Examining clinical meaningfulness in randomized controlled trials: revisiting the Well Elderly II

David Schelly ^[1] ; Alisha Ohl ^[1]
1. [1] Clarkson University
  
  Clarkson University
  
  Town of Potsdam, Estados Unidos
Localización: American Journal of Occupational Therapy, ISSN 0272-9490, Vol. 73, Nº. 1, 2019
Idioma: inglés
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Resumen
- OBJECTIVE. Randomized controlled trial (RCT) interventions often rely on p values, where statistical significance is assumed to provide evidence of an intervention effect. This study provides a secondary data analysis of the Well Elderly II RCT using multiple approaches that examine clinical meaningfulness.
  
  METHOD. We reanalyzed the Well Elderly II RCT using effect size, standard deviation, standard error of measurement, minimal difference, a fragility index, an assessment of poor scores at baseline, and an analysis with a small subgroup of participants removed.
  
  RESULTS. Although some participants improved on several scales, most stayed the same, and a small subset declined. Omitting a small subgroup of participants led to nonsignificant p values.
  
  CONCLUSION. There is evidence that disparities in baseline scores and regression to the mean may have created the appearance of an intervention effect. Our methods of considering clinical meaningfulness suggest improved approaches to analyzing RCT data.