HAND and wrist trauma trials may face avoidable attrition that weakens evidence for patient care.
Attrition Rates in Hand Trauma Trials
Hand and wrist injuries are becoming increasingly common and can limit patients’ ability to work, participate in daily life, and maintain financial stability. Yet the evidence used to guide trauma management may be affected by a persistent methodological challenge: patients disengaging from trial follow-up before outcomes are fully captured.
A new systematic review and meta-analysis protocol will examine attrition rates in hand and wrist trauma trials, with the goal of identifying when patients are most likely to be lost to follow-up, which populations are at greatest risk, and whether attrition differs between surgical and non-surgical interventions.
Follow-Up Gaps May Affect Trial Reliability
Attrition is already recognized across the hand and wrist trauma treatment pathway, where logistical and socioeconomic barriers can prevent patients from returning for assessment. The protocol notes that previous studies have explored this issue, but the timing and causes of attrition in trials remain inconsistent.
The planned review will include prospective randomized controlled trials involving participants with hand or wrist trauma. Investigators will search Embase, PubMed, and CENTRAL, with abstracts screened independently by two reviewers. Eligible studies will be assessed for patient demographics, injury type, intervention type, documented reasons for attrition, and the proportion of participants lost at 30 days, 90 days, 6 months, and 12 months.
Improving Hand And Wrist Trauma Evidence
The meta-analysis will compare attrition across key time frames and assess how patient characteristics, surgical versus non-surgical treatment, and injury type may shape follow-up patterns. The Cochrane risk-of-bias tool 2 will be used to evaluate methodological bias in included randomized controlled trials.
By clarifying attrition rates in hand and wrist trauma trials, the review aims to support more representative evidence and stronger research design. The authors ultimately plan to use the findings to inform a toolkit designed to improve follow-up rates and, in turn, patient outcomes. For clinicians, the work highlights a practical but important issue: trial evidence is only as robust as the follow-up data behind it.
Reference
Ludbrook SEG et al. Attrition rates in hand and wrist trauma trials: a systematic review and meta-analysis protocol. Syst Rev. 2026;10.1186/s13643-026-03201-1.
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