Statistical Methodology for a Clinical Trial Protocol.
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1 Statistical Methodology for a Clinical Trial Protocol. McMaster University Anesthesia Research Interest Group Dinner Meeting December, 3 rd
2 Objectives : Talk about some key concepts for writing a statistical methodology for a research proposal Present guidance to be considered when developing the statistical plan in proposals for clinical research
3 Objectives : Talk about some key concepts for writing a statistical methodology for a research proposal Present guidance to be considered when developing the statistical plan in proposals for clinical research
4 Objectives : Talk about some key concepts for writing a statistical methodology for a research proposal Present guidance to be considered when developing the statistical plan in proposals for clinical research
5 Plan 1 Preliminary questions 2 Study design Sampling and Sample size calculation Statistical analysis plan and data collection 3 Conclusion
6 Preliminary questions When is the time to interact with a statistician? It is never too early to interact with statisticians (see Berverley and Anh (2009) ) No amount of clever analyses can compensate for problems with the design of studies Many clinical investigators are familiar with statistical technics but necessary aware of the design and the way of developing a study protocol
7 Preliminary questions When is the time to interact with a statistician? It is never too early to interact with statisticians (see Berverley and Anh (2009) ) No amount of clever analyses can compensate for problems with the design of studies Many clinical investigators are familiar with statistical technics but necessary aware of the design and the way of developing a study protocol
8 Preliminary questions When is the time to interact with a statistician? It is never too early to interact with statisticians (see Berverley and Anh (2009) ) No amount of clever analyses can compensate for problems with the design of studies Many clinical investigators are familiar with statistical technics but necessary aware of the design and the way of developing a study protocol
9 Preliminary questions When is the time to interact with a statistician? It is never too early to interact with statisticians (see Berverley and Anh (2009) ) No amount of clever analyses can compensate for problems with the design of studies Many clinical investigators are familiar with statistical technics but necessary aware of the design and the way of developing a study protocol
10 Preliminary questions Some key aspects of the statistical analysis plan. What is the research hypothesis. Is the primary hypotheses clearly stated, adequate and realistic? Identify the outcome(s) related to the research question (ex which domain of sf36) What is the type of study design? Randomisation and blinding. What is the type variable and unit measurement? What is the clinically meaningful difference for the primary outcome? Sample size and number of arms (independent or paired)? Allocation ratio, number of evaluation, interval of repeated measurement
11 Preliminary questions Some key aspects of the statistical analysis plan. What is the research hypothesis. Is the primary hypotheses clearly stated, adequate and realistic? Identify the outcome(s) related to the research question (ex which domain of sf36) What is the type of study design? Randomisation and blinding. What is the type variable and unit measurement? What is the clinically meaningful difference for the primary outcome? Sample size and number of arms (independent or paired)? Allocation ratio, number of evaluation, interval of repeated measurement
12 Preliminary questions Some key aspects of the statistical analysis plan. What is the research hypothesis. Is the primary hypotheses clearly stated, adequate and realistic? Identify the outcome(s) related to the research question (ex which domain of sf36) What is the type of study design? Randomisation and blinding. What is the type variable and unit measurement? What is the clinically meaningful difference for the primary outcome? Sample size and number of arms (independent or paired)? Allocation ratio, number of evaluation, interval of repeated measurement
13 Preliminary questions Some key aspects of the statistical analysis plan. What is the research hypothesis. Is the primary hypotheses clearly stated, adequate and realistic? Identify the outcome(s) related to the research question (ex which domain of sf36) What is the type of study design? Randomisation and blinding. What is the type variable and unit measurement? What is the clinically meaningful difference for the primary outcome? Sample size and number of arms (independent or paired)? Allocation ratio, number of evaluation, interval of repeated measurement
