P values and NNTs: What they are and their roles in critical assessment

Richard B. Evans, PhD

Editor-in-Chief, Royal College of Veterinary Surgeons (RCVS) Knowledge Veterinary Evidence; University of Missouri

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The elevator pitch for a canine orthopedics research paper might go something like this: “We did a blinded RCT on 100 dogs comparing TTA to Tightrope and got statistical significance on PVF.”

That single-sentence summary reports two design features, the study design and sample size, and it gives two results, the statistical significance on an outcome variable. Understanding statistical significance (P values) and making outcomes meaningful (NNTs) are the topics of this talk.

P values, which are used to identify real results, are ubiquitous in veterinary research, but their basic interpretation (especially P>0.05) is often misunderstood and incorrectly applied. Moreover, researchers often P hack their results, teasing out a few P<0.05 among a forest of P>0.05, giving the impression that results are real when they probably aren’t.

It’s the job of critical appraisers, and a central part of this talk, to understand what P values mean in the larger context of determining if the results in an article are real or due to chance.

P values are one side of the outcomes coin. The other side is the clinical importance of the results. For example, are group differences large enough to effect changes in practice patterns among clinicians? Often results are described in terms of means of outcome variable: the mean peak vertical force, the mean body condition score, and so on. But is a change of 0.5 in BCS meaningful? That depends.

Numbers needed to treat (NNTs) are way of summarizing outcomes in a way that is clinically useful. I’ll describe NNTs and give examples when they are needed and how to calculate them.


evidence-based veterinary medicine (EBVM), Critically Appraised Topic (CAT), p-value, Number Needed to Treat/Harm (NNT/NNH), critical assessment

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