Cited by 496Statistical Methods in EpidemiologyStatistical Methods in Clinical TrialsMeta-analysis and systematic reviews

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Small studies: strengths and limitations

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Hackshaw, A.·2008·European Respiratory Journal

DOI 10.1183/09031936.00136408

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Abstract

A large number of clinical research studies are conducted, including audits of patient data, observational studies, clinical trials and those based on laboratory analyses. While small studies can be published over a short time-frame, there needs to be a balance between those that can be performed quickly and those that should be based on more subjects and hence may take several years to complete. The present article provides an overview of the main considerations associated with small studies. The definition of “small” depends on the main study objective. When simply describing the characteristics of a single group of subjects, for example the prevalence of smoking, the larger the study the more reliable the results. The main results should have 95% confidence intervals (CI), and the width of these depend directly on the sample size: large studies produce narrow intervals and, therefore, more precise results. A study of 20 subjects, for example, is likely to be too small for most investigations. For example, imagine that the proportion of smokers among a particular group of 20 individuals is 25%. The associated 95% CI is 9–49. This means that the true prevalence in these subjects generally is anywhere between a low or high value, which is not a useful result. When comparing characteristics between two or more groups of subjects ( e.g. examining risk factors or treatments for disease), the size of the study depends on the magnitude of the expected effect size, which is usually quantified by a relative risk, odds ratio, absolute risk difference, hazard ratio, or difference between two means or medians. The smaller the true-effect size, the larger the study needs to be 1, 2. This is because it is more difficult to distinguish between a real effect and random variation. Consider mortality as the end-point in a …

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Clinical Trials: A Practical Approach.
Hill, I. D., & Pocock, S. (1984) · Biometrics · doi:10.2307/2531186 · Cited by 2,918
Statistics notes: Absence of evidence is not evidence of absence
Altman, D. G., & Bland, J. M. (1995) · BMJ · doi:10.1136/bmj.311.7003.485 · Cited by 1,946
Sample Size Tables for Clinical Studies
Machin, D., Campbell, M. J., Tan, S. B., & Tan, S. H. (2008) · Wiley eBooks · doi:10.1002/9781444300710 · Cited by 1,336
Clinical Trials a Practical Approach
Pocock, S. J. (2013) · Thammasat University Digital Collections · Cited by 213
Phase II trial of thalidomide with chemotherapy and as maintenance therapy for patients with poor prognosis small-cell lung cancer
Lee, S. M., James, L. E., Büchler, T., Snee, M. P., Ellis, P., & Hackshaw, A. K. (2007) · Lung Cancer · doi:10.1016/j.lungcan.2007.08.032 · Cited by 36
Self-citation
Two randomised phase III, double blind, placebo controlled trials of thalidomide in patients with advanced non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC)
Lee, S. M., Rudd, R., Woll, P. J., Ottensmeier, C. H. H., James, L. E., Gower, N. H., Spiro, S. G., Jitlal, M., & Hackshaw, A. K. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2008.26.15_suppl.8045 · Cited by 12
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“Third, the study sample was small ( N = 31), which reduces statistical power and the precision of effect size estimates, and limits the generalizability (Hackshaw, 2008).”
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“While this exploratory analysis provides valuable preliminary insights into the microbiota profiles of visually impaired individuals, the sample size limits the generalizability and statistical power of our findings [54, 55].”
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“Though RCTs are often viewed as the gold standard for clinical evidence to determine the true relative efficacy of an intervention,((37)) the inherent limitations of RCTs could be exacerbated by biases in design, recruitment, sample populations, and data analysis that are inevitable in real-world studies.((38)) Inadeq…”
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“Results from this study should be interpreted with caution, as associations may have been over- or under-estimated [46], the full survey was not validated, and participant self-selection [47] may influence findings.”
Result
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“Getting districts to participate in the study proved to be difficult and thus the sample size is small, which may overemphasize the magnitude of the results and limits the level of sophistication of the statistical analysis (Hackshaw, 2008).”
Background
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“Usually small sample sizes do not yield reliable or precise estimates which therefore is usually a common indication to not make a strong conclusion from the trial’s intervention and findings (47).”
Background
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Samaraee, A. A., & Samier, A. (2020) · Qatar medical journal · doi:10.5339/qmj.2020.23 · Cited by 4
“Studies of a small sample size, such as ours, tend to have a very wide confidence interval resulting in a statistically less reliable and valid outcome because the true prevalence lies anywhere between the high and low values of the confidence interval.(28) Researchers know that statistical analysis cannot be properly…”
Background
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“The small size of the study provides limitations.(16) The incidence of post-CEA haematoma is not easy to ascertain reliably.”
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“The small size of students is suitable for an exploratory or hypothesis-generating study (Hackshaw, 2008).”
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“As a pilot program drawing upon a model that has not been studied extensively in extant literature, it is our hope that the findings here will prompt further study (Hackshaw, 2008) of how learning communities can enrich criminal justice student learning outcomes.”
Background
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“Insignificancies observed in different findings of the current trial can possibly be due to either the length of the study or the number of patients included [31].”
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“Small studies can also produce false positive results (Hackshaw 2008).”
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“Another limitation is that this study was conducted with a limited number of participants, which might have enhanced the possible influence of individual preferences regarding protocol application and personalization on the results [64].”
Background
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“many are small and sparsely labeled due to regulatory challenges, ethical considerations [17], data availability (e.”
Background
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“Larger-scale studies are needed to validate these results and provide a more comprehensive assessment of the wristband’s effectiveness [14].”
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P.054 Gender bias in randomized, controlled trials of pharmacological interventions for attention deficit hyperactivity disorder
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Authors: Hackshaw, A.
Affiliations: Cancer Research UK (GB)
Corresponding author: Hackshaw, A.
ORCID: Hackshaw, A.
Venue: European Respiratory Journal
Publisher: European Respiratory Society (ERS)
Published: 2008-10-31
Volume: 32
Issue: 5
Pages: 1141-1143
ISSN: 0903-1936 (ISSN-L)
1399-3003
DOI: 10.1183/09031936.00136408
OpenAlex: W2097412619
Cited by: 496
References: 7
Citations by year: 2026: 29 · 2025: 36 · 2024: 37 · 2023: 56 · 2022: 57 · 2021: 86 · 2020: 51 · 2019: 38 · 2018: 24 · 2017: 20 · 2016: 20 · 2015: 17 · 2014: 9 · 2013: 5 · 2012: 5
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: European Respiratory Journal (publishedVersion)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
Topics: Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Keywords: small sample size, sample size determination, confidence intervals, statistical power, effect size, clinical research design, research limitations, prevalence estimation
MeSH terms: Antineoplastic Agents, Clinical Trials as Topic, Data Interpretation, Statistical, Diet Therapy, Humans, Lung Neoplasms, Research Design, Risk Factors, Smoking, Thalidomide, Time Factors, Reproducibility of Results, Weight Loss, Sample Size, Small Cell Lung Carcinoma

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