Seven studies showed a low risk of bias while three studies showed a high risk of bias according to the Jadad scale. The Jadad scale scores the methodological quality of trials based on randomization, blinding, and withdrawals. Both the Jadad scale and Delphi scale were used to assess study quality, where only studies with a Jadad score of 4-5 and a Delphi score of 6-9 were considered high quality.