Today statistics provides the basis for inference in most medical research. Yet, for want of exposure to statistical theory and practice, it continues to be regarded as the Achilles heel by all concerned in the loop of research and publication – the researchers (authors), reviewers, editors and readers. Most of us are familiar to some degree with descriptive statistical measures such as those of central tendency and those of dispersion. However, we falter at inferential statistics. This need not be the case, particularly with the widespread availability of powerful and at the same time user-friendly statistical software. As we have outlined below, a few fundamental considerations will lead one to select the appropriate statistical test for hypothesis testing. However, it is important that the appropriate statistical analysis is decided before starting the study, at the stage of planning itself, and the sample size chosen is optimum. These cannot be decided arbitrarily after the study is over and data have already been collected. The great majority of studies can be tackled through a basket of some 30 tests from over a 100 that are in use. The test to be used depends upon the type of the research question being asked. The other determining factors are the type of data being analyzed and the number of groups or data sets involved in the study. The following schemes, based on five generic research questions, should help.[1] Question 1: Is there a difference between groups that are unpaired? Groups or data sets are regarded as unpaired if there is no possibility of the values in one data set being related to or being influenced by the values in the other data sets. Different tests are required for quantitative or numerical data and qualitative or categorical data as shown in Fig. 1. For numerical data, it is important to decide if they follow the parameters of the normal distribution curve (Gaussian curve), in which case parametric tests are applied. If distribution of the data is not normal or if one is not sure about the distribution, it is safer to use non-parametric tests. When comparing more than two sets of numerical data, a multiple group comparison test such as one-way analysis of variance (ANOVA) or Kruskal-Wallis test should be used first. If they return a statistically significant p value (usually meaning p 0.7. It is inappropriate to infer agreement by showing that there is no statistically significant difference between means or by calculating a correlation coefficient. Figure 4 Tests to address the question: Is there an agreement between assessment (screening / rating / diagnostic) techniques? Question 5: Is there a difference between time-to-event trends or survival plots? This question is specific to survival analysis[3](the endpoint for such analysis could be death or any event that can occur after a period of time) which is characterized by censoring of data, meaning that a sizeable proportion of the original study subjects may not reach the endpoint in question by the time the study ends. Data sets for survival trends are always considered to be non-parametric. If there are two groups then the applicable tests are Cox-Mantel test, Gehan’s (generalized Wilcoxon) test or log-rank test. In case of more than two groups Peto and Peto’s test or log-rank test can be applied to look for significant difference between time-to-event trends. It can be appreciated from the above outline that distinguishing between parametric and non-parametric data is important. Tests of normality (e.g. Kolmogorov-Smirnov test or Shapiro-Wilk goodness of fit test) may be applied rather than making assumptions. Some of the other prerequisites of parametric tests are that samples have the same variance i.e. drawn from the same population, observations within a group are independent and that the samples have been drawn randomly from the population. A one-tailed test calculates the possibility of deviation from the null hypothesis in a specific direction, whereas a two-tailed test calculates the possibility of deviation from the null hypothesis in either direction. When Intervention A is compared with Intervention B in a clinical trail, the null hypothesis assumes there is no difference between the two interventions. Deviation from this hypothesis can occur in favor of either intervention in a two-tailed test but in a one-tailed test it is presumed that only one intervention can show superiority over the other. Although for a given data set, a one-tailed test will return a smaller p value than a two-tailed test, the latter is usually preferred unless there is a watertight case for one-tailed testing. It is obvious that we cannot refer to all statistical tests in one editorial. However, the schemes outlined will cover the hypothesis testing demands of the majority of observational as well as interventional studies. Finally one must remember that, there is no substitute to actually working hands-on with dummy or real data sets, and to seek the advice of a statistician, in order to learn the nuances of statistical hypothesis testing.
