Rigor Reviewed

Rigor-Reviewed Manuscript

Accelerated continuous theta burst stimulation targeting left primary motor cortex for children with autism spectrum disorder: multicentre randomised sham controlled trial.

Name: Adcurare Rigor Record — Accelerated continuous theta burst stimulation targeting left primary motor cortex for children with autism spectrum disorder: multicentre randomised sham controlled trial.
Item: Accelerated continuous theta burst stimulation targeting left primary motor cortex for children with autism spectrum disorder: multicentre randomised sham controlled trial.
Rating: 100
Author: Adcurare

Tan H, Ren T, Cao A, Fang S, Deng L, Hu B, Wang M, Cheng Y, Zhang X, Li Y, Zhang Y, Zhang L, Chen L, Zhou W, Zhang Q, Li J, Zhou X, Langley C, Luo Q, Zhang J, Sahakian BJ, Yuan TF, Li F

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Adcurare Rigor Review — 4★ (Strong), 0 critical, 4 high issues for “Accelerated continuous theta burst stimulation targeting left primary motor cortex for children with autism spectrum disorder: multicentre randomised sham controlled trial.”

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Adcurare Editorial

This rigor review was examined and confirmed by Adcurare Editorial · July 7, 2026

Adcurare Rigor Review

Rigor Reviewed

4 / 5

Strong — minor issues to address

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern−0.5★
ClaimsOverstated claim−0.5★

Model-reported confidence: highReviewer agreement: highEngine: 7.6.0Source: full text

Problems surfaced2 types

Conclusions overstated beyond the evidence
Internal contradictions in the reported numbers

This Adcurare Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

The manuscript is a well-designed multicentre sham-controlled trial with strong methodological rigor. Minor reporting gaps include lack of explicit model assumption verification, exact p-values not reported, and an overstated claim in the discussion. The paper is otherwise transparent and reproducible.

The paper was evaluated against eight rigor dimensions adapted for a human interventional trial. Some sub-criteria (e.g., species/strain, housing, replicate distinction) were correctly marked not applicable. Three independent reviewers agreed on the overall pass status, with minor disagreements on checklist sub-criteria, which were resolved by weighing evidence. The statistics verification covered only 4 tests; the majority of analyses remain unverified. The claim audit identified one overstated conclusion.

12 major claims checked against the paper's own evidence: 1 not fully backed by the presented evidence (unsupported or overstated).

Recomputed 4 tests: 4 consistent, 0 inconsistent, 4 via agent-written checks.

1 integrity concern flagged (0 high).

Reporting

Eight Dimensions8 pass

Prior work is extensively cited (references 1–30), including prevalence data, prior rTMS trials, and a preliminary pilot study. The rationale linking M1 stimulation to social communication deficits is clearly laid out (Introduction paragraphs 3–4). Limitations of prior rTMS work (systematic exclusion of younger children, those with intellectual disability, need for neuronavigation) are explicitly addressed in the study design (Introduction paragraphs 2–4, Discussion).

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The paper establishes a strong scientific premise by citing prior work, stating a logical rationale, and describing how limitations of prior research are addressed.

Evidence

direct quote[Introduction, paragraphs 2-4]

“current empirical evidence remains limited and inconclusive...systematic exclusion of people with comorbid intellectual disability undermines the ecological validity and generalisability of findings”

direct quote[Introduction, paragraph 3]

“Accumulating evidence highlighted the roles of M1 in regulating action understanding, language processing, and social emotional functions—domains frequently affected in autism”

paraphrase[Introduction, paragraph 4; Methods, Trial design]

“The protocol is specifically designed to include younger children and those with intellectual disability, groups systematically excluded from prior rTMS trials, and eliminates the need for neuronavigation by using motor evoked potential targeting.”

PASSReviewer 2· 95% conf

The scientific premise is well established with extensive citation of prior work and a clear logical rationale for the study.