14 Preliminary questions Some key aspects of the statistical analysis plan. What is the research hypothesis. Is the primary hypotheses clearly stated, adequate and realistic? Identify the outcome(s) related to the research question (ex which domain of sf36) What is the type of study design? Randomisation and blinding. What is the type variable and unit measurement? What is the clinically meaningful difference for the primary outcome? Sample size and number of arms (independent or paired)? Allocation ratio, number of evaluation, interval of repeated measurement
15 Preliminary questions Some key aspects of the statistical analysis plan. What is the research hypothesis. Is the primary hypotheses clearly stated, adequate and realistic? Identify the outcome(s) related to the research question (ex which domain of sf36) What is the type of study design? Randomisation and blinding. What is the type variable and unit measurement? What is the clinically meaningful difference for the primary outcome? Sample size and number of arms (independent or paired)? Allocation ratio, number of evaluation, interval of repeated measurement
16 Preliminary questions Some key aspects of the statistical analysis plan. What is the research hypothesis. Is the primary hypotheses clearly stated, adequate and realistic? Identify the outcome(s) related to the research question (ex which domain of sf36) What is the type of study design? Randomisation and blinding. What is the type variable and unit measurement? What is the clinically meaningful difference for the primary outcome? Sample size and number of arms (independent or paired)? Allocation ratio, number of evaluation, interval of repeated measurement
17 Preliminary questions Some key aspects of the statistical analysis plan. What is the research hypothesis. Is the primary hypotheses clearly stated, adequate and realistic? Identify the outcome(s) related to the research question (ex which domain of sf36) What is the type of study design? Randomisation and blinding. What is the type variable and unit measurement? What is the clinically meaningful difference for the primary outcome? Sample size and number of arms (independent or paired)? Allocation ratio, number of evaluation, interval of repeated measurement
18 Preliminary questions Example 1 based of quality of life outcome. compare the impact of pain on daily activities while on a maintenance dose of Pain-Free vs. Relief Assessments during maintenance is important
19 Preliminary questions Example 1 based of quality of life outcome. compare the impact of pain on daily activities while on a maintenance dose of Pain-Free vs. Relief Assessments during maintenance is important
20 Preliminary questions Example 1 based of quality of life outcome. compare the impact of pain on daily activities while on a maintenance dose of Pain-Free vs. Relief Assessments during maintenance is important
21 Preliminary questions Example 2 based on quality of life outcome. compare the time to 20% improvement in the severity of pain with Pain-Free vs. Relief Earlier assessments are the basis of defining the outcome and should be frequent enough to detect differences between the two regimens
22 Preliminary questions Example 2 based on quality of life outcome. compare the time to 20% improvement in the severity of pain with Pain-Free vs. Relief Earlier assessments are the basis of defining the outcome and should be frequent enough to detect differences between the two regimens
23 1 The study design 2 Sampling and Sample size calculation 3 Statistical analysis plan and data collection
24 1 The study design 2 Sampling and Sample size calculation 3 Statistical analysis plan and data collection
25 1 The study design 2 Sampling and Sample size calculation 3 Statistical analysis plan and data collection
26 Study design The statistical aspects of the design relate essentially to the structure of the study and all aspects of the collection of data and the choice of measurement (Altman 1997) Study designs include case-control, cohort, crossover, factorial design
27 Study design The statistical aspects of the design relate essentially to the structure of the study and all aspects of the collection of data and the choice of measurement (Altman 1997) Study designs include case-control, cohort, crossover, factorial design
28 Study design The statistical aspects of the design relate essentially to the structure of the study and all aspects of the collection of data and the choice of measurement (Altman 1997) Study designs include case-control, cohort, crossover, factorial design
