Instruments assessing risk of bias of randomized trials frequently included items that are not addressing risk of bias issues

Ying Wang, Maryam Ghadimi, Qi Wang, Liangying Hou, Dena Zeraatkar, Atiya Iqbal, Cameron Ho, Liang Yao, Malini Hu, Zhikang Ye, Rachel Couban, Susan Armijo-Olivo, Dirk Bassler, Matthias Briel, Lise Lotte Gluud, Paul Glasziou, Rod Jackson, Sheri A Keitz, Luz M Letelier, Philippe RavaudKenneth F Schulz, Reed A C Siemieniuk, Romina Brignardello-Petersen, Gordon H Guyatt

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)


OBJECTIVES: To establish whether items included in instruments published in the last decade assessing risk of bias of randomized controlled trials (RCTs) are indeed addressing risk of bias.

STUDY DESIGN AND SETTING: We searched Medline, Embase, Web of Science, and Scopus from 2010 to October 2021 for instruments assessing risk of bias of RCTs. By extracting items and summarizing their essential content, we generated an item list. Items that two reviewers agreed clearly did not address risk of bias were excluded. We included the remaining items in a survey in which 13 experts judged the issue each item is addressing: risk of bias, applicability, random error, reporting quality, or none of the above.

RESULTS: Seventeen eligible instruments included 127 unique items. After excluding 61 items deemed as clearly not addressing risk of bias, the item classification survey included 66 items, of which the majority of respondents deemed 20 items (30.3%) as addressing risk of bias; the majority deemed 11 (16.7%) as not addressing risk of bias; and there proved substantial disagreement for 35 (53.0%) items.

CONCLUSION: Existing risk of bias instruments frequently include items that do not address risk of bias. For many items, experts disagree on whether or not they are addressing risk of bias.

Original languageEnglish
Pages (from-to)218-225
Number of pages8
JournalJournal of Clinical Epidemiology
Early online date28 Oct 2022
Publication statusPublished - Dec 2022


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