Evidence-Based Medicine: Hypothesis Testing and Statistical Inference

Research as Hypothesis Testing

Start w/ Null hypothetsis: Innocent until proven guilty. No difference btwn 2 drugs.
Reject Null hypothesis when it is statistically unlikely that Null hypothesis is true.
lternative hypothesis: statistically significant difference. Statistically improbable that the null hypoth is true
!ro"a"ility:
P value: the etent the study deserves to be peed on lol.
!P value means the pro"a"ility that the null hypothesis is true "probability that results occurred even
if no real difference btwn the t eist#
!#o$er the ! value$ "p%&.&'#$ less likely the observed differences were due to chance.. (ore likely that
the treatments are in fact different. in other words$ )ess likely that the null hypothesis is true$ and more
likely that the alternative hypothesis is true. *e can reject the null hypoth.
!eg# p+&.2& means that 2&, probability that the observed differences between 2 t were due to chance
Statistical and -linical significance is different.. /ven if an increase in 0P is statstically significant "most
probable that the raise in 0P is due to diffference in t# the 0P difference may be so slight that there is N1
clinical significance.
2*hen 3ournal articles say that one t was significantly greater than with another t$ the article means that it is
statistically significantly greater. It is up to the reader to determine whether the results are -)INI-4))5
significant enough to be applied in practice.
6ype I and II /rrors
Type I error : reporting that there%s a difference "et$een & groups $hen there $as really no difference.
In a particular eperiment$ the probability of making a 6ype I error + 7 "alpha#. 4s noted above$ usually by
convention $e accept alpha less than '( or )*' as an accepta"le possi"ility of 6ype I error. 8emember that
4lpha and p!value are related but not the same. 4lpha is the pre!defined threshold p value below which the
results would be called statistically significant. P!value is what was actually found in the study. 4lpha is like the
cut off value for P!value.
Type II error +eans failing to reject the null hypothesis even $hen a real difference did e,ist) 0y
convention$ a beta of 2&, or &.2 is usually considered acceptable. "i.e.$ power of &.9&#
Statistical Power " !o$er - . / 0 1 : "ility2pro"a"ility of the study to detect a difference $hen a real
difference is present) In other $ords3 it is the pro"a"ility of N4T +a5ing a Type II error.
6he relationship between type I error$ type II error$ and power is represented in this table:
Truth a"out the Null Hypothesis
True6there is no
difference1
7alse 6there is a difference1
Null hypothesis $as N4T rejected fro+ study
6study doesn%t sho$ difference1
Not an error 6ype II error
"Probability + :#
Null hypothesis $as rejected fro+ the study
6study sho$s difference1
6ype I error
"Probability + 7#
Not an error
"Probability + ;!: + Power#

8alidity
Internal validity means$ in this particular study sample$ do the results appear to be valid "i.e.$ represent the truth
for this sample#<
/ternal validity or =enerali>ability means will the results generali>e to the wider population of sub3ects< -an
we apply these results to the general public
Sa+pling and E,posure llocation
!4ny findings about the sample should be generali>able to the ?population@ that it represents.
9onvenience sa+pling: /asiest approach. eg# 6ake every third patient who comes with a condition.
!cons: not representative of all potential sub3ects.
Stratified Sa+pling: If one or more variables massively impact the results "eg being males or females#
random sampling for each strata "random sampling for males$ random sampling for females# to gather
info that represents both groups fairly.
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