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A RCT represents a study design with possible high interval validity, but this with a possible cost of lower external validity and thereby lower generalizability of the study results.
Extending the number of representative exposure traces may improve the optimality of the method because it will improve the identification of the underlying exposure structure, but it may also result in lower generalizability of C-EVA as it may lead to over-fitting of the clusters to this particular structure.
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Alternatively inclusion criteria may be narrowed, with a corresponding lower degree of generalizability as a consequence.
Except for a few cases, moderator effects were not significant in the random effect models because of the small number of studies, resulting in lower power or generalizability of moderator effects.
There have been comparatively fewer studies that developed an LUR with lower predictability but higher generalizability.
In addition, the SHOP study population was generally well-educated, and generalizability to a lower-educated or more disadvantaged population is unknown.
On the negative side, generalizability might be lowered through the fact that in our study, the same therapist conducted all sessions, which does not allow quantifying therapist and intervention effects.
Generalizability theory coefficients showed lower values for running speed (0.70) versus walking speed (all > 0.84), with the majority of the overall percentage of variability derived from the participant (68%–88% of the total 100%).
Second, our 5-year mortality data were considerably lower than national averages, limiting the generalizability of these findings and providing the plausibility that this was a 'healthier' SCT cohort.
Lastly, the mortality rate was lower than expected, which may compromise the generalizability of the results.
We had a small sample size – one group of third year medical students from a single institution, and our response rate of 62% is lower than the 70% generally accepted for generalizability.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com