Center for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland -
Eur J Phys Rehabil Med. 2019 Jun;55(3):372-377. doi: 10.23736/S1973-9087.19.05807-6. Epub 2019 Apr 15.
The human mind is liable to make biased interpretations. The biomedical paradigm supposes that an objective truth can be reached with rigorous scientific methods. Human risk of bias is defined in this paper as threats to validity of study results that cannot be controlled even by rigorous scientific methods.
To identify categories of potential human risks of biases in quantitative medical and rehabilitation practice and research; and to review the available evidence of human risks of biases in each of these categories.
A narrative review.
Eight potential categories of human risk of bias (HRoB) in clinical and rehabilitation practice and research were identified: identity, integrity, independence, intelligence, ideology, interest, incentive and inequity. There is evidence that conflict of interest, deficient integrity and inequity contribute to biased scientific interpretations; and that due to inequity the evidence of effectiveness of interventions for disadvantaged patient groups is scarce. There is also evidence that biased decisions can occur in health care practice due to the state of inequity.
As all categories of HRoB's start with the letter 'I', these are named the eight Is. The categories overlap with each other. Studies assessing the impacts of biases related to conflict of interests, deficient integrity and inequity were identified. However, other potential human risks of biases have been studied very little or not at all.
The human beings' liability to biased thinking and all categories of HRoB should be recognized in clinical and rehabilitation practice and research, and use the best verified means to reduce the HRoB. More research is needed, particularly on how to reduce HRoB in medical practice and quantitative clinical research. These actions should be considered congruent to those aiming to increase the validity of the scientific method.
The human risk of bias should be considered in assessment of evidence from clinical epidemiology as well as in clinical praxis.
人的思维容易产生有偏差的解释。生物医学范式假设，通过严格的科学方法可以得出客观的真理。本文将人类偏差风险定义为，即使采用严格的科学方法也无法控制的研究结果有效性的威胁。
确定定量医学和康复实践与研究中潜在的人类偏差风险类别，并回顾这些类别中每一类的人类偏差风险的可用证据。
叙述性综述。
确定了临床和康复实践与研究中 8 种潜在的人类偏差风险类别（HRoB）：身份、诚信、独立性、智力、意识形态、利益、激励和不公平。有证据表明，利益冲突、诚信缺陷和不公平导致了有偏差的科学解释；并且由于不公平，干预措施对弱势群体的有效性证据很少。也有证据表明，由于不公平状态，医疗保健实践中可能会做出有偏差的决策。
由于所有类别的 HRoB 都以字母“I”开头，因此将它们命名为八个“Is”。这些类别相互重叠。已经确定了评估与利益冲突、诚信缺陷和不公平相关的偏见影响的研究。然而，其他潜在的人类偏差风险则研究甚少或根本没有研究。
应在临床和康复实践与研究中认识到人类易受偏见思维和所有类别 HRoB 的影响，并使用经过最佳验证的方法来降低 HRoB。需要更多的研究，特别是关于如何减少医学实践和定量临床研究中的 HRoB。这些行动应被视为与旨在提高科学方法有效性的行动相一致。
在评估临床流行病学和临床实践中的证据时，应考虑人类偏差风险。
