Table 1. Risk of bias assessment for included studies.
| Reference | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Total “Y” | Risk category |
|---|---|---|---|---|---|---|---|---|
| [43] | ✓a | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓b |
| [44] | ✓ | ✓ | ✓ | ✓ | •c | ✓ | 5 | ↓ |
| [45] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [46] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [47] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [48] | ✓ | ✓ | ✓ | ×d | × | ✓ | 4 | ≈e |
| [49] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [50] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [51] | ✓ | ✓ | ✓ | × | • | ✓ | 4 | ≈ |
| [26] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [28] | ✓ | ✓ | ✓ | × | × | ✓ | 4 | ≈ |
| [52] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [53] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [54] | × | ✓ | ✓ | × | • | ✓ | 3 | ≈ |
| [55] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [56] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [57] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [30] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [58] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [59] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [22] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [60] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [61] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [62] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [63] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [23] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [64] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [65] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [66] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [67] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [29] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [68] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [69] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [70] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [31] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [71] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [72] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [73] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [74] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [75] | ✓ | ✓ | ✓ | ✓ | × | ✓ | 5 | ↓ |
| [76] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [77] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [78] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [79] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [80] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [81] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [82] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [83] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [32] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [84] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [85] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [86] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [87] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [88] | ✓ | ✓ | ✓ | × | • | ✓ | 4 | ≈ |
| [27] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [89] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [25] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [90] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [91] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [92] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [93] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [94] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [95] | ✓ | ✓ | ✓ | ✓ | × | ✓ | 5 | ↓ |
| [96] | ✓ | ✓ | ✓ | ✓ | × | ✓ | 5 | ↓ |
| [97] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [98] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [99] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [100] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [101] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [102] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [103] | ✓ | ✓ | ✓ | × | × | ✓ | 4 | ≈ |
| [104] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [20] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [105] | ✓ | ✓ | ✓ | ✓ | × | ✓ | 5 | ↓ |
| [106] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [21] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [107] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [108] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [109] | × | ✓ | ✓ | ✓ | × | ✓ | 4 | ≈ |
| [110] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [111] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [112] | × | ✓ | ✓ | × | × | ✓ | 3 | ≈ |
| [113] | × | ✓ | ✓ | × | ✓ | 3 | ≈ | |
| [114] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [115] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [116] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [117] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [118] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [12] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [119] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [120] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [121] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [122] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [123] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [124] | × | ✓ | ✓ | ✓ | × | ✓ | 4 | ≈ |
| [125] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [126] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [127] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [128] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [129] | × | ✓ | ✓ | × | • | ✓ | 3 | ≈ |
| [130] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [131] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [132] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [133] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [134] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [135] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [136] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [137] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [138] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [139] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [140] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [141] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [142] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [143] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [144] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [145] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [146] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [147] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [148] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [149] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [150] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [151] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [152] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [153] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [154] | × | ✓ | ✓ | ✓ | • | ✓ | 4 | ≈ |
| [155] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [156] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [157] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [158] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [24] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [159] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [160] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [161] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [162] | × | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | ↓ |
| [163] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [164] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [165] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [166] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [167] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [168] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ↓ |
| [169] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
| [170] | ✓ | ✓ | ✓ | ✓ | • | ✓ | 5 | ↓ |
✓: Yes.
↓: Low risk of bias.
•: Unclear.
×: No.
≈: Moderate risk of bias.