The Effects of Massage Guns on Performance and Recovery: A Systematic Review

Ricardo Maia Ferreira, Rafael Silva, Pedro Vigário, Pedro Nunes Martins, Filipe Casanova, Ricardo Jorge Fernandes, António Rodrigues Sampaio
J. Funct. Morphol. Kinesiol.
Polytechnic Institute of Maia

Table of Contents

Overall Summary

Study Background and Main Findings

This systematic review investigated the effects of massage guns on performance and recovery in healthy and unhealthy populations. Eleven studies were included, with most exhibiting a moderate risk of bias. Massage guns were found to be effective in improving short-term range of motion (ROM) and flexibility (statistically significant improvements were reported in multiple studies, though specific values were not provided in the analysis). However, they showed no improvement, or even a decrease, in strength, balance, acceleration, agility, and explosive activities. For recovery, massage guns showed some benefits in short-term outcomes, but no significant differences were observed in contraction time, rating of perceived exertion, or lactate concentration. The physiological mechanisms remain uncertain.

Research Impact and Future Directions

The systematic review demonstrates a clear distinction between correlation and causation. While massage guns show a correlation with improved short-term range of motion, flexibility, and recovery, the review correctly avoids claiming a causal relationship for strength, balance, or explosive activities, where performance either remained unchanged or decreased. This cautious approach is appropriate given the limitations of the included studies.

The practical utility of massage guns appears limited to specific contexts. The findings suggest potential benefits for improving flexibility and aiding recovery, which could be useful for athletes and individuals undergoing rehabilitation. However, the lack of positive effects on strength and power, coupled with potential performance decrements, limits their application for pre-competition warm-ups or performance enhancement in explosive activities. The review appropriately places these findings within the context of existing literature on vibration therapy, but acknowledges the novelty of massage guns and the need for more research.

The review provides clear guidance for practitioners regarding the potential use of massage guns for flexibility and recovery, suggesting specific application parameters (frequency, duration). However, it rightly emphasizes the uncertainties surrounding the physiological mechanisms and the need for further research to confirm these recommendations. The review also responsibly highlights contraindications and potential adverse effects, promoting safe and informed application.

Critical unanswered questions remain regarding the long-term effects of massage guns, the optimal application parameters for different populations and outcomes, and the precise physiological mechanisms involved. The review acknowledges that the methodological limitations of the included studies, particularly the moderate risk of bias and small sample sizes, fundamentally affect the strength of the conclusions. Further high-quality, randomized controlled trials with diverse populations and standardized protocols are essential to address these uncertainties and provide more definitive evidence-based guidelines for the use of massage guns.

Critical Analysis and Recommendations

Adherence to Reporting Guidelines (written-content)
The review adhered to PRISMA guidelines and registered with PROSPERO; this enhances transparency and reduces reporting bias.
Section: Materials and Methods
Comprehensive Search Strategy (written-content)
The review used a comprehensive search strategy across multiple databases and employed the P.I.C.O.S. model; this increases the likelihood of capturing all relevant studies.
Section: Materials and Methods
Improved Short-Term ROM and Flexibility (written-content)
The review identified that massage guns can improve short-term range of motion and flexibility; this suggests a potential role in warm-up routines and rehabilitation.
Section: Discussion
No Improvement in Strength and Explosive Activities (written-content)
The review found no improvement, or even a decrease, in strength, balance, and explosive activities with massage gun use; this indicates limited application for performance enhancement in these areas.
Section: Discussion
Limited Number and Quality of Studies (written-content)
The review acknowledges the moderate quality and small number of included studies; this limits the strength of the conclusions and highlights the need for more rigorous research.
Section: Limitations and Future Directions
Focus on Short-Term Outcomes (written-content)
The review notes the lack of long-term outcome data; this prevents making recommendations for long-term use in clinical or athletic settings.
Section: Limitations and Future Directions
Incomplete Reporting of Intervention Parameters (written-content)
The review highlights incomplete reporting of massage gun usage parameters across studies; this hinders replication and understanding of optimal application.
Section: Limitations and Future Directions
Effective Visualization of Study Selection (graphical-figure)
Figure 3 (PRISMA flow diagram) clearly visualizes the study selection process; this enhances transparency and understanding of the review's methodology.
Section: Results

