Supporting materials for review of high impact journals about inclusivity in orthopaedic surgical randomised trials

Orthopaedic surgical trials often aim to evaluate surgery in real-world settings, including a wide range of participants to reflect the target population. This approach helps ensure the research is relevant to clinical practice and that the findings can be widely applied. The National Institute for Health and Care Research (NIHR) in the UK is focusing on improving the inclusion of under-represented groups in healthcare research, such as those of different ages, educational backgrounds, and language abilities. Including diverse participants in trials is crucial to avoid missing important findings and to prevent discrimination. This review looked at whether orthopaedic surgical trials are inclusive of their target populations, including under-served groups. It included 26 trials from various countries and hospital settings. The review found that there is variation in how patients are excluded, limited reporting of key patient characteristics, and insufficient attention to under-served populations in the design and conduct of these trials. To make trials more inclusive and representative, a coordinated effort involving cultural and systemic changes is recommended.