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