Spin Reporting is Common in Pilot and Feasibility Trials in Hip and Knee Arthroplasty: A Methodological Survey

Spin Reporting is Common in Pilot and Feasibility Trials in Hip and Knee Arthroplasty: A Methodological Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Spin Reporting is Common in Pilot and Feasibility Trials in Hip and Knee Arthroplasty: A Methodological Survey Zinnia Chung, Leigh-Ann Grant, Jeslyn Chen, Lawrence Mbuagbaw, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7632918/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Pilot and feasibility trials help identify methodological and logistical challenges. However, biased reporting, known as “spin,” may distort overall study findings and mislead readers, presenting content through a subjective lens. Accurate assessments of feasibility are critical in orthopedic research, where the continued popularity of procedures such as hip and knee arthroplasties emphasizes a need for rapid advancement through research and development. The prevalence of spin practices among pilot and feasibility trials in hip and knee arthroplasties remains unclear. Objectives To evaluate the prevalence of spin reporting practices in pilot and feasibility trials focused on hip and knee arthroplasty. The secondary objective is to identify factors associated with the level of spin featured in the analyzed manuscripts. Methods A search of PubMed identified 147 trials published between 2017–2023, selected using stratified random sampling. Studies were screened for the presence of three spin criteria defined in previous literature, and summarized descriptively. Results Spin appeared in 88.4% of studies (95% CI: 83.3–93.6). Emphasis on intervention effectiveness (81.6%) and statistical significance rather than feasibility (60.5%) were the most common types. Spin was frequent in abstracts (78.9%) and discussions (79.6%), with the highest rates also observed in privately funded (95.7%) and pharmacologic (100%) studies. No clear trend was observed over time. Conclusions Spin is widespread in pilot and feasibility trials involving hip and knee arthroplasty, particularly in abstracts and discussions. Greater adherence to reporting guidelines and explicit communication of feasibility objectives and study limitations are necessary to improve transparency and reduce interpretive bias in this field. Pilot and feasibility trials Pilot trials Feasibility studies Hip Arthroplasty Knee Arthroplasty Hip Replacement Knee Replacement Methodological survey Figures Figure 1 Figure 2 1. Background Pilot and feasibility studies are crucial for optimizing, assessing, and scaling research studies for success. By evaluating project designs on a smaller scale, these trials help researchers identify key barriers to execution and assess core elements such as recruitment potential, study retention, and the assessment process. 1 In particular, randomized controlled trials (RCTs) that included pilot trials were found to achieve publication more quickly, and in higher-impact journals. 2 Additional benefits, such as a lower risk of bias in concealment and masking procedures, have also been identified, demonstrating the direct role of pilot trials in enhancing study design. 2 However, these benefits are contingent on pilot trial outcomes being reported in an objective manner, which should highlight both design strengths and limitations. This ensures that pilot and feasibility trials can maximize their functionality, providing an accurate assessment of a study’s design while identifying areas where uncertainty may still exist. 3 Unfortunately, distorted reporting practices can compromise result interpretation, significantly diminishing the utility of trial outcomes. 4 These approaches often manifest as misleading reporting, interpretation, and extrapolation of study data, referred to as “spin” tactics. 4 Boutron et al. further defined several forms of spin, including approaches that focus on statistical significance, interpret non-significant data as comparable in effectiveness, or make claims of benefit despite statistically nonsignificant results. 5 Other examples of spin are made evident through the use of overly strong wording choices. For instance, in the field of oncology, 56% of studies from a sample of 62 publications used leading terms when reporting results (title, abstract, results, etc.). 6 Other spin tactics include reporting results as being “significant”, “optimal”, or “novel” inappropriately. Meanwhile, in a study of 128 non-randomized papers, 84% demonstrated at least 1 example of spin within their abstracts, while a review of cardiovascular literature found spin in 67% of published main texts. 7 , 8 This appears to be a common pattern across disciplines, with a high prevalence of spin also identified in an analysis of traumatic brain injury, even among projects published in leading medical journals. 9 Inaccurate reporting practices often manifest as an overemphasis on certain study findings while minimizing others. This misrepresentation of pilot/feasibility trial results can subconsciously influence how readers interpret the findings. Although further research is needed to assess the specific impact of spin on readers’ decision-making, two commonly noted consequences are the misinterpretation and favorable presentation of unfeasible results. 4 In this context, misleading communication in study reports calls into question the reliability of pilot and feasibility studies. Furthermore, while the prevalence of spin practices has been studied in published biomedical literature (encompassing clinical trials, observational studies, meta-analyses, systematic reviews, and diagnostic accuracy studies), its impact in pilot trials has yet to be fully explored. 4 In orthopedics, for example, where the demand for hip and knee arthroplasties is projected to increase by almost 40% in 2060, ongoing research supported by pilot and feasibility trials will be crucial. 10 Therefore, the primary objective of this study is to evaluate the prevalence of spin reporting practices in pilot and feasibility trials focused on hip and knee arthroplasty, based on the types of spin identified by Boutron et al. and McKechnie et al. 5,11 Specifically, spin can be categorized into: 1) a focus on statistical significance rather than feasibility, 2) the presentation of non-feasible results (statistically nonsignificant) as feasible or effective), and 3) the emphasis of effectiveness or potential intervention benefits rather than feasibility. 5 , 11 The secondary objective is to describe factors associated with the level of spin featured in the analyzed manuscripts. 2. Methods 2.1 Study Design This methodological survey examines pilot and feasibility literature in hip and knee arthroplasty for the prevalence and characteristics of spin as defined by Boutron et al. and McKechnie et al. 5,11 The manuscript is presented per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as applicable to the study design. Of note, the population used in this study was previously analyzed in a separate publication focused on completeness of reporting based on adherence to the CONSORT 2010 extension for pilot and feasibility trials (doi: 10.1136/bmjopen-2024-085441 ). Neither spin nor any factors associated with its prevalence have been investigated or reported using this dataset. As this study is based on published, publicly available data without the involvement of human participants, ethics review board approval was not required. 2.2 Eligibility Criteria Eligible studies were published between January 01 2017 and December 31, 2023, covering 7 years. This timeframe was chosen based on the 2016 publication of the Consolidated Standards of Reporting Trials (CONSORT) extension for randomized pilot and feasibility trials, ensuring a more standardized population for analysis. 12 Manuscripts were included if they explicitly described themselves as “pilot” or “feasibility” studies in their title, abstract, or main text. Additionally, eligible studies were required to focus on hip and knee arthroplasty, particularly perioperative clinical outcomes. Relevant topics included but were not limited to surgical approaches, imaging, rehabilitation, or biomedical equipment. Furthermore, only studies involving living human participants were considered; those using animal populations, artificial models, or isolated specimens were excluded. Secondary research, including case reports, review articles, and meta-analyses were also excluded. 2.3 Search Strategy A manual search of the PubMed database from January 01 2017 to December 31 2023 was conducted. Relevant texts were identified using a systematic search strategy, using keywords and Medical Subject Headings such as “feasibility studies,” “pilot projects,” "arthroplasty, replacement knee” and “arthroplasty, replacement, hip”. Studies classified as either pilot or feasibility were included in the sample. 2.4 Study Selection Microsoft Excel was used to host the database search results after duplicate entries were filtered out. All texts were screened by three reviewers (ZC, LG, JC) in accordance with the inclusion and exclusion criteria. This process involved three separate phases, with the screening process first limited to titles, then abstracts, and finally to the full text manuscripts. Any discrepancies among the three reviewers were resolved by consensus. A fourth reviewer (LT) was also available to address any further disagreements requiring additional consultation. 2.5 Data Extraction and Synthesis Data collection and extraction were conducted using a form on Microsoft Excel. This form was developed by all three reviewers and included basic study characteristics such as the date of publication, the continent of the first author, the presence of a structured abstract, and the sample size used (based on the intention to treat). Specific factors found to be associated with the prevalence of spin, such as study design, intervention type, published journal, and source of funding were also recorded. 4 , 13 , 14 The prevalence of spin was based on the presence of any spin types identified by Boutron et al. and McKechnie et al. 5,11 The three types included: 1) a focus on statistical significance rather than feasibility, 2) the presentation of non-feasible results (statistically nonsignificant) as feasible or effective), and 3) the emphasis of effectiveness or potential intervention benefits rather than feasibility. 