Cited by 329Meta-analysis and systematic reviewsDelphi Technique in ResearchStatistical Methods in Epidemiology

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When continuous outcomes are measured using different scales: guide for meta-analysis and interpretation

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Murad, Mohammad Hassan, Wang, Zhen, Chu, Haitao, Lin, Lifeng·2019·BMJ

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Abstract

It is common to measure continuous outcomes using different scales (eg, quality of life, severity of anxiety or depression), therefore these outcomes need to be standardized before pooling in a meta-analysis. Common methods of standardization include using the standardized mean difference, the odds ratio derived from continuous data, the minimally important difference, and the ratio of means. Other ways of making data more meaningful to end users include transforming standardized effects back to original scales and transforming odds ratios to absolute effects using an assumed baseline risk. For these methods to be valid, the scales or instruments being combined across studies need to have assessed the same or a similar construct

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Method
Septorhinoplasty and the Late Impact on Olfactory Function: A Review and Meta-analysis
de Sousa, F. A., Santos, M., Correia, J. T., Pinto, A. N., Meireles, L., & Ferreira, M. G. (2022) · Facial Plastic Surgery · doi:10.1055/a-1979-8636 · Cited by 7
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“To increase interpretability, transforming back to a familiar scale was done by multiplying the SMC in PA by the pooled standard deviations of change in studies using the desired original scale and among the largest/ most representative of the primary studies [69, 70].”
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Reveyaz, M.-A., Peyronnel, C., Boëté, Q., Fournier, J., Arnaud, C., Belaïdi, E., Harki, O., Pépin, J., Khouri, C., Faury, G., et al. (2026) · Oxidative Medicine and Cellular Longevity · doi:10.1155/omcl/9967028 · Cited by 7
“An SMD > 0.8 was considered large, 0.5 – 0.8 moderate, and 0.2 – 0.5 small [22].”
Influential
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Tian, H., Wu, L., Qin, H., Li, X., Zhao, X., Zhao, W., Xue, F., Zhao, S., Li, L., & Zeng, W. (2024) · Composites Part B Engineering · doi:10.1016/j.compositesb.2024.111278 · Cited by 6
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“Continuous variables were analyzed using the weighted mean differences (MD) and for studies that evaluated the same outcome with different instruments, we used the standardized mean differences (SMD) with 95% confidence interval (CI) [23] .”
Method
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“18 A statistical significance was acknowledged when p-value <0.05.”
Influential
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Self-citation
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“32 Furthermore, each analysis was assessed separately if an article performed different meta-analyses on more than one outcome or among various populations.”
DOSage of Exercise for chronic low back pain disorders (DOSE): protocol for a systematic review with dose-response network meta-analysis
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“This was performed using pre-intervention standard deviation (SD) estimates from the largest observational study identified [42, 43].”
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“Specifically, the MDs between intervention and con-trol groups in each study was divided by the pooled standard deviation, resulting in SMDs suitable for meta-analysis [28].”
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Self-citation
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Capelusnik, D., Medina, C. L., van der Heijde, D. M. F. M., Aletaha, D., Smolen, J. S., Moltó, A., & Ramiro, S. (2025) · Annals of the Rheumatic Diseases · doi:10.1016/j.ard.2025.08.027 · Cited by 4
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Rees, J. L. C., Saunders, R., Krynicki, C. R., Belli, A., Ahmed, Z., Pietro, V. D., & Stevens, A. R. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1546080 · Cited by 5
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“The different assessments of self-reported psychological or behavioural outcomes pose an issue to the generalisability of the effectiveness of the interventions due to different signalling questions, directions, and units (52).”
Background
Influence of cognitive reserve on cognitive and motor function in α‐synucleinopathies: A systematic review protocol