Section Analysis

Abstract

Key Aspects

Strengths

Suggestions for Improvement

Introduction

Key Aspects

Strengths

Suggestions for Improvement

Non-Text Elements

Figure 1. Example of a massage gun with the different attachment tips.
Figure/Table Image (Page 2)
Figure 1. Example of a massage gun with the different attachment tips.
First Reference in Text
Massage guns are hand-held mechanical devices that have a shape like a small jack- hammer, are electric or battery powered and utilize different shaped applicator tips (e.g., large and small ball, flat tip, bullet/pointy tip and fork) [20] (Figure 1).
Description
  • Key aspect of what is shown: The figure shows a massage gun, which is a handheld device that looks a bit like a small jackhammer. It's powered by electricity or a battery, so it doesn't need to be plugged into the wall while you use it. The key feature here is the different tips that can be attached to the end of the gun. These tips come in various shapes, such as a large ball, a small ball, a flat surface, a pointy bullet shape, or a fork shape. These different tips allow the user to target different muscle groups and apply varying levels of pressure and massage techniques. The caption indicates that the figure is meant to illustrate these different attachment options.
Scientific Validity
  • Enhancement of credibility.: The figure provides a real-world example of the device being discussed, enhancing the credibility of the introduction. It grounds the theoretical discussion in a tangible object, which is important for a scientific audience.
  • Limited contribution to research.: As an introductory figure, it serves its purpose of visually defining the subject of the study. However, it does not contribute directly to any empirical or analytical aspect of the research.
  • Accuracy and reliability.: The figure is an accurate representation of the device being discussed, and there are no misleading elements. This ensures that the audience's understanding is aligned with the authors' intended meaning.
Communication
  • Clarity and conciseness of the caption.: The figure effectively introduces the visual appearance of a massage gun and its various attachments. The caption is concise and accurately describes the figure's content, making it easy for readers to understand what they are looking at.
  • Support for the text description.: The figure provides a clear visual aid to the text description in the introduction. It allows readers to quickly grasp the physical characteristics of a massage gun, complementing the written explanation.
  • Visual clarity and composition.: The image is well-composed, showcasing the massage gun and its different attachment tips clearly. This allows readers to easily identify the various components mentioned in the text.
  • Enhancement of understanding.: The figure enhances the overall understanding of the device being discussed, particularly for readers who may be unfamiliar with massage guns. It helps to bridge the gap between the abstract concept and the concrete reality of the device.