Evidence

direct quote[Introduction, paragraphs 1-4]

“Over the past decade, repetitive transcranial magnetic stimulation (rTMS), a non-invasive neurostimulation technique, has shown clinical efficacy and a favourable safety profile in treating various neuropsychiatric conditions, including depression.”

direct quote[Introduction, paragraph 4]

“We selected the left primary motor cortex (M1) as the stimulation target based on mechanistic and practical considerations.”

direct quote[Introduction, paragraphs 3-4; Discussion, first paragraph of 'Strengths and limitations']

“The systematic exclusion of people with comorbid intellectual disability undermines the ecological validity and generalisability of findings, given the high comorbidity rate.”

PASSReviewer 3· 95% conf

The paper establishes a clear scientific premise by citing prior work on rTMS in ASD, acknowledging its limitations, and providing a logical rationale for the current study.

Evidence

direct quote[Introduction, paragraphs 2-3]

“However, current empirical evidence remains limited and inconclusive.”

direct quote[Introduction, paragraphs 3-4]

“We selected the left primary motor cortex (M1) as the stimulation target based on mechanistic and practical considerations.”

direct quote[Introduction, paragraph 3]

“To address these challenges, we developed and evaluated a rTMS protocol adapted for young children with ASD and children with co-occurring intellectual disability.”

Randomization was stratified by IQ and site using a block design with stated block length. Blinding was implemented for participants, evaluators, and most study personnel, with sham coils that were visually and audibly indistinguishable. An a priori power analysis was conducted based on pilot data. Inclusion and exclusion criteria were clearly pre-specified. The sham control serves as an appropriate control. Replicate distinction and independent replication are not applicable for a human RCT.

Sub-criteria

controlsADEQUATE

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

The study design is well-described with adequate reporting of randomisation, blinding, sample size estimation, inclusion/exclusion criteria, and controls, though power analysis was based on a single-arm pilot and the distinction of biological vs technical replicates is not applicable for a human clinical trial.

Evidence

direct quote[Methods, Randomisation and masking]

“Participants were randomly assigned in a 1:1 ratio...using a block randomisation sequence (block length=4) generated by an independent coordinator in SPSS version 25.0”

direct quote[Methods, Randomisation and masking; Results, Masking integrity]

“Only the intervention operators directly administering the intervention were unmasked...sham coils were used that were visually indistinguishable from the active coils”

direct quote[Methods, Statistical analysis]

“Sample size estimation was based on our previous single arm a-cTBS trial, which showed a mean change in SRS-2 score of 8.5 (standard deviation 17.7). Using a two sided α=0.025 to account for two primary outcomes, and assuming 80% power and 10% attrition, the required sample size was 186 participants.”

PASSReviewer 2· 92% conf

The study design is rigorous with adequate methods for randomisation, blinding, sample size justification, and handling of missing data.

Evidence

direct quote[Methods, 'Randomisation and masking']

“Randomisation was stratified by full scale intelligence quotient level (≥70 or <70) and trial site, using a block randomisation sequence (block length=4) generated by an independent coordinator in SPSS version 25.0.”

direct quote[Methods, 'Randomisation and masking']

“Participants and evaluators were masked to interventions.”

direct quote[Methods, 'Statistical analysis']

“Using a two sided α=0.025 to account for two primary outcomes, and assuming 80% power and 10% attrition, the required sample size was 186 participants.”

PASSReviewer 3· 95% conf

The study design is rigorous, with adequate reporting of randomization, blinding, power analysis, inclusion/exclusion criteria, and controls.

Evidence

direct quote[Methods, Randomisation and masking]

“To maintain the masking of participants and study personnel, sham coils were used that were visually indistinguishable from the active coils.”

direct quote[Methods, Statistical analysis]

Sex is reported: 167 boys, 33 girls (83.5% male). Age is reported (mean 6.5±1.6, range 4–10 years). Health status: ASD diagnosis confirmed, full-scale IQ ≥50, exclusion criteria stated. Demographics: age, sex, IQ, ADOS scores, comorbid ADHD, medication use, site distribution, and residence are all reported in Table 1. Sex_justified is not applicable as both sexes were enrolled. Species_strain_source and housing_conditions are not applicable for a human clinical trial.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Patient demographics, age, sex, IQ, and ASD severity are comprehensively reported. The study enrolled both sexes (83.5% male), and a justification for single-sex analysis is not required. Species/strain/housing are not applicable for a human trial.

