Imagine a study spreadsheet with each participant’s symptom score at discharge and again 30 days later. It can answer different questions: whether the two care groups differ on day 30, whether the same people improved, or whether improvement differed between groups. Before choosing a statistical test, state which question you mean and whether the measurements are independent or repeated. That choice determines the method; the estimate, its uncertainty, and the study limits determine what you may conclude.

A concrete reason to pause

Thirty records, one vague question, several incompatible answers#

AURORA-30 is a wholly synthetic teaching dataset: 30 fictional records constructed for methods training. It contains no real patients, institutions, interventions, or clinical results, and nothing calculated from it is clinical evidence. In the scenario, adults are followed for 30 days after a standardized discharge program or usual care. A colleague sends baseline and day-30 symptom scores and asks, “Did the program help?” It is tempting to open a test menu and compare whichever two numeric columns are visible.

But the rows do not decide the question. A between-group contrast at day 30 compares program with usual care; a baseline-to-day-30 contrast asks whether the same people changed over time; a between-group comparison of change asks whether those trajectories differed. All three can produce correct arithmetic and still support different sentences in the report. Without an explicit trail, the analyst can begin with one question and publish the answer to another without any software error announcing the switch.

Evidence trailSource 1

To prevent that silent switch, follow the decision in order: first preserve the question, then let the design restrict the method.

Preserve

The scientific question the analysis has promised to answer

Artifact

Decision sheet for the wholly synthetic AURORA-30 case (30 fictional records; not clinical evidence) plus structural validator

Prerequisite

Question, unit, outcome, dependence, sample-size justification, and missingness review

Health-analysis evidence chain
  1. 01
    QuestionPopulation · outcome · time
  2. 02
    StructureUnit · dependence · missingness
  3. 03
    MethodEffect · assumptions · diagnostics
  4. 04
    ReportEstimate · interval · limitation
The test name appears only after question, unit, outcome, dependence, and target effect are explicit; interpretation keeps uncertainty and limitations attached.

Why evidence comes before technique

A result must carry the path that makes it interpretable#

In health research, the practical risk is not limited to choosing the wrong test from a menu. The unit of analysis, time point, missing-data handling, target effect, or primary claim can shift while the work is underway. A precise p-value cannot repair that drift. It may only make the wrong scientific answer look more authoritative.

An evidence trail keeps the question, data decisions, estimate, assumptions, diagnostics, and limits connected. It lets a collaborator or reviewer reconstruct the route, challenge a mismatch, and distinguish a prespecified conclusion from an exploratory finding. Technical depth matters here because every number inherits meaning from those decisions—not because complexity is valuable by itself.

That path begins with the quantity the study is trying to estimate—not with the name of a test.

Start before the software

Write the question and target effect#

A question such as “does the intervention work?” is not yet an analysis contract. Name the population, intervention or exposure, comparison, outcome, time point, and the effect you intend to estimate. A mean difference at day 30, an odds ratio over follow-up, and a survival contrast are different targets even when they come from the same dataset.

The complete numerical target—population, comparison, outcome, time point, and effect—is called the estimand. It states exactly what the analysis should estimate. ICH E9(R1) formalizes this connection for clinical trials; outside that scope, the same discipline remains useful, but it does not turn an observational comparison into a causal effect.

Evidence trailSource 2

Once the target is explicit, the next question is who contributes each measurement and which observations are linked.

The design changes the method

Count units, not rows#

In AURORA-30, people in different care groups are independent at day 30, while baseline and day-30 scores from the same person are paired. The spreadsheet contains both structures.

  1. 01

    Independent groups

    Different people or independent units contribute to each group.

  2. 02

    Paired observations

    The simplest repeated structure: commonly two linked measurements from the same person, or one measurement from each member of a matched pair.

  3. 03

    Repeated measures

    The broader case: multiple times or conditions belong to the same unit and must be analyzed with their correlation preserved.

  4. 04

    Clusters

    People may also be nested in clinics, households, wards, or sites.

Evidence trailSource 1

With the unit and dependence identified, these choices can be recorded before the results make one route look more attractive.

The decision record

Turn the hidden choices into a one-page analysis contract#

Now the contract has a reason to exist: it is a compact, verifiable memory of the decisions that prevents the original request from changing silently while the analysis is built. Record the outcome scale, number of groups or times, dependence, target effect, sample-size justification, missing-data plan, family of claims that may require multiplicity control, diagnostics, and reporting package. Separate primary, prespecified claims from exploratory comparisons. Empty fields are useful because they expose decisions that have not been made.

The analysis contract is not a legal document, does not choose a method automatically, and is not paperwork to complete after the result. It narrows the defensible options before execution and gives a reviewer enough context to challenge a mismatch—for example, an independent-samples test applied to repeated measurements from the same participant.

Reference implementation

Preserve the question before choosing the method

AURORA-30 is wholly synthetic. Its JSON makes the question and design decisions reviewable before execution; the dependency-free checker catches missing or internally inconsistent structure. It deliberately does not recommend a statistical method.

analysis-contract.json
{
  "study_id": "AURORA-30",
  "question": {
    "population_id": "eligible_participants",
    "outcome_id": "symptom_score_day_30",
    "comparison_ids": ["discharge_program", "usual_care"],
    "estimand_id": "mean_difference_day_30_program_minus_usual_care"
  },
  "structure": {
    "unit": "participant",
    "between_groups": "independent",
    "baseline_followup": "paired",
    "missingness_reviewed": true
  },
  "planning": {
    "sample_size_justification_id": "precision_for_target_effect",
    "primary_claim_ids": ["day_30_mean_difference"],
    "exploratory_comparisons_labeled": true
  },
  "report": {
    "required": ["estimate", "confidence_interval", "diagnostics", "limitation"],
    "causal_claim_allowed": false
  }
}
Runpython check_contract.py analysis-contract.json
Expected output
AURORA-30 | structural analysis-contract check
supplied_contract: READY_FOR_METHOD_REVIEW
pairing_regression_probe: HOLD
  - baseline and follow-up must remain paired within participant
missing_planning_probe: HOLD
  - planning.sample_size_justification_id is required
  - planning.primary_claim_ids must name at least one primary claim
  - exploratory comparisons must be labeled
causal_claim_regression_probe: HOLD
  - report.causal_claim_allowed must remain false for this teaching case
scope: structural planning aid; no method selection or clinical authorization

Failure exercised. The built-in regression probe relabels baseline and follow-up as independent. The checker returns HOLD because both observations belong to the same participant.

