Choosing the Appropriate

Statistical Tests for Clinical

Research

Hernan Cortez Labao, PTRP BSPT MSPT (Neuro) CPE

Lecturer, Department of Physiotherapy
Faculty of Health and Life Sciences
INTI International University, Nilai, Negeri Sembilan, Malaysia
 Decision When Choosing the Appropriate
Statistical Tool should consider;

1. Research Approach

2. Research / Study Design

3. Type of Data Collected

4. Type of Statistics

5. Parametric or Non-Parametric
 QUALITATIVE vs QUANTITATIVE RESEARCH
APPROACH
QUALITATIVE
 Use to understand,
explain, explore,
discover and clarify
situations, feelings,
perceptions, attitudes,
values, beliefs and QUANTITATIVE
experiences of a group  More structured, rigid, fixed
of people and pre-determined in their
 Not as structured and use to ensure accuracy in
sequential as a measurement and
quantitative research classification
 More clarity & distinction
- Kumar, 2011
between designs &
methods of data collection
 TYPES OF STUDY DESIGN

Number of Contacts Reference Period Nature of Investigation

Cross-Sectional
1 Studies
Retrospective Experimental
2 Before & After
Studies
Prospective Non-
3 or Longitudinal
Experimental
more Studies

Retrospective- Semi-
Prospective Experimental
aka
Quasi-
Experimental

- Copyright Figure adapted from Kumar, 2011

 QUALITATIVE vs QUANTITATIVE DATA

 Can be counted but cannot be computed  Can be calculated/ computed

 “Dummy codes”, numbers do not reflect its  Examples:
actual value Weight
 Examples: Temperature
Yes or No – as “1” or “0” Height
Single as 1, Married as 2, Widow/ Widower as 3
- Kothari & Garg, 2014
 NOMINAL DATA ORDINAL DATA
• Numerical in name only • Places events in order
• Least powerful, can be counted only • Rank orders, highest to lowest, greater or lesser
• No order, no relationship, no distance, and no than
arithmetic origin • No exact distance/ interval not equal
• Examples: Race, Sex, Religion, Handedness • Examples: MMT, MAS, Likert Scale

INTERVAL DATA RATIO DATA

• Interval is equal, but no absolute zero • Have absolute or true zero of measurement
• May have arbitrary zero but no unique origin • Complete absence possible
• More powerful than nominal and ordinal data • All statistical techniques can be done
• Examples: Temperature in Fahrenheit • Examples: Height, Weight, Time, Distance

- Kothari & Garg, 2014

 Levels of Measurement

Nominal Ordinal Interval Ratio

Data may be Meaningful

Data are ordered Meaningful 0 pt. &
classified differences b/w
ratio b/w values
values

• Race • IQ Score
• MMT Score
• Sex • Temp. in °F • Speed
• Ashworth Scale
• Civil Status • Dress Size • Weight
Likert Scale
• Hand Dominance • Distance Travelled

Discrete Data Continuous Data

 DESCRIPTIVE STATISTICS
“methods used in organizing, summarizing, and
presenting data in informative way”
Examples:
 Smith (2007) found out that 60% of 100
students surveyed spent more than 2
hours per day on social networking sites.
 75% of 100 patients who have LBP are
females.
- Kothari & Garg, 2014

INFERENTIAL STATISTICS
“a decision, estimate, prediction, or generalization
about a population based on a sample
Example:
 There is a mean difference of 10.12 secs. b/w pre
and post-test agility scores after completion of
hamstring eccentric training
- Kothari & Garg, 2014
 DESCRIPTIVE STATISTICS

Frequency Distribution Measures of Central Tendency

• No. of occurrence in • Most frequent value, score, or

a given population data
PERCENTAGES MODE
• Ex: 5 in 10 • Nominal/ Categorical Data
individuals, 50% • Ex: Sex, Race, Color, Religion

• Events are in order/ ranks

• Comparison of size of
two units
• Ex: M to F, 3:1
• Ordinal Data, non-normally
RATIO MEDIAN
distributed data
• Ex: MMT, MAS, DTR Grading

• Equality of 2 ratios or • Average

fractions • Interval and Ratio (Continuous
PROPORTIONS MEAN
• Ex: 1 out of 3 = 2 out Data)
of 6 • Ex: Age, Weight, Speed
- Carter, Lubinsky & Domholdt, 2011
 Measures of Central
Frequency Distribution DESCRIPTIVE STATISTICS Tendency

Measures of Dispersion
- “is the amount of spread in the data”

• Difference between highest and lowest score

RANGE • Appropriate to use with MEDIAN
• Ex: High Score – Low Score = Range (95 – 32 = 63)

• Requires every score to be calculated

• Generally reported with MEAN
• Degrees of Freedom (DOF) – no. of items that are free to VARIANCE
fluctuate
• Ex: DOF = N-1

