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The systematic reviews and meta-analyses chosen for our study were required to be of similar methodological standing and meet strict criteria found in Cochrane systematic reviews. Our exclusions included studies such as meta-analyses that were not the primary aim of the study, narrative reviews instead of systematic reviews, reviews of reviews, case reports, study collected data, case-control studies, and individual patient data meta-analyses.    Data extraction for quality assessment involved whether quality or risk of bias was assessed, tools used to measure risk of bias or quality, whether authors used individual methods to assess quality, whether quality or risk of bias was graded, and what scale was used to grade quality or risk of bias. We also observed whether high risk of bias or low quality studies were found, whether high risk of bias or low quality studies were included in the studies, how risk of bias or quality was presented in the article. In the situation where high risk of bias or low quality studies were found and included, we assessed whether subgroup analysis, meta-regression, or sensitivity analyses were used to deal with quality of reporting.  \textbf{Data Analysis}\subsection{}  \textbf{Data Analysis}\subsection{}  We performed a descriptive analysis of the frequency and percentage use of quality assessment tools. We tabulated the frequency of quality assessment tools used, type of tools, types of scales used, how the quality information was presented, types of methods used to deal with risk of bias or low quality. We also looked at frequency of high risk of bias or low quality studies being included in data set of articles, and if studies were included, were they dealt with using subgroup analysis, meta-regression, or sensitivity analysis (figure 2). Statistical analyses were performed with STATA version 13.1 software (State Corporation, College Station, Texas, USA).     \section{Results} 
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