Materials and Methods

Key Aspects

Strengths

Suggestions for Improvement

Non-Text Elements

Figure 2. Description of the online search strategy.
Figure/Table Image (Page 4)
Figure 2. Description of the online search strategy.
First Reference in Text
An example of an online search strategy draft used in the MEDLINE database is presented in Figure 2:
Description
  • Key aspect of what is shown: Figure 2 shows how the authors looked for studies in a database called MEDLINE. Databases are basically large, organized collections of research articles. To find relevant articles, researchers use search strategies, which involve typing in specific words or phrases (keywords) that describe the topic they're interested in. In this case, the authors used keywords like "Massage* gun", "Percussi*", and "Vibration* massage*" to find studies about massage guns. The asterisk (*) is used as a wildcard, meaning it will find words that start with those letters (e.g., "Massage", "Massages", "Massaging"). They also used other terms related to specific brands of massage guns and terms related to performance and recovery. They combined these keywords using "OR" and "AND". "OR" means the search will find articles that contain any of the terms listed, while "AND" means the search will only find articles that contain all of the terms listed. This figure is showing the specific combination of keywords and operators they used in MEDLINE.
Scientific Validity
  • Limited scope of the search strategy.: The figure provides an example of the search strategy used in one database (MEDLINE), but it does not show the search strategies used in other databases (PubMed, PEDro, Scopus, SPORTDiscus, Web of Science and Google Scholar). It would be more comprehensive to include the search strategies for all databases used.
  • Limited scope of the search strategy.: The figure provides an example of the search strategy used in one database (MEDLINE), but it does not show the search strategies used in other databases (PubMed, PEDro, Scopus, SPORTDiscus, Web of Science and Google Scholar). It would be more comprehensive to include the search strategies for all databases used.
  • Lack of information about search filters or limits.: The figure shows the search terms and Boolean operators used, but it does not provide any information about the search filters or limits applied (e.g., language, publication date). This information is important for assessing the comprehensiveness of the search.
  • Assessment of the sensitivity and specificity of the search.: The search strategy appears to be comprehensive, using a combination of keywords, mesh terms, and Boolean operators to identify relevant studies. However, it is difficult to assess the sensitivity and specificity of the search without knowing the number of articles retrieved and the number of relevant articles missed.
Communication
  • Clarity and structure of the overview.: The figure provides a clear and well-structured overview of the search strategy used in the MEDLINE database. This allows readers to understand and potentially replicate the search process.
  • Helpfulness in understanding the search terms.: The figure is helpful in understanding the keywords and search terms used, as well as how they were combined using Boolean operators. This provides transparency and allows for critical evaluation of the search strategy.
  • Ease of following the search strategy.: The layout and organization of the figure make it easy to follow the different steps of the search strategy. This is important for readers who may not be familiar with database searching.
  • Enhancement of transparency and reproducibility.: The figure enhances the overall transparency and reproducibility of the study by providing a detailed description of the search strategy. This is important for ensuring the validity and reliability of the research.
Table 1. Inclusion and exclusion criteria.
Figure/Table Image (Page 4)
Table 1. Inclusion and exclusion criteria.
First Reference in Text
The inclusion and exclusion criteria applied to this review are described in Table 1.
Description
  • Key aspect of what is shown: Table 1 lists the rules the authors used to decide which research papers to include in their review, and which to leave out. These rules are called inclusion and exclusion criteria. The table is split into two columns: 'Inclusion' and 'Exclusion'. The 'Inclusion' column lists characteristics that a study *must* have to be included in the review. For example, the studies had to be randomized or nonrandomized experimental studies, had to have experimental and control groups with detailed description of the massage guns used methodology, had to include healthy and unhealthy (with acute injuries) individuals, had to measure outcomes related with performance, injury prevention and health promotion, had to have at least one of the keywords, be published before January 2023 and have their full version. The 'Exclusion' column lists characteristics that would cause a study to be excluded. For example, studies that were books, systematic reviews, case reports, expert opinions, observational, interviews or surveys, include studies focused only on other devices or hand percussive/vibration interventions, include chronic injuries, illnesses, syndromes or other similar conditions, perform experimental or control groups composed by animals, cadaveric, in vitro or in silico. By setting these rules, the authors aim to make sure that the review only includes studies that are relevant and of high quality.
Scientific Validity
  • Relevance and rigor of the included studies.: The inclusion criteria ensure that the included studies are relevant to the research question and have a rigorous design (e.g., experimental studies with control groups).
  • Minimization of bias and focus on relevant evidence.: The exclusion criteria help to minimize bias and ensure that the review focuses on the most relevant and reliable evidence (e.g., excluding studies with chronic injuries, animal studies, or non-experimental designs).
  • Alignment with the research question and objectives.: The inclusion and exclusion criteria are aligned with the research question and the objectives of the systematic review. This ensures that the review addresses the intended topic and provides meaningful insights.
  • Potential for more specific criteria.: The criteria could be more specific in some areas. For example, the inclusion criterion 'measure outcomes related with performance, injury prevention and health promotion' is quite broad. Specifying the types of performance, injury prevention, and health promotion outcomes would enhance clarity.
Communication
  • Clarity of the inclusion and exclusion criteria.: The table clearly presents the criteria used to determine which studies were included in the review and which were excluded. This is crucial for understanding the scope and limitations of the review.
  • Effectiveness of the table format.: The table format makes it easy to quickly compare the inclusion and exclusion criteria side-by-side. This allows readers to efficiently assess the rationale behind the study selection process.
  • Specificity and clarity of the criteria.: The criteria are specific and well-defined, reducing ambiguity and ensuring that the study selection process was consistent and reproducible.
  • Enhancement of transparency and rigor.: The table enhances the overall transparency and rigor of the review by explicitly stating the criteria used to select studies. This allows readers to critically evaluate the study selection process and assess the potential for bias.

Results

Key Aspects

Strengths

Suggestions for Improvement

Non-Text Elements

Figure 3. PRISMA flow diagram highlighting the selection process for the...
Full Caption

Figure 3. PRISMA flow diagram highlighting the selection process for the studies included in the systematic review. Abbreviations: WBV-whole body vibration.

