Statistics in Physiotherapy Research
Statistics in Physiotherapy Research
Basic Statistics
• Types of graphs
• Correlational statistics
• Tests of reliability
• Inferential statistics
o Hypothesis testing
o P-value
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Overview
• Types of graphs
• Correlational statistics
• Tests of reliability
• Inferential statistics
o Hypothesis testing
o P-value
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Population, Sample, and Observations
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Variables
• Qualitative
Variables which take values that cannot be ordered in a logical or natural way. Example:
1. The color of the eyes.
2. The name of a political party.
3. The type of transport used to travel to work.
• Quantitative
Variables that represent measurable quantities. The values which these variables can
take can be ordered in a logical and natural way. Examples:
1. Size of shoes.
2. Price for houses
3. Number of semesters studied.
4. Weight of a person.
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Variables
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Variables
popula&on 𝛀
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Types of Statistics
• Typical indicators for descriptive statistics are the central tendency and the variability
• The central tendency provides information about the characteristics of a sample
• The central tendency is usually expressed in mean or median values
• The variability describes the distribution of values around the mean
• The standard deviation is usually used as an indicator of variability in a sample
• For population measures, the standard error and 95% confidence intervals are
available
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Types of Graphs?
When to use what type of figure?
Compare the training Performance development Proportions of Achilles Relation between jump
effects in the intervention from pre-test to post-test tendon ruptures in height and 20m sprint time
and control group
different sports
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Types of Graphs
That’s the reason why we are going to talk about few types of graphs 😃
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Types of Graphs: Pie Charts
• PIE CHART
Used to visualize the absolute and relative frequencies of nominal (categorical) and ordinal
variables.
Luxembourg Residents Nationality
Luxembourg
Residents %
Nationality
LUX 53,3
PRT 16,2
FRANCE 7,2
ITA 3,5
BEL 3,4
GER 2,2
Other EU 7,3
non-EU 6,9 LUX PRT FRANCE ITA BEL GER Other EU non-EU
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Types of Graphs: Bar Charts
• BAR CHART
Used to visualize the absolute and relative frequencies of observed values of a variable. Can
be used for nominal and ordinal variables.
Favorite kind of
People
movie
Comedy 30
Action 95
Romance 10
Drama 75
SciFi 55
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Types of Graphs: Histograms
• HISTOGRAM
Used to visualize the distribution of values of continuous variables.
M&M as favorite candy
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Types of Graphs: Histograms vs Bar Charts
Gaps
No gaps
Bar Chart
Histogram
LU:NEX https://www.forbes.com/sites/naomirobbins/2012/01/04/a-histogram-is-not-a-bar-chart/#3a4cd86b6d77 15
Types of Graphs: Line Graphs
• LINE GRAPHS
Used to visualize quantitative data collected over a specific topic and a specific time interval.
Data points are connected by a line, and they represent the observations.
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Types of Graphs: Boxplots
• BOXPLOTS
Used to visualize the distribution of data based on a five number summary (“minimum”, first
quartile (Q1), median, third quartile (Q3), and “maximum”).
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Types of Graphs: Scatter Plots
• SCATTER PLOTS
Used to visualize the relationship between two quantitative variables measured on the same
individuals.
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Other forms of data presentation
• TABLES
Used to present results from research, e.g., within or between-group comparisons.
Chan MC, et al. Does Kinesiology Taping Improve the Early Postoperative Outcomes in Anterior Cruciate Ligament
Reconstruction? A Randomized Controlled Study. Clin J Sport Med. 2017 May;27(3):260-265.
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Other forms of data presentation
• TABLES
Or used to show
participants’
demographic
or clinical
characteristics.
Malisoux L, et al. Can parallel use of different running shoes decrease running-related injury risk?
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Scand J Med Sci Sports. 2015 Feb;25(1):110-5. 21
Outliers
• What is an outlier?
An outlier represents a value distant from the rest, due to variability or error
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Outliers
1) Q1 − 1.5*IQR
2) Q3 + 1.5*IQR. IQR = Q3 - Q1
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Outliers
• Exercise!
Consider the database “BPT12_Simple_Data.xlsx” in StudyNet
To answer:
1) Is the maximal value of Hand Grip strength considered as an outlier?
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Exercises
• Please consider the studies 3, 4 and 6 in StudyNet, and answer the following
questions:
1) Is Figure 1 of study 3 a bar graph or a histogram? Justify.
6) In study 4, what is the most common type of injury, and area affected, in Alpine skiing?