5 Furthermore, the frequency at which each spin type appeared was reported alongside its location in the text (abstract, main text, or conclusion). Spin criteria that did not appear were indicated with a “0” and those that were not applicable were marked with “n/a.” Based on the level of spin reported, studies could be classified under “high spin” (2 or more spin tactics, and a prevalence of spin above the 75th percentile), “moderate spin” (spin prevalence around the 50th percentile) or “low spin” (spin prevalence below the 25th percentile to no spin at all). The JBI risk of bias assessment tool was used to evaluate the studies by two independent reviewers (ZC, LG), working in duplicates. 15 Any discrepancies were reviewed and resolved by a third reviewer (JC). 2.7 Statistical Analysis Spin outcomes were recorded using descriptive statistics, captured as the number of studies (%) reporting of each type of spin, alongside the prevalence of spin across the study population. The percentage of studies found to have at least one of the item definitions of ‘spin,’ in their abstracts, results/discussions, and conclusions were also reported in this way. Data was also organized visually to assess patterns associated with the prevalence of spin, sorting by source of funding (federal, private, not-for-profit, none, and not specified), the intervention type (physiotherapy, surgical, diagnostic, pharmacologic, equipment, or other), the year of publication (2017–2023), and the size of the study population (divided into quartiles, with groupings of 2–21, 22–35, 36–61, 62+). 4,13,14 Analyses were performed using Microsoft Excel computing software and results were tabulated and presented using Microsoft Word. 3. Results 3.1 Search results: 427 records were returned from the PubMed database, 371 of which were retrieved for further assessment following preliminary screening of titles and abstracts. After full-text screening, 278 eligible publications were identified, with a stratified random sample of 21 studies selected from each included year (2017–2023). The randomization was completed using a digital random number generator. A sample size of 21 studies per year allowed for an equal distribution of studies in the context of database volume limitations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram is featured in Fig. 1 . [ Location of Fig. 1 ] 3.2 Study Characteristics The characteristics of the study population (n = 147) are summarized in Table 1 , including study design, primary focus, intervention type and category, sample size, and funding source. Randomized controlled trials accounted for the largest proportion (35.4% (52/147), followed by cohort studies (25.9%, 38/147). A majority of studies focused on knee arthroplasty (53.1%, 78/147) while 27.2% (40/147) examined hip procedures. Physiotherapy-based interventions were the most frequently investigated (19.7%, 29/147), followed by surgical (15%, 22/147) as well as diagnostic (15%, 22/147) interventions. Most interventions targeted the post-operative phase (52.4, 77/142), and enrolled smaller samples, with 34% (50/147) including between 2 and 25 participants. In terms of funding, 35.4% (52/147) of studies received no financial support, while others were funded by federal (26.5%, 39/147), private (15.6%, 23/147), and not-for-profit (14.3%, 21/147) sources. Table 1 Summary of Study Characteristics: n = 147 Category n (%) Study Design RCT 52 (35.4) Non randomized trial 19 (12.9) Cohort study 38 (25.9) Case controlled 5 (3.4) Cross sectional 3 (2.0) Other 30 (20.4) Study Focus Hip 40 (27.2) Knee 78 (53.1) Both 29 (19.7) Intervention Type Other 49 (33.3) Physiotherapy 29 (19.7) Surgical 22 (15.0) Diagnostic 22 (15.0) Pharmacologic 13 (8.8) Equipment 12 (8.2) Intervention Category Preoperative 27 (18.4) Intraoperative 31 (21.1) Postoperative 77 (52.4) Long term 0 (0.0) Combined 10 (6.8) Not applicable 2 (1.4) Total Study Population Q1: n = 2–21 33 (82.5) Q2: n = 22–35 31 (91.2) Q3: n = 36–61 34 (91.9) Q4: n = 62+ 22 (88.9) Source of Funding Federal 39 (26.5) Private sector 23 (15.6) Not-for-profit 21 (14.3) None 52 (35.4) Not specified 12 (8.2) [Location of Table 1 ] 3.3 Prevalence of Spin Spin was highly prevalent in this study population, with 88.4% (130/147, 95%CI 83.3–93.6) of manuscripts exhibiting at least one of the three predefined spin types. The most common approach involved emphasizing an intervention’s effectiveness or potential benefits rather than its feasibility (81.6%, 120/147, 95%CI 75.3, 87.9). In contrast, fewer studies presented statistically non-significant or non-feasible results as effective (27.2%, 40/147, 95%CI 20.0, 34.4). However, a majority prioritized statistical significance over feasibility (60.5%, 89/147, 95%CI 52.6, 68.5). Full details are presented in Table 2 . Table 2 Overview of Reporting Based on the SPIN criteria (n = 147) Overview of SPIN prevalence Number of studies (n) demonstrating spin (%) 95% CI Overall: Demonstrated at least 1 type of spin practice 130 (88.4) 83.3, 93.6 Practice 1: A focus on statistical significance rather than feasibility (e.g. secondary outcomes) 89 (60.5) 52.6, 68.5 Practice 2: Presenting non-feasible results (statistically nonsignificant) as feasible or effective 40 (27.2) 20.0,34.4 Practice 3: Emphasizing effectiveness or potential intervention benefits rather than feasibility. 120 (81.6) 75.3, 87.9 [Location of Table 2 ] 3.4 Locations of Spin Reporting Abstracts and discussions displayed a higher presence of spin, with both frequently incorporating practice 3—framing interventions in terms of potential effectiveness or benefit rather than feasibility. This approach appeared in 68.7% of discussions (101/147, 95%CI 61.2, 76.2) and 56.5% (83/147, 95%CI 48.5, 64.5) of abstracts, whereas other spin types were present in fewer than half of sections. Conclusions showed a marked reduction in overall spin prevalence, declining from 79.6% (117/147, 95%CI 73.1, 86.1) in discussions to 56.5% (83/147, 95%CI 48.5, 64.5), though practice 3 remained the most frequently used strategy. By comparison, spin type 2 (presenting non feasible results as effective) was consistently the least common across all study components. [ Location of Table 3 ] Table 3 Distribution of SPIN by location within a paper Overview of SPIN instances n (%) with spin type in abstract 95% CI n (%) with spin type in discussion 95% CI n (%) with spin type in conclusion 95% CI Overall: Any spin practice 116 (78.9) 72.3, 85.5 117 (79.6) 73.1, 86.1 83 (56.5) 48.5, 64.5 Practice 1: A focus on statistical significance rather than feasibility 67 (45.6) 37.5, 53.6 69 (46.9) 38.9, 55.0 22 (15.0) 9.2, 20.7 Practice 2: Presenting non-feasible results as feasible or effective 13 (8.8) 4.3, 13.4 33 (22.5) 15.7, 29.2 12 (8.2) 3.7, 12.6 Practice 3: Emphasizing effectiveness or potential intervention benefits rather than feasibility. 83 (56.5) 48.5, 64.5 101 (68.7) 61.2, 76.2 70 (47.6) 39.6, 55.7 3.5 Patterns of Spin Reporting Figure 2 illustrates spin reporting patterns across several study characteristics, including funding source, intervention type, publication year, and sample size. Among studies that disclosed funding information, those backed by a private source exhibited the highest rate of spin at 95.7% (22/23, 95%CI 92.4, 98.9). This was followed closely by federally and non-funded manuscripts (87.2% and 88.5%, respectively). By contrast, works funded by not-for-profit organizations showed the lowest occurrence, at 76.2% (16/21, 95%CI 69.3, 83.1). All pharmacologic studies (13/13) demonstrated spin, as did 95.5% (21/22, 95%CI 92.1, 98.8) of those involving diagnostic equipment. In comparison, surgical intervention studies showed a lower rate of spin at 81.8% (18/22, 95%CI 75.6, 88.1). No consistent temporal trend was identified, although spin peaked in 2020 (100.0%, 21/21) before declining to 76.2% in 2023 (16/21, 95%CI 69.3, 83.1). Variation was also observed across study sizes: spin appeared less frequently in both small (Q1: n = 2–21, 82.5%, 33/40) and large (Q4: n ≥ 62, 88.9%, 32/36) samples, while mid-sized studies (Q2: n = 22–35 and Q3: 36–61) exceeded 90% prevalence. [ Location of Fig. 2 ] 4. Discussion 4.1 Location of Spin and Overall Prevalence This methodological survey found a high frequency of spin in pilot and feasibility research on hip and knee arthroplasty, with 88.4% of included manuscripts demonstrating at least one instance. This rate is consistent with prior findings in oncology (75%, 39/52), pharmacovigilance (63%, 63/100), and non-randomized abstracts (84%, 107/128). 7,13,16 However, the use of spin varies considerably across fields. For example, with research in traumatic brain injury and RCT infographics reported much lower prevalence, at 22% (33/150) and 33% (39/119), respectively. 9 , 14 A methodological review by Chiu et al. echoed this variability, noting prevalence as low as 9.7% in lung cancer studies and as high as 100% in trials evaluating cardioverter defibrillators. 4 Differences also emerged within sections of individual reports. In this sample, abstracts and discussions sections contained the highest levels of spin (78.9% 116/147, and 79.6% 117/147 of studies) while conclusions showed a marked decline (56.5, 83/147). Similar patterns have been observed in other disciplines; for instance, Lazarus et al. reported spin in 84% of abstracts and Ito et al. found it in 73.1% of main texts from oncology trials. Meanwhile, Boutron et al. observed lower frequencies in parallel-group RCTs, with spin present in just 37.5% of abstracts, 29.2% of main texts and 23.6% of conclusions. 5 , 12 , 14 Owing to the wide range of reporting styles, spin categorizations, and study populations/sizes examined, establishing a consistent estimate of spin prevalence remains a challenge. 4 The current investigation focused on pilot and feasibility studies, many of which involved smaller samples sizes (n < 100) and were intended to inform the development of future definitive studies. Unfortunately, concerns arise when the "pilot" designation is applied post hoc, often to justify small sample sizes or address methodological shortcomings, as documented in the dental literature. 17 When studies adopt this label due to underpowered sample sizes or novel project topics, spin can enhance the perceived significance and readership of smaller projects, possibly contributing to the higher prevalence noted in this study. In this study, spin was most prevalent in studies with sample sizes ranging from 22–35 participants, as well as 36–61. However, it should be noted that this project also did not identify a particularly higher presence of spin in studies with the smallest sample sizes in the investigated population (n = 2–21). This may reflect fewer opportunities for data over-interpretation, with authors more likely to acknowledge the exploratory nature of smaller-scale projects. At this magnitude, authors may also find themselves faced with stricter guidelines and requirements for publication, promoting a more cautious approach. As a whole, misleading communication can have detrimental effects, leading to misinterpretation of trial conclusions and the formation of inadequate clinical recommendations. 