Interpretation of correlations in clinical research

Abstract

Background: Critically analyzing research is a key skill in evidence-based practice and requires knowledge of research methods, results interpretation, and applications, all of which rely on a foundation based in statistics. Evidence-based practice makes high demands on trained medical professionals to interpret an ever-expanding array of research evidence.

Objective: As clinical training emphasizes medical care rather than statistics, it is useful to review the basics of statistical methods and what they mean for interpreting clinical studies.

Methods: We reviewed the basic concepts of correlational associations, violations of normality, unobserved variable bias, sample size, and alpha inflation. The foundations of causal inference were discussed and sound statistical analyses were examined. We discuss four ways in which correlational analysis is misused, including causal inference overreach, over-reliance on significance, alpha inflation, and sample size bias.

Results: Recent published studies in the medical field provide evidence of causal assertion overreach drawn from correlational findings. The findings present a primer on the assumptions and nature of correlational methods of analysis and urge clinicians to exercise appropriate caution as they critically analyze the evidence before them and evaluate evidence that supports practice.

Conclusion: Critically analyzing new evidence requires statistical knowledge in addition to clinical knowledge. Studies can overstate relationships, expressing causal assertions when only correlational evidence is available. Failure to account for the effect of sample size in the analyses tends to overstate the importance of predictive variables. It is important not to overemphasize the statistical significance without consideration of effect size and whether differences could be considered clinically meaningful.

Keywords: Correlation; causal relationships; clinical education; commentary; instructional materials; non-experimental methods; practice-based research.

Figure 1:

1) Perfect negative correlation between two variables; 2) No patterned relationship between 2 variables; 3) Perfect positive correlation between two variables

Figure 2:

As the number of comparisons increases, the alpha error rate increases; running 20 comparisons with no correction factor and a significance level set at 0.05 will result in 64% chance of a relationship appearing to be significant (better than 50/50 odds).