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 29 May 2009
Bad Research on Morton's Neuroma and Shockwave Therapy

In the latest JAPMA, there is this paper: Extracorporeal Shockwave Therapy for Interdigital Neuroma: A Randomized, Placebo-Controlled, Double-Blind Trial. This RCT compared shockwave therapy for an interdigital neuroma to a placebo.

The purpose of a RCT is to determine how much more effective an intervention is compared to a placebo. To do this the correct way to analyse a RCT is to compare the outcomes BETWEEN the intervention and placebo groups.

The authors concluded “Extracorporeal shockwave therapy is a possible alternative to surgical excision for Morton’s neuroma” based on a WITHIN groups analysis which is the wrong way!

I put there numbers into SPSS and did a BETWEEN groups comparison and got a p value that was not close to being statistically significant. The authors data showed that shockwave therapy for interdigital neuromas was no better than a placebo!

How does research like this get through the hurdles that are required for publication? See this discussion: Shockwave therapy for Morton's neuroma.

UPDATE: 20 September:

The latest issue of JAPMA has 3 letters to the editor about the above paper: Payne, Landorf & Turlik and a reponse from the authors where they admit they got it wrong. This still does not answer the question as to how it got past the JAPMA review process and why the Editor has not formally withdrawn the publication.

Craig Payne


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