Rapid Maxillary Expansion and Nocturnal Enuresis in Children and Adolescents: A Systematic Review of Controlled Clinical Trials

Table 2

Rating the overall quality of evidence according to the GRADE’s approach.

No. of participants	Risk of bias	Indirectness	Imprecision	Inconsistency	Publication bias	Overall quality of evidence
A reduction in the number of wet nights per week
129	Serious^a	Not serious^b	Serious^C	Not serious^d	Not suspected^e	Very low⊕〇〇〇

^aTwo non-RCTs were ranked of moderate ROB and one non-RCT was ranked of serious ROB. ^bAll included studies were similar in terms of the inclusion criteria of participants, interventions (RME), and the primary outcome measures (the number of wet nights per week). ^cThe total number of participants for the primary outcome was very small (129). In addition, although the best quality study [26] reported a statistically significant decrease in the number of wet nights/week during the 2 weeks following the treatment with an RME, the difference between the intervention and control groups was not statistically significant. ^dAll studies reported a similar pattern and magnitude of effect in the main outcome measure between the intervention and control group. ^eA very comprehensive search of multiple sources was carried out. No clinical trials had been found to be registered in trials registry websites, but have not been published. Studies of positive and negative findings were published and included.