2013
DOI: 10.2522/ptj.20120296
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Interpretation of Subgroup Effects in Published Trials

Abstract: With the rapidly expanding number of studies reporting on treatment subgroups come new challenges in analyzing and interpreting this sometimes complex area of the literature. This article discusses 3 important issues regarding the analysis and interpretation of existing trials or systematic reviews that report on treatment effect modifiers (subgroups) for specific physical therapy interventions. The key messages are: (1) point estimates of treatment modifier effect size (interaction effect) and their confidenc… Show more

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Cited by 24 publications
(22 citation statements)
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“…The absence of comparator interventions in studies investigating outcomes after a specific treatment makes it difficult to differentiate between treatment effect modifiers and non-specific prognostic factors. Future studies should determine a sufficient limiting sample size to order to guide recruitment of an appropriate sample size 25. Finally, studies need to apply appropriate blinding where possible for participants and treating clinicians, but it is critical to blind investigators assessing the outcome to minimise false positives, or negatives and potential biases.…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…The absence of comparator interventions in studies investigating outcomes after a specific treatment makes it difficult to differentiate between treatment effect modifiers and non-specific prognostic factors. Future studies should determine a sufficient limiting sample size to order to guide recruitment of an appropriate sample size 25. Finally, studies need to apply appropriate blinding where possible for participants and treating clinicians, but it is critical to blind investigators assessing the outcome to minimise false positives, or negatives and potential biases.…”
Section: Discussionmentioning
confidence: 99%
“…Second, in discussion with the corresponding author of the QUADCPR, a fifth section was added to assess whether outcomes are treatment effect modifiers—(5) quality of treatment approach. This section addressed the quality of the treatment approach using published recommendations on the preferred study methods for identifying treatment effect modifiers and subgroup effects 14 24 25. An additional four questions were inserted into the checklist (Questions 24–27) that addressed treatment explanation and implementation of the target treatment and comparator treatment.…”
Section: Methodsmentioning
confidence: 99%
“…Our study endeavoured to identify predictive psychological variables at baseline that were related to poorer or improved outcomes after LSF surgery. It is worth noting that for prognostic studies that explore the prescriptive value of an intervention, failure to use a double arm trial can lead to false assumptions that the intervention is the reason that the patient had a successful outcome (Kent et al, ; Hancock et al, ). When using a double arm trial (such as a randomized controlled trial), the results of a statistical interaction test determine if those who are in one group get more benefit from the target treatment (compared to the control treatment) (Hancock et al, ).…”
Section: Discussionmentioning
confidence: 99%
“…It is worth noting that for prognostic studies that explore the prescriptive value of an intervention, failure to use a double arm trial can lead to false assumptions that the intervention is the reason that the patient had a successful outcome (Kent et al, ; Hancock et al, ). When using a double arm trial (such as a randomized controlled trial), the results of a statistical interaction test determine if those who are in one group get more benefit from the target treatment (compared to the control treatment) (Hancock et al, ). Further, using a single arm trial for prognostic studies may only identify variables at baseline that are likely to be associated with a positive or a negative recovery at follow‐up regardless of the intervention, such as age or baseline health status.…”
Section: Discussionmentioning
confidence: 99%
“…Findings such as these are less helpful when determining who are and are not candidates for surgery, although each does lend value in the grand scheme of clinical decision-making. This is a common problem that has been recognized previously and can lead to inappropriate decision modeling [21,24].…”
Section: Introductionmentioning
confidence: 97%