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N. Karniel1,2, E. Shimon3, N. Gemer3, R. Zivion3, S. Portnoy3
1Tel Aviv University, Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv, Israel, 2The Hadassah University Medical Center, Physical Therapy, Jerusalem, Israel, 3Tel Aviv University, Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv, Israel
Background: Cognitive bias is extensively documented in clinical practice at all stages of clinical diagnosis, including in anamnesis, prognosis, and clinical decision making. Although documentations of cognitive bias in medicine are plentiful, documentation of bias in health professions, e.g. occupational therapy, are scarce, specifically concerning physical evaluations.
Purpose: Our research aims were:
(1) to test for differences in occupational therapists' assessment of lateral pinch force modulation between young and older adults,
(2) to test for a difference in occupational therapists' assessment of lateral pinch force modulation between women and men, and
(3) to test for a correlation between the tendency to bypass an intuitive response and the degree of cognitive bias.
(1) to test for differences in occupational therapists' assessment of lateral pinch force modulation between young and older adults,
(2) to test for a difference in occupational therapists' assessment of lateral pinch force modulation between women and men, and
(3) to test for a correlation between the tendency to bypass an intuitive response and the degree of cognitive bias.
Methods: We recruited 37 occupational therapists using convenient sampling. Inclusion criteria were at least one year of experience.
Tools: We collected data regarding the tendency of the subjects to bypass an intuitive response, as well as their rational information processing and experiential information processing. In order to test the bias of the subjects in evaluating lateral pinch modulation of individuals of different sexes and ages, we coupled pre-recorded simulation videos of the digital output of pinch examinations of different levels of abilities, with videos of male and female, old and young individuals pressing the force sensor.
These tools are detailed below:
The Cognitive Reflection Test (CRT), measure the tendency to bypass an intuitive response that has an incorrect effect. Rational‐Experiential Inventory–40 (REI-40).The tool measures two independent dimensions of human processing: rational information processing and experiential information processing. System for evaluating the modulation of the lateral pinch force: The system was designed and constructed for this study.
Visual Analogue Scale (VAS) A 10 centimeter long horizontal line. The subject is asked to mark his or her subjective level regarding a question, how would you rate the performance of the patient?
Tools: We collected data regarding the tendency of the subjects to bypass an intuitive response, as well as their rational information processing and experiential information processing. In order to test the bias of the subjects in evaluating lateral pinch modulation of individuals of different sexes and ages, we coupled pre-recorded simulation videos of the digital output of pinch examinations of different levels of abilities, with videos of male and female, old and young individuals pressing the force sensor.
These tools are detailed below:
The Cognitive Reflection Test (CRT), measure the tendency to bypass an intuitive response that has an incorrect effect. Rational‐Experiential Inventory–40 (REI-40).The tool measures two independent dimensions of human processing: rational information processing and experiential information processing. System for evaluating the modulation of the lateral pinch force: The system was designed and constructed for this study.
Visual Analogue Scale (VAS) A 10 centimeter long horizontal line. The subject is asked to mark his or her subjective level regarding a question, how would you rate the performance of the patient?
Results: We found statistically significant higher bias towards old individuals compared to young ones (p<0.001) However, there were no differences in the bias between male and female individuals. Although there were statistically significant differences in the confidence levels for evaluating males versus females and old versus young individuals, the differences between the medians were very small (0.1). We found statistically significant correlation between the score of the rational ability section in the REI-40 and the bias of assessment of lateral pinch force modulation in old individuals (p<0.001, r=0.537)
Conclusions: Occupational therapists might not be aware of their bias in interpreting physical examinations of older adults. Further research is needed to demonstrate biases in other health professions and various physical examination, e.g., observational gait analysis. Also, the efficacy of intervention programs for teaching the therapists to be aware and reduce bias should be studied.
Implications: Occupational therapists might not be aware of their bias in interpreting physical examinations of older adults. Biased evaluation might cause assignment of redundant exercises and therefore loss of time, effort and costs. The study of cognitive bias in medicine, and specifically in health professions, is an imperative step towards understanding the effects of these biases on clinical decision making.
Funding acknowledgements: This research received no external funding.
Keywords:
cognitive bias
Rational‐Experiential Inventory-40
Cognitive reflection test
cognitive bias
Rational‐Experiential Inventory-40
Cognitive reflection test
Topics:
Older people
Education: clinical
Education
Older people
Education: clinical
Education
Did this work require ethics approval? Yes
Institution: The Tel Aviv University
Committee: The Tel Aviv University Institutional Review Board
Ethics number: granted ethical approval (#0002681-1).
All authors, affiliations and abstracts have been published as submitted.