Figure/Table Image (Page 6)
Figure 3. PRISMA flow diagram highlighting the selection process for the studies included in the systematic review. Abbreviations: WBV-whole body vibration.
First Reference in Text
Database searches returned 8586 records of which 8305 were duplicates. From those, 281 records were screened, but only 11 could be included [34–44]. The flow diagram in Figure 3 summarizes the selection process.
Description
  • Key aspect of what is shown: Figure 3 uses a PRISMA flow diagram to show how the authors selected studies for their review. PRISMA stands for Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and it's a standard way to show how studies are identified, screened, and included in a review. The diagram starts with the total number of records identified from database searches (8515) and other methods (71). Then, it shows how many records were removed because they were duplicates (8234 or 71), leaving 281 records to be screened. The diagram then shows how many reports were assessed for eligibility (15) and the reasons for exclusion (e.g., 'WBV (n = 147)', 'Diseases (n = 18)', 'Review (n = 3)', 'Not massage guns (n = 98)', 'There was not enough information (n = 4)'). Finally, it shows the number of studies that were included in the review (11). The diagram provides a clear visual representation of the study selection process, allowing readers to easily understand how the authors arrived at their final sample of studies.
Scientific Validity
  • Adherence to standard reporting guidelines.: The PRISMA flow diagram is a standard tool for reporting the study selection process in systematic reviews, enhancing the rigor and transparency of the research.
  • Transparency in reporting the study selection process.: The diagram provides a clear accounting of the number of records at each stage of the selection process, allowing for a critical evaluation of the study selection process and potential sources of bias.
  • Clear articulation of the reasons for exclusion.: The reasons for excluding records are clearly stated, which is important for understanding the scope and limitations of the review.
  • Lack of information about the characteristics of the excluded studies.: The diagram provides a comprehensive overview of the study selection process, but it does not provide any information about the characteristics of the excluded studies. This information could be helpful for understanding the potential impact of the exclusion criteria on the review's findings.
Communication
  • Clarity and conciseness of the visualization.: The PRISMA flow diagram effectively visualizes the study selection process, making it easy to understand the number of records identified, screened, and included in the systematic review. It provides a clear and concise overview of the entire selection process.
  • Adherence to the PRISMA format.: The diagram follows the standard PRISMA format, which is widely recognized and understood in the scientific community. This ensures that readers can easily interpret the information presented.
  • Inclusion of key information and reasons for exclusion.: The diagram includes key information about the number of records at each stage of the selection process, as well as the reasons for exclusion. This provides transparency and allows for critical evaluation of the study selection process.
  • Enhancement of transparency and rigor.: The diagram enhances the overall transparency and rigor of the systematic review by providing a clear and comprehensive overview of the study selection process. This allows readers to assess the potential for bias and evaluate the validity of the review's findings.
Figure 4. Risk of bias: (a) randomized trials studies assessment; (b)...
Full Caption

Figure 4. Risk of bias: (a) randomized trials studies assessment; (b) percentage distribution in randomized trials; (c) nonrandomized trials studies assessment; (d) percentage distribution in non- randomized trials. [34-44].