29 Sampling and Sample size calculation Example of study design.
30 Sampling and Sample size calculation The following factors are essential in sampling : 1 Sampling methods 2 Sample size Calculation 3 Participation (response) 4 Inclusion/ exclusion criteria, consent form
31 Sampling and Sample size calculation The following factors are essential in sampling : 1 Sampling methods 2 Sample size Calculation 3 Participation (response) 4 Inclusion/ exclusion criteria, consent form
32 Sampling and Sample size calculation The following factors are essential in sampling : 1 Sampling methods 2 Sample size Calculation 3 Participation (response) 4 Inclusion/ exclusion criteria, consent form
33 Sampling and Sample size calculation The following factors are essential in sampling : 1 Sampling methods 2 Sample size Calculation 3 Participation (response) 4 Inclusion/ exclusion criteria, consent form
34 Sampling and Sample size calculation Example of sampling methods. Figure 1 : Sampling Methods. Produced by Agriculture and Consumer
35 Sampling and Sample size calculation Requirement for the sample size calculation The variable type of primary outcome measurement must be defined before sample size and power calculation Sample size is needed for primary outcome Sample size for secondary outcomes is often helpful for the reviewers
36 Sampling and Sample size calculation Requirement for the sample size calculation The variable type of primary outcome measurement must be defined before sample size and power calculation Sample size is needed for primary outcome Sample size for secondary outcomes is often helpful for the reviewers
37 Sampling and Sample size calculation Requirement for the sample size calculation The variable type of primary outcome measurement must be defined before sample size and power calculation Sample size is needed for primary outcome Sample size for secondary outcomes is often helpful for the reviewers
38 Sampling and Sample size calculation Requirement for the sample size calculation The variable type of primary outcome measurement must be defined before sample size and power calculation Sample size is needed for primary outcome Sample size for secondary outcomes is often helpful for the reviewers
39 Sampling and Sample size calculation Example of pain outcomes in a systematic review
40 Sampling and Sample size calculation Type of outcomes Categorical : binary (gender : Male vs Female), nominal (e.g. blood group), ordinal (e.g. level of pain : minimal, severe, unboreable) Numerical data : discrete (number of children), continuous (body temperature) Other types : ranks (preference of treatment), rate and ratios (rate of growth per decade), scores (ASA scores), latent scores, visual analogue scale, censored data
41 Sampling and Sample size calculation Type of outcomes Categorical : binary (gender : Male vs Female), nominal (e.g. blood group), ordinal (e.g. level of pain : minimal, severe, unboreable) Numerical data : discrete (number of children), continuous (body temperature) Other types : ranks (preference of treatment), rate and ratios (rate of growth per decade), scores (ASA scores), latent scores, visual analogue scale, censored data
42 Sampling and Sample size calculation Type of outcomes Categorical : binary (gender : Male vs Female), nominal (e.g. blood group), ordinal (e.g. level of pain : minimal, severe, unboreable) Numerical data : discrete (number of children), continuous (body temperature) Other types : ranks (preference of treatment), rate and ratios (rate of growth per decade), scores (ASA scores), latent scores, visual analogue scale, censored data
43 Sampling and Sample size calculation Type of outcomes Categorical : binary (gender : Male vs Female), nominal (e.g. blood group), ordinal (e.g. level of pain : minimal, severe, unboreable) Numerical data : discrete (number of children), continuous (body temperature) Other types : ranks (preference of treatment), rate and ratios (rate of growth per decade), scores (ASA scores), latent scores, visual analogue scale, censored data
44 Sampling and Sample size calculation Determination of the effect size effect size : Measure of the magnitude of treatment effect and represent a clinically or biologically important difference (SMD, MID,... ) It is more a clinical question than a statistical one represent the difference we need to have ability to detect any effect This determination is based on clinical knowledge of the primary endpoint The statistician and the investigator should examine the literature, past research to determine a study effect size
45 Sampling and Sample size calculation Determination of the effect size effect size : Measure of the magnitude of treatment effect and represent a clinically or biologically important difference (SMD, MID,... ) It is more a clinical question than a statistical one represent the difference we need to have ability to detect any effect This determination is based on clinical knowledge of the primary endpoint The statistician and the investigator should examine the literature, past research to determine a study effect size
46 Sampling and Sample size calculation Determination of the effect size effect size : Measure of the magnitude of treatment effect and represent a clinically or biologically important difference (SMD, MID,... ) It is more a clinical question than a statistical one represent the difference we need to have ability to detect any effect This determination is based on clinical knowledge of the primary endpoint The statistician and the investigator should examine the literature, past research to determine a study effect size
47 Sampling and Sample size calculation Determination of the effect size effect size : Measure of the magnitude of treatment effect and represent a clinically or biologically important difference (SMD, MID,... ) It is more a clinical question than a statistical one represent the difference we need to have ability to detect any effect This determination is based on clinical knowledge of the primary endpoint The statistician and the investigator should examine the literature, past research to determine a study effect size
48 Sampling and Sample size calculation Determination of the effect size effect size : Measure of the magnitude of treatment effect and represent a clinically or biologically important difference (SMD, MID,... ) It is more a clinical question than a statistical one represent the difference we need to have ability to detect any effect This determination is based on clinical knowledge of the primary endpoint The statistician and the investigator should examine the literature, past research to determine a study effect size
49 Sampling and Sample size calculation Determination of the effect size effect size : Measure of the magnitude of treatment effect and represent a clinically or biologically important difference (SMD, MID,... ) It is more a clinical question than a statistical one represent the difference we need to have ability to detect any effect This determination is based on clinical knowledge of the primary endpoint The statistician and the investigator should examine the literature, past research to determine a study effect size
50 Sampling and Sample size calculation Do all the studies need sample size calculation? No, but pilot studies may need a power analysis because they are about testing the protocol than test analysis For the pilot or/ and feasibility study, the sample size calculation is not a requirement (see Arain et al and Thabane et al. 2010) The use of pilot study should be used cautiously. When the sample size of pilot study is too small, the subsequent sample size calculation cannot be realistic.
