Overall Quality Score (GRADE rating)
·         High ·         Moderate ·         Low ·         Very low	High (Randomised trial /double upgraded Ix studies Further research is very unlikely to change our confidence in the estimate of effect
	Moderate: Downgraded randomised trials /Upgraded observational studies Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
	Low: Double downgraded randomised trials/Observational studies Low quality— Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
	Very Low : Triple down graded randomised trials/downgraded observational studies/case series/case reports. Any estimate of effect is very uncertain