Figure/Table Image (Page 8)
Figure 4. Risk of bias: (a) randomized trials studies assessment; (b) percentage distribution in randomized trials; (c) nonrandomized trials studies assessment; (d) percentage distribution in non- randomized trials. [34-44].
First Reference in Text
After the selection of the studies, the reviewers independently appraised the risk of bias of the 11 studies [34–44]. Nine [34-36,38-40,42,43] were accessed using RoB 2 and three [37,41,44] using ROBINS-I.
Description
  • Key aspect of what is shown: Figure 4 presents the authors' assessment of how likely it is that the results of each study are wrong due to flaws in the study design or execution. This is called 'risk of bias'. The figure is divided into four parts. Parts (a) and (c) show the risk of bias assessment for each individual study, broken down by different aspects of study design (e.g., randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result for randomized trials, and confounding, selection of the participants, classification of interventions, deviations from intended interventions, missing data, measurement of outcomes and selection of the reported result for non-randomized trials). Each aspect is rated as having 'Low risk', 'Some concerns', or 'High risk'. Parts (b) and (d) summarize the overall risk of bias across all studies, showing the percentage of studies that fall into each risk category for each aspect of study design. The risk of bias was assessed using two different tools: RoB 2 (Risk of Bias 2) for randomized trials and ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) for non-randomized trials.
Scientific Validity
  • Use of established tools for assessing the risk of bias.: The use of established tools (RoB 2 and ROBINS-I) for assessing the risk of bias enhances the scientific validity of the review. These tools provide a structured and standardized approach to evaluating the quality of the included studies.
  • Detailed breakdown of the domains assessed for risk of bias.: The figure provides a detailed breakdown of the different domains assessed for risk of bias, allowing for a comprehensive evaluation of the quality of the included studies.
  • Lack of information about the specific criteria used to assign risk of bias ratings.: The figure does not provide information about the specific criteria used to assign risk of bias ratings (e.g., low, some concerns, high risk). Providing more detail about the criteria used would enhance the transparency and reproducibility of the risk of bias assessment.
  • Lack of reporting of inter-rater reliability.: The inter-rater reliability of the risk of bias assessment is not reported. Reporting the inter-rater reliability would provide further support for the validity of the risk of bias assessment.
Communication
  • Comprehensive overview of risk of bias assessment.: The figure provides a comprehensive overview of the risk of bias assessment for both randomized and nonrandomized trials, enhancing the transparency and credibility of the review.
  • Effective use of different formats to present the risk of bias assessment.: Presenting the risk of bias assessment in both individual study format (a and c) and percentage distribution format (b and d) allows readers to easily assess the overall quality of the included studies.
  • Effective use of color-coding to facilitate quick identification of potential biases.: The use of color-coding (e.g., low risk, some concerns, high risk) facilitates the quick identification of potential biases within the included studies.
  • Enhancement of the understanding of the risk of bias assessment.: The figure enhances the overall understanding of the risk of bias assessment by providing a detailed breakdown of the different domains assessed. This allows readers to critically evaluate the study selection process and assess the potential for bias.
Table 2. Results of individual studies.
Figure/Table Image (Page 9)
Table 2. Results of individual studies.
First Reference in Text
Table 2 provides a detailed summary of the included studies' characteristics.
Description
  • Key aspect of what is shown: Table 2 summarizes the key details from each of the 11 studies included in the review. The table is organized with each row representing a single study and each column representing a different aspect of the study. The columns include the authors of the study, the objectives or goals of the study, the characteristics of the people who participated in the study (e.g., age, sex, weight, height), the different groups or cohorts in the study (e.g., percussive therapy group, control group), the outcomes that were measured in the study (e.g., fatigue, strength, ROM), and the main results of the study. For example, for the study by Alonso-Calvete et al. [38], the table shows that the study analyzed the effects of percussive massage therapy on lifeguards' recovery after a water rescue, that the participants were 14 lifeguards (13 male, 1 female) with an average age of 21.7 years, that the cohorts were percussive therapy (2 min, frequency 53 Hz) and passive recovery (8 min sitting), that the outcomes were fatigue (RPE and blood lactate), and that the results showed no significant differences between the two groups in lactate clearance or perceived fatigue.
Scientific Validity
  • Comprehensive overview of the included studies.: The table provides a comprehensive overview of the included studies, allowing for a critical appraisal of their methodologies and findings.
  • Inclusion of key information about the participants' characteristics.: The table includes key information about the participants' characteristics, which is important for assessing the generalizability of the studies' findings.
  • Inclusion of information about the interventions used.: The table includes information about the interventions used in the studies, which is important for assessing the effectiveness of the interventions.
  • Inclusion of information about the outcomes measured.: The table includes information about the outcomes measured in the studies, which is important for assessing the relevance of the studies to the research question.
  • Lack of information about the risk of bias for each study.: The table could be improved by including information about the risk of bias for each study. This would allow readers to quickly assess the quality of the evidence.
Communication
  • Comprehensiveness of the summary.: The table provides a comprehensive summary of the included studies, allowing readers to quickly compare and contrast their characteristics and findings.
  • Organization and clarity of the table.: The table is well-organized, with clear headings and subheadings that facilitate easy navigation and information retrieval.
  • Inclusion of key information.: The table includes key information about the studies, such as the authors, objectives, participants' characteristics, cohorts, outcomes, and results. This allows readers to assess the relevance and validity of the studies.
