Aims

Weightbearing instructions after musculoskeletal injury or orthopaedic surgery are a key aspect of the rehabilitation pathway and prescription. The terminology used to describe the weightbearing status of the patient is variable; many different terms are used, and there is recognition and evidence that the lack of standardized terminology contributes to confusion in practice.

Purpose. In recent years, it has become increasingly common to publish the level of evidence of orthopaedic research in journal publications. Our primary research question is: is there an improvement in the levels of evidence of articles published in paediatric orthopaedic journals over time? In addition, what is the current status of levels of evidence in paediatric orthopaedic journals?. Methods. All articles in the Journal of Paediatric Orthopaedics-A and Journal of Paediatric Orthopaedics-B for 2001, 2002, 2007 and 2008, and in the Journal of Children's Orthopaedics for 2007 and 2008, were collected. Animal, cadaveric and basic science studies, expert opinion and review articles were then excluded. The 750 remaining articles were blinded and put in random order. The abstract, introduction and methods of each article were independently reviewed. According to the currently accepted grading system, study type (therapeutic, prognostic, diagnostic, economic) and level of evidence (I, II, III, IV) were assigned. Inter- and intra-observer reliability were investigated. Results. There were no statistically significant differences in the study type or levels of evidence in articles published before and after 2003. Of articles published during 2007/2008, 2.1% were graded as Level I, 3.6% as Level II, 17.4% as Level III, and 41.8% as Level IV. JPO-A published 5.7% Level I studies, while JPO-B and JCO published 4.9% and 4.6%, respectively. JPO-A published a lower percentage of Level III and IV studies as compared to JPO-B and JCO. The inter-observer reliability for study type and levels of evidence was high (kappa 0.921 and 0.860, respectively). The intra-observer reliability was moderate (kappa 0.842 and 0.613, respectively). Conclusion. Since the introduction of levels of evidence to journals in 2003, there has been minimal change in the quality of evidence in paediatric orthopaedic publications. Paediatric orthopaedic articles can be reliably graded by non-epidemiologically trained individuals