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Applied analysis of recurrent events: a practical overview
  1. Jos W R Twisk1,
  2. Nynke Smidt2,
  3. Wieke de Vente3
  1. 1Department of Clinical Epidemiology and Biostatistics, VUmc, Amsterdam, Netherlands
  2. 2Institute for Research in Extramural Medicine, VUmc
  3. 3Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
  1. 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;


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.

  • recurrent events
  • Cox regression
  • GEE analysis
  • random coefficient analysis
  • multilevel analysis

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  • Funding: none.

  • Conflicts of interest: none declared.

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