  • Enhancement of transparency and rigor.: The table enhances the overall transparency and rigor of the systematic review by providing a detailed summary of the included studies. This allows readers to critically evaluate the evidence and assess the potential for bias.
Table 2. Cont.
Figure/Table Image (Page 10)
Table 2. Cont.
First Reference in Text
No explicit numbered reference found
Description
  • Key aspect of what is shown: This is simply the second part of Table 2, which summarizes the key details from each of the 11 studies included in the review. Since the table was too long to fit on one page, it was split into two parts, with 'Table 2. Cont.' indicating that this is a continuation of the previous table. The columns and rows are the same as in the first part of Table 2, providing information about the authors, objectives, participants' characteristics, cohorts, outcomes, and results for the remaining studies.
Scientific Validity
  • Enhancing replicability through full dataset presentation.: By presenting the full dataset, the authors enable other researchers to verify their analyses and draw their own conclusions, enhancing the replicability of the review.
  • Maintaining rigorous standards throughout the table.: It's crucial that the continuation table uses the same rigorous standards as the first part of the table, including accurate data extraction and consistent formatting.
  • Enabling assessment of overall trends and patterns.: Without the full dataset, it would be impossible to assess the overall trends and patterns in the data, limiting the conclusions that can be drawn from the review.
Communication
  • Importance of presenting all included studies.: The continuation of Table 2 is crucial for presenting all the included studies, ensuring a comprehensive overview of the evidence base.
  • Clarity of the caption.: The 'Table 2. Cont.' caption clearly indicates that this is a continuation of the previous table, avoiding confusion for the reader.
  • Consistency in formatting and structure.: The consistent formatting and structure of the continued table maintain the readability and ease of comparison across all included studies.
  • Enhancement of rigor and transparency.: The continuation of the table enhances the overall rigor and transparency of the systematic review by providing a complete summary of all included studies.
Table 2. Cont.
Figure/Table Image (Page 11)
Table 2. Cont.
First Reference in Text
No explicit numbered reference found
Description
  • Key aspect of what is shown: This is simply the second part of Table 2, which summarizes the key details from each of the 11 studies included in the review. Since the table was too long to fit on one page, it was split into two parts, with 'Table 2. Cont.' indicating that this is a continuation of the previous table. The columns and rows are the same as in the first part of Table 2, providing information about the authors, objectives, participants' characteristics, cohorts, outcomes, and results for the remaining studies.
Scientific Validity
  • Enhancing replicability through full dataset presentation.: By presenting the full dataset, the authors enable other researchers to verify their analyses and draw their own conclusions, enhancing the replicability of the review.
  • Maintaining rigorous standards throughout the table.: It's crucial that the continuation table uses the same rigorous standards as the first part of the table, including accurate data extraction and consistent formatting.
  • Enabling assessment of overall trends and patterns.: Without the full dataset, it would be impossible to assess the overall trends and patterns in the data, limiting the conclusions that can be drawn from the review.
Communication
  • Importance of presenting all included studies.: The continuation of Table 2 is crucial for presenting all the included studies, ensuring a comprehensive overview of the evidence base.
  • Clarity of the caption.: The 'Table 2. Cont.' caption clearly indicates that this is a continuation of the previous table, avoiding confusion for the reader.
  • Consistency in formatting and structure.: The consistent formatting and structure of the continued table maintain the readability and ease of comparison across all included studies.
  • Enhancement of rigor and transparency.: The continuation of the table enhances the overall rigor and transparency of the systematic review by providing a complete summary of all included studies.
Table 2. Cont.
Figure/Table Image (Page 12)
Table 2. Cont.
First Reference in Text
No explicit numbered reference found
Description
  • Key aspect of what is shown: This is simply the second part of Table 2, which summarizes the key details from each of the 11 studies included in the review. Since the table was too long to fit on one page, it was split into two parts, with 'Table 2. Cont.' indicating that this is a continuation of the previous table. The columns and rows are the same as in the first part of Table 2, providing information about the authors, objectives, participants' characteristics, cohorts, outcomes, and results for the remaining studies.
Scientific Validity
  • Enhancing replicability through full dataset presentation.: By presenting the full dataset, the authors enable other researchers to verify their analyses and draw their own conclusions, enhancing the replicability of the review.
  • Maintaining rigorous standards throughout the table.: It's crucial that the continuation table uses the same rigorous standards as the first part of the table, including accurate data extraction and consistent formatting.
  • Enabling assessment of overall trends and patterns.: Without the full dataset, it would be impossible to assess the overall trends and patterns in the data, limiting the conclusions that can be drawn from the review.
Communication
  • Importance of presenting all included studies.: The continuation of Table 2 is crucial for presenting all the included studies, ensuring a comprehensive overview of the evidence base.
  • Clarity of the caption.: The 'Table 2. Cont.' caption clearly indicates that this is a continuation of the previous table, avoiding confusion for the reader.
  • Consistency in formatting and structure.: The consistent formatting and structure of the continued table maintain the readability and ease of comparison across all included studies.
  • Enhancement of rigor and transparency.: The continuation of the table enhances the overall rigor and transparency of the systematic review by providing a complete summary of all included studies.

Discussion

Key Aspects

Strengths

Suggestions for Improvement

Limitations and Future Directions

Key Aspects

Strengths

Suggestions for Improvement

Conclusions

Key Aspects

Strengths

Suggestions for Improvement

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