18 When combined with an inadequately designed pilot, spin further undermines the trial’s purpose as a tool for refining and optimizing future project development. 4.2 Type of spin used Among manuscripts that employed spin, type 3 (emphasizing potential effectiveness or intervention benefits rather than feasibility) was by far the most common, appearing in 81.6% of studies (120/147). This approach reflects a broader trend of overstating favorable outcomes, which has been shown to influence patient perceptions by increasing the likelihood of a treatment option being viewed as beneficial. 19 A systematic review of analgesic RCTs similarly found that suggesting treatment benefit despite nonsignificant results was among the most prevalent forms of spin (29% of included trials). 20 Comparable tactics have been observed in other specialties such as wound care, bariatric surgery, and urology, where authors often obscure non-significant findings through vague phrasing and semantic manipulation. 21 , 22 , 23 Rather than reporting feasibility challenges or clearly presenting neutral outcomes, these strategies redirect attention toward speculative trends and implications, ultimately distorting how an intervention is perceived. This framing may be particularly appealing in pilot and feasibility studies, where demonstrating some form of perceived benefit can help frame a study as “promising” and support its advancement to a full-scale trial. Unlike full-scale RCTs, these early-phase investigations are often seen as “prerequisites” for securing future funding or scaling up. As a result, researchers may feel compelled to highlight findings that appear “useful,” even when feasibility metrics were the intended focus. 24 In support of this, participants in a qualitative study by von Klinggraeff et al. noted that pilot studies labelled as “successful” were more likely to proceed to subsequent trials, while less favorable ones were typically abandoned. 24 These perceived pressures may incentivize the use of spin as a tool to promote study advancement and justify further investment. 4.3 Patterns of spin reporting Patterns in spin reporting and its potential predictors have been inconsistent. Although 95.7% (22/23) of private/industry funded studies in this review exhibited at least 1 instance of spin compared 76.2% (16/21) of their not-for-profit counterparts, no definite associations have been established in the literature. For example, a meta-analysis of 1110 spin-focused studies by Chiu et al. found no increased likelihood of spin in industry-sponsored research relative to non-industry funded work (RR 1.08, 95%CI 0.87, 1.34). 4 Even so, evidence from specific fields has suggested otherwise. In neurosurgery, a review by Khan et al. reported that industry-sponsored trials were 23 times more likely to present favorable outcomes, potentially due to factors such as publication agreements or preferential funding. 25 Likewise, in wound care, 89% of industry funded RCTs abstracts demonstrated spin compared to 60% of those with non-profit support. 23 While the role of funding remains difficult to investigate in the context of heterogeneous study designs, researchers should remain mindful of the potential bias it may introduce to intent and framing of a study. Spin was also most prevalent in trials investigating pharmacologic interventions, appearing in 100% (12/12) of such studies. Although evidence on the influence of intervention type remains mixed, several plausible explanations have been proposed regarding its potential to foster higher spin use. Drug trials are often commercially sponsored, especially when conducted by or in manufacturing companies, introducing potential conflicts of interest. 26 At the same time, these studies frequently involve complex designs with multiple endpoints and secondary outcomes, creating more opportunities for selective emphasis. External pressure from stakeholders, including regulatory agencies and review committees, may also encourage the presentation of “positive” or actionable results. Even so, trials focused on surgical interventions demonstrated the lowest prevalence of spin (81.8%) despite being subject to many similar pressures that may be faced by their pharmacological counterparts. A possible emphasis on objectives focused on technical process feasibility and safety compared to efficacy or non-inferiority may contribute to this observation, as well as different target endpoints. No consistent patterns in spin frequency were observed when grouped by publication year or sample size. 4.4 Implications for practice The presence of spin in pilot and feasibility literature on hip and knee arthroplasty introduces opportunities for bias and misrepresentation, ultimately distorting the field’s understanding of emerging interventions. Advancement requires both favorable and unfavorable results to shape future trial design and minimize research redundancy. Yet, as seen in cervical arthroplasty trials registered on clinicaltrials.gov, there is a tendency to highlight outcomes with perceived clinical impact, while less impressive results often go unpublished. 27 This dynamic is particularly concerning in arthroplasty, where 87.5% of industry-funded studies report favorable conclusions, and 75% of hip and knee implant trials receive commercial sponsorship. These conditions create an environment highly susceptible to potential influences promoting spin, increasing the risk that results are selectively emphasized to portray interventions in a more favorable light. 28 , 29 As noted earlier, such framing can shape reader perceptions, increasing the likelihood that treatments are rated as beneficial and driving greater interest in full-text review. 19 , 30 The cumulative effect is a decline in the true clinical applicability of findings, which may ultimately hinder informed decision making by clinician, caregivers, and patients. 5. Conclusions 5.1 Recommendations To mitigate these risks, clear reporting frameworks are essential. This is where clear reporting guidelines for pilot and feasibility trials, such as the CONSORT extension, can help to guide outcomes reporting, directing attention to areas such as study powering that may be easily overlooked. Prospective trial registration (e.g. through ClinicalTrials.gov) that explicitly outlines feasibility objectives pertaining to feasibility metrics can also hold authors accountable to predetermined aims, rather than switching the emphasis to more appealing post hoc narratives. Finally, authors should explicitly study limitations and communicate them transparently. This action serves as a reminder to interpret findings with caution and an understanding of limits. 5.2 Strengths and limitations Several limitations should be acknowledged from this study. Spin can be interpreted and classified in various ways, and this project specifically adapted the checklist from Boutron et al. and McKechnie et al. to suit the context of pilot/feasibility trials. 5 , 11 However, the heterogeneity in classification tools across the spin-focused literature, some of which included more than three spin categories, may limit direct comparisons and contribute to differing estimates of prevalence. Projects using more broader definitions may naturally report higher rates of spin than those using a narrower framework, as was done here. In addition, while three independent reviewers conducted a data extraction process with strong interrater agreement, the process still involved an element of subjectivity, particularly in evaluating the more nuanced cases of spin. Furthermore, because this was a descriptive analysis, potential influencing factors–such as funding source, intervention type, publication year, and sample size–were evaluated solely in terms of frequency. Additional statistical analysis, including logistic regression may be beneficial in understanding predictors of spin. While PubMed was the only database used in this methodological survey, larger scale systematic reviews and meta analyses may also use databases such as Embase to obtain a larger sample size for review. Looking ahead, efforts to develop a more unified framework for classifying and recognizing spin may benefit both researchers and readers. Standardized approaches would also enable more reliable cross-study comparisons and help clarify patterns across different research domains and trial designs. 5.3 Conclusions Following trends across other healthcare fields, pilot/feasibility trials in hip and knee arthroplasty employ high levels of spin reporting, particularly in abstracts and main texts. Spin was more prevalent in industry-funded and pharmacologic projects, although the specific influence of study type and funding source remain uncertain. Given the role of these trials in shaping subsequent research and clinical innovation, the presence of spin may distort perceptions of intervention utility and feasibility. Improved adherence to reporting guidelines such as the CONSORT extension for pilot trials, along with clear communication of study limitations and feasibility objectives, will be critical to enhancing transparency and minimizing interpretive bias in this literature. Declarations Protocol The protocol for this review was not registered. No amendments were made. Ethics approval and consent to participate This methodological review did not require ethics approval, as it was solely based on peer reviewed, publicly available literature. No confidential health data or participant identifiers were used in the final manuscript. Consent for publication Not applicable. Competing interests All authors have read and understood the journal’s policy on declaration of interests and declare: Funding This research received no specific funding or grant. Author’s contributions ZC – study conceptualization, data curation, statistical analysis, data visualization, writing original draft, manuscript edits and revisions; LG – data curation, writing original draft, manuscript edits and revisions; JC - data curation, writing original draft, manuscript edits and revisions; LM – study conceptualization, manuscript edits and revisions; LMt – study conceptualization, manuscript edits and revisions; LG – study conceptualization, data validation, writing original draft, manuscript edits and revisions, principal investigator. All authors read and approved the final manuscript. Acknowledgements Not applicable. Availability of data and materials All datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011;45(5):626–9. 