The DOI matches its Crossref record; 78 of the 78 references it cites were found in a registry or an index; none of the 26 sources its claims cite is checked for support yet.
A "SMART" Design for Building Individualized Treatment Sequences
Open accessAbstract
Interventions often involve a sequence of decisions. For example, clinicians frequently adapt the intervention to an individual's outcomes. Altering the intensity and type of intervention over time is crucial for many reasons, such as to obtain improvement if the individual is not responding or to reduce costs and burden when intensive treatment is no longer necessary. Adaptive interventions utilize individual variables (severity, preferences) to adapt the intervention and then dynamically utilize individual outcomes (response to treatment, adherence) to readapt the intervention. The Sequential Multiple Assignment Randomized Trial (SMART) provides high-quality data that can be used to construct adaptive interventions. We review the SMART and highlight its advantages in constructing and revising adaptive interventions as compared to alternative experimental designs. Selected examples of SMART studies are described and compared. A data analysis method is provided and illustrated using data from the Extending Treatment Effectiveness of Naltrexone SMART study.
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Claims the paper makes
41 Own interpretation · 17 Not checked yet · 10 No basis given · 5 Own method · 4 Own result
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The results reported in Table 6 also indicate that the adaptive interventions in comparisons 3 and 4 are not significantly different in terms of achieving drinking abstinence at the end of stage two [estimated logitP(Y = 1) = −0.61; −0.39, ns, for comparison 3 and 4, respectively].”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE EXTEND TRIAL EXAMPLE > Results
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The missing data are missing at random or otherwise appropriately handled by multiple imputation, so that the imputation yields valid estimates.
- Rests on an assumption: The logistic regression model is correctly specified for estimating the effects of the adaptive interventions.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The results reported in Table 6 indicate that the adaptive interventions in comparisons 1 and 2 are significantly different in terms of achieving drinking abstinence at the end of stage two [estimated logit P(Y = 1) = −1.17; −0.96, p < 0.05, for comparison 1 and 2, respectively].”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE EXTEND TRIAL EXAMPLE > Results
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The missing data are missing at random or otherwise appropriately handled by multiple imputation, so that the imputation yields valid estimates.
- Rests on an assumption: The logistic regression model is correctly specified for estimating the effects of the adaptive interventions.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These advantages are (a) increased validity of analyses aimed at discovering when the effect of one intervention is enhanced by subsequent or prior interventions, (b) increased validity of analyses aimed at discovering useful tailoring variables, and (c) increased ability to reduce the impact of cohort effects.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > Comparison to Alternative Experimental Designs
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The best intervention option for a patient varies with the values of the tailoring variables.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Specifically, investigators can collect information on candidate tailoring variables that are outcomes of the initial intervention and assess their usefulness in matching subsequent intervention options to participants.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > Why Run a SMART Trial?
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The best intervention option for a patient varies with the values of the tailoring variables.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Other questions may concern the comparison of adaptive interventions that are embedded in the SMART trial, such as the differences between the eight adaptive interventions specified in Table 2.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > Why Run a SMART Trial?
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The Sequential Multiple Assignment Randomized Trial (SMART)provides high-quality data that can be used to construct adaptive interventions.”
§ A “SMART” Design for Building Individualized Treatment Sequences > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Data from a SMART design can be used to address many interesting questions that are useful for the construction of high-quality adaptive intervention. These questions may concern the comparison of different intervention options at different stages of the intervention.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > Why Run a SMART Trial?
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These advantages are (a) increased validity of analyses aimed at discovering when the effect of one intervention is enhanced by subsequent or prior interventions, (b) increased validity of analyses aimed at discovering useful tailoring variables, and (c) increased ability to reduce the impact of cohort effects.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > Comparison to Alternative Experimental Designs
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“As in standard intervention trials, the randomization allows scientists to make valid causal inferences concerning the relative effectiveness of the intervention options without having to make unverifiable assumptions (Rubin 1974, 2007).”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > What Is the SMART Design?
What the sources say
- Not checked yetcites Rubin 1974
- Not checked yetcites Rubin 2007
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“For example, in secondary data analyses of the ADHD study, Nahum-Shani et al. (2011a,b) found evidence that children’s adherence to the first-stage intervention could be used to individualize the second-stage intervention.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > Comparison to Alternative Experimental Designs
What the sources say
- Not checked yetcites Nahum-Shani et al. (2011a,b)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 17
- Probably not a substantial claim. 12
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The results reported in Table 5 indicate that the coefficients of A1, and A1*A2nr are significantly different from zero (β̂1 = 0.39; β̂5 = −0.14, p < 0.05, respectively), and the coefficient of A2R is marginally significant (β̂2 = −0.24, p = 0.10).”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE EXTEND TRIAL EXAMPLE > Results
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The missing data are missing at random or otherwise appropriately handled by multiple imputation, so that the imputation yields valid estimates.
