Risk of Bias Assessment The methodologist assessed the risk of bias in all included studies. The Cochrane Risk of Bias tool was used to assess the risk of bias for randomized controlled trials (RCTs)5 and the Risk of Bias in Non- randomized Studies of Interventions (ROBINS-I) tool to evaluate risk of bias for observational studies.6 In cases in which existing systematic reviews were available, we used the Documentation and Appraisal Review Tool to assess methodological quality.7 Meta-analysis When individual studies were available or an existing meta-analysis needed to be updated, we used the Cochrane Collaboration Review Manager, version 5.2,8 to pool the results across individual studies. We used a random-effects model and the method of DerSimonian and Laird to pool the individual estimates.9 Risk ratio (RR) was used to report the results for dichotomous outcomes and mean difference for continuous outcomes with accompanying 95% CIs. Statistical TABLE ] (Continued) Grade of Recommendation Bene t vs Risk and Burdens Methodologic Strength of Supporting Evidence Implications Weak (conditional) recommendation, very- low quality evidence Uncertainty in the estimates of bene ts, risks, and burden; bene ts, risk and burden may be closely balanced We have very little con dence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect Other alternatives may be equally reasonable. 