10.1016/j.jpsychires.2010.10.008 . 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Lazarus C, Haneef R, Ravaud P, Boutron I. Classification and prevalence of spin in abstracts of non-randomized studies evaluating an intervention. BMC Med Res Methodol . 2015;15:85. Published 2015 Oct 13. 10.1186/s12874-015-0079-x Khan MS, Lateef N, Siddiqi TJ, et al. Level and Prevalence of Spin in Published Cardiovascular Randomized Clinical Trial Reports With Statistically Nonsignificant Primary Outcomes: A Systematic Review. JAMA Netw Open. 2019;2(5):e192622. 10.1001/jamanetworkopen.2019.2622 . Published 2019 May 3. de Porto JVM, de Oliveira Júnior ALF, de Freitas Martins LP, et al. Spin in traumatic brain injury literature: prevalence and associated factors. A systematic review. J Neurosurg. 2024;141(4):887–94. 10.3171/2023.11.JNS231822 . Published 2024 May 10. Matharu GS, Culliford DJ, Blom AW, Judge A. 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Do infographics 'spin' the findings of health and medical research? BMJ Evid Based Med. 2025;30(2):84–90. 10.1136/bmjebm-2024-113033 . Published 2025 Mar 21. Barker TH, Stone JC, Sears K, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evid Synthesis. 2023;21(3):494–506. 10.11124/JBIES-22-00430 . Mouffak A, Lepelley M, Revol B, et al. High prevalence of spin was found in pharmacovigilance studies using disproportionality analyses to detect safety signals: a meta-epidemiological study. J Clin Epidemiol. 2021;138:73–9. 10.1016/j.jclinepi.2021.06.022 . Khan MIU, Brar HK, Sun CY, et al. The reporting of pilot and feasibility studies in the top dental specialty journals is suboptimal. Pilot Feasibility Stud. 2022;8(1):224. 10.1186/s40814-022-01182-1 . Sensever FA, de Lucena Alves CP, Lima GDS, Loomans B, Opdam N, Pereira-Cenci T. Spin and reporting in systematic reviews with meta-analysis of randomized clinical trials in restorative dentistry. J Dent. 2022;125:104282. 10.1016/j.jdent.2022.104282 . Boutron I, Haneef R, Yavchitz A et al. Three randomized controlled trials evaluating the impact of spin in health news stories reporting studies of pharmacologic treatments on patients'/caregivers' interpretation of treatment benefit. BMC Med . 2019;17(1):105. Published 2019 Jun 4. 10.1186/s12916-019-1330-9 Gewandter JS, McKeown A, McDermott MP, et al. Data interpretation in analgesic clinical trials with statistically nonsignificant primary analyses: an ACTTION systematic review. J Pain. 2015;16(1):3–10. 10.1016/j.jpain.2014.10.003 . Rassy N, Rives-Lange C, Carette C, et al. Spin occurs in bariatric surgery randomized controlled trials with a statistically nonsignificant primary outcome: A systematic review. J Clin Epidemiol. 2021;139:87–95. 10.1016/j.jclinepi.2021.05.004 . Wu J, Ho W, Klotz L, Yuan M, Lee JY, Krakowsky Y. Assessing Spin in Urology Randomized Controlled Trials With Statistically Nonsignificant Primary Outcomes. J Urol. 2023;209(3):494–503. 10.1097/JU.0000000000003105 . Lockyer S, Hodgson R, Dumville JC, Cullum N. Spin in wound care research: the reporting and interpretation of randomized controlled trials with statistically non-significant primary outcome results or unspecified primary outcomes. Trials. 2013;14:371. 10.1186/1745-6215-14-371 . Published 2013 Nov 6. von Klinggraeff L, Dugger R, Okely AD, et al. Early-stage studies to larger-scale trials: investigators' perspectives on scaling-up childhood obesity interventions. Pilot Feasibility Stud. 2022;8(1):31. 10.1186/s40814-022-00991-8 . Published 2022 Feb 7. Khan NR, Saad H, Oravec CS, et al. A Review of Industry Funding in Randomized Controlled Trials Published in the Neurosurgical Literature-The Elephant in the Room. Neurosurgery. 2018;83(5):890–7. 10.1093/neuros/nyx624 . Ottwell R, Rogers TC, Anderson JM, et al. Evaluation of Spin in the Abstracts of Systematic Reviews and Meta-Analyses Focused on the Treatment of Acne Vulgaris: Cross-Sectional Analysis. JMIR Dermatol. 2020;3(1):e16978. 10.2196/16978 . Radcliff K, Siburn S, Murphy H, Woods B, Qureshi S. Bias in cervical total disc replacement trials. Curr Rev Musculoskelet Med. 2017;10(2):170–6. 10.1007/s12178-017-9399-2 . Barakat N, Ramamurti P, Duensing IM, Browne JA. Financial Conflicts of Interest and Industry Funding are Associated With Conclusions Favorable to New Technologies: A Review of Published Economic Analyses in Hip and Knee Arthroplasty. J Arthroplasty. 2024;39(9S1):S299–S. 305.e9. Ezzet KA. The prevalence of corporate funding in adult lower extremity research and its correlation with reported results. J Arthroplasty. 2003;18(7 Suppl 1):138–45. 10.1016/s0883-5403(03)00289-4 . Chow R, Huang E, Fu S, et al. Spin in Randomized Controlled Trials in Obstetrics and Gynecology: A Systematic Review. Womens Health Rep (New Rochelle). 2022;3(1):795–802. 10.1089/whr.2021.0141 . Published 2022 Sep 20. Supplementary Files EQUATORNetworkReportingChecklist.docx InfographicAbstract.png Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Minor revision 27 Apr, 2026 Reviewers agreed at journal 15 Jan, 2026 Reviewers invited by journal 22 Oct, 2025 Editor assigned by journal 22 Sep, 2025 First submitted to journal 19 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7632918","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":533333013,"identity":"29fdceea-9968-41ba-95cf-e3106a0fe81b","order_by":0,"name":"Zinnia Chung","email":"","orcid":"","institution":"McMaster University Faculty of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zinnia","middleName":"","lastName":"Chung","suffix":""},{"id":533333014,"identity":"9ea20d6d-fbd9-4082-bf6c-647c5011a794","order_by":1,"name":"Leigh-Ann Grant","email":"","orcid":"","institution":"McMaster University Faculty of Health 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13:39:17","extension":"html","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":114468,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7632918/v1/83622c9a128df13bdbc2a79e.html"},{"id":95027798,"identity":"36baa815-b999-4ee1-bd9f-e3110b97f5af","added_by":"auto","created_at":"2025-11-03 13:39:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":296625,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7632918/v1/429104ce9dcd5349ab8a691c.png"},{"id":95027814,"identity":"597357f8-54d9-43e5-9a84-b043e59070c4","added_by":"auto","created_at":"2025-11-03 13:39:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":713391,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of Pilot and Feasibility Trials Reporting ≥1 Instance of Spin, by Funding, Intervention, Year, and Study Size\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7632918/v1/4a16eaf81c5e759e3f4541d1.png"},{"id":95312127,"identity":"a2e3f161-6d1e-43d3-9be9-62e90895818e","added_by":"auto","created_at":"2025-11-06 15:47:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1525897,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7632918/v1/5011dd5b-914d-4c86-9ac1-f4b80465e675.pdf"},{"id":95221983,"identity":"2027ced3-3ce1-451a-b2c5-e8f751901a4e","added_by":"auto","created_at":"2025-11-05 16:19:59","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":276212,"visible":true,"origin":"","legend":"","description":"","filename":"EQUATORNetworkReportingChecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7632918/v1/e6d2cb914844b8cc0197c28f.docx"},{"id":95027809,"identity":"07e0977b-efd0-43d7-8646-7521cf2ce02f","added_by":"auto","created_at":"2025-11-03 13:39:18","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":255916,"visible":true,"origin":"","legend":"","description":"","filename":"InfographicAbstract.png","url":"https://assets-eu.researchsquare.com/files/rs-7632918/v1/d79978fb51940ee02712f7fe.png"}],"financialInterests":"","formattedTitle":"Spin Reporting is Common in Pilot and Feasibility Trials in Hip and Knee Arthroplasty: A Methodological Survey","fulltext":[{"header":"1. Background","content":"\u003cp\u003ePilot and feasibility studies are crucial for optimizing, assessing, and scaling research studies for success. By evaluating project designs on a smaller scale, these trials help researchers identify key barriers to execution and assess core elements such as recruitment potential, study retention, and the assessment process.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e In particular, randomized controlled trials (RCTs) that included pilot trials were found to achieve publication more quickly, and in higher-impact journals.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Additional benefits, such as a lower risk of bias in concealment and masking procedures, have also been identified, demonstrating the direct role of pilot trials in enhancing study design.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e However, these benefits are contingent on pilot trial outcomes being reported in an objective manner, which should highlight both design strengths and limitations. This ensures that pilot and feasibility trials can maximize their functionality, providing an accurate assessment of a study\u0026rsquo;s design while identifying areas where uncertainty may still exist.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eUnfortunately, distorted reporting practices can compromise result interpretation, significantly diminishing the utility of trial outcomes.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e These approaches often manifest as misleading reporting, interpretation, and extrapolation of study data, referred to as \u0026ldquo;spin\u0026rdquo; tactics.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Boutron et al. further defined several forms of spin, including approaches that focus on statistical significance, interpret non-significant data as comparable in effectiveness, or make claims of benefit despite statistically nonsignificant results.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Other examples of spin are made evident through the use of overly strong wording choices. For instance, in the field of oncology, 56% of studies from a sample of 62 publications used leading terms when reporting results (title, abstract, results, etc.).\u003csup\u003e6\u003c/sup\u003e Other spin tactics include reporting results as being \u0026ldquo;significant\u0026rdquo;, \u0026ldquo;optimal\u0026rdquo;, or \u0026ldquo;novel\u0026rdquo; inappropriately. Meanwhile, in a study of 128 non-randomized papers, 84% demonstrated at least 1 example of spin within their abstracts, while a review of cardiovascular literature found spin in 67% of published main texts.