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Overview
• Types of graphs
• Correlational statistics
• Tests of reliability
• Inferential statistics
o Hypothesis testing
o P-value
LU:NEX 26
Correlational Statistics
• What is correlation?
Correlation is used to test the relationship between variables (quantitative or categorical).
It is a measure of how things are related.
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Correlational Statistics
When variables are qualitative ordinal scale variables, then Spearman correlation coefficient
can be used as an alternative to the Pearson coefficient
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Correlational Statistics
Height(cm) Weight(kg)
• Example 158 48 Height vs Weight
162 57
100
163 57 R² = 0.793
170 60
154 45 90
167 55
177 62
80
170 65
179 70
170 68 70
180 80
182 81
60
r2 = 0.79
155 60
157 58 𝑟 = 0.79 = 0.89
166 63 50
177 80
174 79
40
169 70
140 150 160 170 180 190 200
188 88
179 80
172 77 Adding a trendline helps to show the tendency behavior
181 88 between variables
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Correlational Statistics
• 0 à no correlation
• 1 à positive strong correlation
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Correlational Statistics
• Exercise!
Determine the type (e.g., positive or negative) and magnitude of the correlation
between (considering the database “BPT12_Simple_Data.xlsx” in StudyNet):
1) BMI and Weight.
2) Weight and Height.
LU:NEX 32
Overview
• Types of graphs
• Correlational statistics
• Tests of reliability
• Inferential statistics
o Hypothesis testing
o P-value
LU:NEX 33
Reliability Tests
Percent Agreement or k-statistics (Cohen’s k), is the most used with categorical variables.
It determines how well an observation produces the same value, for the same patient, on
repeated measurements (ideally 2 examiners)
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Reliability Tests
• Example of a table
Percent agreement across multiple data collectors (fictitious data).
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276-82.
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Reliability Tests: % of Agreement
total
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Reliability Tests: Crosstabulation
• Crosstabulation (crosstab)
The purpose of crosstabulation is to show in tabular format the relationship between two or
more categorical variables. Categorical variables include those in which distinct categories
exist such as gender, ethnicity, place of residence, responses, grades, and many more.
cells
Range of k: −1 to +1
k = 0 è represents the amount of agreement that can be expected from random chance.
k = 1 è represents perfect agreement between the raters.
k = -1 è represents great disagreement among raters (low negative k are seen as no agreement).
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276-82.
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Reliability Tests: Cohen’s Kappa Statistics
McHugh ML. Interrater reliability: the kappa statistics. Biochem Med (Zagreb). 2012 Oct; 22(3): 276–282 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900052/
Hunt RJ. Percent agreement, Pearson's correlation, and kappa as measures of inter-examiner reliability. J Dent Res. 1986 Feb;65(2):128-30.
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Reliability Tests: Coefficient of Variation
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Reliability Tests: Coefficient of Variation
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Reliability tests: ICC
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Other Tests of Reliability
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Other Tests of Reliability
Furlan L, and Sterr A. The Applicability of Standard Error of Measurement and Minimal Detectable Change to Motor Learning
Research-A Behavioral Study. Front Hum Neurosci. 2018 Mar 22;12:95.
Beninato M., and Portney L.G.. Applying Concepts of Responsiveness to Patient Management in Neurologic Physical Therapy. From
JNPT 2011
See Table 2 of the paper of Neto et al (2015) in CANVAS
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Other Tests of Reliability
-MDC95
• Exercise:
Consider the Excel dataset “Reliability” in StudyNet:
1) Determine the % of agreement and the Cohen’s Kappa for the SLR test
2) Determine the coefficient of variation for the shoulder abduction measurements
LU:NEX 46
Revision Exercise
• Exercise:
Consider the Excel dataset “BPT12_Simple_Data.xlsx”:
LU:NEX 47
Overview
• Types of graphs
• Correlational statistics
• Tests of reliability
• Inferential statistics
o Hypothesis testing
o P-value
LU:NEX 48
Inferential Statistics
• Inferential statistics:
Inferential statistics refers to the generalization of results from a sample of participants to the
whole population.
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Inferential Statistics: Hypothesis Testing
• Hypothesis testing:
Hypothesis testing is one of the most used methods of inferential statistics.
Before going into the hypothesis testing, let us understand the following example:
Imagine the mean score of this class is 35 marks out of 100. I am not happy with this, and I
decide that extra classes on statistics are necessary in order to improve the performance of
the class. After taking the extra classes, the class scored an average of 40 marks out of 100.
How can we be sure whether the increase in marks is a results of the extra classes or is it just
random?
