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FOTO Rehab Outcomes Blog

A Case for Clinician Confirmation Bias

Although I would like to entertain the idea of confirmation bias as having a positive aspect to contemplate, I think it is also best to remember that this study focused on pain-free individuals. In my mind, pain-free individuals are different beasts than the patients that we treat.

What I'd like to do is just pretend that this study had subjects who were patients experiencing pain. It appears that our beliefs about what we do, how we do it and the anticipated results may have an effect on our patients. How do we determine the treatments we choose? I do tend to think that some amount of confirmation bias enters into the picture.  There has to be a reason that we prefer the choices that we make when determining clinical interventions.

Beware of clinicians that do not have a preference. The other positive news... even if a patient prefers something different than your preference, you still have the opportunity to improve outcomes. 

Below you will find a quick view of the abstract. 


The influence of clinical equipoise and patient preferences on outcomes of conservative manual interventions for spinal pain: an experimental study.




Expected pain relief from treatment is associated with positive clinical outcomes in patients with musculoskeletal pain. Less studied is the influence on outcomes related to the preference of patients and providers for a specific treatment.


We sought to determine how provider and patient preferences for a manual therapy intervention influenced outcomes in individuals with acutely induced low back pain (LBP).


Pain-free participants were randomly assigned to one of two manual therapies (joint biased [JB] or constant touch [CT]) 48 hours after completing an exercise protocol to induce LBP. Expectations for pain relief and preferences for treatment were collected at baseline, prior to randomization. Pain relief was assessed using a 100 mm visual analog scale. All study procedures were conducted in a private testing laboratory at the University of Florida campus.


Sixty participants were included in this study. After controlling for preintervention pain intensity, the multivariate model included only preintervention pain (B=0.12, p=0.07) and provider preference (B=3.05, p<0.0001) and explained 35.8% of the variance in postintervention pain. When determining whether a participant met his or her expected pain relief, receiving an intervention from a provider with a strong preference for that intervention increased the odds of meeting a participant's expected pain relief 68.3 times (p=0.013) compared to receiving any intervention from a provider with no preference. Receiving JB intervention from any provider increased the odds of meeting expected relief 29.7 times (p=0.023). The effect of a participant receiving an intervention they preferred was retained in the model but did not meet the criteria for a significant contribution.


Our primary findings were that participant and provider preferences for treatment positively influence pain outcomes in individuals with acutely induced LBP, and joint-biased interventions resulted in a greater chance of meeting participants' expected outcomes. This is contrary to our hypothesis that the interaction of receiving an intervention for which a participant had a preference would result in the best outcome.

2017 Apr 26;10:965-972. doi: 10.2147/JPR.S130931. eCollection 2017.