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e This appears to be a common pattern across disciplines, with a high prevalence of spin also identified in an analysis of traumatic brain injury, even among projects published in leading medical journals.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eInaccurate reporting practices often manifest as an overemphasis on certain study findings while minimizing others. This misrepresentation of pilot/feasibility trial results can subconsciously influence how readers interpret the findings. Although further research is needed to assess the specific impact of spin on readers\u0026rsquo; decision-making, two commonly noted consequences are the misinterpretation and favorable presentation of unfeasible results.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e In this context, misleading communication in study reports calls into question the reliability of pilot and feasibility studies. Furthermore, while the prevalence of spin practices has been studied in published biomedical literature (encompassing clinical trials, observational studies, meta-analyses, systematic reviews, and diagnostic accuracy studies), its impact in pilot trials has yet to be fully explored.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e In orthopedics, for example, where the demand for hip and knee arthroplasties is projected to increase by almost 40% in 2060, ongoing research supported by pilot and feasibility trials will be crucial.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eTherefore, the primary objective of this study is to evaluate the prevalence of spin reporting practices in pilot and feasibility trials focused on hip and knee arthroplasty, based on the types of spin identified by Boutron et al. and McKechnie et al.\u003csup\u003e5,11\u003c/sup\u003e Specifically, spin can be categorized into: 1) a focus on statistical significance rather than feasibility, 2) the presentation of non-feasible results (statistically nonsignificant) as feasible or effective), and 3) the emphasis of effectiveness or potential intervention benefits rather than feasibility.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e The secondary objective is to describe factors associated with the level of spin featured in the analyzed manuscripts.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study Design\u003c/h2\u003e\u003cp\u003eThis methodological survey examines pilot and feasibility literature in hip and knee arthroplasty for the prevalence and characteristics of spin as defined by Boutron et al. and McKechnie et al.\u003csup\u003e5,11\u003c/sup\u003e The manuscript is presented per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as applicable to the study design. Of note, the population used in this study was previously analyzed in a separate publication focused on completeness of reporting based on adherence to the CONSORT 2010 extension for pilot and feasibility trials (doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2024-085441\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2024-085441\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Neither spin nor any factors associated with its prevalence have been investigated or reported using this dataset. As this study is based on published, publicly available data without the involvement of human participants, ethics review board approval was not required.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Eligibility Criteria\u003c/h2\u003e\u003cp\u003eEligible studies were published between January 01 2017 and December 31, 2023, covering 7 years. This timeframe was chosen based on the 2016 publication of the Consolidated Standards of Reporting Trials (CONSORT) extension for randomized pilot and feasibility trials, ensuring a more standardized population for analysis.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Manuscripts were included if they explicitly described themselves as \u0026ldquo;pilot\u0026rdquo; or \u0026ldquo;feasibility\u0026rdquo; studies in their title, abstract, or main text. Additionally, eligible studies were required to focus on hip and knee arthroplasty, particularly perioperative clinical outcomes. Relevant topics included but were not limited to surgical approaches, imaging, rehabilitation, or biomedical equipment. Furthermore, only studies involving living human participants were considered; those using animal populations, artificial models, or isolated specimens were excluded. Secondary research, including case reports, review articles, and meta-analyses were also excluded.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Search Strategy\u003c/h2\u003e\u003cp\u003eA manual search of the PubMed database from January 01 2017 to December 31 2023 was conducted. Relevant texts were identified using a systematic search strategy, using keywords and Medical Subject Headings such as \u0026ldquo;feasibility studies,\u0026rdquo; \u0026ldquo;pilot projects,\u0026rdquo; \"arthroplasty, replacement knee\u0026rdquo; and \u0026ldquo;arthroplasty, replacement, hip\u0026rdquo;. Studies classified as either pilot or feasibility were included in the sample.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Study Selection\u003c/h2\u003e\u003cp\u003eMicrosoft Excel was used to host the database search results after duplicate entries were filtered out. All texts were screened by three reviewers (ZC, LG, JC) in accordance with the inclusion and exclusion criteria. This process involved three separate phases, with the screening process first limited to titles, then abstracts, and finally to the full text manuscripts. Any discrepancies among the three reviewers were resolved by consensus. A fourth reviewer (LT) was also available to address any further disagreements requiring additional consultation.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Data Extraction and Synthesis\u003c/h2\u003e\u003cp\u003eData collection and extraction were conducted using a form on Microsoft Excel. This form was developed by all three reviewers and included basic study characteristics such as the date of publication, the continent of the first author, the presence of a structured abstract, and the sample size used (based on the intention to treat). Specific factors found to be associated with the prevalence of spin, such as study design, intervention type, published journal, and source of funding were also recorded.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe prevalence of spin was based on the presence of any spin types identified by Boutron et al. and McKechnie et al.\u003csup\u003e5,11\u003c/sup\u003e The three types included: 1) a focus on statistical significance rather than feasibility, 2) the presentation of non-feasible results (statistically nonsignificant) as feasible or effective), and 3) the emphasis of effectiveness or potential intervention benefits rather than feasibility.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Furthermore, the frequency at which each spin type appeared was reported alongside its location in the text (abstract, main text, or conclusion). Spin criteria that did not appear were indicated with a \u0026ldquo;0\u0026rdquo; and those that were not applicable were marked with \u0026ldquo;n/a.\u0026rdquo; Based on the level of spin reported, studies could be classified under \u0026ldquo;high spin\u0026rdquo; (2 or more spin tactics, and a prevalence of spin above the 75th percentile), \u0026ldquo;moderate spin\u0026rdquo; (spin prevalence around the 50th percentile) or \u0026ldquo;low spin\u0026rdquo; (spin prevalence below the 25th percentile to no spin at all). The JBI risk of bias assessment tool was used to evaluate the studies by two independent reviewers (ZC, LG), working in duplicates.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Any discrepancies were reviewed and resolved by a third reviewer (JC).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.7 Statistical Analysis\u003c/h2\u003e\u003cp\u003eSpin outcomes were recorded using descriptive statistics, captured as the number of studies (%) reporting of each type of spin, alongside the prevalence of spin across the study population. The percentage of studies found to have at least one of the item definitions of \u0026lsquo;spin,\u0026rsquo; in their abstracts, results/discussions, and conclusions were also reported in this way. Data was also organized visually to assess patterns associated with the prevalence of spin, sorting by source of funding (federal, private, not-for-profit, none, and not specified), the intervention type (physiotherapy, surgical, diagnostic, pharmacologic, equipment, or other), the year of publication (2017\u0026ndash;2023), and the size of the study population (divided into quartiles, with groupings of 2\u0026ndash;21, 22\u0026ndash;35, 36\u0026ndash;61, 62+).\u003csup\u003e4,13,14\u003c/sup\u003e Analyses were performed using Microsoft Excel computing software and results were tabulated and presented using Microsoft Word.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Search results:\u003c/h2\u003e\u003cp\u003e427 records were returned from the PubMed database, 371 of which were retrieved for further assessment following preliminary screening of titles and abstracts. After full-text screening, 278 eligible publications were identified, with a stratified random sample of 21 studies selected from each included year (2017\u0026ndash;2023). The randomization was completed using a digital random number generator. A sample size of 21 studies per year allowed for an equal distribution of studies in the context of database volume limitations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram is featured in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e[\u003cb\u003eLocation of\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e]\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Study Characteristics\u003c/h2\u003e\u003cp\u003eThe characteristics of the study population (n\u0026thinsp;=\u0026thinsp;147) are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, including study design, primary focus, intervention type and category, sample size, and funding source. Randomized controlled trials accounted for the largest proportion (35.4% (52/147), followed by cohort studies (25.9%, 38/147). A majority of studies focused on knee arthroplasty (53.1%, 78/147) while 27.2% (40/147) examined hip procedures. Physiotherapy-based interventions were the most frequently investigated (19.7%, 29/147), followed by surgical (15%, 22/147) as well as diagnostic (15%, 22/147) interventions. Most interventions targeted the post-operative phase (52.4, 77/142), and enrolled smaller samples, with 34% (50/147) including between 2 and 25 participants. In terms of funding, 35.4% (52/147) of studies received no financial support, while others were funded by federal (26.5%, 39/147), private (15.6%, 23/147), and not-for-profit (14.3%, 21/147) sources.