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Inferential Statistics: Hypothesis Testing
• Hypothesis testing:
Hypothesis testing determines the probability (p-value) of difference, or non-difference,
between groups.
The p-value provides evidence against the null hypothesis (H0) stated;
The smaller p-value is, the stronger the evidence against H0 and in favor of the alternative
hypothesis (Ha).
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Inferential Statistics: Hypothesis Testing
Alternative hypothesis - Ha
à Runners using more than one pair of shoes have a lower risk of sustaining a RRI than runners
who use only one pair of shoes
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Inferential Statistics: Hypothesis Testing
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Pearson’s Chi-square Test
The test compares the Observed (real) values with the Expected. For that, the expected
values must be calculated!
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Pearson’s Chi-square Test
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Pearson’s Chi-square Test
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Pearson’s Chi-square Test
LU:NEX 58
Pearson’s Chi-square Test
• Exercise:
Consider the Excel dataset “BPT12_Simple_Data.xlsx”:
1) Determine the association in distribution between the variables Sex and Height (in groups
of 20cm).
2) Determine the association in distribution between the variables Sex and BMI (in groups of
5).
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Student’s T-tests
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Student’s T-tests
• Let us understand better the concept of a T-test by breaking some spaghetti (no offense to Italians J)
• Research question:
→ Would a single spaghetti from two different brands break in
the same way? Or
→ How many pieces we obtain from breaking a single spaghetti
from two different brands?
• Hypotheses:
→ Null: The spaghetti from the two different brands breaks in the
same way.
→ Alternative: The spaghetti from the two different brands
breaks differently from one another.
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Student’s T-tests
• Student’s T-test:
The t test tells us how significant the differences between group means are.
Then, there are three main questions that we should ask about the difference between groups (or
conditions, or the sample and population means):
1. Can I be certain that the difference between groups (or between conditions, or between the
sample mean and population mean) is not due to random chance?
2. How big is the difference?
3. Is this difference important?
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Student’s T-tests
• Student’s T-test:
Different variance
Difference between the means
within the sample
of the groups (same average)
𝐴𝑣𝑔! 𝐴𝑣𝑔"
LU:NEX
Consider the variability 64
Student’s T-tests
• Student’s T-test:
Difference between the means
𝑠𝑖𝑔𝑛𝑎𝑙 𝑑𝑖𝑓𝑓𝑒𝑟𝑒𝑛𝑐𝑒 𝑏𝑒𝑡𝑤𝑒𝑒𝑛 𝑔𝑟𝑜𝑢𝑝 𝑚𝑒𝑎𝑛𝑠
of the groups 𝑡= =
𝑛𝑜𝑖𝑠𝑒 𝑣𝑎𝑟𝑖𝑎𝑏𝑖𝑙𝑖𝑡𝑦 𝑜𝑓 𝑔𝑟𝑜𝑢𝑝𝑠
𝐴𝑣𝑔% − 𝐴𝑣𝑔&
𝑡=
𝐴𝑣𝑔! 𝐴𝑣𝑔"
𝑠%! 𝑠&!
+
𝑁% 𝑁&
where,
s2 è variance
N è sample size
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Variability 65
Student’s T-tests
𝑠𝑖𝑔𝑛𝑎𝑙 𝑑𝑖𝑓𝑓𝑒𝑟𝑒𝑛𝑐𝑒 𝑏𝑒𝑡𝑤𝑒𝑒𝑛 𝑔𝑟𝑜𝑢𝑝 𝑚𝑒𝑎𝑛𝑠
• Student’s T-test: 𝑡= =
𝑛𝑜𝑖𝑠𝑒 𝑣𝑎𝑟𝑖𝑎𝑏𝑖𝑙𝑖𝑡𝑦 𝑜𝑓 𝑔𝑟𝑜𝑢𝑝𝑠
t-value
(the degree to which the difference can be explained by the group)
Assume Ha Assume H0
The difference is significant The difference is NOT significant
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Student’s T-tests
• Degrees of freedom
Sample size
𝑑𝑓 = 𝑁 − 𝑃
Number of parameters
or relationships
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Student’s T-tests
• Or we can do it in excel
1) Manually calculate the average, standard deviation, variance and t-value è check in the
LU:NEX 69
Student’s T-tests
• Exercise:
Consider the Excel dataset “BPT12_Simple_Data.xlsx”, and determine if there are differences
between the means of:
LU:NEX 70
Student’s T-tests
• Exercise:
Consider the Excel dataset “BPT12_Simple_Data.xlsx”:
Do people with overweight have higher Heart Rate compared with people with non-
overweight people ?
LU:NEX 71
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