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“To account for differences in measurement scales, we rescaled all outcomes reported on non-100-point scales to a 0–100 scale and used SMD as the effect measure, enabling the combination of studies assessing the same outcome across different scales (52–54).”
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“Firstly, the measurement tools used in the included studies needed to specifically measure the intended outcome (Deeks et al., 2024; Murad et al., 2019).”
Incidence and risk factors for recurrent membranous nephropathy after kidney transplantation: a systematic review and meta-analysis
Bai, J., Zheng, Z., Cao, J., Ji, L., Zhang, J., Yang, Y., & Guo, Q. (2025) · Annals of Medicine · doi:10.1080/07853890.2025.2522971 · Cited by 3
Comparative Effectiveness of Interventions to Treat Cancer Treatment-Related Cognitive Impairment in Adult Cancer Survivors Following Systemic Therapy: A Systematic Review with Network Meta-Analyses
Wolfe, D. M., Hamel, C., Berard, J. A., Veroniki, A. A., Skidmore, B., Kanji, S., Rabheru, K., McGee, S. F., Forbes, L. M., Machado, I., et al. (2025) · Cancers · doi:10.3390/cancers17213430 · Cited by 5
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Keykha, E., Hajisadeghi, S., & Heidari, M. T. (2025) · BMC Oral Health · doi:10.1186/s12903-025-07334-y · Cited by 3
“This variability arises from several factors, including different methods of DFA measurement and the scales used, which can affect results and make data pooling in meta-analyses more difficult [3, 69, 70].”
The postoperative analgesic efficacy of three peripheral nerve blocks in hip fracture surgery: a systematic review and meta-analysis of randomised trials
Vermazen, K., Niblett, A., Thomson, C., & Tebbett, A. (2026) · Archives of Orthopaedic and Trauma Surgery · doi:10.1007/s00402-025-06139-6 · Cited by 3
Post-COVID pain and quality of life in COVID-19 patients: protocol for a meta-analysis and systematic review
Miao, M., Xu, Y., Yang, Y., Li, P., Jia, M., Wen, Z., Yu, M., Zhang, J., & Gu, J. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-057394 · Cited by 3
β-glucuronidase as a biomarker for assessing the exposure to anticholinergic pesticides: A meta-analysis
Serafín-Fabián, J. I., Moreno‐Godínez, M. E., Flores‐Alfaro, E., Parra‐Rojas, I., Rojas‐García, A. E., Campos-Viguri, G. E., Cahua‐Pablo, J. Á., & Ramírez‐Vargas, M. A. (2023) · Environmental Toxicology and Pharmacology · doi:10.1016/j.etap.2023.104279 · Cited by 3
Improving oral health and related health behaviours (substance use, smoking, diet) in people with severe and multiple disadvantage: A systematic review of effectiveness and cost-effectiveness of interventions
McGowan, L. J., John, D. A., Kenny, R. P. W., Joyes, E. C., Adams, E. A., Shabaninejad, H., Richmond, C., Beyer, F. R., Landes, D. P., Watt, R. G., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0298885 · Cited by 3
The impact of patient engagement on patient safety in care transitions after cancer treatment: Protocol for a systematic review and meta-analysis
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Authors: Murad, M. H., Wang, Z., Chu, H., & Lin, L.
Affiliations: Mayo Clinic (US)
University of Minnesota (US)
Florida State University (US)
Corresponding author: Murad, Mohammad Hassan
ORCID: Murad, Mohammad Hassan
Wang, Zhen
Chu, Haitao
Lin, Lifeng
Venue: BMJ
Publisher: BMJ
Published: 2019-01-22
Volume: 364
Pages: k4817
ISSN: 1756-1833 (ISSN-L)
0959-8138
DOI: 10.1136/bmj.k4817
PMC: PMC6890471
OpenAlex: W2912626077
Cited by: 329
References: 28
Citations by year: 2026: 65 · 2025: 71 · 2024: 63 · 2023: 40 · 2022: 39 · 2021: 34 · 2020: 16 · 2019: 1
FWCI: 15.04
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations: BMJ (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (U01DK106786)
U.S. National Library of Medicine (R21LM012744, R21LM012197)
Topics: Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Social Sciences › Sociology and Political Science › Delphi Technique in Research
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
Keywords: scale standardization, continuous outcomes, meta-analysis, standardized mean difference, odds ratio, minimally important difference, ratio of means, baseline risk, quality of life, anxiety, depression
MeSH terms: Algorithms, Anxiety, Child, Data Interpretation, Statistical, Decision Making, Depression, Female, Humans, Parents, Quality of Life, Reference Standards, Severity of Illness Index, Meta-Analysis as Topic, Outcome Assessment, Health Care

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When continuous outcomes are measured using different scales: guide for meta-analysis and interpretation

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