What does mean? Was this information gathered as a primary source from researchers? The Qualsyst critical appraisal tool by Kmet [26] and the National Health and Medical Research Council (NHMRC) Evidence Hierarchy Levels of Evidence [27] were used to assess the methodological quality of the included studies: I (systematic review of level II studies); II (randomised controlled trial); III-1 (pseudo-randomised controlled trial); III-2 (comparative study with concurrent controls); III-3 (comparative study without concurrent controls); IV (case series with either post-test or pre-post outcomes). The Qualsyst tool provides a systematic, reproducible and quantitative means of appraising the methodological quality of research across a broad range of study designs. The Qualsyst consists of 14 items. All items have a three-point ordinal scoring (yes = 2, partial = 1, no = 0). A total score can be converted into a percentage score. A score above 80% is considered strong quality, a score of 60 to 79% considered good, a score of 50 to 59% considered adequate, and a score below 50% considered poor quality. Studies with poor study quality were excluded from further analysis in this review