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of Study Characteristics: n\u0026thinsp;=\u0026thinsp;147\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy Design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52 (35.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon randomized trial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19 (12.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCohort study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38 (25.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCase controlled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (3.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCross sectional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (2.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30 (20.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStudy Focus\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHip\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40 (27.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e78 (53.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29 (19.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntervention Type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49 (33.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysiotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29 (19.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22 (15.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiagnostic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22 (15.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePharmacologic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13 (8.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEquipment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (8.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntervention Category\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27 (18.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntraoperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31 (21.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e77 (52.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLong term\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCombined\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (6.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal Study Population\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ1: n\u0026thinsp;=\u0026thinsp;2\u0026ndash;21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33 (82.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ2: n\u0026thinsp;=\u0026thinsp;22\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31 (91.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ3: n\u0026thinsp;=\u0026thinsp;36\u0026ndash;61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34 (91.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ4: n\u0026thinsp;=\u0026thinsp;62+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22 (88.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSource of Funding\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFederal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39 (26.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate sector\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23 (15.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot-for-profit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21 (14.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52 (35.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot specified\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (8.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e[Location of\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e]\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Prevalence of Spin\u003c/h2\u003e\u003cp\u003eSpin was highly prevalent in this study population, with 88.4% (130/147, 95%CI 83.3\u0026ndash;93.6) of manuscripts exhibiting at least one of the three predefined spin types. The most common approach involved emphasizing an intervention\u0026rsquo;s effectiveness or potential benefits rather than its feasibility (81.6%, 120/147, 95%CI 75.3, 87.9). In contrast, fewer studies presented statistically non-significant or non-feasible results as effective (27.2%, 40/147, 95%CI 20.0, 34.4). However, a majority prioritized statistical significance \u003cem\u003eover\u003c/em\u003e feasibility (60.5%, 89/147, 95%CI 52.6, 68.5). Full details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOverview of Reporting Based on the SPIN criteria (n\u0026thinsp;=\u0026thinsp;147)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverview of SPIN prevalence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of studies (n) demonstrating spin (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall: Demonstrated at least 1 type of spin practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e130 (88.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83.3, 93.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractice 1: A focus on statistical significance rather than feasibility (e.g. secondary outcomes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e89 (60.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52.6, 68.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractice 2: Presenting non-feasible results (statistically nonsignificant) as feasible or effective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40 (27.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.0,34.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractice 3: Emphasizing effectiveness or potential intervention benefits rather than feasibility.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e120 (81.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.3, 87.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e[Location of\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e]\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Locations of Spin Reporting\u003c/h2\u003e\u003cp\u003eAbstracts and discussions displayed a higher presence of spin, with both frequently incorporating practice 3\u0026mdash;framing interventions in terms of potential effectiveness or benefit rather than feasibility. This approach appeared in 68.7% of discussions (101/147, 95%CI 61.2, 76.2) and 56.5% (83/147, 95%CI 48.5, 64.5) of abstracts, whereas other spin types were present in fewer than half of sections. Conclusions showed a marked reduction in overall spin prevalence, declining from 79.6% (117/147, 95%CI 73.1, 86.1) in discussions to 56.5% (83/147, 95%CI 48.5, 64.5), though practice 3 remained the most frequently used strategy. By comparison, spin type 2 (presenting non feasible results as effective) was consistently the least common across all study components.\u003c/p\u003e\u003cp\u003e[\u003cb\u003eLocation of\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e]\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of SPIN by location within a paper\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverview of SPIN instances\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%) with spin type in abstract\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en (%) with spin type in discussion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003en (%) with spin type in conclusion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall: Any spin practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e116 (78.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72.3, 85.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e117 (79.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e73.1, 86.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e83 (56.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e48.5, 64.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractice 1: A focus on statistical significance rather than feasibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67 (45.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37.5, 53.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69 (46.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e38.9, 55.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e22 (15.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9.2, 20.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractice 2: Presenting non-feasible results as feasible or effective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13 (8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.3, 13.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33 (22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e15.7, 29.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12 (8.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.7, 12.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractice 3: Emphasizing effectiveness or potential intervention benefits rather than feasibility.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e83 (56.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48.5, 64.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e101 (68.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e61.2, 76.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e70 (47.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e39.6, 55.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Patterns of Spin Reporting\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates spin reporting patterns across several study characteristics, including funding source, intervention type, publication year, and sample size. Among studies that disclosed funding information, those backed by a private source exhibited the highest rate of spin at 95.7% (22/23, 95%CI 92.4, 98.9). This was followed closely by federally and non-funded manuscripts (87.2% and 88.5%, respectively). By contrast, works funded by not-for-profit organizations showed the lowest occurrence, at 76.2% (16/21, 95%CI 69.3, 83.1).