Statistics in publishing: the (mis)use of the p-value (part 1)

In hand surgery research, most studies, whether
observational studies or randomized controlled
trials (RCT), are aimed at finding out whether there
is an effect (association or difference) of a certain
determinant on a specific outcome. This is usually
determined using null-hypothesis significance test-
ing (NHST), in which a p-value <0.05 is considered
as evidence that the findings are significant. Although
this method is widely used, it has been criticized
since its inception. The critique has been mainly
focused on the misuse of NHST, but also more con-
ceptually on the method itself. In part 1 of this
two-part article, we discuss some examples of how
the p-value can be misused, using a simulated data-
set partly based on real data from an RCT (Broekstra
et al., 2022). In part 2, we will discuss the conceptual
criticism and offer some guidance on alternatives.
In this example study, women with a distal radial
fracture were randomized either to an intervention
(cast þ rehabilitation programme) or control (cast
only) group in a 1:1 ratio. The intervention was
aimed at restoring hand function, which was mea-
sured using the Patient-Rated Wrist Evaluation
(PRWE), a validated patient-reported outcome meas-
ure for determining hand function in patients with
wrist problems, with a score ranging between 0 (no
problems) and 100 (severe problems