Table 4. Assessment of certainty of evidence of the eligible studies.

Study	Initial rating	Downgrading?	Upgrading?	Confidence in body of evidence
Abbas et al., 2022 [27]	High	Yes↓	No	Moderate
Aksak et al., 2022 [28]	High	No	No	High
Al-Alami et al., 2022 [29]	Moderate	Yes, 1	Yes, 1	Low
Al-Bashiti et al., 2022 [30]	High	Yes, 1	No	Moderate
Azzawi and Abdulrahman, 2022 [31]	High	Yes, 1	No	Moderate
Best et al, 2021 [32]	High	No	No	High
Camici et al., 2021 [33]	High	No	No	High
Cinislioglu et al., 2022 [34]	High	No	No	High
Dipankar et al., 2022 [35]	Moderate	No	No	Moderate
Enikeev et al., 2022 [36]	High	No	No	High
Erbay et al., 2021 [37]	Moderate	Yes, 1	Yes, 1	Moderate
Falahieh et al., 2021 [38]	Moderate	No	No	Moderate
Gacci et al., 2021 [39]	High	yes, 1	No	Moderate
Gul et al., 2021 [40]	High	Yes (2)	No	Moderate
Guo et al., 2021 [41]	High	Yes, 1	No	Moderate
Hadisi et al., 2022 [42]	High	Yes, 1	No	Moderate
Hamarat et al., 2022 [43]	High	No	No	High
Holtmann et al., 2020 [44]	High	Yes, 1	No	Moderate
Hu et al., 2022 [45]	High	No	No	High
Kadihasanoglu et al., 2021 [46]	High	Yes, 1	Yes	High
Karkin and Gürlen, 2022 [47]	Moderate	Yes, 1	No	High
Koç & Keseroğlu, 2021 [48]	Moderate	Yes,1	No	Low
Kumar et al., 2023 [49]	Moderate	No	Yes, 1	High`
Li et al., 2020 [50]	High	No	No	High
Livingstone et al., 2022 [51]	High	Yes, 1	No	Moderate
Ma et al., 2021 [52]	High	Yes, 1	Yes, 1	High
Maleki and Tartibian, 2021 [53]	High	No	No	High
Okçelik, 2020 [54]	High	Yes, 1	No	Moderate
Paoli et al., 2023 [55]	Moderate	No	Yes, 1	High
Pazir et al., 2021 [56]	Moderate	Yes, 1	No	Low
Piroozmanesh et al., 2021 [57]	High	No	No	High
Rafiee and Tabei, 2021 [58]	High	No	No	High
Ruan et al., 2021 [59]	High	No	No	High
Salonia et al., 2021 [60]	High	Yes, 1	Yes, 1	High
Salonia et al., 2022 [61]	High	Yes, 1	Yes, 1	High
Sunnu et al., 2022 [62]	Moderate	No	No	Moderate
Temiz et al., 2020 [63]	High	No	No	High
Vahidi et al 2022 [64]	High	Yes, 1	No	Moderate
Wang et al 2022 [65]	High	Yes, 1	No	Moderate
Xu et al., 2021 [66]	High	Yes (1)	N0	Moderate