Designs, Variations and Examples of the Stepped Wedge Design: Supplementary Materials

February 27, 2015 03:00 PM to 03:30 PM EST
Miriam Dickinson, PhD, University of Colorado; Bethany Kwan, PhD, MSPH, University of Colorado and CaReNet PBRN

This webinar recording accompanies the “Advanced Methods for Primary Care Research: The Stepped Wedge Design” PBRN Webinar. In this recording, Drs. Kwan and Dickinson provide an in-depth overview of three specific variations of stepped wedge designs; (1) repeated cross-sectional, (2) cohort and (3) region-level randomization designs. A comprehensive list of additional resources is provided at the conclusion of the webinar. This list is also accessible here:

This Live series activity, AHRQ Practice-Based Research Network Resource Center National Webinars, from 09/10/2014 - 09/10/2015, has been reviewed and is acceptable for credit by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This webinar has been approved for 1.25 elective CME credit(s).


Moderator: Rebecca Roper, MS, MPH, Director, Practice-Based Research Network Initiative, Agency for Healthcare Research and Quality

Critical Reference Material: 

1. Brown CA, Lilford RJ. The stepped wedge trial design: a systematic review. BMC Med Res Methodol. 2006;6:54.

2. Dainty KN, Scales DC, Brooks SC, et al. A knowledge translation collaborative to improve the use of therapeutic hypothermia in post-cardiac arrest patients: protocol for a stepped wedge randomized trial. Implement Sci. 2011;6:4.

3. Golden MR, Kerani RP, Stenger M, Hughes JP, Aubin M, Malinski C, et al. (2015) Uptake and Population-Level Impact of Expedited Partner Therapy (EPT) on Chlamydia trachomatis and Neisseria gonorrhoeae: The Washington State Community-Level Randomized Trial of EPT. PLoS Med 12(1): e1001777. doi:10.1371/journal.pmed.1001777

4. Haines T, Hemming K, Girling A, Hill A-M, Bulsara M, Deeks J. Where should stepped-wedge designs be placed in the evidence hierarchy? Using the “within-wedge” analysis approach to generate evidence of possible bias. BMC Health Services Research. 2014;14(Suppl 2):P54.

5. Handley MA, Schillinger D, Shiboski S. Quasi-experimental designs in practice-based research settings: design and implementation considerations. J Am Board Fam Med. Sep-Oct 2011;24(5):589-596.

6. Hemming K, Lilford R, Girling AJ. Stepped-wedge cluster randomised controlled trials: a generic framework including parallel and multiple-level designs. Stat Med. Jan 30 2015;34(2):181-196.

7. Hussey MA, Hughes JP. Design and analysis of stepped wedge cluster randomized trials. Contemp Clin Trials (PDF - 245 KB). Feb 2007;28(2):182-191.

8. Kitson AL, Schultz TJ, Long L, et al. The prevention and reduction of weight loss in an acute tertiary care setting: protocol for a pragmatic stepped wedge randomised cluster trial (the PRoWL project). BMC Health Services Research. 2013;13:299.

9. Kotz D, Spigt M, Arts IC, Crutzen R, Viechtbauer W. Researchers should convince policy makers to perform a classic cluster randomized controlled trial instead of a stepped wedge design when an intervention is rolled out. J Clin Epidemiol. Dec 2012;65(12):1255-1256.

10. Kotz D, Spigt M, Arts IC, Crutzen R, Viechtbauer W. Use of the stepped wedge design cannot be recommended: a critical appraisal and comparison with the classic cluster randomized controlled trial design. J Clin Epidemiol. Dec 2012;65(12):1249-1252.

11. Mdege ND, Man MS, Taylor Nee Brown CA, Torgerson DJ. Systematic review of stepped wedge cluster randomized trials shows that design is particularly used to evaluate interventions during routine implementation. J Clin Epidemiol. Sep 2011;64(9):936-948.

12. Mdege ND, Man MS, Taylor nee Brown CA, Torgerson DJ. There are some circumstances where the stepped-wedge cluster randomized trial is preferable to the alternative: no randomized trial at all. Response to the commentary by Kotz and colleagues. J Clin Epidemiol. Dec 2012;65(12):1253-1254.

13. Mhurchu CN, Gorton D, Turley M, et al. Effects of a free school breakfast programme on children's attendance, academic achievement and short-term hunger: results from a stepped-wedge, cluster randomised controlled trial. J Epidemiol Community Health. Mar 2013;67(3):257-264.

14. Morrison LJ, Brooks SC, Dainty KN, et al. Improving Use of Targeted Temperature Management After Out-of-Hospital Cardiac Arrest: A Stepped Wedge Cluster Randomized Controlled Trial. Critical Care Medicine. 9000;Publish Ahead of Print.

15. van den Broek IV, van Bergen JE, Brouwers EE, et al. Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation. Bmj. 2012;345:e4316.

16. Woertman W, de Hoop E, Moerbeek M, Zuidema SU, Gerritsen DL, Teerenstra S. Stepped wedge designs could reduce the required sample size in cluster randomized trials. J Clin Epidemiol. Jul 2013;66(7):752-758.


Event Materials:


Last Modified: August 2015