- Rests on an assumption: The logistic regression model is correctly specified for estimating the effects of the adaptive interventions.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Notice that the regression coefficient for A2NR is not significantly different from zero (β̂3 = 0.02), meaning that on average, there is no difference between the two treatment options for nonresponders in achieving abstinence.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE EXTEND TRIAL EXAMPLE > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The missing data are missing at random or otherwise appropriately handled by multiple imputation, so that the imputation yields valid estimates.
- Rests on an assumption: The logistic regression model is correctly specified for estimating the effects of the adaptive interventions.
None of the sources cited for this claim have been checked yet.
In the paper
“This approach is based on the notion that patients differ in their responses to interventions: In order for an intervention to be most effective, it should be individualized and repeatedly adapted over time to individual progress.”
§ A “SMART” Design for Building Individualized Treatment Sequences > OVERVIEW
What the sources say
- Not checked yetcites Bierman et al. 2006
- Not checked yetcites Marlowe et al. 2008
- Not checked yetcites McKay 2005
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Evidence-based practice … is not a specific treatment or a set of treatments, but rather an orientation or a value system that relies on evidence to guide the entire treatment process. Thus, a critical element of evidence-based care is periodic assessment to gauge whether the treatment selected initially is in fact proving helpful.”
§ A “SMART” Design for Building Individualized Treatment Sequences > OVERVIEW
What the sources say
- Not checked yetcites Weisz et al. (2004)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Because SMARTs are used to develop adaptive interventions as opposed to confirming that a particular adaptive intervention is better than control, SMARTs should be followed by a randomized confirmatory trial in which the developed adaptive intervention is compared to an appropriate alternative.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > What Is the SMART Design?
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“The conceptual advantages of adaptive interventions over a fixed-intervention approach (in which all patients are offered the same type or dosage of the intervention) have long been recognized by behavioral scientists.”
§ A “SMART” Design for Building Individualized Treatment Sequences > OVERVIEW
What the sources say
- Not checked yetcites Weisz et al. (2004)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In contrast, in a SMART study the clinical team can prospectively manipulate and record the type and intensity of the intervention during the initial stage.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > Comparison to Alternative Experimental Designs
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, the quality and validity of these recall measures might be lower relative to the more proximally measured adherence collected during the SMART study.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > Comparison to Alternative Experimental Designs
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Forty-one participants dropped out at the second stage.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE EXTEND TRIAL EXAMPLE > Sample
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Secondary research questions typically concern (a) the comparison of second-stage intervention options, (b) the comparison of embedded adaptive interventions, and (c) the usefulness of candidate tailoring variables (beyond the tailoring variable already embedded in the design).”
§ A “SMART” Design for Building Individualized Treatment Sequences > EXAMPLES OF SMART STUDIES > Comparison of SMART Studies
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The advantages of SMART designs over a randomized comparison of the fully formed adaptive intervention with a control are related to the fact that the SMART design enables clinical scientists to open the “black box” using randomized comparisons. In contrast, the randomized two-group comparison approach is designed with a very different goal, that is, to provide information on whether the adaptive”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > Comparison to Alternative Experimental Designs
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The effective sample size for the randomized study was 253 participants.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE EXTEND TRIAL EXAMPLE > Sample
plainn = 253- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“In the CCNIA study, only a subset of the nonresponding children is rerandomized. Specifically, children who do not respond to JAE+EMT are randomly assigned either to receive intensified JAE+EMT or to switch to JAE+AAC.”
§ A “SMART” Design for Building Individualized Treatment Sequences > EXAMPLES OF SMART STUDIES > Comparison of SMART Studies
What the sources say
- Not checked yetcites Kasari 2009a,b
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In the ExTENd example, this would be the main effect of NTX+TDM versus NTX alone for responding participants and the main effect of CBI+MM+NTX versus CBI+MM+placebo for nonresponding participants.”
§ A “SMART” Design for Building Individualized Treatment Sequences > USING DATA FROM A SMART TO INFORM THE CONSTRUCTION OF AN OPTIMIZED ADAPTIVE INTERVENTION
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Only three adaptive interventions are embedded in the CCNIA SMART design, in which only two critical decisions were addressed by randomization: one concerning the frontline intervention and the other concerning the rescue intervention for nonresponders to one of the frontline interventions.”
