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Application Of ANOVA in Medical

Aida Nabilah binti Sadon, loke Su Leng
Nurul Nadia Binti Selamat, Nur Fatihah Binti Zulkifli
Audrey Err Kiat Joo ∗

University Tun Hussein Onn Malaysia

May 10, 2019


This article is written about the application of analysis of variance (ANOVA) in medical research.
Credit is given to all the writers and producers of all references that gave us knowledge and
finding to complete this article. Journal is our main references but articles and web sites that have
the related content also help us a lot. ANOVA is likely to be used in the medical research because
it is most effective way to compare the means, as we can see in the one – way ANOVA, two – way
ANOVA and so on that used to compare means between groups that we interested to studies.
It is preferred model in industries like pharmaceuticals and medical research because of ability
to test more than two samples simultaneously. In this article is about One – Way ANOVA, Two
– Way ANOVA, Three – Way ANOVA, Factorial ANOVA, Repeated ANOVA, P – spline model,
Circular ANOVA, and Multivariate ANOVA. Those components are used to be found and helping
in medical research and studies.

I. Introduction results, which also known as “multiple com-
parison analysis” tests.There frequently used
tatistically analysis is widely used in

test is are Tukey,The Fisher Least Significant
helping inteprating , analysing a typical Difference (LSD) method , which is used to
research to gain a professionally anal- compare pairs of treatment means and the Dun-
ysed result. In todays world, there many type nett’s test is used to compare treatment means
of softwares such as MINITAB, SSPS , R and with a control. Nowadays , the application of
so on can help to analysis the data faster and multiple comparison tests in medical research
easier . For example, hypothesis testing can has increased , and this help many medical
be tested by only type in the data in the soft- researchers to get a critcical review for the re-
ware and the analysed data will shown and seach. The objective of of the article was to get
get the intepreted result without calculate it a specific and deeply investigate the applica-
manually which is time wasting.ANOVA is tion of ANOVA helps in the medical field and
known as Analysis of Varience which is widely how to avoid the misused of the ANOVA to get
used in analysis data and used to determine the information which will mislead the reader.
whether there are any statistically significant
differences between the means of more inde-
II. Methods
pendent group.In simple words, by comparing
the means of two or more samples by using
We started with searching some journals and
the F distribution , we can get the result which
articles through some websites that were re-
is the data is significantly effect one and an-
lated to the general topic which is ANOVA
other or not. By conducting ANOVA , there
in medical research. Then, we analyze and
are three assumptions need to follow : the
sorted out the journals and articles that related
data must be normally distributed , the sam-
to the more specific scope which is the applica-
ples data must be independents one and each
tion of analysis of variance (ANOVA) in medi-
others and there is no muticollinearity exist
cal research. The journals were schemed and
in the model.The analysis of varience have
scanned one by one in order to point out the
a wide application , especially in the medi-
applications of ANOVA in medical research.
cal field.However , ANOVA cannot provide a
After the points had been sorted out, we para-
more detailed infomation on the differences
phrased, combined and summarized into some
amongst the study groups. So , the post hoc
simpler points. We are using Texmaker appli-
test is introduced, which will provide a more
cation to organize and present the topic. Tex-
detailed and specific information for ANOVA
maker is a free, modern and cross-platform
∗A thank you or further information open-source Latex editor with an integrated

pdf viewer which is entirely a Qt application. can be computed by using ANOVA method.
It also integrates many tools needed to develop In the analysis, there are two variation in the
documents with Latex. We conduct and run response which are variation attributable to
this application under the supervising of a lec- differences between the classification variables
turer. and variation attributable to random error. By
using this analysis, the significance of the clas-
sification effects can be determine.ANOVA test
III. Results
is used to study the influence of adding garlic

1. One - way ANOVA for the One-Way Re- and thyme and their combination on immune

search, it is has applied in quite a number of response and some blood parameters in broiler.

medical research such as optometric research. The data collected from the experiment was

It can be used to test differences between sev- carried out in a complete randomized design.

eral different groups of treatment that making By using ANOVA analysis, the significant dif-

multiple comparisons between groups means ferences among the means were determined by

using t-test. It also can be applied in analysing using significant level of p less than 0.05.

the ischemic heart real dataset suggest that, 2. Factorial ANOVA Factorial designs for
after proper manipulation. The resting electro- clinical trials are often used in medical, dental,
diagram (ECG) signals can be used as an effec- and orthodontic research. It is assess two or
tive tool in the clinical ischemic heart screening, more interventions simultaneously and main
without the need of the further stress test as the advantage of this design is its efficiency in
current standard procedure. One-Way ANOVA terms of sample size as more than one inter-
can be widely used in medical field, one of the vention may be assessed on the same partic-
examples is ANOVA can be used to study how ipants. This design is the only design that
length of stay of patients can be reduced. in allows testing for interaction and large sam-
the journal "Quality Quandaries : Health CAre ple size required if specific study want to be
Quality - Reducing the Length of patients Stay further because the study is looking for the
At a Hospital", ANOVA test is used repeat- interaction effect. By using this design also
edly to check the factor that may influence the reduced the cost and resources and manage-
length of stay and eliminate factors that do not. ment needs due to the fact that smaller sample
ANOVA also can be used to find the smallest will be required compared with two separate
set of genes that can ensure highly accurate trials. Advantages in using factorial ANOVA
classification of cancer from micro array data is allow two or more parameters to be assessed
by using supervised machine learning algo- at the same time in the same time in the same
rithms. The importance ranking of each gene population simultaneously. More efficient tri-

