The review addressed a clear question that was defined in terms of the participants, intervention, outcomes and study design. Relevant studies were sought from several sources, but it was not clear if unpublished studies were eligible or if any language limitations had been applied, thus the potential for publication and language bias could not be assessed. Methods were used to minimise reviewer errors and bias in the extraction of some data, but it was unclear whether similar steps were taken at the study selection stage. Only RCTs were included, but the quality of them was not assessed; the results from these studies and any synthesis may not, therefore, be reliable.
The studies were pooled using meta-analysis, but statistical heterogeneity was not assessed. However, the presentation of results from individual studies with 95% CIs and as forest plots allowed an examination of heterogeneity amongst the studies. Potential side-effects are an important consideration in such treatments but, although the authors made some reference to this in their discussion, these data appears to be lacking from their review. A lack of complete reporting of review methods and the lack of an assessment of the quality of the included studies made it difficult to assess the robustness of the conclusions.