Fig. 1

Flow diagram of the search and inclusion of references. This diagram visually represents the process of study selection for this systematic review. The search process began with a comprehensive review of databases, resulting in an initial pool of articles. After screening for relevance and applying inclusion and exclusion criteria, the number of studies included in the review was reduced. The diagram highlights the key stages of study selection, including the number of studies excluded at each step due to factors such as irrelevance, methodological issues, and lack of outcome data