highly significantP < 0.0001
The heterogeneity test yielded a highly significant result ( Q = 1052, df = 20, P < 0.0001, τ2 (between-study) = 1417, τ2 (within-study) = 12029), with 89.46% of the total variance ascribed to within-study variation and 10.5% to between-study differences, indicating substantial biological and methodological variability among included studies.