Open Access Research article

The reporting of methods for reducing and detecting bias: an example from the WHO Misoprostol Third Stage of Labour equivalence randomised controlled trial

Gilda Piaggio1*, Diana Elbourne2, Kenneth F Schulz3, José Villar1, Alain PY Pinol1, A M Gülmezoglu1 and the WHO Research Group to evaluate Misoprostol in the Management of the Third Stage of Labour

Author Affiliations

1 UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

2 London School of Hygiene and Tropical Medicine, London, UK

3 Family Health International and Department of Obstetrics and Gynecology, University of North Carolina, USA

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BMC Medical Research Methodology 2003, 3:19 doi:10.1186/1471-2288-3-19

Published: 3 October 2003

Abstract

Background

The aim of this article is to explore ways in which selection bias and ascertainment bias can be reduced and investigated in trials, by using the example of a drug trial carried out in both developed and developing countries in hospital delivery wards.

Methods

We describe an innovative and practical design for the boxes for packing the drugs as a way of increasing the security of allocation concealment and blinding. We also assess ascertainment bias using sensitivity analyses, as some unblinding could have occurred due to a potential side effect of one of the drugs.

Results

The sensitivity analyses indicated that the conclusions about the relative effects of the treatments could be maintained even in the unlikely worst-case scenarios.

Conclusions

Detailed description of the procedures protecting against common biases and of the assessment of ascertainment bias in this trial should allow readers to confidently appraise and interpret the results obtained. In addition, our experiences will assist others in planning trials in the future.

Keywords:
clinical trials; reporting; randomisation; allocation concealment; blinding; misoprostol; selection bias; ascertainment bias; equivalence trial; developing countries