51 Sampling and Sample size calculation Do all the studies need sample size calculation? No, but pilot studies may need a power analysis because they are about testing the protocol than test analysis For the pilot or/ and feasibility study, the sample size calculation is not a requirement (see Arain et al and Thabane et al. 2010) The use of pilot study should be used cautiously. When the sample size of pilot study is too small, the subsequent sample size calculation cannot be realistic.
52 Sampling and Sample size calculation Do all the studies need sample size calculation? No, but pilot studies may need a power analysis because they are about testing the protocol than test analysis For the pilot or/ and feasibility study, the sample size calculation is not a requirement (see Arain et al and Thabane et al. 2010) The use of pilot study should be used cautiously. When the sample size of pilot study is too small, the subsequent sample size calculation cannot be realistic.
53 Sampling and Sample size calculation Do all the studies need sample size calculation? No, but pilot studies may need a power analysis because they are about testing the protocol than test analysis For the pilot or/ and feasibility study, the sample size calculation is not a requirement (see Arain et al and Thabane et al. 2010) The use of pilot study should be used cautiously. When the sample size of pilot study is too small, the subsequent sample size calculation cannot be realistic.
54 Sampling and Sample size calculation Software and online Resources Gpower, R/ Splus, STATA, SAS, SPSS,... Online resources : http :// rollin/stats/ssize/ http ://
55 Statistical analysis plan and data collection Statistical analysis plan and data collection Always driven by the research question, the study design and the type of measurement Provide a plan that includes a detailed description of statistical procedures for each variable, group and subgroups (e.g. baseline characteristics, comorbid conditions,â) specify these methods in advance in order to minimize bias and maintain the integrity Use confidence limits and p values Explain how statistical assumptions or model diagnostics will be examined (validation and calibration). Explain how to deal with missing data
56 Statistical analysis plan and data collection Statistical analysis plan and data collection Always driven by the research question, the study design and the type of measurement Provide a plan that includes a detailed description of statistical procedures for each variable, group and subgroups (e.g. baseline characteristics, comorbid conditions,â) specify these methods in advance in order to minimize bias and maintain the integrity Use confidence limits and p values Explain how statistical assumptions or model diagnostics will be examined (validation and calibration). Explain how to deal with missing data
57 Statistical analysis plan and data collection Statistical analysis plan and data collection Always driven by the research question, the study design and the type of measurement Provide a plan that includes a detailed description of statistical procedures for each variable, group and subgroups (e.g. baseline characteristics, comorbid conditions,â) specify these methods in advance in order to minimize bias and maintain the integrity Use confidence limits and p values Explain how statistical assumptions or model diagnostics will be examined (validation and calibration). Explain how to deal with missing data
58 Statistical analysis plan and data collection Statistical analysis plan and data collection Always driven by the research question, the study design and the type of measurement Provide a plan that includes a detailed description of statistical procedures for each variable, group and subgroups (e.g. baseline characteristics, comorbid conditions,â) specify these methods in advance in order to minimize bias and maintain the integrity Use confidence limits and p values Explain how statistical assumptions or model diagnostics will be examined (validation and calibration). Explain how to deal with missing data
59 Statistical analysis plan and data collection Statistical analysis plan and data collection Always driven by the research question, the study design and the type of measurement Provide a plan that includes a detailed description of statistical procedures for each variable, group and subgroups (e.g. baseline characteristics, comorbid conditions,â) specify these methods in advance in order to minimize bias and maintain the integrity Use confidence limits and p values Explain how statistical assumptions or model diagnostics will be examined (validation and calibration). Explain how to deal with missing data
60 Statistical analysis plan and data collection Statistical analysis plan and data collection Always driven by the research question, the study design and the type of measurement Provide a plan that includes a detailed description of statistical procedures for each variable, group and subgroups (e.g. baseline characteristics, comorbid conditions,â) specify these methods in advance in order to minimize bias and maintain the integrity Use confidence limits and p values Explain how statistical assumptions or model diagnostics will be examined (validation and calibration). Explain how to deal with missing data
