effect size or downward on the basis of small effect size or study-quality issues such as imprecision. Overall, the revised table clarifies and makes more transparent The Journal’s LOE-assignment process.

Notably, The Journal has decided to depart from the CEBM update in two important ways. We will not follow the CEBM’s policy of reserving Level-I designation for systematic reviews, believing that certain high-quality original research also merits Level-I status. In addition, because economic and population-health decisions play an increasingly important role in orthopaedic surgery today, we have retained economic studies in our table, while the CEBM eliminated such research from its update.

Finally, the editorial reminds readers that “a higher LOE does not necessarily reflect the clinical importance of a given study.” Ultimately, each reader is responsible for deciding what constitutes the best external evidence for his or her specific clinical question.

Please let us know what you think about the revised LOE table by clicking the “Leave a comment” button.

JBJS Webinar Now On-Demand – Return to Sports after ACL Reconstruction

“When will I be able to play again?” Following ACL reconstruction surgery, that’s a question physical therapists and orthopaedic surgeons invariably hear—often repeatedly—from their athletically inclined patients.

The multiple factors that go into answering this difficult question are the subject of this complimentary webinar.

Current evidence suggests that approximately 50 to 60 percent of patients post ACL-reconstruction eventually return to sports at preinjury levels. But the timing of that return—and the many variables leading to it—create a series of challenging clinical decision points. This webinars explores the most relevant surgical, rehabilitative, and patient-centered factors that contribute to sound decisions in which surgeons, physical therapists, and patients participate fully.

Moderated by Robert Marx, MD, JBJS Associate Editor for Evidence-based Orthopaedics, this webinar focuses on two articles, one from each journal.

After the articles’ primary authors present their data, two additional return-to-sports experts add their perspectives to this body of research.


Robert Marx, MD

Presenting authors:

Freddie Fu, MD and Terese Chmielewski, PT, PhD, SCS


Kevin Wilk, PT, DPT, FAPTA and Kurt Spindler, MD

Register now!

This webinar is brought to you by the Journal of Orthopaedic & Sports Physical Therapy and The Journal of Bone and Joint Surgery