Application Of ANOVA in Medical

Research
Aida Nabilah binti Sadon, loke Su Leng
Nurul Nadia Binti Selamat, Nur Fatihah Binti Zulkifli
Audrey Err Kiat Joo ∗

University Tun Hussein Onn Malaysia

bellaadomk@gmail.com

sulengloke@gmail.com

nadn8780@gmail.com

norfatihahzulkiflee@gmail.com

audreyerr@hotmail.com

May 10, 2019

Abstract

This article is written about the application of analysis of variance (ANOVA) in medical research.
Credit is given to all the writers and producers of all references that gave us knowledge and
finding to complete this article. Journal is our main references but articles and web sites that have
the related content also help us a lot. ANOVA is likely to be used in the medical research because
it is most effective way to compare the means, as we can see in the one – way ANOVA, two – way
ANOVA and so on that used to compare means between groups that we interested to studies.
It is preferred model in industries like pharmaceuticals and medical research because of ability
to test more than two samples simultaneously. In this article is about One – Way ANOVA, Two
– Way ANOVA, Three – Way ANOVA, Factorial ANOVA, Repeated ANOVA, P – spline model,
Circular ANOVA, and Multivariate ANOVA. Those components are used to be found and helping
in medical research and studies.

1
 I. Introduction
tatistically analysis is widely used in
S
helping inteprating , analysing a typical
research to gain a professionally anal-
ysed result. In todays world, there many type
of softwares such as MINITAB, SSPS , R and
so on can help to analysis the data faster and
easier . For example, hypothesis testing can
be tested by only type in the data in the soft-
ware and the analysed data will shown and
get the intepreted result without calculate it
manually which is time wasting.ANOVA is
known as Analysis of Varience which is widely
used in analysis data and used to determine
whether there are any statistically significant
differences between the means of more inde-
pendent group.In simple words, by comparing
the means of two or more samples by using
the F distribution , we can get the result which
is the data is significantly effect one and an-
other or not. By conducting ANOVA , there
are three assumptions need to follow : the
data must be normally distributed , the sam-
ples data must be independents one and each
others and there is no muticollinearity exist
in the model.The analysis of varience have
a wide application , especially in the medi-
cal field.However , ANOVA cannot provide a
more detailed infomation on the differences
amongst the study groups. So , the post hoc
test is introduced, which will provide a more
detailed and specific information for ANOVA
∗A thank you or further information
2
results, which also known as “multiple com-
parison analysis” tests.There frequently used
test is are Tukey,The Fisher Least Significant
Difference (LSD) method , which is used to
compare pairs of treatment means and the Dun-
nett’s test is used to compare treatment means
with a control. Nowadays , the application of
multiple comparison tests in medical research
has increased , and this help many medical
researchers to get a critcical review for the re-
seach. The objective of of the article was to get
a specific and deeply investigate the applica-
tion of ANOVA helps in the medical field and
how to avoid the misused of the ANOVA to get
the information which will mislead the reader.
II. Methods
We started with searching some journals and
articles through some websites that were re-
lated to the general topic which is ANOVA
in medical research. Then, we analyze and
sorted out the journals and articles that related
to the more specific scope which is the applica-
tion of analysis of variance (ANOVA) in medi-
cal research. The journals were schemed and
scanned one by one in order to point out the
applications of ANOVA in medical research.
After the points had been sorted out, we para-
phrased, combined and summarized into some
simpler points. We are using Texmaker appli-
cation to organize and present the topic. Tex-
maker is a free, modern and cross-platform
open-source Latex editor with an integrated
pdf viewer which is entirely a Qt application.
It also integrates many tools needed to develop
documents with Latex. We conduct and run
this application under the supervising of a lec-
turer.
III. Results
1. One - way ANOVA for the One-Way Re-
search, it is has applied in quite a number of
medical research such as optometric research.
It can be used to test differences between sev-
eral different groups of treatment that making
multiple comparisons between groups means
using t-test. It also can be applied in analysing
the ischemic heart real dataset suggest that,
after proper manipulation. The resting electro-
diagram (ECG) signals can be used as an effec-
tive tool in the clinical ischemic heart screening,
without the need of the further stress test as the
current standard procedure. One-Way ANOVA
can be widely used in medical field, one of the
examples is ANOVA can be used to study how
length of stay of patients can be reduced. in
the journal "Quality Quandaries : Health CAre
Quality - Reducing the Length of patients Stay
At a Hospital", ANOVA test is used repeat-
edly to check the factor that may influence the
length of stay and eliminate factors that do not.
ANOVA also can be used to find the smallest
set of genes that can ensure highly accurate
classification of cancer from micro array data
by using supervised machine learning algo-
rithms. The importance ranking of each gene
can be computed by using ANOVA method.
In the analysis, there are two variation in the
response which are variation attributable to
differences between the classification variables
and variation attributable to random error. By
using this analysis, the significance of the clas-
sification effects can be determine.ANOVA test
is used to study the influence of adding garlic
and thyme and their combination on immune
response and some blood parameters in broiler.
The data collected from the experiment was
carried out in a complete randomized design.
By using ANOVA analysis, the significant dif-
ferences among the means were determined by
using significant level of p less than 0.05.
2. Factorial ANOVA Factorial designs for
clinical trials are often used in medical, dental,
and orthodontic research. It is assess two or
more interventions simultaneously and main
advantage of this design is its efficiency in
terms of sample size as more than one inter-
vention may be assessed on the same partic-
ipants. This design is the only design that
allows testing for interaction and large sam-
ple size required if specific study want to be
further because the study is looking for the
interaction effect. By using this design also
reduced the cost and resources and manage-
ment needs due to the fact that smaller sample
will be required compared with two separate
