Spin and the subacromial balloon spacer for massive, irreparable rotator cuff tears.

Spin plays a major role in tennis, basketball, baseball, golf, soccer, cricket, pool, bowling, ping pong, and all other ball sports.

Spin is achieved by applying an unbalanced force to the ball, causing it to rotate in the direction desired by the player.

In publications of clinical research on innovative treatments, positive spin is a frequent form of unbalanced reporting in which beneficial claims are overemphasized while negative findings are minimized, resulting in a biased conclusion that emphasizes the value of the intervention.

The authors of Evaluation of Spin in Reviews of Biodegradable Balloon Spacers for Massive, Irreparable Rotator Cuff Tears list 12 types of spin:

Abstracts are the part of publications most commonly read by surgeons. Spin is most problematic in abstracts, given their brevity and can result in the misrepresentation of a study’s actual findings. 

These authors conducted a search in the PubMed and Embase databases using the search terms: “subacromial balloon”, “subacromial spacer”, “rotator cuff”,  “irreparable”, “systematic review”, and “meta-analysis.” 

A total of 29 studies met their inclusion criteria, of which 10 were reviews or meta-analyses and the remaining 19 were primary studies. The majority of included studies were classified as level IV evidence and only one RCT met this study’s inclusion criteria. 

Spin was highly prevalent in the abstracts of primary studies, systematic reviews, and  meta-analyses discussing the use of the subacromial balloon spacer in the treatment of massive, irreparable rotator cuff tears: spin was identified in 27 of the 29 studies ( 93.1%). Below is a list of the types of spin re-ordered by frequency of occurrence in publications on the subacromial balloon.

Spin commonly served to promote the clinical successes of balloon spacer implantation, often by overlooking confounding factors that may question the accuracy of a study’s findings as shown in the two most frequent types:

Type 3 spin, “Selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention”

Type 9 spin, “Conclusion claims the beneficial effect of the experimental treatment despite reporting bias”.

Comment:  To date, there is a lack of high-quality evidence demonstrating superiority of the subacromial balloon spacer in treating massive irreparable rotator cuff tears. Subacromial balloon spacer for irreparable rotator cuff tears of the shoulder (START:REACTS): a group-sequential, double-blind, multicentre randomised controlled trial. found that débridement alone outperformed the subacromial balloon spacer for the treatment of these tears.

Similar frequencies of spin are likely to be found in abstracts regarding most other orthopaedic interventions.

Analyzing Spin in Abstracts of Orthopaedic Randomized Controlled Trials With Statistically Insignificant Primary Endpoints found an incidence of 44%.

Evaluation of spin in systematic reviews and meta-analyses of superior capsular reconstruction found least 1 form of spin in all 17 qualifying studies. The most common types of spin were type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies") and type 9 ("Conclusion claims the beneficial effect of the experimental treatment despite reporting bias"), both of which were observed in 11 studies (65%). A statistically significant association between lower level of evidence and type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies") was observed. Interestingly, The Number of Surgeons Using Superior Capsular Reconstruction for Rotator Cuff Repair Is Declining

Readers, reviewers, authors and editors need to be alert to spin in reports of research and consider its presence in efforts to optimize the literature and in the interpretation of current publications, especially those concerning new technologies.

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