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Mean Difference, Standardized Mean Difference (SMD), and Their Use in Meta-Analysis: As Simple as It Gets
Open accessAbstract
In randomized controlled trials (RCTs), endpoint scores, or change scores representing the difference between endpoint and baseline, are values of interest. These values are compared between experimental and control groups, yielding a mean difference between the experimental and control groups for each outcome that is compared. When the mean difference values for a specified outcome, obtained from different RCTs, are all in the same unit (such as when they were all obtained using the same rating instrument), they can be pooled in meta-analysis to yield a summary estimate that is also known as a mean difference (MD). Because pooling of the mean difference from individual RCTs is done after weighting the values for precision, this pooled MD is also known as the weighted mean difference (WMD). Sometimes, different studies use different rating instruments to measure the same outcome; that is, the units of measurement for the outcome of interest are different across studies. In such cases, the mean differences from the different RCTs cannot be pooled. However, these mean differences can be divided by their respective standard deviations (SDs) to yield a statistic known as the standardized mean difference (SMD). The SD that is used as the divisor is usually either the pooled SD or the SD of the control group; in the former instance, the SMD is known as Cohen's d, and in the latter instance, as Glass' delta. SMDs of 0.2, 0.5, and 0.8 are considered small, medium, and large, respectively. SMDs can be pooled in meta-analysis because the unit is uniform across studies. This article presents and explains the different terms and concepts with the help of simple examples.
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“SMD magnitude was categorized as trivial (≤ 0.19), small (0.20–0.49), moderate (0.50–0.79), and large (≥ 0.80) [20].”
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Ortiz, H. A. D. L. B., Parizotto, N. A., Chamorro-Lange, C., & Liebano, R. E. (2026) · Chiropractic & Manual Therapies · doi:10.1186/s12998-026-00653-z
“…search algorithm: ("Lasers" OR "Laser Therapy" OR "High-Inten-sity Laser Therapy" OR “High-power laser” OR "Class IV laser") AND ("Musculoskeletal Pain" OR "Musculoskeletal (CIs) were calculated using the inverse-variance method, which applies greater weight to studies with lower variance [34].”
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“…groups, adjusting for the underlying variability (standard deviation) in the data. commonly, sMD thresholds of 0.2, 0.5, and 0.8 indicate small, medium, and large effect sizes [43]. however, these thresholds are often context-specific and do not necessarily imply clinical or social significance.”
InfluentialRush, M. N. M., Hoofnagle, M. H., Niziolek, G. M., Ghosh, S., Spinella, P. C., Bochicchio, G. V., & Turnbull, I. R. (2026) · Shock · doi:10.1097/shk.0000000000002881
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“Covariate balance before and after weighting was assessed using standardized mean differences (SMDs), with smaller values indicating improved balance [20 ].”
Xingling, L., Huang, H., & Kechen, L. (2026) · Nurse Education Today · doi:10.1016/j.nedt.2026.107255
Interpreting heterogeneity and effect size in meta-analysis of Suzetrigine for acute pain
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“Weights were truncated at the 1st and 99th percentiles to improve numerical stability and mitigate the in fl uence of extreme weights (44 – 46 (48, 49).”
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“Consistent with conventional interpretation, an SMD around 0.6 reflects a moderate effect, supporting the conclusion that DSST is associated with meaningful increases in sleep duration [35].”
InfluentialJotaki, S., Yamamoto, N., Imai, E., Goto, Y., & Tamura, T. (2026) · BMC Anesthesiology · doi:10.1186/s12871-026-04081-7
“For QoR, SMDs of 0.2–0.5, 0.5–0.8, and > 0.8 were considered small, moderate, and large, respectively [49].”
Influential
Metadata
- Authors
- Andrade, C.
- Affiliations
- National Institute of Mental Health and Neurosciences (IN)
- Corresponding author
- Andrade, Chittaranjan
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2020-09-22
- Volume
- 81
- Issue
- 5
- ISSN
- 0160-6689 (ISSN-L)
- 1555-2101
- OpenAlex
- W3089264828
- Cited by
- 841
- References
- 5
- Citations by year
- 2026: 158 · 2025: 221 · 2024: 199 · 2023: 161 · 2022: 77 · 2021: 25
- FWCI
- 40.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Keywords
- mean difference, standardized mean difference, Cohen's d, effect size, meta-analysis, change scores, rating instruments, effect size heterogeneity
- MeSH terms
- Data Interpretation, Statistical, Humans, Statistics as Topic, Meta-Analysis as Topic
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