2.5. Quality Appraisal

Three review authors independently assessed risk of bias for each study using risk of bias tools from Cochrane. The ROBINS-I assessment tool [30] and the RoB 2 risk of bias tool [31] were used to evaluate the quality of non-randomized (n = 6) and randomized trials (n = 10), respectively. For both tools, “Low risk” correspond to the risk of bias in a high quality study. Disagreements in risk of bias were resolved by discussion and consensus. Both tools include domain items relating to deviations from the intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. The ROBINS-I also includes items relating to confounding, selection of participants, and classification of intervention. The RoB 2 includes items relating to the randomization process. Risk of bias was assessed for each domain and pooled for an overall risk of bias rating for each study. All papers provided enough information to produce a final rating.