Part of the difficulty in appraising/interpreting studies for clinical context is the absence of a pre-defined minimally clinically important difference (MICD).
If any effect size (improvement in exercise time) greater than zero is sufficient to justify PCI, then even if PCI actually does nothing, no study will ever be able to completely “rule out” possible benefit.
At some point, we have to say “improvement less than 45/30/15 seconds” means PCI probably does not provide sufficient clinical benefit.
With Orbita, since the cardiology community never pre-defined the MCID for exercise time in PCI, they can just keep moving the goal post. Prior to Orbita claims suggested 90 second benefits. Orbita confidence intervals (-8.9-42) suggests benefit (if it exists) is not more than 42 seconds. So guidelines/others can change the goal post and say “30 second benefit can’t be excluded” and thus Orbita is not practice changing.
At the end of the day, if folks are asking for a larger RCT without predefining the MCID, then expect the goal posts to continue to change if the results don’t go their way.
As for communicating study results as a journalist, I would always start by asking “what is the MCID”? Is it one value? Do clinicians/patients/etc have different MCID? How do we interpret the confidence interval & results given our clinical expectations? And if the proponents of an intervention can’t decide on an MCID, or keep changing/lowering the MCID, be very suspicious.