Multi-centre trial = better than single-centre?

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Multi-centre clinical studies are generally considered superior to single-centre studies due to several key factors. The statistical quality of a study improves with an increased number of participants, as errors in counting statistics decrease with larger sample sizes. Multi-centre trials typically yield larger participant numbers, enhancing statistical power and reducing biases that may arise from a single institution's demographic. However, challenges such as maintaining protocol control across different centres exist, particularly in fields like radiation oncology, where inter-institutional differences must be managed. While intuitively understood, the advantages of multi-centre studies are supported by statistical principles that emphasize the importance of diverse and representative samples to avoid sampling bias. This evidence can be crucial for grant applications seeking to justify the design of multi-centre trials.
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Hi all,
My first post here, I've been asked to find out for a friend - are there any good papers which show that a multi-centre clinical study/trial is better than a single-centre one? She believes the evidence says multi-centres are, but wants proof for a grant application.
Thanks!
 
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That sounds like the kind of thing that is intuitively rather obvious, but you would likely run into a lot of problems if you were to attempt to quantify it.

From basic statistics though, one could argue that the quality of a study improves as N increases because errors in counting statistics are inversely proportional to the root of N. And a multi-institutional study is likely to have more numbers than a single institutional one.

Further, one might argue that biases are likely to be reduced across difference centres.

One issue that comes up is protocol control. In radiation oncology, for example, centres that participate in clinical trials are usually required to verify their dosimetry calibrations through a third party so as to control for inter-institutional differences.
 
I think Choppy is spot on here. I would be a bit surprised if you needed to cite research about designing a multi center study. It is more or less the statistics which favor such designs in order to recruit an appropriate amount of participants to increase statistical power (http://en.m.wikipedia.org/wiki/Statistical_power) and to avoid sampling bias (http://en.m.wikipedia.org/wiki/Sampling_bias). The former may not be the most important factor if the study will be performed in a large city where you can recruit enough subjects to detect some minimum change in the end points being studied. However even if you can recruit enough subjects to get the appropriate statistical power, the sample that you choose may not be representative of the entire population.
 
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