als will be created in terms of sources include peated measures the ANOVA power curves
the sample size compare to separate trials after based on the estimated covariance also quite
assessment of each parameter. For example frequently used by choosing a sample size for
factorial design applied in orthodontic treat- a repeated measures ANOVA design. Medical
ment especially dental orthodontic research. imaging and many more other types of health-
But, still there disadvantages which is, it is care research often used for repeated measures
time consuming because extra time may re- ANOVA.
quired when 2 treatments applied at the same 4. P-SPLINE In spatial and spartio - tem-
time. Besides that, process in analyzing the poral model become an important area of re-
data and randomization might be a little more search in many fields such as disease map-
complex because participants need to be allo- ping, epidemiology and environmental stud-
cated to four arms either in one or two stage. ies that may have consist of large size of data.
For the appropriateness and acceptability or P-spline is an ANOVA-type interaction mod-
tolerance of combined interactions on biologic els for spatio – temporal smoothing and it is
and scientific grounds must be explored and one type of the analysis of variance model
determined. Plus, if interaction is expected that allowing consideration of interaction terms
but there is no intention to detect the interac- which can be decomposed as a sum of smooth
tion, the factorial design has no sample size functions similarly as an ANOVA decomposi-
advantages compared with 2-separate two-arm tion. Besides those, the ANOVA-type P-spline
parallel trials. Model can extrapolating cancer mortality by
3. Repeated- measures ANOVA For the re- having the trends which can be very valuable
peated measures ANOVA, the mean difference as a tool to predict cancer burden. This is
comparison procedures are very widely used in because the P-spline models can split the pre-
mostly biological and medical research. From dictions into components representing region-
an article in Archives Of Physical Medicine and specific features and characteristics common
Rehabilitation as they analysed the incurred of to the whole country. 5. Multivariate ANOVA
spinal cord injury(SCI) as children and adoles- Multivariate analysis of variance (MANOVA)
cents which is a medical research amongst the is an extension of the univariate analysis of
youngsters. Next, like clinical chemistry ex- variance (ANOVA). In multivariate analysis
periment, Cardiac Tropponin I was measured under the name of multilevel modelling, this
repeatedly overtume at different hours to find method is applied in clinical metabolic profil-
out its minor elevation was association with ing studies by employed two clinical metam-
cardiovascular diseases and death rate after a bolomics datasets as the testing grounds. It is
month. Next, the confidence regions for re- also applied in study in relationships between

smoking alcohol consumption, and HRQoL applicability and tractability are not fully as-
(Health – related quality of life) in different sessed as for their linear counterpart. It is used
groups of people, reports on physical educa- to assess the occurrence of the fever in differ-
tion and sports students who regularly par- ent year, transformed linear time in months
ticipate in sports activities seem to be miss- to circular time and convert it to radian form
ing. Therefore, this study is about to com- since directional analysis is best suited to ra-
pare HRQoL among physical education and dian measures. The main assumption for circu-
sports students with regard to the consump- lar ANOVA is all r-independent samples must
tion of alcohol and smoking. Other than that, come from von Mises distribution with equal
MANOVA also used to test three hypothesises directional means and equal concentration pa-
for mental health scales and three hypothesises rameters. But in real life, this assumptions may
for physical health scales. To determine either not be satisfied, therefore alternative tests for
the hypothesis are accepted or not is by using circular ANOVA must be considered in order
Pillias Trace and F value. as usual if p-value to avoid those assumptions or replace circular
is less than 0.05, it can conclude that the dif- ANOVA if the assumptions are not satisfied. It
ferences between the means are statistically is called circular in R package repository. Cir-
significant. For another example of application cular data is obtained by measuring directions
of MANOVA is in test for gene set analysis or arrival times of subjects with respect to a
which it is designed to identify genes sets con- reference point on the unit circle. For example,
sisting of differentially expressed genes for two if the arrival time of patient to an emergency
or more experimental conditions. room is the main interest, then the data can be

6. Circular ANOVA Circular ANOVA is ap- recorded in 24-hours clock notation and can

plied to circular data which is measured in later be converted to the angles on the unit cir-

angles or directions on the unit circle. Because cle. Other than that, it is used Crimean-Congo

circular data have a periodical nature, the cal- hemorrhage fever cases in each month as a

culation of descriptive and inferential statistics dependent linear variable and time in radian

works different than in linear statistics. Cir- as a circular explanatory variable. The differ-

cular ANOVA is one-way analysis of variance ent descriptive statistics for the data and apply

method to test the equality of mean directions circular ANOVA on them are calculated and

in circular data analysis but it is requires some found very sensible methods with few draw-

assumptions. In particular, it is gaining accep- backs. The data collection methods have been

tance by many academicians to assess scenar- described in detail, it is collected monthly from

ios that have circularity in their nature. There the district for the particular years period. In

are few stochastic circular models, but their this study, circular ANOVA were analysed to

assess whether there are statistically significant
differences between years of the distribution in
the country in the that particular years.

IV. Conclusion

In conclusion, medical research have used

many kind of method in statistic to help their
research with low cost and less time consum-
ing because it is all statistic do. ANOVA have
been applied in many field nowadays and med-
ical field is not excepted. Statistician is needed
for the medical research,it is because method
that used in the research need professional to
handle it and explained the results given from
the method.