J Orthop Surg (Hong Kong). 2026 May-Aug;34(2):10225536261483752. doi: 10.1177/10225536261483752. Epub 2026 Aug 24.
ABSTRACT
BackgroundPhysical therapy and exercise form the cornerstone of plantar fasciitis management, and clinicians rely heavily on systematic reviews to navigate a crowded and heterogeneous evidence base. Exercise interventions are inherently difficult to blind, outcome measures vary widely across trials, and protocols differ in dosage, supervision, and adherence, creating ample opportunity for selective framing. Whether spin, reporting behavior that inflates perceived benefit without falsification, has shaped this literature remains unknown.MethodsPubMed, Embase, Web of Science, and the Cochrane Library were searched. Spin was classified using the Yavchitz et al. taxonomy across misleading interpretation, misleading reporting, and inappropriate extrapolation domains. Methodological quality was assessed using A Measurement Tool to Assess Systematic Reviews, Version 2 (AMSTAR-2).ResultsSeven systematic reviews were included. Selective overemphasis on efficacy outcomes and selective focus on statistically significant results each affected 4 of 7 reviews (57%), and conclusions claiming benefit despite high risk of bias were present in 3 of 7 (43%). On AMSTAR-2, no review reported primary study funding sources (0/7), no review provided a list of excluded studies (0/7), and duplicate data extraction was performed in only 2 of 7 (29%).ConclusionsSpin in the physical therapy plantar fasciitis literature operates subtly, not through overreaching extrapolation but through selective framing of results already within the data. This form is harder to detect and correct than outright misrepresentation. Strengthened protocol pre-registration, funding disclosure, and peer review processes that explicitly assess data-conclusion alignment are necessary to produce a trustworthy evidence base for this foundational treatment category.
PMID:42636417 | DOI:10.1177/10225536261483752
