Carretero 2009

Methods	Parallel randomised clinical trial
Participants	Country of study: Spain Setting: outpatient clinic Condition: fibromyalgia (with major depression) Prior management details: unclear n = 26 Age: active group 47.5 (SD 5.7) years, sham group 54.9 (SD 4.9) years Duration of symptoms: unclear "chronic" Gender distribution: 2 M, 24 F
Interventions	Stimulation type: rTMS Stimulation parameters: frequency 1 Hz; coil orientation not specified; 110% RMT; number of trains 20; duration of trains 60 s; ITI 45 s; number of pulses 1200 Stimulation location: R DLPFC Number of treatments: up to 20 on consecutive working days Control type: coil angled 45º from the scalp
Outcomes	Primary: Likert pain scale 0‐10, anchors "no pain" to "extreme pain" When taken: 2 weeks, 4 weeks and 8 weeks from commencement of study Secondary: none
Notes	COI: no declaration made Sources of support: IUNICS Institute, Research Institute of Health Sciences
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: method of randomisation not specified
Allocation concealment (selection bias)	Unclear risk	Comment: allocation concealment not specified
Adequate blinding of participants?	Unclear risk	Comments: sham credibility assessment ‐ suboptimal. Coil angled 45º away from scalp. Did not control for sensory characteristics of active stimulation and was visually distinguishable
Adequate blinding of assessors?	Low risk	Quote: "patients and raters (but not the treating physician) were blind to the procedure"
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: only 1 participant in each group did not complete the study. Unlikely to have strongly influenced the findings
Selective reporting (reporting bias)	Low risk	Comment: outcomes presented clearly and in full
Study Size	High risk	Comment: < 50 participants per treatment arm
Study duration	Unclear risk	Comment: ≥ 2 weeks but < 8 weeks' follow‐up
Other bias	Low risk	Comment: no significant other bias detected