fig1

Figure 1. PRISMA flow diagram. This study followed the PRISMA 2020 guidelines for systematic literature screening. The initial search of databases and clinical trial registries yielded 759 records (749 from databases and websites and 10 from registries). After removing 372 duplicate records and 12 records excluded for other reasons, 375 records remained for screening. Title and abstract screening excluded 212 records that did not meet the inclusion criteria. Of the 163 records selected for full-text review, 5 could not be retrieved, leaving 158 articles for eligibility assessment. At this stage, 8 articles were excluded due to inconsistent study design, inappropriate study populations, or missing essential data. Ultimately, 150 records (148 journal articles and 2 registry entries) were included in final evidence synthesis. PRISMA: Preferred Reporting Items for Systematic reviews and Meta-Analyses.