Table A3:
GRADE Evidence Profile for the Comparison of rTMS and Sham Treatment
| No. of Studies (Design) | Risk of Biasa | Inconsistency | Indirectness | Imprecision | Publication Bias | Upgrade Considerations | Quality |
|---|---|---|---|---|---|---|---|
| HF Left DLPFC | |||||||
| Change in Depression Score | |||||||
| 30 (RCTs) | No serious limitations | Serious limitations (−1)b | No serious limitations | No serious limitations | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| Response Rate | |||||||
| 31 (RCTs) | No serious limitations | Serious limitations (−1)b | No serious limitations | No serious limitations | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| Remission Rate | |||||||
| 17 (RCTs) | No serious limitations | No serious limitations | Serious limitations (−1)c | No serious limitations | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| LF Right DLPFC | |||||||
| Change in Depression Score | |||||||
| 8 (RCTs) | No serious limitations | Serious limitations (−1)b | No serious limitations | No serious limitations | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| Response Rate | |||||||
| 10 (RCTs) | No serious limitations | Serious limitations (−1)b | No serious limitations | No serious limitations | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| Remission Rate | |||||||
| 7 (RCTs) | No serious limitations | No serious limitations | Serious limitations (−1)c | No serious limitations | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| Bilateral | |||||||
| Change in Depression Score | |||||||
| 6 (RCTs) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | No other considerations | ⊕⊕⊕⊕ High |
| Response Rate | |||||||
| 10 (RCTs) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | No other considerations | ⊕⊕⊕⊕ High |
| Remission Rate | |||||||
| 7 (RCTs) | No serious limitations | No serious limitations | Serious limitations (−1)c | No serious limitations | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| cTBS | |||||||
| Change in Depression Score | |||||||
| 1 (RCT) | No serious limitations | No serious limitations | No serious limitations | Serious limitations (−1)d | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| Response Rate | |||||||
| 2 (RCTs) | No serious limitations | No serious limitations | No serious limitations | Serious limitations (−1)d | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| iTBS | |||||||
| Change in Depression Score | |||||||
| 1 (RCT) | No serious limitations | No serious limitations | No serious limitations | Serious limitations (−1)d | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| Response Rate | |||||||
| 2 (RCTs) | No serious limitations | No serious limitations | No serious limitations | Serious limitations (−1)e | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| Remission Rate | |||||||
| 1 (RCT) | No serious limitations | No serious limitations | Serious limitations (−1)f | No serious limitations | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| Bilateral TBS | |||||||
| Change in Depression Score | |||||||
| 1 (RCTs) | No serious limitations | No serious limitations | No serious limitations | Serious limitations (−1)d | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| Response Rate | |||||||
| 2 (RCTs) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | No other considerations | ⊕⊕⊕ High |
| Remission Rate | |||||||
| 1 (RCT) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | No other considerations | ⊕⊕⊕⊕ High |
| Deep TMS | |||||||
| Change in Depression Score | |||||||
| 1 (RCT) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | No other considerations | ⊕⊕⊕⊕ High |
| Response Rate | |||||||
| 3 (RCTs) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | No other considerations | ⊕⊕⊕⊕ High |
| Remission Rate | |||||||
| 3 (RCTs) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | No other considerations | ⊕⊕⊕⊕ High |
| Overall rTMS Relapse Rate | |||||||
| 1 (RCT) | No serious limitations | No serious limitations | No serious limitations | No serious limitations | Undetected | No other considerations | ⊕⊕⊕ Moderate |
| Overall rTMS Adverse Events | |||||||
| 31 (RCTs) | No serious limitations | No serious limitations | Serious limitations (−1)g | No serious limitations | Undetected | No other considerations | ⊕⊕⊕ Moderate |
Abbreviations: DLPFC, dorsolateral prefrontal cortex; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; HF, high frequency; LF, low frequency; RCT, randomized controlled trial; rTMS, repetitive transcranial magnetic stimulation; TBS, theta burst stimulation; TMS, transcranial magnetic stimulation.
a
Many RCTs had low or unclear risk of bias; however, we thought that it did not warrant downgrading.
b
Substantial statistical heterogeneity (I2 > 50%).
c
Different cut-points used to define remission.
d
Wide range of scores or confidence intervals overlap both beneficial and non-beneficial treatment effects.
e
Wide confidence intervals.
f
ITBS was given at accelerated pace, which is unlike current clinical practice.
g
Adverse events were always secondary outcomes; not many events occurred; and adverse events were measured using scales or counts.