Analysis and reporting of stepped wedge randomised controlled trials: synthesis and critical appraisal of published studies, 2010 to 2014.
BACKGROUND
Stepped wedge cluster randomised trials introduce interventions to groups of clusters in a random order and have been used to evaluate interventions for health and wellbeing. Standardised guidance for reporting stepped wedge trials is currently absent, and a range of potential analytic approaches have been described.


METHODS
We systematically identified and reviewed recently published (2010 to 2014) analyses of stepped wedge trials. We extracted data and described the range of reporting and analysis approaches taken across all studies. We critically appraised the strategy described by three trials chosen to reflect a range of design characteristics.


RESULTS
Ten reports of completed analyses were identified. Reporting varied: seven of the studies included a CONSORT diagram, and only five also included a diagram of the intervention rollout. Seven assessed the balance achieved by randomisation, and there was considerable heterogeneity among the approaches used. Only six reported the trend in the outcome over time. All used both 'horizontal' and 'vertical' information to estimate the intervention effect: eight adjusted for time with a fixed effect, one used time as a condition using a Cox proportional hazards model, and one did not account for time trends. The majority used simple random effects to account for clustering and repeat measures, assuming a common intervention effect across clusters. Outcome data from before and after the rollout period were often included in the primary analysis. Potential lags in the outcome response to the intervention were rarely investigated. We use three case studies to illustrate different approaches to analysis and reporting.


CONCLUSIONS
There is considerable heterogeneity in the reporting of stepped wedge cluster randomised trials. Correct specification of the time-trend underlies the validity of the analytical approaches. The possibility that intervention effects vary by cluster or over time should be considered. Further work should be done to standardise the reporting of the design, attrition, balance, and time-trends in stepped wedge trials.
Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK. calum.davey@lshtm.ac.uk.
Calum
C
Davey
Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK. James.Hargreaves@lshtm.ac.uk.
James
J
Hargreaves
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. Jennifer.Thompson@lshtm.ac.uk.|London Hub for Trials Methodology Research, MRC Clinical Trials Unit at University College London, London, UK. Jennifer.Thompson@lshtm.ac.uk.
Jennifer A
JA
Thompson
London Hub for Trials Methodology Research, MRC Clinical Trials Unit at University College London, London, UK. a.copas@ucl.ac.uk.|MRC Clinical Trials Unit at University College London, London, UK. a.copas@ucl.ac.uk.
Andrew J
AJ
Copas
Department of Clinical, Educational and Health Psychology, University College London, London, UK. e.beard@ucl.ac.uk.|Department of Epidemiology and Public Health, University College London, London, UK. e.beard@ucl.ac.uk.
Emma
E
Beard
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. James.Lewis@lshtm.ac.uk.|MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. James.Lewis@lshtm.ac.uk.
James J
JJ
Lewis
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. Katherine.Fielding@lshtm.ac.uk.|MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. Katherine.Fielding@lshtm.ac.uk.
Katherine L
KL
Fielding
D016000:Cluster Analysis; D003627:Data Interpretation, Statistical; D006801:Humans; D018579:Patient Selection; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D012107:Research Design / Q000592:standards / Q000706:statistics & numerical data; D018401:Sample Size; D013997:Time Factors