Chart 6. Quality of evidence (GRADE).

Myotherapy exercises compared with the absence of exercises in individuals older than 18 years.
Assessment of the certainty							Number of patients		Effect		Certainty	Importance
Number of studies	Study design	Risk of bias	Inconsistency	Indirect evidence	Imprecision	Other considerations	Myotherapy exercises	Absence of exercises	Relative (95% CI)	Absolute (95% CI)
Anterior tongue pressure (follow-up ranging from 3 to 8 weeks; assessed with IOPI)
11	Randomized clinical trials	Very severea	Not severe	Not severe	Not severe	None	252	227	-	DM 6.05 kPa higher (4.39 higher to 7.71 lower)	⨁⨁◯◯ Low	Myotherapy exercises increase anterior tongue pressure. However, the studies analyzed had methodological biases.
Posterior tongue pressure (follow-up ranging from 4 to 8 weeks; assessed with IOPI)
5	Randomized clinical trials	Not severe	Not severe	Severeb	Severec	None	137	126	-	DM 5.45 kPa higher (2.8 higher to 8.11 lower)	⨁⨁◯◯ Low	Myotherapy exercises increase posterior tongue pressure. However, the outcome was not assessed in adults, and there were few participants.

^aStudies with moderate and low methodological quality contribute to more than 50% of the weight in the meta-analysis for this outcome;

^bThere was an absence of studies in adults assessing this outcome. All studies were conducted in older adults;

^cFew participants had this outcome assessed

Caption: CI = Confidence Interval; DM = Difference of Means; IOPI = Iowa Oral Performance Instrument