Evidence

direct quote[Abstract; Table 1]

“200 children aged 4-10 years with autism spectrum disorder (167 boys and 33 girls)”

direct quote[Table 1]

“Age (years), mean (SD) [active] 6.6 (1.8); Full scale IQ, mean (SD) [active] 72.1 (18.8)”

direct quote[Table 1]

“Residence [Urban 92/96] ... Comorbid with ADHD [33/32] ... Concurrent psychotropic medication use [11/13]”

PASSReviewer 2· 92% conf

Key biological variables including age, sex, IQ, ASD diagnosis, and comorbidities are well reported.

Evidence

direct quote[Table 1]

“Age (years), mean (SD) Active group 6.6 (1.8) Sham group 6.4 (1.5)”

direct quote[Table 1]

“Comorbid with intellectual disability (full scale IQ <70) 50 (50) 51 (51)”

direct quote[Table 1]

“Urban 92 (92) 96 (96)”

PASSReviewer 3· 95% conf

Key biological variables including age, sex, IQ, and comorbidities are well reported.

Evidence

direct quote[Abstract, Participants]

“200 children aged 4-10 years with autism spectrum disorder (167 boys and 33 girls)”

direct quote[Results, Baseline characteristics]

“200 eligible participants (mean age 6.5±1.6 years; 83.5% male)”

direct quote[Table 1]

“Full scale IQ, mean (SD) | 72.1 (18.8) | 72.3 (16.9)”

The trial protocol was approved by the ethics committees of all three participating hospitals (Xinhua Hospital, Qilu Hospital, Zhengzhou Children's Hospital) with a specific protocol number (XHEC-C-2023-043-4) for the lead site. Written informed consent was obtained from legal guardians. The study states adherence to the Declaration of Helsinki and Good Clinical Practice. IACUC statement is not applicable (human trial).

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 98% conf

Ethical approval from named committees at all three sites and written informed consent from legal guardians are reported, along with regulatory compliance statements.

Evidence

direct quote[Methods, Trial design; Ethics statements]

“The trial protocol was approved by the ethics committees of all participating sites, including Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine (XHEC-C-2023-043-4)”

direct quote[Methods, Trial design; Ethics statements]

“Written informed consent was obtained from the legal guardians of all participants after a thorough in-person explanation of the study procedures.”

direct quote[Ethics statements]

“The study was conducted in accordance with the Good Clinical Practice and the principles of the Declaration of Helsinki.”

PASSReviewer 2· 95% conf

Ethical approvals are clearly reported with named ethics committees, protocol numbers, and informed consent.

Evidence

direct quote[Methods, 'Trial design'; Ethics statements]

“The trial protocol was approved by the ethics committees of all participating sites, including Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine (XHEC-C-2023-043-4)”

direct quote[Methods, 'Trial design'; Ethics statements]

“Written informed consent was obtained from the legal guardians of all participants after a thorough in-person explanation of the study procedures.”

direct quote[Ethics statements]

“The study was conducted in accordance with the Good Clinical Practice and the principles of the Declaration of Helsinki.”

PASSReviewer 3· 95% conf

Ethical approvals from named committees, informed consent, and regulatory compliance are all adequately reported.

Evidence

direct quote[Ethics statements]

“The trial protocol was approved by the ethics committees of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine (XHEC-C-2023-043-4) and each participating site in accordance with the Declaration of Helsinki.”

direct quote[Methods, Trial design]

“Written informed consent was obtained from the legal guardians of all participants after a thorough in-person explanation of the study procedures.”

direct quote[Ethics statements]

“The study was conducted in accordance with the Good Clinical Practice and the principles of the Declaration of Helsinki.”

The TMS device is identified by model and manufacturer. The statistical software (R version 4.5.2) and SPSS version 25.0 are identified. Antibodies, cell lines, mycoplasma testing, and organisms are not applicable for this human interventional trial. Reagents are scored against the investigational product, which is adequately identified.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 88% conf

The investigational device (transcranial magnetic stimulation device, M-100 Ultimate) is identified with manufacturer, and the sham coil is described. The rTMS device is the key resource for this intervention trial. Software tools (SPSS, R) are identified with versions. No antibodies, cell lines, or organisms are used, and these are correctly marked not applicable.

