The DOI matches its Crossref record; 27 of the 27 references it cites were found in a registry or an index.
Properties of the urn randomization in clinical trials
Abstract
In this article we review the important statistical properties of the urn randomization (design) for assigning patients to treatment groups in a clinical trial. The urn design is the most widely studied member of the family of adaptive biased-coin designs. Such designs are a compromise between designs that yield perfect balance in treatment assignments and complete randomization which eliminates experimental bias. The urn design forces a small-sized trial to be balanced but approaches complete randomization as the size of the trial (n) increases. Thus, the urn design is not as vulnerable to experimental bias as are other restricted randomization procedures. In a clinical trial it may be difficult to postulate that the study subjects constitute a random sample from a well-defined homogeneous population. In this case, a randomization model provides a preferred basis for statistical inference. We describe the large-sample permutational null distributions of linear rank statistics for testing the equality of treatment groups based on the urn design. In general, these permutation tests may be different from those based on the population model, which is equivalent to assuming complete randomization. Poststratified subgroup analyses can also be performed on the basis of the urn design permutational distribution. This provides a basis for analyzing the subset of patients with observed responses when some patients' responses can be assumed to be missing-at-random. For multiple mutually exclusive strata, these tests are correlated. For this case, a combined covariate-adjusted test of treatment effect is described. Finally, we show how to generalize the urn design to a prospectively stratified trial with a fairly large number of strata.
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“To address these aims, participants were randomized to one of four intervention arms using an urn randomization scheme (27) and received either nonpersonalized, generalized dietary advice (Control; Level 0), or one of three levels of PN.”
From Effect of an Internet-based, personalized nutrition randomized trial on dietary changes associated with the Mediterranean diet: the Food4Me Study (2016) · cites this paper as [27]
Citations
Cites
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Properties of permuted-block randomization in clinical trials
Matts, J. P., & Lachin, J. M. (1988) · Controlled Clinical Trials · doi:10.1016/0197-2456(88)90047-5 · Cited by 321
An application of an urn model to the design of sequential controlled clinical trials.
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Self-citationAllocation of Patients to Treatment in Clinical Trials
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Two-Sample Repeated Significance Tests Based on the Modified Wilcoxon Statistic
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The Adaptive Biased Coin Design for Sequential Experiments
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Lachin, J. M. (1988) · Controlled Clinical Trials · doi:10.1016/0197-2456(88)90045-1 · Cited by 200
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Beam, E. L., Herstein, J. J., & Kupzyk, K. A. (2025) · Health Security · doi:10.1177/23265094251398059
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Lachin, J. M., Cleary, P. A., Crofford, O. B., GENUTH, S. M., Nathan, D., Clark, C. M., Ferris, F. L., & Siebert, C. (2006) · Springer eBooks · doi:10.1007/0-387-30107-0_9
Ulriksen, L. B., Bilet-Mossige, M., Moreira, H. C., Larsen, K., & Nordahl‐Hansen, A. (2024) · Figshare · doi:10.6084/m9.figshare.26600083
Statistical Analysis PlanPreprint
Bernhardt, J., & Churilov, L. P. (2026) · medRxiv · doi:10.64898/2026.03.11.26348100
Payne, A. M., Schmidt, N. B., Meyer, A. M., & Hajcak, G. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122125
Fitzpatrick, S., Arunagiri, V., Traynor, J. M., Fredborg, B. K., Daros, A. R., Crenshaw, A. O., Fitzpatrick, D., McMain, S., Monson, C. M., Courey, L., et al. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-08374-6
High-capacity transcranial direct current stimulation (HC-tDCS)
Donnery, K., FallahRad, M., Osorio, S., Koochesfahani, M. B., Khadka, N., Saw, M., Mo, J., Babaev, B., Bhuiyan, R., Elwassif, J. M., et al. (2026) · Brain stimulation · doi:10.1016/j.brs.2026.103233
Metadata
- Authors
- Wei, L. J., & Lachin, J. M.
- Affiliations
- University of Michigan (US)
- George Washington University (US)
- Corresponding author
- Lachin, John M.
- Venue
- Controlled Clinical Trials
- Publisher
- Elsevier BV
- Published
- 1988-12
- Volume
- 9
- Issue
- 4
- Pages
- 345-364
- ISSN
- 0197-2456 (ISSN-L)
- OpenAlex
- W2080083219
- Cited by
- 308
- References
- 24
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 13 · 2023: 14 · 2022: 6 · 2021: 21 · 2020: 14 · 2019: 14 · 2018: 6 · 2017: 11 · 2016: 13 · 2015: 9 · 2014: 23 · 2013: 10 · 2012: 17
- FWCI
- 3.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Controlled Clinical Trials (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (acceptedVersion)
- Funders
- National Institutes of Health (1r01am035952-01, 7r01ca045122-01)
- National Cancer Institute (R01-CA-45122)
- National Institute of Diabetes and Digestive and Kidney Diseases (N01-DK-2-2206)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Social Sciences › Decision Sciences › Management Science and Operations Research › Optimal Experimental Design Methods
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Keywords
- restricted randomization, experimental bias, permutation tests, linear rank statistics
- MeSH terms
- Clinical Trials as Topic, Humans, Prospective Studies, Random Allocation, Research Design, Statistics as Topic, Models, Statistical
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