5 Continuous two-group comparison

Continuous outcomes are commonly compared either between different groups of participants or between linked measurements from the same participants. These designs require different analyses because they contain different sources of variability.

For independent groups, inference concerns a contrast between populations, such as a difference in mean biomarker change between Control and Drug_A. For paired measurements, inference concerns the distribution of the within-person differences, such as the change in systolic blood pressure from baseline to week 12.

The design and estimand should be specified before examining assumptions. Distributional diagnostics then assess whether a mean-based model is reasonable and, for independent groups, whether a common-variance model is credible.

5.1 Decision framework

Design Target Method Main consideration
independent groups difference in means Welch two-sample t-test unequal variances allowed
independent groups difference in means pooled Student t-test requires a common variance
independent groups rank-based contrast Wilcoxon–Mann–Whitney test rank/distributional estimand
paired measurements mean within-person difference paired t-test normality concerns the paired differences
paired measurements rank-based paired contrast Wilcoxon signed-rank test interpretation depends on the distribution of differences

Welch’s test is generally the safer mean-based procedure for independent groups because it does not require equal variances. The pooled Student test remains useful when a common-variance model is justified.