Evidence

direct quote[Methods, Interventions]

“All sites used the same model of pulsed magnetic stimulation device (M-100 Ultimate, Shenzhen Yingchi Technology Co., China).”

direct quote[Methods, Statistical analysis; Randomisation and masking]

“All statistical analyses were performed using R version 4.5.2 (R Foundation for Statistical Computing, Vienna, Austria). ... SPSS version 25.0 (IBM Corp., Armonk, NY, USA)”

PASSReviewer 2· 90% conf

The key resource (the investigational TMS device) is identified, and software tools are adequately reported.

Evidence

direct quote[Methods, 'Interventions']

“All sites used the same model of pulsed magnetic stimulation device (M-100 Ultimate, Shenzhen Yingchi Technology Co., China).”

direct quote[Methods, 'Randomisation and masking'; 'Statistical analysis']

“SPSS version 25.0 (IBM Corp., Armonk, NY, USA)”

direct quote[Methods, 'Statistical analysis']

“All statistical analyses were performed using R version 4.5.2 (R Foundation for Statistical Computing, Vienna, Austria).”

PASSReviewer 3· 95% conf

The investigational product (TMS device) and software are adequately identified.

Evidence

direct quote[Methods, Interventions]

“All sites used the same model of pulsed magnetic stimulation device (M-100 Ultimate, Shenzhen Yingchi Technology Co., China).”

direct quote[Methods, Statistical analysis]

“All statistical analyses were performed using R version 4.5.2 (R Foundation for Statistical Computing, Vienna, Austria).”

The primary analysis uses linear regression with adjustments for stratification factors. Exact p-values and 95% confidence intervals are reported for primary and secondary outcomes. Effect sizes (Cohen's d) are provided. Statistical software is identified. Data presentation includes per-group n, means, SDs, and CIs. Assumptions are handled through the use of standard methods and sensitivity analyses. Mathematical plausibility checks are not applicable for continuous outcomes with N>100.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 92% conf

Statistical tests are named (linear regression, ordinal logistic regression, mixed effects models), effect sizes and confidence intervals are reported, software is identified, and data presentation includes per-group Ns, means, SDs, CIs, and figures. Exact p-values are reported, and multiple imputation is used. Some assumptions are implicitly handled (no explicit normality test reported, but standard methods with sensitivity analyses), and mathematical plausibility cannot be fully verified from summary data but shows no obvious errors.

Evidence

direct quote[Methods, Statistical analysis]

“group differences in changes were assessed using linear regression, adjusting for baseline SRS-2 scores...Ordinal outcomes (CGI-I ratings) were compared using ordinal logistic regression.”

direct quote[Results, Primary efficacy outcome; Table 2]

“mean difference in SRS-2 scores of −6.25 (95% CI −8.69 to −3.81; Cohen’s d −0.92; P<0.001)”

direct quote[Methods, Statistical analysis]

“All statistical analyses were performed using R version 4.5.2 ... SPSS version 25.0”

PASSReviewer 2· 85% conf

Statistical tests are named, adjustments are made for multiple primary endpoints, and effect sizes with CIs are reported. Some assumptions are not explicitly verified, but this is typical for a large RCT.

Evidence

direct quote[Methods, 'Statistical analysis']

“SRS-2 change scores (T0 to T1 and T0 to T2) were considered continuous, and the group differences in changes were assessed using linear regression, adjusting for baseline SRS-2 scores.”

direct quote[Results, 'Primary efficacy outcome']

“P<0.001”

direct quote[Results, 'Primary efficacy outcome']

“mean difference in SRS-2 scores of −6.25 (95% confidence interval (CI) −8.69 to −3.81; Cohen’s d −0.92; P<0.001)”

PASSReviewer 3· 95% conf

Statistical methods are well described, with named tests, exact p-values, effect sizes, and confidence intervals reported.

