Analysis of Reference Practices among Practicing Orthopaedicians in India

Abstract
Purpose On-The-Go (OTG) references are those that clinicians make within a tight deadline at the point of patient care to
direct critical decisions. We conducted this study to assess the knowledge level of orthopaedicians on clinical usefulness and
quality appraisal of diferent reference methods along with their attitude towards its utility for practice. Materials and Methods A web-based survey was administered through Google Forms among the members of the Tamil Nadu Orthopaedic Association (TNOA) by snowball sampling method. The survey was designed by the Quality Appraisal Committee (QAC) of Orthopaedic Research Group (ORG) with 17 items. Association and correlation analysis were done between diferent responses in the survey to fnd out ways to improve the reference practices. Results 177 participants with a mean age of 43.5 years completed the survey. About 45.8% (n=81) of participants had prior knowledge on the Oxford Levels of Evidence. However, they were not familiar with using them for critical appraisal of evidence. About 86.5% (n=153) of participants were worried about the quality of the content they seek for reference. Among the reference sources, online research articles were used by 54.2% (n=96), digital applications by 21.4% (n=38), digital textbooks by 15.2% (n=27), and other methods like peer discussion by 5.1% (n=9). A signifcant association was noted between the participants who chose level I studies for their reference and their familiarity with the concept of fragility (p=0.006) and heterogenicity (p=0.021) and types of bias (p=0.003). A signifcant association was noted between participants with active journal subscription and their familiarity with the concept of spin (p=0.016) and their knowledge of the heterogeneity of study results (p=0.019). We found a signifcant association between age (<40 years of age) and knowledge on various types of bias (p=0.032), eterogenicity (p=0.01), and fragility (p=0.021). Conclusion This is the frst study on the information-seeking behaviour of the orthopaedicians. OTG references remain a part of the orthopaedic practice and are made mostly by accessing online research articles. Imparting knowledge of their quality appraisal should be an active part of the orthopaedic curriculum. This will, in turn, improve the attitude and reference practices leading to better decision-making towards patient care.