Misconceptions, Misuses, and Misinterpretations of P Values and Significance Testing

Area of Science:

• Biostatistics
• Medical Research Methodology
• Orthopaedic Research

Background:

• P values and statistical significance are frequently misinterpreted in biomedical research.
• Orthopaedic publications are affected by widespread misconceptions regarding statistical interpretation.
• The American Statistical Association (ASA) has issued principles for the correct use and interpretation of p values.

Purpose of the Study:

• To discuss the 6 core principles of the ASA statement on p values and statistical testing.
• To highlight common misinterpretations of statistical significance in research.
• To provide recommendations for improving statistical reporting and interpretation in orthopaedics.

Main Methods:

• Review and discussion of the 6 principles outlined in the ASA's official statement on p values.
• Analysis of the implications of these principles for biomedical and orthopaedic research.
• Formulation of recommendations for authors, investigators, educators, and editors.

Main Results:

• P values indicate data incompatibility with a model, not hypothesis truth probability.
• Statistical significance does not measure effect size or importance.
• Decisions should not solely rely on p-value thresholds; transparency and full reporting are essential.

Conclusions:

• Authors should avoid "statistically significant"/"nonsignificant" claims and report effect magnitudes with precision.
• Education in biostatistics and epidemiology is vital for orthopaedic professionals.
• Journal editors and reviewers must enforce ASA principles for robust scientific inference.