OBJECTIVE: Factorial designs can allow efficient evaluation of multiple treatments within a single trial. We evaluated the design, analysis, and reporting in a sample of factorial trials.
STUDY DESIGN AND SETTING: Review of 2x2 factorial trials evaluating health-related interventions and outcomes in humans. Using MEDLINE, we identified articles published between January 2015 and March 2018. We randomly selected 100 articles for inclusion.
RESULTS: Few trials (22%) provided a rationale for using a factorial design. Only 63 trials (63%) assessed the interaction for the primary outcome, and 39/63 (62%) made a further assessment for at least one secondary outcome. 12/63 trials (19%) identified a significant interaction for the primary outcome, and 16/39 trials (41%) for at least one secondary outcome. Inappropriate methods of analysis to protect against potential negative effects from interactions were common, with 18 trials (18%) choosing the analysis method based on a preliminary test for interaction, and 13% (n=10/75) of those conducting a factorial analysis including an interaction term in the model.
CONCLUSIONS: Reporting of factorial trials was often suboptimal, and assessment of interactions was poor. Investigators often used inappropriate methods of analysis to try to protect against adverse effects of interactions.