§ A “SMART” Design for Building Individualized Treatment Sequences > EXAMPLES OF SMART STUDIES > Comparison of SMART Studies
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Nahum-Shani et al. (2011a,b) provide analysis methods for addressing primary and secondary research questions using data from SMART studies.”
§ A “SMART” Design for Building Individualized Treatment Sequences > USING DATA FROM A SMART TO INFORM THE CONSTRUCTION OF AN OPTIMIZED ADAPTIVE INTERVENTION
What the sources say
- Not checked yetcites Nahum-Shani et al. (2011a,b)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In a randomized two-group trial, there is no randomization to different second-stage interventions, and thus again analyses must depend on variation due to nonadherence and implementation infidelity.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > Comparison to Alternative Experimental Designs
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Forty-nine participants dropped out prior to experiencing two heavy drinking days and thus experienced no effect of the first-stage randomization.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE EXTEND TRIAL EXAMPLE > Sample
plainn = 9- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The RBT SMART study, on the other hand, contrasts variants of the same intervention (RBT) and hence involves only one treatment modality.”
§ A “SMART” Design for Building Individualized Treatment Sequences > EXAMPLES OF SMART STUDIES > Comparison of SMART Studies
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In SMART designs, the intervention offered to a specific participant is adapted on the basis of information obtained on this participant (e.g., the participant’s signs of early response or level of adherence to the initial interventions), whereas in adaptive experimental designs, the randomization probabilities are adapted on the basis of information obtained from other participants in prior”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL > The SMART Experimental Design Versus the Adaptive Experimental Design
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, eight adaptive interventions are embedded in the RBT and the ExTENd SMART designs, in which five critical decisions were addressed by randomizations.”
§ A “SMART” Design for Building Individualized Treatment Sequences > EXAMPLES OF SMART STUDIES > Comparison of SMART Studies
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The number of treatment modalities utilized in SMART studies depends on the scientific evidence and the research questions at hand.”
§ A “SMART” Design for Building Individualized Treatment Sequences > EXAMPLES OF SMART STUDIES > Comparison of SMART Studies
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Only three additional participants dropped out during the first-stage treatment; the data from these participants were deleted, leaving a sample size of 250 participants.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE EXTEND TRIAL EXAMPLE > Sample
plainn = 3- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“To accommodate the resulting missing data, multiple imputation was used in the analyses below.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE EXTEND TRIAL EXAMPLE > Sample
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These results indicate that we are to provide nonresponders with the more-intensive second-stage intervention (CBI+MM+NTX); it is less clear whether we should begin with the lenient or the stringent definition of nonresponse.”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE EXTEND TRIAL EXAMPLE > Results
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Rests on an assumption: The missing data are missing at random or otherwise appropriately handled by multiple imputation, so that the imputation yields valid estimates.
- Rests on an assumption: The logistic regression model is correctly specified for estimating the effects of the adaptive interventions.
In the paper
“The missing data in this data set are handled with multiple imputation using the R mice procedure (van Buuren & Groothuis-Oudshoorn 2010).”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE EXTEND TRIAL EXAMPLE > Results
What the sources say
- Not checked yetcites van Buuren & Groothuis-Oudshoorn 2010
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Each participant is consistent with two adaptive interventions (i.e., the observed primary outcome of each participant is used in estimating the average primary outcome of two adaptive interventions; for more details, see Nahum-Shani et al. 2011a).”
§ A “SMART” Design for Building Individualized Treatment Sequences > THE EXTEND TRIAL EXAMPLE > Sample
What the sources say
- Not checked yetcites Nahum-Shani et al. 2011a
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
The best intervention option for a patient varies with the values of the tailoring variables.
“The logic is that the best intervention option for patients varies according to different values of the tailoring variables.”
The paper relies on this without support.
Comorbid conditions require decisions about which disorder to treat first or whether to treat multiple disorders at once.
“A third reason for considering an adaptive intervention is the presence of, or evolving, comorbidities (e.g., comorbid HIV infection and substance use, depression and alcoholism). Comorbid conditions require decisions regarding which disorder should be treated first or whether multiple disorders should be treated simultaneously.”
The paper relies on this without support.
The high cost of intensive interventions, along with possible burden and side effects, justifies developing interventions that reduce intensity when possible.
“Fifth, the high cost of intensive interventions combined with possible burden and/or side effects motivate the development of interventions in which the intensity of the treatment is reduced when possible.”
The paper relies on this without support.
Interest among intervention scientists in experimental designs that directly inform intervention adaptation has grown in recent years.
