ArticleTrials2017
Analysis of cluster randomised stepped wedge trials with repeated cross-sectional samples.
Article in Trials, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05358522 (Learning Health System Clinician Feedback Using Patient-reported Data to Increase Implementation of Post-operative Opioid Prescribing Guidelines), which is not on this map. Cited by 105 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Learning Health System Clinician Feedback Using Patient-reported Data to Increase Implementation of Post-operative Opioid Prescribing Guidelines: a Stepped-wedge Cluster Randomized Trial
Who cites it
105 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- A Systematic Review of Studies Describing the Effectiveness, Acceptability, and Potential Harms of Place-Based Interventions to Address Loneliness and Mental Health Problems.International journal of environmental research and public health · 2022Pooled it
- Health Economic Evaluation Alongside Stepped Wedge Trials: A Methodological Systematic Review.PharmacoEconomics · 2021Pooled it
- Effectiveness of structured lactation support and human donor milk banking in German NICUs: a stepped-wedge cluster-randomized trial.BMC medicine · 2026Trial
- Adherence to smartphone-delivered antimicrobial prescribing guidelines in hospitals in Lao PDR: A stepped-wedge cluster randomized controlled trial.PLoS medicine · 2026Trial
- World Health Organization Multimodal Improvement Strategy for Hand Hygiene: A Stepped-Wedge Cluster Randomized Trial.JAMA network open · 2026Trial
- The effect of increasing availability of vegetarian meals on their sales in worksite cafeterias: a stepped-wedge cluster randomised controlled trial.The international journal of behavioral nutrition and physical activity · 2026Trial
- Implementation outcomes of a symptom management intervention in ambulatory oncology practices evaluated using a cluster randomized stepped-wedge trial design.Implementation science : IS · 2025Trial
- Trial
- Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative).Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Trial
- Effectiveness of Integrating Suicide Care in Primary Care : Secondary Analysis of a Stepped-Wedge, Cluster Randomized Implementation Trial.Annals of internal medicine · 2024Trial
- Trial
- Rapid Initiation of Injection Naltrexone for Opioid Use Disorder: A Stepped-Wedge Cluster Randomized Clinical Trial.JAMA network open · 2024Trial
- Opportunistic Treatment of Hepatitis C Infection Among Hospitalized People Who Inject Drugs (OPPORTUNI-C): A Stepped Wedge Cluster Randomized Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Trial
- Standards-based audit to improve quality of maternal and newborn care-A stepped-wedge cluster randomised trial in Malawi.PloS one · 2024Trial
- Effectiveness and Cost of an Enhanced Mailed Fecal Test Outreach Colorectal Cancer Screening Program: Findings from the PROMPT Stepped-Wedge Trial.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2023Trial
- Automated Large Vessel Occlusion Detection Software and Thrombectomy Treatment Times: A Cluster Randomized Clinical Trial.JAMA neurology · 2023Trial
- The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): an international, stepped wedge cluster randomised controlled trial.Lancet (London, England) · 2023Trial
- Surmounting Withdrawal to Initiate Fast Treatment with Naltrexone (SWIFT): A stepped wedge hybrid type 1 effectiveness-implementation study.Contemporary clinical trials · 2023Trial
- Trial
- Random effect misspecification in stepped wedge designs.Clinical trials (London, England) · 2022Trial
45 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
Abstract
backgroundThe stepped wedge cluster randomised trial (SW-CRT) is increasingly being used to evaluate policy or service delivery interventions. However, there is a dearth of trials literature addressing analytical approaches to the SW-CRT. Perhaps as a result, a significant number of published trials have major methodological shortcomings, including failure to adjust for secular trends at the analysis stage. Furthermore, the commonly used analytical framework proposed by Hussey and Hughes makes several assumptions.
methodsWe highlight the assumptions implicit in the basic SW-CRT analytical model proposed by Hussey and Hughes. We consider how simple modifications of the basic model, using both random and fixed effects, can be used to accommodate deviations from the underlying assumptions. We consider the implications of these modifications for the intracluster correlation coefficients. In a case study, the importance of adjusting for the secular trend is illustrated.
resultsThe basic SW-CRT model includes a fixed effect for time, implying a common underlying secular trend across steps and clusters. It also includes a single term for treatment, implying a constant shift in this trend under the treatment. When these assumptions are not realistic, simple modifications can be implemented to allow the secular trend to vary across clusters and the treatment effect to vary across clusters or time. In our case study, the naïve treatment effect estimate (adjusted for clustering but unadjusted for time) suggests a beneficial effect. However, after adjusting for the underlying secular trend, we demonstrate a reversal of the treatment effect.
conclusionDue to the inherent confounding of the treatment effect with time, analysis of a SW-CRT should always account for secular trends or risk-biased estimates of the treatment effect. Furthermore, the basic model proposed by Hussey and Hughes makes a number of important assumptions. Consideration needs to be given to the appropriate model choice at the analysis stage. We provide a Stata code to implement the proposed analyses in the illustrative case study.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.