Evidence

direct quote[Methods, Statistical analysis]

“SRS-2 change scores (T0 to T1 and T0 to T2) were considered continuous, and the group differences in changes were assessed using linear regression, adjusting for baseline SRS-2 scores.”

direct quote[Results, Primary efficacy outcome]

“mean difference in SRS-2 scores of −6.25 (95% confidence interval (CI) −8.69 to −3.81; Cohen’s d −0.92; P<0.001)”

direct quote[Results, Primary efficacy outcome]

“Cohen’s d −0.92”

Data availability statement: 'The data underlying the findings in this paper are openly and publicly available and can be found at: https://osf.io/tg9me/overview'. This provides a concrete route to the data. Code: 'The code used to analyse the data in the paper can be found in the supplementary appendix.' The OSF link likely contains the code as well. Repository_deposit is satisfied by the OSF link. Accession numbers are not applicable (no sequencing data). Code sharing is done via supplementary appendix and the OSF repository, though not a version-controlled public repo with a permanent identifier (OSF provides a DOI-like persistent identifier). This is considered adequate.

Sub-criteria

code sharingADEQUATE

accession numbersN/A

repository depositADEQUATE

data availability statementADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Data are deposited in a public repository (OSF) with a persistent identifier, and a data availability statement is provided. Code is referenced in the supplementary appendix and is also on the OSF repository, which qualifies as shared. A data availability statement is present and adequate.

Evidence

direct quote[Data availability statement]

“The data underlying the findings in this paper are openly and publicly available and can be found at: https://osf.io/tg9me/overview”

direct quote[Data availability statement; Methods, Statistical analysis]

“The code used to analyse the data in the paper can be found in the supplementary appendix.”

PASSReviewer 2· 90% conf

Data are deposited in a public repository (OSF) with a link, and code is provided in the supplementary appendix.

Evidence

direct quote[Data availability statement]

“The data underlying the findings in this paper are openly and publicly available and can be found at: https://osf.io/tg9me/overview .”

direct quote[Data availability statement]

“The code used to analyse the data in the paper can be found in the supplementary appendix.”

PASSReviewer 3· 95% conf

Data and code are made available with a concrete access route.

Evidence

direct quote[Data availability statement]

“The data underlying the findings in this paper are openly and publicly available and can be found at: https://osf.io/tg9me/overview .”

direct quote[Data availability statement]

“The code used to analyse the data in the paper can be found in the supplementary appendix.”

The trial is registered at ClinicalTrials.gov (NCT05927792). The paper states it follows CONSORT guidelines. Limitations are discussed in detail, including baseline differences, expectancy effects, and generalisability. Conclusions are proportional to the evidence. Funding sources and conflicts of interest are disclosed.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineADEQUATE

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 92% conf

The manuscript is reported transparently: methods are complete, the trial is registered (NCT05927792), CONSORT guidelines are followed, limitations are discussed, conclusions are proportional, and funding and conflicts of interest are disclosed.

Evidence

direct quote[Abstract; Methods, Trial design]

“Trial registration ClinicalTrials.gov NCT05927792”

direct quote[Methods, Trial design]

“This study followed the CONSORT (consolidated standards of reporting trials) guidelines”

direct quote[Discussion, Strengths and limitations]

“Several limitations warrant consideration...we observed a trend towards baseline differences in SRS-2 scores between groups...expectancy bias...more than 80% of enrolled participants were boys”

PASSReviewer 2· 92% conf

The trial is registered, follows CONSORT guidelines, discusses limitations, and conclusions are proportional. Funding and COI are transparent.

Evidence

direct quote[Abstract; Methods]

“ClinicalTrials.gov NCT05927792”

direct quote[Discussion, 'Strengths and limitations']

“Although we anticipated equivalent groups owing to randomisation, we observed a trend towards baseline differences in SRS-2 scores between groups.”

direct quote[End of manuscript, after Discussion]

“This study was supported by grants from the National Natural Science Foundation of China (82125032, 82430104, 82325019, 82527801, 82461160261, 82204048, U24A20748, 82404755)”

PASSReviewer 3· 95% conf

The trial is registered, follows CONSORT guidelines, discusses limitations, and has proportional conclusions.

Evidence

direct quote[Abstract, Trial registration]

“ClinicalTrials.gov NCT05927792”

direct quote[Methods, Trial design]

“This study followed the CONSORT (consolidated standards of reporting trials) guidelines”

direct quote[Discussion, Strengths and limitations]

“Several limitations warrant consideration when interpreting the results.”

6 copyedit issues flagged: mostly consistency, clarity, grammar.

