Cutting edge or blunt instrument: how to decide if a stepped wedge design is right for you

Abstract

The last 10 years have seen an extraordinary surge of interest in ‘stepped wedge’ designs for evaluating interventions to improve health and social care. Reviews of published trials and registered protocols have shown an exponential increase in the number of trials citing a stepped wedge approach.1–6 A growing body of work on methods for the design, conduct and analysis of stepped wedge trials has emerged, building on seminal work by Hussey and Hughes in 2007.7 The Consolidated Standards of Reporting Trials reporting guidelines for stepped wedge cluster randomised trials are now available, making it easier for investigators to appraise evidence and plan their own evaluations.8