“In recent years, intervention scientists have become increasingly interested in experimental designs that explicitly inform the adaptive aspects of the intervention.”
The paper relies on this without support.
The missing data are missing at random or otherwise appropriately handled by multiple imputation, so that the imputation yields valid estimates.
“To accommodate the resulting missing data, multiple imputation was used in the analyses below.”
“The missing data in this data set are handled with multiple imputation using the R mice procedure (van Buuren & Groothuis-Oudshoorn 2010).”
The paper relies on this without support.
The logistic regression model is correctly specified for estimating the effects of the adaptive interventions.
“The logistic regression model below can be used to compare the eight adaptive interventions embedded in the ExTENd trial:”
“(1)logitP(Y=1|A1,A2R,A2NR,O1)=β0+β1*A1+β2*A2R+β3*A2NR+β4*A1*A2R+β5*A1*A2NR+γTO1.”
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The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The adaptive intervention that a SMART design produces can be incorporated into clinical practice more naturally and seamlessly than the findings of a fixed-intervention study [53, 54, 62].”
From A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders (2021) · cites this paper as [53]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Different SMART designs are suitable for addressing different types of scientific questions [21,23].”
From Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research (2014) · cites this paper as [23]
The cited source says what the claim attributes to it.
In the citing paper
“Findings of the sequential randomization aspect of the SMART design during treatment can inform clinician decisions about treatment sequencing based on the individual patient’s response to the intervention currently in use, further supporting personalized treatment [53, 54].”
From A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders (2021) · cites this paper as [53]
The cited source says what the claim attributes to it.
In the citing paper
“making them ideal for developing an adaptive intervention that optimizes outcomes based on patient treatment history [51–54].”
From A Sequential Multiple Assignment Randomized Trial (SMART) study of medication and CBT sequencing in the treatment of pediatric anxiety disorders (2021) · cites this paper as [53]
In the citing paper
“Lei et al. [23] describe the rationale and scientific questions addressed by four different SMART studies either recently completed or underway in autism, attention-deficit/hyperactivity disorder (ADHD), and for various substance use disorders.”
From Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research (2014) · cites this paper as [23]
In the citing paper
“The Sequential Multiple Assignment Randomized Implementation Trial (SMART) implementation design is a special case of the factorial experiment (32, 67, 78) involving multistage randomizations where the site-level implementation process can be modified if unsuccessful.”
From An Overview of Research and Evaluation Designs for Dissemination and Implementation (2017) · cites this paper as [67]
In the citing paper
“the likelihood of response of these syndromes to the introduction of new antidepressants is very variable [29-33].”
From The Deceptive Manifestations of Treatment Resistance in Depression: A New Look at the Problem (2020) · cites this paper as [33]
In the citing paper
“Even with slow tapering, the likelihood of withdrawal syndromes and persistent postwithdrawal disorders and symptoms is very high”
From The Deceptive Manifestations of Treatment Resistance in Depression: A New Look at the Problem (2020) · cites this paper as [33]
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Metadata
- Authors
- Lei, H., Nahum-Shani, I., Lynch, K., Oslin, D., & Murphy, S. A.
- Affiliations
- University of Michigan (US)
- University of Pennsylvania (US)
- Philadelphia VA Medical Center (US)
- Venue
- Annual Review of Clinical Psychology
- Publisher
- Annual Reviews
- Published
- 2012-04-27
- Volume
- 8
- Issue
- 1
- Pages
- 21-48
- ISSN
- 1548-5943 (ISSN-L)
- 1548-5951
- PMC
- PMC3887122
- OpenAlex
- W2163084572
- Cited by
- 557
- References
- 78
- Citations by year
- 2026: 24 · 2025: 32 · 2024: 63 · 2023: 37 · 2022: 46 · 2021: 56 · 2020: 50 · 2019: 55 · 2018: 47 · 2017: 33 · 2016: 34 · 2015: 25 · 2014: 35 · 2013: 14 · 2012: 4
- FWCI
- 3.73
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Annual Review of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01aa014851-04)
- National Institute on Alcohol Abuse and Alcoholism (R01 AA-014851, RC1AA019092)
- National Institute of Mental Health (R01MH080015)
- National Institute on Drug Abuse (P50DA010075)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods and Bayesian Inference
- Keywords
- adaptive interventions, sequential multiple assignment randomized trial, treatment response, medication adherence, naltrexone, experimental design comparison
- MeSH terms
- Mental Disorders, Humans, Research Design, United States, Program Evaluation, Randomized Controlled Trials as Topic, Program Development, Patient-Centered Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-06 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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