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Evaluating the Strength of Evidence in Favor of Rehabilitation Effects: A Bayesian Analysis - 09/02/22

Doi : 10.1016/j.rehab.2021.101503 
Adam R. Kinney a, b, , Addie Middleton c, James E. Graham d
a Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, Aurora, CO, USA 
b Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA 
c New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA 
d Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA 

Corresponding author at: Rocky Mountain Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs, 1700 N Wheeling St., Aurora, CO 80045, USA.Rocky Mountain Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs1700 N Wheeling St., AuroraCO 80045USA

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Abstract

Background

Relying solely on null hypothesis significance testing to investigate rehabilitation interventions may result in researchers erroneously concluding the presence of a treatment effect.

Objective

We sought to quantify the strength of evidence in favour of rehabilitation treatment effects by calculating Bayes factors (BF10s) for significant findings. Additionally, we sought to examine associations between BF10s, P-values, and Cohen's d effect sizes.

Methods

We searched the Cochrane Database of Systematic Reviews for meta-analyses with “rehabilitation” as a keyword that evaluated a rehabilitation intervention. We extracted means, standard deviations, and sample sizes for treatment and comparison groups from individual findings within 175 meta-analyses. Investigators independently classified the interventions according to the Rehabilitation Treatment Specification System. We calculated t-statistics, P-values, effect sizes, and BF10s for each finding. We isolated statistically significant findings (P0.05); applied evidential categories to BF10s, P-values, and effect sizes; and examined relationships descriptively.

Results

We analysed 1935 rehabilitation findings. Across intervention types, 25% of significant findings offered only anecdotal evidence in favour of a treatment effect; only 48% indicated strong evidence. This pattern persisted within intervention types and when conducting robustness analyses. Smaller P-values and larger effect sizes were associated with stronger evidence in favour of a treatment effect. However, a notable portion of findings with P-value 0.01 to 0.05 (63%) or a large effect size (18%) offered anecdotal evidence in favour of an effect.

Conclusions

For a substantial portion of statistically significant rehabilitation findings, the data neither support nor refute the presence of a treatment effect. This was the case among a notable portion of large treatment effects and for most findings with P-value>0.01. Rehabilitation evidence would be improved by researchers adopting more conservative levels of significance, complementing the use of null hypothesis significance testing with Bayesian techniques and reporting effect sizes.

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Keywords : Bayes factor, Statistical power, Null hypothesis significance testing, Meta-research, Meta-analysis, Bayesian analysis


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Vol 65 - N° 1

Articolo 101503- Gennaio 2022 Ritorno al numero
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