Current controversies: Null hypothesis significance testing

Abstract Traditional null hypothesis significance testing (NHST) incorporating the critical level of significance of 0.05 has become the cornerstone of decision‐making in health care, and nowhere less so than in obstetric and gynecological research. However, such practice is controversial. In partic...

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Main Authors: Philip M. Sedgwick, Anne Hammer, Ulrik Schiøler Kesmodel, Lars Henning Pedersen
Format: Article
Language:English
Published: Wiley 2022-06-01
Series:Acta Obstetricia et Gynecologica Scandinavica
Subjects:
Online Access:https://doi.org/10.1111/aogs.14366
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author Philip M. Sedgwick
Anne Hammer
Ulrik Schiøler Kesmodel
Lars Henning Pedersen
author_facet Philip M. Sedgwick
Anne Hammer
Ulrik Schiøler Kesmodel
Lars Henning Pedersen
author_sort Philip M. Sedgwick
collection DOAJ
description Abstract Traditional null hypothesis significance testing (NHST) incorporating the critical level of significance of 0.05 has become the cornerstone of decision‐making in health care, and nowhere less so than in obstetric and gynecological research. However, such practice is controversial. In particular, it was never intended for clinical significance to be inferred from statistical significance. The inference of clinical importance based on statistical significance (p < 0.05), and lack of clinical significance otherwise (p ≥ 0.05) represents misunderstanding of the original purpose of NHST. Furthermore, the limitations of NHST—sensitivity to sample size, plus type I and II errors—are frequently ignored. Therefore, decision‐making based on NHST has the potential for recurrent false claims about the effectiveness of interventions or importance of exposure to risk factors, or dismissal of important ones. This commentary presents the history behind NHST along with the limitations that modern‐day NHST presents, and suggests that a statistics reform regarding NHST be considered.
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spelling doaj-art-e75f7342d6374b93b89f8480017ac1ed2025-08-20T03:30:57ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122022-06-01101662462710.1111/aogs.14366Current controversies: Null hypothesis significance testingPhilip M. Sedgwick0Anne Hammer1Ulrik Schiøler Kesmodel2Lars Henning Pedersen3Institute for Medical and Biomedical Education St George's, University of London London UKDepartment of Obstetrics and Gynecology Gødstrup Hospital Gødstrup DenmarkDepartment of Obstetrics and Gynecology Aalborg University Hospital Aalborg DenmarkDepartment of Clinical Medicine Aarhus University Aarhus DenmarkAbstract Traditional null hypothesis significance testing (NHST) incorporating the critical level of significance of 0.05 has become the cornerstone of decision‐making in health care, and nowhere less so than in obstetric and gynecological research. However, such practice is controversial. In particular, it was never intended for clinical significance to be inferred from statistical significance. The inference of clinical importance based on statistical significance (p < 0.05), and lack of clinical significance otherwise (p ≥ 0.05) represents misunderstanding of the original purpose of NHST. Furthermore, the limitations of NHST—sensitivity to sample size, plus type I and II errors—are frequently ignored. Therefore, decision‐making based on NHST has the potential for recurrent false claims about the effectiveness of interventions or importance of exposure to risk factors, or dismissal of important ones. This commentary presents the history behind NHST along with the limitations that modern‐day NHST presents, and suggests that a statistics reform regarding NHST be considered.https://doi.org/10.1111/aogs.14366null hypothesis significance testingstatistical significancep < 0.05clinical significance
spellingShingle Philip M. Sedgwick
Anne Hammer
Ulrik Schiøler Kesmodel
Lars Henning Pedersen
Current controversies: Null hypothesis significance testing
Acta Obstetricia et Gynecologica Scandinavica
null hypothesis significance testing
statistical significance
p < 0.05
clinical significance
title Current controversies: Null hypothesis significance testing
title_full Current controversies: Null hypothesis significance testing
title_fullStr Current controversies: Null hypothesis significance testing
title_full_unstemmed Current controversies: Null hypothesis significance testing
title_short Current controversies: Null hypothesis significance testing
title_sort current controversies null hypothesis significance testing
topic null hypothesis significance testing
statistical significance
p < 0.05
clinical significance
url https://doi.org/10.1111/aogs.14366
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AT ulrikschiølerkesmodel currentcontroversiesnullhypothesissignificancetesting
AT larshenningpedersen currentcontroversiesnullhypothesissignificancetesting