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. 2025 Aug 22;29(1):146. doi: 10.1007/s10006-025-01432-5

Table 3.

Risk of bias of primary studies collected from systematic reviews

Author Risk of bias assessment in primary studies (RCTs) Risk of bias assessment in primary studies (NRSI) Tool for assessing risk of bias
Xiang et al. 2019

5 with unclear risk of bias

5 with high risk of bias

Included only RCTs Cochrane Collaboration’s tool (2011)
Chen et al. 2016

1 with low risk of bias

5 with unclear risk of bias

2 with high risk of bias

Included only RCTs Cochrane Collaboration’s tool (2011)
He et al. 2017

2 with low risk of bias

3 with unclear risk of bias

4 with high risk of bias

1 with high risk of bias Cochrane Collaboration’s tool (2011)
Al-Hamed et al. 2017

4 with unclear risk of bias

1 with high risk of bias

1 with high risk of bias Cochrane Collaboration’s tool (2011)
Barona- Dorado et al. 2014

2 with total score 3

1 with total score 4

Included only RCTs Jadad Scale (1996)
Lopes da Silva et al. 2020

3 with low risk of bias

12 with unclear risk of bias

5 with high risk of bias

Included only RCTs Cochrane Collaboration’s tool (2011)
Aloy- Prosper et al. 2010 NR
Toledano-Serrabona et al. 2021

1 with low risk of bias

1 with unclear risk of bias

1 with high risk of bias

Included only RCTs Cochrane Collaboration’s tool (2011)
Lee et al. 2016

6 with unclear risk of bias

1 with high risk of bias

Included only RCTs Cochrane Collaboration’s tool (2011)
Barbato et al. 2016

3 with low RoB,

8 with unclear RoB

5 with high RoB

Included only RCTs Cochrane Collaboration’s tool (2011)
Camps-Font et al. 2018

7 with low RoB,

1 with unclear RoB

13 with high RoB

Included only RCTs Cochrane Collaboration’s tool (2011)
Ramos et al. 2022

1 with low RoB

13 with unclear RoB

3 with high risk of bias

Included only RCTs Cochrane Collaboration’s tool (2011)
Pang et al. 2022

7 with low risk of bias

1 with some concerns

1 with high risk of bias

7 with moderate risk of bias

1 with critical risk of bias

Cochrane’s ROBINS-I (2016) for NRSI and RoB 2 (2019) for RCTs.
Soo-Hoong Low et al. 2020

1 with low risk of bias

6 with low risk of bias

1 with high risk of bias

8 with unclear risk of bias

2 with high risk of bias

Cochrane Collaboration’s tool (2011)
Franchini M et al., 2019 3 with high risk of bias Included only RCTs Cochrane Collaboration’s tool (2011)
Miron RJ et al. 2016 NR
Danylyuk Y., 2019 NR
Del Fabbro M et al. 2011 3 with moderate risk of bias

1 with high risk of bias

2 with moderate risk of bias

Custom risk of bias tool that assessed sample size

calculation; concealed allocation of treatment;

completeness of information on

reasons for withdrawal by trial group; the randomization

method (if applicable); the definition of

exclusion/inclusion criteria; the comparability

of control and treatment groups at

entry, and the calibration and blinding of

evaluator(s) for outcome assessment. All

these criteria were judged as adequate/non

adequate.

Fujioka-Kobayashi M et al. 2021

12 with low risk of bias

6 with some concerns

Included only RCTs Cochrane’s RoB 2 (2019) for RCTs
Zhu J. et al. 2020 

13 with low risk of bias

6 with unclear risk of bias

Included only RCTs Cochrane Collaboration’s tool (2011)
Zhu J. et al. 2019  Overall risk of bias score for each study was not reported Cochrane Collaboration’s tool (2011)
Canellas J.V.D.S et al., 2020

29 with unclear risk of bias

8 with high risk of bias

Included only RCTs Cochrane Collaboration’s tool (2011)
Del Fabbro M. et al. 2017 Overall risk of bias score for each study was not reported Cochrane Collaboration’s tool (2011)
Snopek et al., 2021 6 with unclear risk of bias Included only RCTs Cochrane Collaboration’s tool (2008)
Jakobsen C et al., 2013 NR
Morjaria KR. et al. 2014 2 with high risk of bias Included only RCTs

Custom tool based on:

Cochrane Collaboration’s tool (2008)

Jadad Scale (2007)

CONSORT statement 2010

Canellas et al. 2017

1 with unclear risk of bias

6 with high risk of bias

Included only RCTs Cochrane Collaboration’s tool (2011)
Domic et al., 2023

3 with low risk of bias

7 with some concerns

1 with low risk of bias Cochrane’s ROBINS-I (2016) for NRSI and RoB 2 (2019) for RCTs.
Santos Pereira et al., 2023 1 with high risk of bias Included only RCTs Cochrane Collaboration’s tool (2011)
Lu Ye et al., 2024

21 with low risk of bias

9 with some concerns

3 with high risk of bias

Included only RCTs Cochrane’s RoB 2 (2019) for RCTs
Chen et al., 2023

4 with low risk of bias

1 with high risk of bias

Included only RCTs Cochrane’s RoB 2 (2019) for RCTs
Menager et al., 2023

1 with low risk of bias

9 with high risk of bias

1 with unclear risk of bias

4 with high risk of bias

Cochrane’s RoB 2 (2019) for RCTs 
Yuan et al., 2023

11 with some concerns

3 with high risk of bias

Included only RCTs Cochrane’s RoB 2 (2019) for RCTs