Table 4.
GRADE assessment - summary of findings
| Outcomes | Anticipated absolute
effects |
№ of participants (N° estimates; studies’ design) | Certainty of the evidence (GRADE) | Comments | |
|---|---|---|---|---|---|
| Range of Means in Control | Mean in Group, estimate and 95% CI | ||||
| MT | 39.42 to 51.66 | MD 6.90 higher (4.16 to 9.63) | 200 (4; non-RCTs) | ⨁◯◯◯ Very low a, b, c, d, e |
Patients with fibromyalgia have higher MT. |
| ICI | 0.31 to 1.16 | MD 0.40 lower (−0.69 to −0.11) | 481 (10; non-RCTs) | ⨁◯◯◯ VERY LOW a, b, c, e, f |
Patients with fibromyalgia have lower inhibition (ICI). |
| CSP | 48.58 to 185.85 | MD 7.82 lower (−40.77 to 25.14) | 289 (7; non-RCTs) | ⨁◯◯◯ VERY LOW a, b, c, f, g |
Patients with fibromyalgia have no differences in CSP. |
| ICF | 0.71 to 1.89 | MD 0.25 lower (−0.69 to 0.20) | 346 (7; non-RCTs) | ⨁◯◯◯ VERY LOW a, b, c, f, g |
Patients with fibromyalgia have no differences in facilitation. |
| MEP | 0.34 to 1.64 | MD 0.31 higher (−0.59 to 1.21) | 454 (10; non-RCTs) | ⨁◯◯◯ VERY LOW a, b, c, f, g |
Patients with fibromyalgia have no differences in MEP. |
| MT | 45.25 to 71.70 | MD 1.79 lower (−5.62 to 2.03) | 212 (5; RCTs) | ⨁◯◯◯ VERY LOW h, i, c, d, g |
Patients with fibromyalgia have no changes in MT after treatment. |
| ICI | 0.42 to 0.49 | MD 0.19 higher (0.10 to 0.29) | 233 (6 RCTs) | ⨁⨁◯◯ LOW h, b, c, f, e |
Patients with fibromyalgia have increases in ICI after treatment. |
| CSP | 64.00 to 64.75 | MD 14.92 higher (4.86 to 24.98) | 66 (2 RCTs) | ⨁⨁⨁◯ MODERATE h, b, c, d, e |
Patients with fibromyalgia have increases in CSP after treatment. |
| ICF | 1.91 to 3.13 | MD 0.78 higher (−0.27 to 1.82) | 206 (5 RCTs) | ⨁◯◯◯ VERY LOW h, b, c, f, g |
Patients with fibromyalgia have no changes in ICF after treatment. |
| MEP | 0.60 to 1.44 | MD 0.21 higher (−0.42 to 0.83) | 60 (2 RCTs) | ⨁◯◯◯ VERY LOW h, b, c, f, g |
Patients with fibromyalgia have no changes in MEP after treatment. |
Note:
The certainty of the evidence started at low due to the inclusion of non-RCTs.
In most of the included studies moderate risk of bias was detected (40–60% of the items were correct). We downgraded one level due to risk of bias.
The population included is extrapolatable to the population of the research question. We did not downgrade due to indirectness.
There is overlap of confidence intervals suggesting only small variation. No statistical heterogeneity. We did not downgrade for inconsistency.
The confidence intervals were relatively narrow and did not include the point of no effect. We did not downgrade due to imprecision.
There is moderate overlap of confidence intervals suggesting considerable variations. Substantial statistical heterogeneity (I2 higher 60%). We downgraded one level due to inconsistency.
The confidence intervals were broad and included the point of no effect. We downgraded one level due to imprecision.
The certainty of the evidence started at high due to the inclusion of RCTs only.
The included studies presented high to moderate risk of bias. We downgraded two levels due to risk of bias.
CSP: cortical silent period,ICI: intracortical inhibition, ICF: intracortical facilitation, MD: mean differences, MEP: motor evocate potential, MT: Motor threshold, RCT: randomized controlled trial.