A methodological quality assessment of studies was performed by 2 investigators (XZ and DL) independently using the PEDro scale.[9] The PEDro scale has demonstrated acceptable validity and reliability among physiotherapy trials[10] and was selected due to its high interrater reliability and strong convergence with the Cochrane Back and Neck (CBN) risk of bias tool.[11,12] The scale evaluates 11 items including: inclusion criteria and source, random allocation, concealed allocation, similarity at baseline, subject blinding, therapist blinding, assessor blinding, completeness of follow up, intention-to-treat analysis, between-group statistical comparisons, and point measures and variability. Each item is rated as either a “yes” or “no” and the total PEDro score is tallied by the total number of “yes” items (excluding the inclusion criteria and source item). In a few instances, discrepancies regarding study qualification or methodological quality scores were resolved between investigators by discussion after scores/lists had been generated independently. In these cases the authors worked together to come to an agreement on inclusion/exclusion or quality score.

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