## 3 Results
### Risk of Bias Assessment  
The risk of bias, assessed using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool, varied across the included studies, ranging from low to serious [35; 36; 37; 38; 39; 40; 41; 42; 43; 44; 45; 46; 47; 48; 49; 50; 51]. A low risk of bias was observed in regard to the randomization process and deviations from the intended interventions, with most studies maintaining methodological rigor [35; 36; 37; 38; 39; 40; 41; 42; 43; 44; 45; 46; 47; 48; 49; 50]. Over 60% of the studies showed a low risk of bias in these domains, ensuring proper randomization and adherence to intervention protocols [35; 36; 38; 40; 42; 43; 44; 45; 46; 48; 49; 50].  
However, a moderate-to-serious risk of bias was noted in regard to missing outcome data and outcome measurement, raising concerns about incomplete datasets and assessment inconsistencies [35; 37; 39; 41; 43; 44; 47; 49; 51]. Notably, 35-40% of the studies displayed serious risk in these areas, which may affect the reliability of the reported results [35; 37; 39; 41; 43; 44; 47; 49; 51]. Selection of the reported results also showed a moderate-to-serious risk, suggesting selective reporting or inconsistent findings [35; 36; 37; 39; 40; 42; 45; 47; 50].  
The randomization process was adequate in most studies, although two studies failed to ensure proper sequence concealment, increasing selection bias risk [46; 50]. The blinding of outcome assessors was also incomplete in several studies, potentially influencing subjective assessments [36; 46; 47; 49; 51]. Overall, while many studies showed a low-to-moderate risk of bias, missing data and outcome measurement require careful interpretation [35; 36; 37; 38; 39; 50; 51]. Further details on the risk of bias assessment are available in Figure 2.  
\begin{table}
\begin{tabular}{c c c c c c c c c c c c c c} \hline \hline
**Author, Year** & **Score** & **Quality** & **1** & **2** & **3** & **4** & **5** & **6** & **7** & **8** & **9** & **10** & **11** \\ \hline [PERSON] et al. (2024) [35] & 9 & Excellent & Yes & Yes & Yes & Yes & No & Yes & Yes & Yes & Yes & Yes \\ \hline [PERSON] et al. (2023) [36] & 8 & Good & Yes & Yes & Yes & Yes & No & Yes & Yes & No & Yes & Yes \\ \hline [PERSON] et al. (2023) [37] & 8 & Good & Yes & Yes & Yes & Yes & Yes & No & Yes & Yes & No & Yes & Yes \\ \hline [PERSON] et al. (2023) [38] & 9 & Excellent & Yes & Yes & Yes & Yes & Yes & Yes & Yes & No & Yes & Yes \\ \hline [PERSON] et al. (2023) [39] & 7 & Good & Yes & Yes & Yes & Yes & No & Yes & Yes & No & Yes & Yes \\ \hline [PERSON] et al. (2023) [40] & 9 & Excellent & Yes & Yes & Yes & Yes & Yes & Yes & Yes & No & Yes & Yes \\ \hline [PERSON] et al. (2022) [41] & 8 & Good & Yes & Yes & Yes & Yes & No & Yes & Yes & No & Yes & Yes \\ \[PERSON] et al. (2022b) [42] & 9 & Excellent & Yes & Yes & Yes & Yes & No & Yes & Yes & Yes & Yes & Yes \\ \[PERSON] et al. (2021) [43] & 8 & Good & Yes & Yes & Yes & Yes & No & Yes & Yes & Yes & Yes & Yes \\ \[PERSON] et al. (2021) [44] & 8 & Good & Yes & Yes & No & Yes & Yes & No & Yes & Yes & Yes & Yes \\ \[PERSON] et al. (2020) [45] & 9 & Excellent & Yes & Yes & Yes & Yes & No & Yes & Yes & Yes & Yes & Yes \\ \[PERSON] et al. (2021) [46] & 9 & Excellent & Yes & Yes & Yes & Yes & No & Yes & Yes & Yes & Yes & Yes \\ \[PERSON] et al. (2019) [47] & 8 & Good & Yes & Yes & Yes & Yes & No & Yes & Yes & No & Yes & Yes \\ \[PERSON] et al. (2018) [48] & 8 & Good & Yes & Yes & Yes & Yes & Yes & No & Yes & Yes & No & Yes & Yes \\ \[PERSON] et al. (2017) [49] & 9 & Excellent & Yes & Yes & Yes & Yes & Yes & No & Yes & Yes & Yes & Yes \\ \[PERSON] et al. (2013) [50] & 8 & Good & Yes & Yes & Yes & Yes & Yes & No & Yes & Yes & No & Yes & Yes \\ \hline [PERSON] et al. (2002) [51] & 7 & Good & Yes & Yes & No & Yes & Yes & No & Yes & Yes & Yes \\ \hline \hline \end{tabular}
\begin{tabular}{c c c c c c c c c c c c c} \hline \hline  & & & & & & & & & & & & & & & \\ \end{tabular}
\end{table}
Table 1: Methodological quality analysis (PEDro scale).