Quality assessment and certainty of evidence assessment
Two researchers independently evaluated the quality of included RCTs by
using the Risk of Bias (RoB) 2 Tool.11 The RoB2 tool
uses a three-point scale, including “low risk of bias,” “some
concerns,” and “high risk of bias,” by investigating five domains at
risk of bias. Disagreements were resolved by discussion; if no agreement
was reached after discussion, a third researcher (BD) was involved to
correctly assign the risk of bias.
The grading of recommendations assessment, development, and evaluation
(GRADE) system was used to rate the certainty and, therefore, the
quality of evidence for each outcome.12