Production boundary. The identifiers are portable code literals. The artifact checks planning structure only; design-aware review still owns method choice, interpretation, and any use with real health data.

Evidence trailSource 2Source 3

The plan narrows the candidate methods; diagnostics then show whether the selected model is a reasonable description of the data.

Assumptions are design claims

Diagnose the model, not normality by ritual#

A large p-value from a normality test does not prove normality, and a small p-value does not automatically require a rank test. Consider the design, residual structure, sample size, outliers, skew, variance pattern, measurement scale, and what parameter the method actually estimates. When relevant to the selected model, use visual checks such as Q–Q and residual-versus-fitted plots as diagnostics—not as mechanical proof that assumptions hold.

Rank-based methods are not generic “tests of medians.” Depending on the method and assumptions, they may address distributional ordering, probability of superiority, or a location shift; a median contrast requires additional conditions. When assumptions are doubtful, consider a method that targets the effect more directly, a robust analysis, or a prespecified sensitivity analysis.

Evidence trailSource 4Source 5

After checking those assumptions, the result still needs enough context to be interpreted without guesswork.

Interpretation package

Do not let the p-value travel alone#

For the chosen AURORA-30 question, a reader needs five pieces together. Removing any one of them changes what can be understood from the result.

  1. 01

    Estimate

    State the effect on a scale the question can defend.

  2. 02

    Interval

    Show the uncertainty around that estimate.

  3. 03

    Diagnostics

    Record the checks that matter for the selected method.

  4. 04

    p-value

    Use it only when a prespecified hypothesis test is relevant.

  5. 05

    Limitation

    Name what the design, missingness, bias, or data cannot establish.

Evidence trailSource 3Source 6

This package makes the analysis reviewable, but it does not give the analysis powers that the study design never had.

Scope boundary

A coherent analysis is not clinical authorization#

The distinction matters because a well-executed calculation can still come from biased sampling, weak measurement, or a design that supports association rather than causation.

CAN

  • Expose why a method matches the question and design
  • Prevent common independent-versus-paired mistakes
  • Keep effect, interval, diagnostics, and limitations together
  • Make deviations from the analysis plan reviewable

CANNOT

  • Repair biased sampling or an invalid measurement process
  • Create causal evidence from association alone
  • Replace ethics, domain expertise, or clinical judgment
  • Guarantee that an estimate transports to another population

The boundary now turns into a practical sequence: if any required answer is missing, return to that decision before naming the method.

Reusable checklist

Twelve questions before naming the method#

Read these questions from top to bottom. Each answer becomes an input to the next, so the checklist is a path through the analysis rather than twelve independent boxes.

  • What is the question and estimand?
  • What population and unit of analysis are represented?
  • What is the outcome type and scale?
  • How many groups, times, or conditions exist?
  • Are observations independent, paired, repeated, or clustered?
  • How was the sample obtained, how was its size justified, and which biases are plausible?
  • Are missingness, outliers, units, dates, and coding reviewed?
  • Which assumptions are reasonable from design and data?
  • Was the analysis prespecified, which claims are primary or exploratory, and how many comparisons are planned?
  • Which method estimates the target effect directly?
  • Which effect, interval, and diagnostics accompany the result?
  • Which limitations prevent causal or broader claims?

If the twelve answers point to one coherent analysis, the method can finally be named and its result interpreted within the declared limits.

Conclusion

Preserve the question, not only the result#

The central lesson is not that every health analysis needs a more sophisticated method. It is that the same data can support several mathematically correct analyses while only one matches the question the study promised to answer. A defensible result therefore carries its route: question, unit, target effect, assumptions, decisions about the data, estimate, uncertainty, diagnostics, and limits.

Before naming a method, write one sentence stating who is compared, on which outcome, at what time, and through which effect. If another qualified person cannot reconstruct the same analysis from that sentence and its decision record, the work is not ready for a test menu. The contract earns its value by making that gap visible early—when the question can still be repaired without rewriting the result.

Primary sources

Primary sources

  1. Altman and Bland: Statistics notes—Units of analysis

    Shows why the observational unit and the number of data values are not interchangeable.

  2. ICH E9(R1): Estimands and Sensitivity Analysis

    Connects trial objectives, estimands, intercurrent events, missing observations, and sensitivity analysis.

  3. SAMPL Guidelines

    Provides statistical-analysis and reporting guidance, including estimates, uncertainty, and transparent method descriptions.

  4. Altman and Bland: Parametric v non-parametric methods for data analysis

    Explains why method choice should follow the parameter of interest and the distributional problem rather than a ritual test of normality.

  5. Fay and Proschan: Wilcoxon–Mann–Whitney or t-test?

    Details the distinct interpretations available for the Wilcoxon–Mann–Whitney procedure under different assumptions.

  6. ASA Statement on p-Values

    Explains what p-values do and do not measure and why transparency and full reporting matter.

  7. EQUATOR Network reporting-guideline library

    Routes reporting guidance by study design and research type.

From one checklist to a complete evidence record

Build the analysis from question to auditable report.