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Statistical Methods in Medical Research
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Article

Estimating dose–response effects in psychologicaltreatment trials: the role of instrumental variables

Mohammad Maracy1* and Graham Dunn2

1 Biostatistics, Health Methodology Research Group, School of Community Based Medicine, University of Manchester, UK (Current address: Biostatistics and Epidemiology Group, School of Health, Isfahan University of Medical Science, Iran
2 Biostatistics, Health Methodology Research Group, School of Community Based Medicine, University of Manchester, UK

* To whom correspondence should be addressed.


   Abstract

We present a relatively non-technical and practically orientated review of statistical methods that can be used to estimate dose–response relationships in randomised controlled psychotherapy trials in which participants fail to attend all of the planned sessions of therapy. Here we are investigating the effects on treatment outcome of the number of sessions attended when the latter is possibly subject to hidden selection effects (hidden confounding). The aim is to estimate the parameters of a structural mean model (SMM) using randomisation, and possibly randomisation by covariate interactions, as instrumental variables. We describe, compare and illustrate the equivalence of the use of a simple G-estimation algorithm and two two-stage least squares procedures that are traditionally used in economics.

First published on November 26, 2008
Statistical Methods in Medical Research 2008, doi:10.1177/0962280208097243


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