• Amount of dispersion or variation with a set of

STANDARD values
DEVIATION • Appropriate to use with MEAN - Carter, Lubinsky & Domholdt, 2011
• Ex: 75 + 1.5 - Blaxter, Hughes & Tight, 2010
 RANGE

Measures of
Dispersion VARIANCE
- “is the amount of spread in the
data”

Variance: x = X- 𝑥ҧ
Population Variance: 𝜎 2 = 𝛴𝑥 2
STANDARD N
DEVIATION Sample Variance: 𝑠 = σ 𝑥 2
2

N-1
Population s = 𝜎 2
 Association

2 Variables

Non- Analysis of Relationship

Experimental Relationship

PARAMETRIC and NON-PARAMETRIC

> 2 Variables Prediction

INFERENTIAL Within Group

STATISTICS 2 Groups

Between Group
Analysis of
Experimental Difference
Within Group

> 2 Groups

Between Group
 PARAMETRIC TESTS
- “ is a hypothesis testing procedure based on
the assumption that observed data are
distributed…to make inference or
probability”
- “assume normal distribution of values or a
bell-shaped curve
- Chin & Lee, 2008

ASSUMPTIONS
1. Data must be RATIO or INTERVAL.
2. Subjects should be RANDOMLY SELECTED.
3. Data should be NORMALLY DISTRIBUTED.
4. VARIANCE should be SIMILAR.

 #1 CANNOT be violated
 #2-4 can be violated to some extent
- Kothari & Garg, 2014 ; Carter, Lubinsky & Domholdt, 2011
1. Data must be RATIO or 2. Subjects should be RANDOMLY
INTERVAL SELECTED

#1 CANNOT be violated

3. Data should be NORMALLY 4. VARIANCE should be SIMILAR

DISTRIBUTED
• Shapiro-Wilk Test - if N is < • Levene’s Test
50 • Hartley’s Fmax
• Bartlett’s Test
• Kolmogorov-Smirnov Test – • Cochran Test
large sample size (but
weaker)

- Kothari & Garg, 2014 ; Carter, Lubinsky & Domholdt, 2011

 Relationship – Relationship –
Association –
Spearman’s Rho Pearson’s Correlation
Chi-Square Test
Non-Experimental Correlation Coefficient
Inferential NO YES

Statistics Parametric
Assumptions Fulfilled?
IF variables Both Nominal/ Both Ordinal
are; Categorical
2 Variables? 1 Ordinal & 1 Ratio/ Both Ratio/ Interval
1 Nominal, 1 Interval
Ordinal

Binary Logistic Categorical

Multiple Linear Regression
Regression Regression
Analysis of Dichotomous Multiple
YES
Categories Categories Local Regression
Relationship
Quantile Regression NO Parametric
Kendall–Theil NPLR Assumptions Fulfilled?

IF variables Both Ordinal

More than 2 are;
Categorical 1 Ordinal & 1 Both Ratio/ Interval
Variables?
Ratio/ Interval
- Laerd Statistics, 2018
 P: Dependent T-Test
Within Group
NP: Wilcoxon Test Experimental
2 Groups Inferential Statistics
P: Independent T-Test
Between Group
NP: Mann-Whitney Test
Analysis of
Difference Bonferroni’s or Tukey’s
P: 1-Way ANOVA
Test
Within Group NP: Friedman Test
Individual Wilcoxon-Signed
(Ranks), Kruskall-Wallis Rank Test
(H) Test
> 2 Groups
P: 2-Way ANOVA Bonferroni’s or Tukey’s Test
Between Group
NP: Kruskall-Wallis (H) Dunn’s or Dunn-
Chi-Square Test Test Bonferroni’s Test
Discrete DV
of Difference - Laerd Statistics, 2018
References
• Blaxter, L., Hughes, C., & Tight, M. (2010). How to research, 4th Ed. McGraw
Hill Companies, New York.
• Carter R., Lubinsky, J., & Domholdt, E. (2010). Rehabilitation research:
principles and applications, 4th Ed. St. Louis, Missouri, Elsevier Saunders.
• Kothari, C.R. & Garg, G. (2014). Research methodology: methods and
techniques, 3rd Ed. New Age International Publishers, New Delhi.
• Kumar, M.J. (2013). Making Your Research Paper Discoverable: Title Plays the
Winning Trick. IETE Technical Review 30, 361. doi:10.4103/0256-4602.123113
• Kumar, R. (2011). Research methodology: a step-by-step guide for beginners,
3rd Ed. SAGE, Los Angeles.
• https://statistics.laerd.com/
• Pictures from public domains
ACKNOWLEDGMENT:

INDIAN CLINICAL RESEARCH SCAN ME TO GET A COPY

ASSOCIATION (ICRA) https://qrgo.page.link/J9UfY