trials. Advantages in using factorial ANOVA
is allow two or more parameters to be assessed
at the same time in the same time in the same
population simultaneously. More efficient tri-
3
als will be created in terms of sources include
the sample size compare to separate trials after
assessment of each parameter. For example
factorial design applied in orthodontic treat-
ment especially dental orthodontic research.
But, still there disadvantages which is, it is
time consuming because extra time may re-
quired when 2 treatments applied at the same
time. Besides that, process in analyzing the
data and randomization might be a little more
complex because participants need to be allo-
cated to four arms either in one or two stage.
For the appropriateness and acceptability or
tolerance of combined interactions on biologic
and scientific grounds must be explored and
determined. Plus, if interaction is expected
but there is no intention to detect the interac-
tion, the factorial design has no sample size
advantages compared with 2-separate two-arm
parallel trials.
3. Repeated- measures ANOVA For the re-
peated measures ANOVA, the mean difference
comparison procedures are very widely used in
mostly biological and medical research. From
an article in Archives Of Physical Medicine and
Rehabilitation as they analysed the incurred of
spinal cord injury(SCI) as children and adoles-
cents which is a medical research amongst the
youngsters. Next, like clinical chemistry ex-
periment, Cardiac Tropponin I was measured
repeatedly overtume at different hours to find
out its minor elevation was association with
cardiovascular diseases and death rate after a
month. Next, the confidence regions for re-
4
peated measures the ANOVA power curves
based on the estimated covariance also quite
frequently used by choosing a sample size for
a repeated measures ANOVA design. Medical
imaging and many more other types of health-
care research often used for repeated measures
ANOVA.
4. P-SPLINE In spatial and spartio - tem-
poral model become an important area of re-
search in many fields such as disease map-
ping, epidemiology and environmental stud-
ies that may have consist of large size of data.
P-spline is an ANOVA-type interaction mod-
els for spatio – temporal smoothing and it is
one type of the analysis of variance model
that allowing consideration of interaction terms
which can be decomposed as a sum of smooth
functions similarly as an ANOVA decomposi-
tion. Besides those, the ANOVA-type P-spline
Model can extrapolating cancer mortality by
having the trends which can be very valuable
as a tool to predict cancer burden. This is
because the P-spline models can split the pre-
dictions into components representing region-
specific features and characteristics common
to the whole country. 5. Multivariate ANOVA
Multivariate analysis of variance (MANOVA)
is an extension of the univariate analysis of
variance (ANOVA). In multivariate analysis
under the name of multilevel modelling, this
method is applied in clinical metabolic profil-
ing studies by employed two clinical metam-
bolomics datasets as the testing grounds. It is
also applied in study in relationships between
smoking alcohol consumption, and HRQoL
(Health – related quality of life) in different
groups of people, reports on physical educa-
tion and sports students who regularly par-
ticipate in sports activities seem to be miss-
ing. Therefore, this study is about to com-
pare HRQoL among physical education and
sports students with regard to the consump-
tion of alcohol and smoking. Other than that,
MANOVA also used to test three hypothesises
for mental health scales and three hypothesises
for physical health scales. To determine either
the hypothesis are accepted or not is by using
Pillias Trace and F value. as usual if p-value
is less than 0.05, it can conclude that the dif-
ferences between the means are statistically
significant. For another example of application
of MANOVA is in test for gene set analysis
which it is designed to identify genes sets con-
sisting of differentially expressed genes for two
or more experimental conditions.
6. Circular ANOVA Circular ANOVA is ap-
plied to circular data which is measured in
angles or directions on the unit circle. Because
circular data have a periodical nature, the cal-
culation of descriptive and inferential statistics
works different than in linear statistics. Cir-
cular ANOVA is one-way analysis of variance
method to test the equality of mean directions
in circular data analysis but it is requires some
assumptions. In particular, it is gaining accep-
tance by many academicians to assess scenar-
ios that have circularity in their nature. There
are few stochastic circular models, but their
applicability and tractability are not fully as-
sessed as for their linear counterpart. It is used
to assess the occurrence of the fever in differ-
ent year, transformed linear time in months
to circular time and convert it to radian form
since directional analysis is best suited to ra-
dian measures. The main assumption for circu-
lar ANOVA is all r-independent samples must
come from von Mises distribution with equal
directional means and equal concentration pa-
rameters. But in real life, this assumptions may
not be satisfied, therefore alternative tests for
circular ANOVA must be considered in order
to avoid those assumptions or replace circular
ANOVA if the assumptions are not satisfied. It
is called circular in R package repository. Cir-
cular data is obtained by measuring directions
or arrival times of subjects with respect to a
reference point on the unit circle. For example,
if the arrival time of patient to an emergency
room is the main interest, then the data can be
recorded in 24-hours clock notation and can
later be converted to the angles on the unit cir-
cle. Other than that, it is used Crimean-Congo
hemorrhage fever cases in each month as a
dependent linear variable and time in radian
as a circular explanatory variable. The differ-
ent descriptive statistics for the data and apply
circular ANOVA on them are calculated and
found very sensible methods with few draw-
backs. The data collection methods have been
described in detail, it is collected monthly from
the district for the particular years period. In
this study, circular ANOVA were analysed to
5
assess whether there are statistically significant
differences between years of the distribution in
the country in the that particular years.

IV. Conclusion

In conclusion, medical research have used

many kind of method in statistic to help their
research with low cost and less time consum-
ing because it is all statistic do. ANOVA have
been applied in many field nowadays and med-
ical field is not excepted. Statistician is needed
for the medical research,it is because method
that used in the research need professional to
handle it and explained the results given from
the method.

References