Evidence Quality Assessment

The review will apply RoB 2 to randomized controlled trials. GRADE will be used to rate certainty of evidence for each outcome. The review will apply ROBINS-I to observational study designs. Risk of bias and study quality will be assessed using Bradford Hill causation criteria. Studies scoring below 5 will be weak quality, 5-9 moderate quality, and above 10 high quality. Overall evidence quality for each outcome will be assessed using GRADE. Two reviewers will independently assess risk of bias, with conflicts referred to a third reviewer. Methodological quality will also be evaluated using the PEDro scale. Sensitivity analysis will test whether findings remain robust across study quality, sample size, and meta-analysis technique. For the RoB 2 tool, the overall risk of bias for each study is determined by the highest risk level identified across all five domains. The GRADE framework assesses evidence quality across five dimensions and produces a final four-point quality rating for each outcome. Two independent reviewers apply different quality assessment tools depending on study type, with discrepancies resolved by a third reviewer. Studies rated high risk or poor quality will be…