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAll pharmacologic studies (13/13) demonstrated spin, as did 95.5% (21/22, 95%CI 92.1, 98.8) of those involving diagnostic equipment. In comparison, surgical intervention studies showed a lower rate of spin at 81.8% (18/22, 95%CI 75.6, 88.1). No consistent temporal trend was identified, although spin peaked in 2020 (100.0%, 21/21) before declining to 76.2% in 2023 (16/21, 95%CI 69.3, 83.1). Variation was also observed across study sizes: spin appeared less frequently in both small (Q1: n\u0026thinsp;=\u0026thinsp;2\u0026ndash;21, 82.5%, 33/40) and large (Q4: n\u0026thinsp;\u0026ge;\u0026thinsp;62, 88.9%, 32/36) samples, while mid-sized studies (Q2: n\u0026thinsp;=\u0026thinsp;22\u0026ndash;35 and Q3: 36\u0026ndash;61) exceeded 90% prevalence.\u003c/p\u003e\u003cp\u003e[\u003cb\u003eLocation of\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e]\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Location of Spin and Overall Prevalence\u003c/h2\u003e\u003cp\u003eThis methodological survey found a high frequency of spin in pilot and feasibility research on hip and knee arthroplasty, with 88.4% of included manuscripts demonstrating at least one instance. This rate is consistent with prior findings in oncology (75%, 39/52), pharmacovigilance (63%, 63/100), and non-randomized abstracts (84%, 107/128).\u003csup\u003e7,13,16\u003c/sup\u003e However, the use of spin varies considerably across fields. For example, with research in traumatic brain injury and RCT infographics reported much lower prevalence, at 22% (33/150) and 33% (39/119), respectively.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e A methodological review by Chiu et al. echoed this variability, noting prevalence as low as 9.7% in lung cancer studies and as high as 100% in trials evaluating cardioverter defibrillators.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDifferences also emerged within sections of individual reports. In this sample, abstracts and discussions sections contained the highest levels of spin (78.9% 116/147, and 79.6% 117/147 of studies) while conclusions showed a marked decline (56.5, 83/147). Similar patterns have been observed in other disciplines; for instance, Lazarus et al. reported spin in 84% of abstracts and Ito et al. found it in 73.1% of main texts from oncology trials. Meanwhile, Boutron et al. observed lower frequencies in parallel-group RCTs, with spin present in just 37.5% of abstracts, 29.2% of main texts and 23.6% of conclusions.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eOwing to the wide range of reporting styles, spin categorizations, and study populations/sizes examined, establishing a consistent estimate of spin prevalence remains a challenge.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e The current investigation focused on pilot and feasibility studies, many of which involved smaller samples sizes (n\u0026thinsp;\u0026lt;\u0026thinsp;100) and were intended to inform the development of future definitive studies. Unfortunately, concerns arise when the \"pilot\" designation is applied post hoc, often to justify small sample sizes or address methodological shortcomings, as documented in the dental literature.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e When studies adopt this label due to underpowered sample sizes or novel project topics, spin can enhance the perceived significance and readership of smaller projects, possibly contributing to the higher prevalence noted in this study. In this study, spin was most prevalent in studies with sample sizes ranging from 22\u0026ndash;35 participants, as well as 36\u0026ndash;61. However, it should be noted that this project also did not identify a particularly higher presence of spin in studies with the smallest sample sizes in the investigated population (n\u0026thinsp;=\u0026thinsp;2\u0026ndash;21). This may reflect fewer opportunities for data over-interpretation, with authors more likely to acknowledge the exploratory nature of smaller-scale projects. At this magnitude, authors may also find themselves faced with stricter guidelines and requirements for publication, promoting a more cautious approach. As a whole, misleading communication can have detrimental effects, leading to misinterpretation of trial conclusions and the formation of inadequate clinical recommendations.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e When combined with an inadequately designed pilot, spin further undermines the trial\u0026rsquo;s purpose as a tool for refining and optimizing future project development.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Type of spin used\u003c/h2\u003e\u003cp\u003eAmong manuscripts that employed spin, type 3 (emphasizing potential effectiveness or intervention benefits rather than feasibility) was by far the most common, appearing in 81.6% of studies (120/147). This approach reflects a broader trend of overstating favorable outcomes, which has been shown to influence patient perceptions by increasing the likelihood of a treatment option being viewed as beneficial.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e A systematic review of analgesic RCTs similarly found that suggesting treatment benefit despite nonsignificant results was among the most prevalent forms of spin (29% of included trials).\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Comparable tactics have been observed in other specialties such as wound care, bariatric surgery, and urology, where authors often obscure non-significant findings through vague phrasing and semantic manipulation.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Rather than reporting feasibility challenges or clearly presenting neutral outcomes, these strategies redirect attention toward speculative trends and implications, ultimately distorting how an intervention is perceived.\u003c/p\u003e\u003cp\u003eThis framing may be particularly appealing in pilot and feasibility studies, where demonstrating some form of perceived benefit can help frame a study as \u0026ldquo;promising\u0026rdquo; and support its advancement to a full-scale trial. Unlike full-scale RCTs, these early-phase investigations are often seen as \u0026ldquo;prerequisites\u0026rdquo; for securing future funding or scaling up. As a result, researchers may feel compelled to highlight findings that appear \u0026ldquo;useful,\u0026rdquo; even when feasibility metrics were the intended focus.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e In support of this, participants in a qualitative study by von Klinggraeff et al. noted that pilot studies labelled as \u0026ldquo;successful\u0026rdquo; were more likely to proceed to subsequent trials, while less favorable ones were typically abandoned.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e These perceived pressures may incentivize the use of spin as a tool to promote study advancement and justify further investment.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Patterns of spin reporting\u003c/h2\u003e\u003cp\u003ePatterns in spin reporting and its potential predictors have been inconsistent. Although 95.7% (22/23) of private/industry funded studies in this review exhibited at least 1 instance of spin compared 76.2% (16/21) of their not-for-profit counterparts, no definite associations have been established in the literature. For example, a meta-analysis of 1110 spin-focused studies by Chiu et al. found no increased likelihood of spin in industry-sponsored research relative to non-industry funded work (RR 1.08, 95%CI 0.87, 1.34).\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eEven so, evidence from specific fields has suggested otherwise. In neurosurgery, a review by Khan et al. reported that industry-sponsored trials were 23 times more likely to present favorable outcomes, potentially due to factors such as publication agreements or preferential funding.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Likewise, in wound care, 89% of industry funded RCTs abstracts demonstrated spin compared to 60% of those with non-profit support.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e While the role of funding remains difficult to investigate in the context of heterogeneous study designs, researchers should remain mindful of the potential bias it may introduce to intent and framing of a study.\u003c/p\u003e\u003cp\u003eSpin was also most prevalent in trials investigating pharmacologic interventions, appearing in 100% (12/12) of such studies. Although evidence on the influence of intervention type remains mixed, several plausible explanations have been proposed regarding its potential to foster higher spin use. Drug trials are often commercially sponsored, especially when conducted by or in manufacturing companies, introducing potential conflicts of interest.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e At the same time, these studies frequently involve complex designs with multiple endpoints and secondary outcomes, creating more opportunities for selective emphasis. External pressure from stakeholders, including regulatory agencies and review committees, may also encourage the presentation of \u0026ldquo;positive\u0026rdquo; or actionable results. Even so, trials focused on surgical interventions demonstrated the lowest prevalence of spin (81.8%) despite being subject to many similar pressures that may be faced by their pharmacological counterparts. A possible emphasis on objectives focused on technical process feasibility and safety compared to efficacy or non-inferiority may contribute to this observation, as well as different target endpoints. No consistent patterns in spin frequency were observed when grouped by publication year or sample size.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Implications for practice\u003c/h2\u003e\u003cp\u003eThe presence of spin in pilot and feasibility literature on hip and knee arthroplasty introduces opportunities for bias and misrepresentation, ultimately distorting the field\u0026rsquo;s understanding of emerging interventions. Advancement requires both favorable and unfavorable results to shape future trial design and minimize research redundancy. Yet, as seen in cervical arthroplasty trials registered on clinicaltrials.gov, there is a tendency to highlight outcomes with perceived clinical impact, while less impressive results often go unpublished.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThis dynamic is particularly concerning in arthroplasty, where 87.5% of industry-funded studies report favorable conclusions, and 75% of hip and knee implant trials receive commercial sponsorship. These conditions create an environment highly susceptible to potential influences promoting spin, increasing the risk that results are selectively emphasized to portray interventions in a more favorable light.