Clinical Significance and Interpretation of Quantitative Results

Chapter 21 Clinical Significance and Interpretation of Quantitative Results

Question #1

Tell whether the following statement is true or false:

Results of a study need to be evaluated with thought to the aims of the study.

Answer to Question #1

True

The results need to be evaluated and interpreted, giving thought to the aims of the study, its theoretical basis, the body of related research evidence, and limitations of the adopted research methods.

Question #2

Tell whether the following statement is true or false:

Methodologic decisions affect the inferences that can be made between study results and the real clinical world.

Answer to Question #2

True

Inference is central to interpretation. Methodologic decisions made by researchers affect the inferences that can be made about the correspondence between study results and “truth in the real world.”

Interpretation of Quantitative Research Results #1

Issues of interpretation

Aspects of interpretation

The credibility of the results

Precision of estimates of effects

Magnitude of effects

Underlying meaning of the results

Generalizability of results

Implications for future research, theory development, and nursing practice

Interpretation of Quantitative Research Results #2

Credibility of quantitative results

Proxies and credibility

Credibility and validity

Credibility and bias

Credibility and corroboration

Precision and meaning of results

Magnitude of effects and importance

Interpreting hypothesized results

Interpretation of Quantitative Research Results #3

Interpreting nonsignificant results

Interpreting unhypothesized significant results

Interpreting mixed results

Generalizability and applicability of the results

Implications of the results

Question #3

Tell whether the following statement is true or false:

Credibility assessments involve a careful assessment of validity threats and biases that could undermine the accuracy of the results.

Answer to Question #3

True

Credibility assessments can involve a careful assessment of study rigor through an analysis of validity threats and biases that could undermine the accuracy of the results.

Credibility Assessment

Approaches include

Evaluating the degree of congruence between abstract constructs and the proxies actually

Careful assessment of study rigor

Corroboration (replication) of results

Clinical Significance #1

Group-level results are often inferred on the basis of such statistics as effect size indexes, confidence intervals, and number needed to treat.

Individual results are discussed in terms of effects.

Clinical Significance #2

Benchmark: threshold that designates a meaningful amount of change

Ask whether

A change in the attribute is real

A patient in a dysfunctional state returns to normal functioning

A patient has achieved a symptom state that is acceptable to them

The amount of change in an attribute can be considered minimally important

Clinical Significance #3

Minimal important change (MIC)

Value for the amount of change score points that an individual patient must achieve in order to be credited with having a clinically important change

Clinical Significance #4

Methods of establishing the MIC

A consensus panel

An anchor-based approach

A distribution-based method

Bases the MIC on the distributional characteristics of the sample

Triangulation of approaches is increasingly common

Clinical Significance #5

MICs cannot be used to interpret

Group means

Differences in means

MICs can be used to interpret

If each person in a sample has or has not achieved a change greater than the MIC

Responder analysis compares the percentage of responders in different study groups.

Group Level

Group-level clinical significance (practical significance)

Involves using statistical information other than p values to draw conclusions about the usefulness or importance of research findings

Most widely used statistics

Effect size (ES) indexes

Confidence intervals (CIs)

Number needed to treat (NNT)

Individual Level

Individual-level clinical significance

Efforts to come to conclusions about clinical significance at the individual level can be directly linked to EBP goals

Benchmark

The Reliable Change Index (RCI)

Patient acceptable symptom state (PASS)

Minimal important change (MIC)

Critiquing Interpretations

Review discussion section of research reports for statements regarding

Limitations

Sampling deficiencies

Practical constraints

Data-quality problems

Methodology section

How limitations were considered in interpreting the results

Question #4

Which results are considered when interpreting the results of a quantitative research study? (Select all that apply.)

Magnitude of the effects

Underlying meaning of the results

Implication for nursing practice

Cost of the study

Credibility of the results

Answer to Question #4

A, B, C, E

The interpretation of quantitative research results (the outcomes of the statistical analyses) typically involves consideration of (1) the credibility of the results; (2) precision of estimates of effects; (3) magnitude of effects; (4) underlying meaning of the results; (5) generalizability of results; and (6) implications for future research, theory development, and nursing practice. Cost of the study is not generally considered relevant to the quality of the results.

Clinical Significance and Interpretation of Quantitative Results

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