Table 4.
Risk of bias assessment using AXIS tool for cross-sectional design risk of bias
| Author / Year | Introduction | Methods | Results | Discussion | Other | Total Out of 20 | Quality | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13a | 14 | 15 | 16 | 17 | 18 | 19a | 20 | |||
| Al Agili et al., (2004) [35] | 1 | 1 | 0 | 1 | 1 | 1 | x | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 0 | x | 1 | 14 | M |
| Al Habashneh et al., (2012) [60] | 1 | 1 | 0 | 1 | 1 | 1 | x | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 17 | H |
| AlHammad et al., (2020) [45] | 1 | 1 | 0 | 1 | x | x | x | 1 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 1 | 0 | 1 | 1 | 10 | M |
| Allison et al., (2000) [36] | 1 | 1 | 0 | 1 | 1 | 0 | x | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | x | 14 | M |
| Al-shehri., (2012) [64] | 1 | 1 | 0 | 1 | 0 | 0 | x | 1 | 1 | 1 | 1 | 1 | x | 0 | 1 | 1 | 1 | 1 | x | 1 | 13 | M |
| Alshihri et al., (2021) [46] | 1 | 1 | 0 | 1 | 1 | 0 | x | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 16 | H |
| Barry et al., (2014) [37] | 1 | 1 | 1 | 1 | 1 | 0 | x | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | x | 1 | 16 | H |
| Bhaskar et al., (2016) [47] | 1 | 1 | 0 | 1 | 1 | 0 | x | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 15 | H |
| Brickhouse et al., (2009) [48] | 1 | 1 | 1 | 1 | 1 | 1 | x | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | x | 1 | 17 | H |
| Chi et al., (2010) [61] | 1 | 1 | 1 | 1 | 1 | 1 | x | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 18 | H |
| De Jongh et al., (2008) [49] | 1 | 1 | 1 | 1 | 1 | 1 | x | 1 | x | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | x | 1 | 16 | H |
| de Souza et al., (2023) [42] | 1 | 1 | 1 | 1 | 1 | 1 | x | 1 | x | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 17 | H |
| Fenning et al., (2020) [65] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | x | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 18 | H |
| Gerreth et al., (2016) [50] | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | x | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | x | 1 | 12 | M |
| Holt & Parry, (2019) [51] | 1 | 1 | 0 | 1 | 1 | 0 | x | 1 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 13 | M |
| Hu & Da Silva, (2022) [44] | 1 | 1 | 1 | 1 | 1 | 1 | x | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 18 | H |
| Kachwinya et al., (2022) [62] | 1 | 1 | 1 | 1 | 0 | 0 | x | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 15 | H |
| Krishnan et al., (2018) [52] | 1 | 1 | 0 | 1 | 1 | 0 | x | 1 | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 14 | M |
| Lai et al., (2012) [53] | 1 | 1 | 0 | 1 | 1 | 0 | x | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 16 | H |
| Liu et al., (2022) [40] | 1 | 1 | 0 | 1 | 0 | 0 | x | 1 | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 1 | 0 | 1 | 1 | 10 | M |
| Nelson et al., (2011) [14] | 1 | 1 | 1 | 1 | 1 | 1 | x | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | x | 1 | 17 | H |
| Puthiyapurayil et al., (2022) [56] | 1 | 1 | 1 | 1 | 1 | 1 | x | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 0 | 1 | 1 | 1 | x | 1 | 16 | H |
| Rajput et al., (2021) [57] | 1 | 1 | 1 | 1 | 1 | 0 | x | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 14 | M |
| Sabbarwal et al., (2018) [43] | 1 | 1 | 1 | 1 | 0 | 1 | x | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 16 | H |
| Schultz et al., (2001) [34] | 1 | 1 | 1 | 1 | 1 | 1 | x | 1 | 1 | 1 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 0 | x | 1 | 14 | M |
| Shyama et al., (2015) [58] | 1 | 1 | 0 | 1 | 0 | 0 | x | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 0 | x | 1 | 12 | M |
| Stein et al., (2012) [59] | 1 | 1 | 0 | 1 | 1 | 1 | x | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | x | 1 | 15 | H |
| Zahran et al., (2023) [66] | 1 | 1 | 1 | 1 | 1 | 1 | x | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 18 | H |
| Zhou et al., (2021) [63] | 1 | 1 | 0 | 1 | 1 | 0 | x | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 16 | H |
| Zickafoose et al., (2015) [67] | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | x | 1 | 17 | H |
Y Yes = 1, N No = 0, DK Don’t know = x
aItem is reverse scored
low-quality (L) scores range from 1-7 (RED), medium quality (M) from 8-14 (Yellow), and high quality (H) scores range from 15-20 (Green)
Items:
1. Were the aims/objectives of the study clear?
2. Was the study design appropriate for the stated aim(s)?
3. Was the sample size justified?
4. Was the target/reference population clearly defined? (Is it clear who the research was about?)
5. Was the sample frame taken from an appropriate population base so that it closely represented the target/reference population under investigation?
6. Was the selection process likely to select subjects/participants that were representative of the target/reference population under investigation?
7. Were measures undertaken to address and categorise non-responders?
8. Were the risk factor and outcome variables measured appropriate to the aims of the study?
9. Were the risk factor and outcome variables measured correctly using instruments/measurements that had been trialled, piloted or published previously?
10. Is it clear what was used to determined statistical significance and/or precision estimates? (e.g. p-values, confidence intervals).
11. Were the methods (including statistical methods) sufficiently described to enable them to be repeated?
12. Were the basic data adequately described?
13. Does the response rate raise concerns about non-response bias?
14. If appropriate, was information about non-responders described?
15. Were the results internally consistent?
16. Were the results presented for all the analyses described in the methods?
17. Were the authors' discussions and conclusions justified by the results?
18. Were the limitations of the study discussed?
19. Were there any funding sources or conflicts of interest that may affect the authors’ interpretation of the results?
20. Was ethical approval or consent of participants attained?