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e As noted earlier, such framing can shape reader perceptions, increasing the likelihood that treatments are rated as beneficial and driving greater interest in full-text review.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e The cumulative effect is a decline in the true clinical applicability of findings, which may ultimately hinder informed decision making by clinician, caregivers, and patients.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Conclusions","content":"\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e5.1 Recommendations\u003c/h2\u003e\u003cp\u003eTo mitigate these risks, clear reporting frameworks are essential. This is where clear reporting guidelines for pilot and feasibility trials, such as the CONSORT extension, can help to guide outcomes reporting, directing attention to areas such as study powering that may be easily overlooked. Prospective trial registration (e.g. through ClinicalTrials.gov) that explicitly outlines feasibility objectives pertaining to feasibility metrics can also hold authors accountable to predetermined aims, rather than switching the emphasis to more appealing post hoc narratives. Finally, authors should explicitly study limitations and communicate them transparently. This action serves as a reminder to interpret findings with caution and an understanding of limits.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e5.2 Strengths and limitations\u003c/h2\u003e\u003cp\u003eSeveral limitations should be acknowledged from this study. Spin can be interpreted and classified in various ways, and this project specifically adapted the checklist from Boutron et al. and McKechnie et al. to suit the context of pilot/feasibility trials.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e However, the heterogeneity in classification tools across the spin-focused literature, some of which included more than three spin categories, may limit direct comparisons and contribute to differing estimates of prevalence. Projects using more broader definitions may naturally report higher rates of spin than those using a narrower framework, as was done here. In addition, while three independent reviewers conducted a data extraction process with strong interrater agreement, the process still involved an element of subjectivity, particularly in evaluating the more nuanced cases of spin. Furthermore, because this was a descriptive analysis, potential influencing factors\u0026ndash;such as funding source, intervention type, publication year, and sample size\u0026ndash;were evaluated solely in terms of frequency. Additional statistical analysis, including logistic regression may be beneficial in understanding predictors of spin. While PubMed was the only database used in this methodological survey, larger scale systematic reviews and meta analyses may also use databases such as Embase to obtain a larger sample size for review. Looking ahead, efforts to develop a more unified framework for classifying and recognizing spin may benefit both researchers and readers. Standardized approaches would also enable more reliable cross-study comparisons and help clarify patterns across different research domains and trial designs.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003e5.3 Conclusions\u003c/h2\u003e\u003cp\u003eFollowing trends across other healthcare fields, pilot/feasibility trials in hip and knee arthroplasty employ high levels of spin reporting, particularly in abstracts and main texts. Spin was more prevalent in industry-funded and pharmacologic projects, although the specific influence of study type and funding source remain uncertain. Given the role of these trials in shaping subsequent research and clinical innovation, the presence of spin may distort perceptions of intervention utility and feasibility. Improved adherence to reporting guidelines such as the CONSORT extension for pilot trials, along with clear communication of study limitations and feasibility objectives, will be critical to enhancing transparency and minimizing interpretive bias in this literature.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eProtocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol for this review was not registered. No amendments were made.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis methodological review did not require ethics approval, as it was solely based on peer reviewed, publicly available literature. No confidential health data or participant identifiers were used in the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eAll authors have read and understood the journal\u0026rsquo;s policy on declaration of interests and declare:\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research received no specific funding or grant.\u003c/p\u003e\n\u003ch2\u003eAuthor\u0026rsquo;s contributions\u003c/h2\u003e\n\u003cp\u003eZC \u0026ndash; study conceptualization, data curation, statistical analysis, data visualization, writing original draft, manuscript edits and revisions; LG \u0026ndash; data curation, writing original draft, manuscript edits and revisions; JC - data curation, writing original draft, manuscript edits and revisions; LM \u0026ndash; study conceptualization, manuscript edits and revisions; LMt \u0026ndash; study conceptualization, manuscript edits and revisions; LG \u0026ndash; study conceptualization, data validation, writing original draft, manuscript edits and revisions, principal investigator. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eAll datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLeon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011;45(5):626\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpsychires.2010.10.008\u003c/span\u003e\u003cspan address=\"10.1016/j.jpsychires.2010.10.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYing X, Ehrhardt S. 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J Arthroplasty. 2003;18(7 Suppl 1):138\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0883-5403(03)00289-4\u003c/span\u003e\u003cspan address=\"10.1016/s0883-5403(03)00289-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChow R, Huang E, Fu S, et al. Spin in Randomized Controlled Trials in Obstetrics and Gynecology: A Systematic Review. Womens Health Rep (New Rochelle). 2022;3(1):795\u0026ndash;802. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/whr.2021.0141\u003c/span\u003e\u003cspan address=\"10.1089/whr.2021.0141\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2022 Sep 20.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pilot-and-feasibility-studies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pafs","sideBox":"Learn more about [Pilot and Feasibility Studies](http://pilotfeasibilitystudies.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/PAFS/default.aspx","title":"Pilot and Feasibility Studies","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pilot and feasibility trials, Pilot trials, Feasibility studies, Hip Arthroplasty, Knee Arthroplasty, Hip Replacement, Knee Replacement, Methodological survey","lastPublishedDoi":"10.21203/rs.3.rs-7632918/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7632918/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePilot and feasibility trials help identify methodological and logistical challenges. However, biased reporting, known as \u0026ldquo;spin,\u0026rdquo; may distort overall study findings and mislead readers, presenting content through a subjective lens. Accurate assessments of feasibility are critical in orthopedic research, where the continued popularity of procedures such as hip and knee arthroplasties emphasizes a need for rapid advancement through research and development. The prevalence of spin practices among pilot and feasibility trials in hip and knee arthroplasties remains unclear.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eTo evaluate the prevalence of spin reporting practices in pilot and feasibility trials focused on hip and knee arthroplasty. The secondary objective is to identify factors associated with the level of spin featured in the analyzed manuscripts.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA search of PubMed identified 147 trials published between 2017\u0026ndash;2023, selected using stratified random sampling. Studies were screened for the presence of three spin criteria defined in previous literature, and summarized descriptively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSpin appeared in 88.4% of studies (95% CI: 83.3\u0026ndash;93.6). Emphasis on intervention effectiveness (81.6%) and statistical significance rather than feasibility (60.5%) were the most common types. Spin was frequent in abstracts (78.9%) and discussions (79.6%), with the highest rates also observed in privately funded (95.7%) and pharmacologic (100%) studies. No clear trend was observed over time.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eSpin is widespread in pilot and feasibility trials involving hip and knee arthroplasty, particularly in abstracts and discussions. Greater adherence to reporting guidelines and explicit communication of feasibility objectives and study limitations are necessary to improve transparency and reduce interpretive bias in this field.\u003c/p\u003e","manuscriptTitle":"Spin Reporting is Common in Pilot and Feasibility Trials in Hip and Knee Arthroplasty: A Methodological Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-03 13:38:55","doi":"10.21203/rs.3.rs-7632918/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2026-04-27T10:17:54+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2026-01-15T12:27:12+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-22T10:27:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-22T12:37:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pilot and Feasibility Studies","date":"2025-09-19T13:02:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pilot-and-feasibility-studies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pafs","sideBox":"Learn more about [Pilot and Feasibility Studies](http://pilotfeasibilitystudies.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/PAFS/default.aspx","title":"Pilot and Feasibility Studies","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c49106c2-d1c4-40a0-a6bd-4153a736475a","owner":[],"postedDate":"November 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T22:13:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-03 13:38:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7632918","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7632918","identity":"rs-7632918","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}