Summary of progress /findings (approx 300 words)
A recent systematic review identified 63 placebo surgery trials in the literature (Wartolowska 2016). None involved the hand or upper extremity. Placebo interventions are an important methodological option in trial design but face both scientific and ethical challenges. The placebo effect is the perceived therapeutic benefit not attributed to the surgery and leads to an overestimation of the specific (true) effect of the intervention. Before developing hand surgery trials with a placebo arm, it is important to understand patient and surgeon attitudes to them and the potential barriers to implementation.
Is it feasible to conduct a hand surgery randomized controlled trial with a placebo arm?
The project has three main components:
1. A national survey of hand surgeons and hand therapists to investigate their beliefs and attitudes towards placebo interventions. This will build on recent placebo surgery surveys from NDORMS (Wartolowska 2014; Baldwin 2016) and use the RSTN / BSSH to enable comprehensive national and international coverage.
2. Create a priority-setting scheme to identify procedures or interventions patients, surgeons and therapists have most doubt about. These might include surgical procedures such as a simple trapiezectomy for OA or repairing a digital nerve, or interventions such as steroid injections for flexor tenosynovitis or osteoarthritis. After an initial survey, a workshop will be organized to discuss the final candidates.
3. Patient and public engagement to explore attitudes towards placebo interventions in hand surgery and acceptability of possible trial ideas.