Checked 70 references: 64 verified — 6 not checked.

Reproducibility

1 data/code link checked; 1 live.

Registered (1 ID: ClinicalTrials.gov). Reporting guideline cited: CONSORT.

Adcurare Rigor Action ItemsFinal pass before journal submission

The manuscript is ready after minor edits. The most important pre-submission actions are to tone down the overstated claim about 'major advancement', report exact p-values, and add a statement on model assumption verification. Addressing these will strengthen the paper for submission.

1.
HIGHreporting
Temper the claim that the protocol is a 'major advancement towards equitable autism care worldwide' in the Discussion; replace with language that acknowledges the preliminary nature of the MCID, short follow-up, and potential biases.
The current claim is overstated relative to the evidence and will likely be flagged by reviewers or editors.
2.
HIGHstatistics
Report exact p-values to 2-3 significant figures (e.g., 'P=0.00023' instead of 'P<0.001') for the primary outcome and all secondary outcomes where currently given as '<0.001'.
Exact p-values allow readers to assess the strength of evidence more precisely; reviewers expect this standard.
3.
HIGHstatistics
Add a subsection in 'Statistical analysis' describing that model assumptions (normality of residuals, homoscedasticity) were checked for the primary linear regression models, and state the method used (e.g., Q-Q plots, residual plots) and any corrective actions taken.
Verification of assumptions is a standard requirement for linear regression; its absence is a common reviewer concern.
4.
HIGHrigor
Add a clear description of outlier handling criteria in the 'Statistical analysis' section: define how outliers were identified (e.g., >3 SD from mean) and whether any data points were excluded or sensitivity analyses performed.
The paper currently lacks explicit outlier handling, which is a gap in the study design reporting.
5.
MEDIUMdata code
Deposit the analysis code in a version-controlled repository (e.g., GitHub, Zenodo) with a permanent DOI, and update the Data availability statement to include this link alongside the OSF link.
Code in a supplementary appendix is not versioned; a repository with a DOI improves reproducibility and discoverability.
6.
MEDIUMreporting
Add a statement indicating whether an independent Data Safety Monitoring Board (DSMB) oversaw the trial, and if so, include details in the 'Methods' section.
DSMB oversight is standard for clinical trials and enhances transparency.
7.
MEDIUMreporting
Provide individual participant data plots (e.g., spaghetti plots or jitter plots) for the primary SRS-2 outcome, either in the main figure or as supplementary material.
Individual-level data allow readers to assess distribution, outliers, and variability beyond group means and SDs.
8.
MEDIUMreporting
Report the exact p-value for the CGI-I analysis at T2 (currently P=0.008) and for the masking integrity test (currently P=0.09) to three significant figures.
Consistency across the manuscript in reporting exact p-values strengthens statistical reporting.
9.
MEDIUMreporting
Consider reporting a pretest measure of treatment expectancy (e.g., credibility/expectancy questionnaire) to formally assess potential expectancy bias, as acknowledged in the limitations.
Adding this measure would strengthen the analysis of blinding and expectancy effects.
10.
MEDIUMreporting
In Table 3, break down 'scalp discomfort' into more specific categories (e.g., 'pain', 'tingling') to provide a more granular safety profile.
Detailed adverse event reporting improves clinical interpretation and regulatory compliance.
11.
LOWcopyedit
In Table 3 footnote, ensure the asterisked row ('Transient limb spasm') is clearly referenced; move the footnote text closer to the table if needed.
Clarity in table footnotes avoids reader confusion.
12.
LOWcopyedit
In Table 2, rename the sub-rows 'Production: Tell story' and 'Comprehension: Tell story' to 'Production (storytelling)' and 'Comprehension (story)' to avoid ambiguity.
Clearer labelling improves readability.
13.
LOWcopyedit
In Methods, 'Statistical analysis', rephrase 'The primary outcome was served as the change' to 'The primary outcome was defined as the change'.
Corrects a grammatical error for clarity.
14.
LOWcopyedit
In Table 3, for the Tinnitus row, change '0 (0)' to '0 (0.0)' for consistency with percentages shown to one decimal place.
Formatting consistency improves professional appearance.

Full text (73,848 chars)Analyzed: Jul 7, 2026

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