THEORY AND METHODS

Applied analysis of recurrent events: a practical overview

Jos W R Twisk¹, Nynke Smidt² and Wieke de Vente³

¹ Department of Clinical Epidemiology and Biostatistics, VUmc, Amsterdam, Netherlands
² Institute for Research in Extramural Medicine, VUmc
³ Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands

Correspondence to:
Correspondence to:
Dr J W R Twisk
Department of Clinical Epidemiology and Biostatistics and EMGO-institute, Vrije Universiteit medical centre (VUmc), Vd Boechorststraat 7, 1081 BT Amsterdam, Netherlands; JWR.Twisk{at}vumc.nl

Study objective: The purpose of this paper is to give an overview and comparison of different easily applicable statistical techniques to analyse recurrent event data.

Setting: These techniques include naive techniques and longitudinal techniques such as Cox regression for recurrent events, generalised estimating equations (GEE), and random coefficient analysis. The different techniques are illustrated with a dataset from a randomised controlled trial regarding the treatment of lateral epicondylitis.

Main results: The use of different statistical techniques leads to different results and different conclusions regarding the effectiveness of the different intervention strategies.

Conclusions: If you are interested in a particular short term or long term result, simple naive techniques are appropriate. However, if the development of a particular outcome is of interest, statistical techniques that consider the recurrent events and additionally corrects for the dependency of the observations are necessary.

Keywords: recurrent events; Cox regression; GEE analysis; random coefficient analysis; multilevel analysis

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