ArticleClinical trials (London, England)2026
Additional crossovers in cluster randomised crossover trials do not always increase statistical power.
Article in Clinical trials (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCluster randomised crossover designs (CRXOs) are a powerful type of longitudinal cluster randomised trial in which all participating clusters switch between two treatment conditions. "Multiple-period" CRXOs divide the trial duration into a number of periods of equal length and can allow for multiple crossovers between treatment conditions. It can be assumed that increasing the number of crossovers leads to an increase in statistical power. We investigate whether this is true for standard correlation structures, comparing CRXO designs with equal numbers of clusters, participants, and periods but differing in the number of crossovers, considering continuous outcomes.
methodsWe consider the formula for the variance of the treatment effect estimator for multiple-period CRXOs under exchangeable and block-exchangeable within-cluster correlation structures, assuming equal cluster-period sizes and different patterns of treatment conditions in the treatment sequences varying in the number of crossovers. We also conduct a simulation study to compare the statistical power between multiple-period CRXO designs with different numbers of crossovers that share the same number and duration of periods and the same number of participants in each cluster period.
resultsUnder exchangeable and block-exchangeable correlation structures and equal cluster-period sizes, the number of crossovers in the treatment sequences does not impact study power, provided the design is balanced in terms of the number of periods and clusters implementing each condition.
conclusionsWhen an exchangeable or block-exchangeable within-cluster correlation structure and a time-invariant effect of treatment are assumed, power calculations for CRXO designs are invariant to the specific ordering of treatment conditions. In particular, a CRXO design with additional crossovers does not lead to increased statistical power compared to a CRXO design with just one crossover for these within-cluster correlation structures. Further work is required to investigate the utility of multiple crossovers in situations where the treatment effect varies over time.
Indexed as
Identifiers
What OpenQuestion holds
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.