Case studies  /  Life sciences

Linear Mixed Effects Models for an Intervention Measured Over Six Occasions

Recovering a defensible effect estimate from repeated measures with missing follow-up, where repeated measures ANOVA could not be used.

Life sciencesSector
Linear mixed effects modelsMethod
SAS and RSoftware
~350 participants across six occasionsScale
About five weeksDuration

The challenge

What the organisation came with

A research organisation needed to establish whether an intervention remained effective once participant characteristics were taken into account.

Each participant was measured on six occasions, which creates two problems at once. Repeated measurements on the same person are correlated — someone who scores high at occasion one tends to score high at occasion two — so the observations are not independent, and treating them as if they were understates the standard errors and overstates significance.

The second problem was missing follow-up. Not every participant was measured on every occasion. Attendance drops off, and the resulting dataset is unbalanced. That rules out the method most researchers reach for first.

The approach

How it was analysed, and why that method

Why mixed effects rather than repeated measures ANOVA

Repeated measures ANOVA was rejected outright. It assumes complete, balanced data: every participant measured at every occasion. Faced with missing follow-up it either discards every participant with a single missing measurement, or requires imputation before the analysis can run at all. With 350 participants and six occasions, listwise deletion would have removed a substantial and non-random portion of the sample.

Linear mixed effects models handle unbalanced data directly. Participants contribute whatever measurements they have, and a random effect for participant captures the correlation between that person's repeated measurements — modelling the dependence explicitly rather than pretending it does not exist.

Why the missing data mattered so much

Participants who drop out are rarely a random sample of those who stay. A method that silently excludes them does not just lose power; it changes what the remaining sample represents.

Adjustment and sensitivity

Participant characteristics were included as fixed effects so the intervention estimate could be read as adjusted rather than raw. Sensitivity analyses were then run to establish how far the conclusion depended on the modelling choices — a result that survives a reasonable range of specifications is one you can defend; one that appears under a single specification is not.

The analysis was carried out in SAS and R, with the code annotated so it could be rerun and checked independently.

Delivered

What the client received

Statistical report with adjusted intervention estimates
Sensitivity analyses across model specifications
Annotated code in SAS and R

The value

What changed as a result

The findings informed the next phase of the project and the decisions that followed it.

The sensitivity work was as important as the headline estimate: it established the range of assumptions under which the conclusion held, which is what a reviewer or funder asks about first.

About this case study

Written from the assigned statistician's own project notes. The client is not named and no identifying detail, data or figures are published. Scale and timeframe are approximate.

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