61 Statistical analysis plan and data collection Data collection Writing a codebook is important : serve as a reference for the team, help newcomers and the statistician to understand the project, facilitate communication Should contains : variables names, variables labels, variables codes, variables formats (prevent typo and help to identify missing), Suggest a way to code missing and have an unique code for date variables, provides range Deidentified and protect data
62 Statistical analysis plan and data collection Data collection Writing a codebook is important : serve as a reference for the team, help newcomers and the statistician to understand the project, facilitate communication Should contains : variables names, variables labels, variables codes, variables formats (prevent typo and help to identify missing), Suggest a way to code missing and have an unique code for date variables, provides range Deidentified and protect data
63 Statistical analysis plan and data collection Data collection Writing a codebook is important : serve as a reference for the team, help newcomers and the statistician to understand the project, facilitate communication Should contains : variables names, variables labels, variables codes, variables formats (prevent typo and help to identify missing), Suggest a way to code missing and have an unique code for date variables, provides range Deidentified and protect data
64 Statistical analysis plan and data collection Data collection Writing a codebook is important : serve as a reference for the team, help newcomers and the statistician to understand the project, facilitate communication Should contains : variables names, variables labels, variables codes, variables formats (prevent typo and help to identify missing), Suggest a way to code missing and have an unique code for date variables, provides range Deidentified and protect data
65 Statistical analysis plan and data collection Selection of variables : beware of univariable screening The use of bivariate selection for selecting variables to be used in multivariate analysis is inappropriate (Guo-Wen et al. (1996)) Wrongly rejects potentially important variables when the relationship between an outcome and a risk factor is confounded by any confounder and when this confounder is not properly controlled
66 Statistical analysis plan and data collection Selection of variables : beware of univariable screening The use of bivariate selection for selecting variables to be used in multivariate analysis is inappropriate (Guo-Wen et al. (1996)) Wrongly rejects potentially important variables when the relationship between an outcome and a risk factor is confounded by any confounder and when this confounder is not properly controlled
67 Statistical analysis plan and data collection Selection of variables : beware of univariable screening The use of bivariate selection for selecting variables to be used in multivariate analysis is inappropriate (Guo-Wen et al. (1996)) Wrongly rejects potentially important variables when the relationship between an outcome and a risk factor is confounded by any confounder and when this confounder is not properly controlled
68 Statistical analysis plan and data collection Results and discussion. Describe the flow of participants through the study (via a diagram for instance) Validation and limitations (non representative sample size, few events per predictor,... ) Discuss about the implications for future research
69 Statistical analysis plan and data collection Results and discussion. Describe the flow of participants through the study (via a diagram for instance) Validation and limitations (non representative sample size, few events per predictor,... ) Discuss about the implications for future research
70 Statistical analysis plan and data collection Results and discussion. Describe the flow of participants through the study (via a diagram for instance) Validation and limitations (non representative sample size, few events per predictor,... ) Discuss about the implications for future research
71 Conclusion Conclusion Study design, sampling, analysis plan and data collection are essential It is a multidisciplinary effort : clinical investigators, statisticians, librarians, research assistants have to collaborate
72 Conclusion Conclusion Study design, sampling, analysis plan and data collection are essential It is a multidisciplinary effort : clinical investigators, statisticians, librarians, research assistants have to collaborate
73 Conclusion Conclusion Study design, sampling, analysis plan and data collection are essential It is a multidisciplinary effort : clinical investigators, statisticians, librarians, research assistants have to collaborate
74 Conclusion Thank you for your attention.
75 Conclusion Bibliography. Adams-Huet, B Ahn, C (2009), Bridging clinical investigators and statisticians : Writing the statistical methodology for a research proposal  Journal of Investigative Medicine, vol 57, no. 8, pp  /JIM.0b013e3181c2996c. Altman, D. G. (1991). Practical statistics for medical research. London : Chapman and Hall. Arain et al. (2010) What is aâ pilotâ or feasibilityâ study? A review of current practice and editorial policy. Thabane L. et al. (2010). A tutorial on pilot studies : the what, why and how.
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