Background Clinical practice guidelines (CPGs) provide recommendations for practice, but the proliferation of CPGs issued by multiple organisations in recent years has raised concern about their quality. The aim of this study was to systematically appraise CPGs quality for low back pain (LBP) interventions and to explore inter-rater reliability (IRR) between quality appraisers. The time between systematic review search and publication of CPGs was recorded. Methods Electronic databases (PubMed, Embase, PEDro, TRIP), guideline organisation databases, websites, and grey literature were searched from January 2016 to January 2020 to identify GPCs on rehabilitative, pharmacological or surgical intervention for LBP management. Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool to evaluate CPGs quality and record the year the CPGs were published and the year the search strategies were conducted. Results A total of 21 CPGs met the inclusion criteria and were appraised. Seven (33%) were broad in scope and involved surgery, rehabilitation or pharmacological intervention. The score for each AGREE II item was: Editorial Independence (median 67%, interquartile range [IQR] 31–84%), Scope and Purpose (median 64%, IQR 22–83%), Rigour of Development (median 50%, IQR 21–72%), Clarity and Presentation (median 50%, IQR 28–79%), Stakeholder Involvement (median 36%, IQR 10–74%), and Applicability (median 11%, IQR 0–46%). The IRR between the assessors was nearly perfect (interclass correlation 0.90; 95% confidence interval 0.88–0.91). The median time span was 2 years (range, 1–4), however, 38% of the CPGs did not report the coverage dates for systematic searches. Conclusions We found methodological limitations that affect CPGs quality. In our opinion, a universal database is needed in which guidelines can be registered and recommendations dynamically developed through a living systematic reviews approach to ensure that guidelines are based on updated evidence. Level of evidence 1 Trial registration REGISTRATION PROSPERO DETAILS: CRD42019127619.

introduction: this paper updates and summarizes the current evidence informing rehabilitation of patients with coVid-19 and/or describing the consequences of the disease and its treatment. EVidEncE acQuisition: studies published from May 1 st to June 30 th , 2021 were selected, excluding descriptive studies and expert opinions. papers were categorized according to study design, research question, coVid-19 phase, limitations of functioning of rehabilitation interest, and type of rehabilitation service involved. from this edition, we improved the quality assessment using the Joanna briggs institute checklists for observational studies and the cochrane risk of bias tool for randomized-controlled clinical trials (rcts). EVIDENCE SYNTHESIS: Twenty-five, out of 3699 papers, were included. They were three RCTs, 13 cross-sectional studies and nine cohort studies. Twenty studies reported data on symptom prevalence (N.=13) or disease natural history (N.=7); and five studies reported intervention effectiveness at the individual level. all study participants were coVid survivors and 48% of studies collected information on participants 6 months or longer after coVid-19 onset. the most frequent risks of bias for rcts concerned weaknesses in allocation concealment, blinding of therapists, and lack of intention-to-treat analysis. Most analytical studies failed to identify or deal with confounders, describe or deal with dropouts or eventually perform an appropriate statistical analysis. conclusions: Most studies in this updated review targeted the prevalence of limitations of functioning of rehabilitation interest in co-VID-19 survivors. This is similar to past review findings; however, data in the new studies was collected at longer follow-up periods (up to one year after symptom onset) and in larger samples of participants. More rcts and analytical observational studies are available, but the methodological quality of recently published studies is low. There is a need for good quality intervention efficacy and effectiveness studies to complement the rapidly expanding evidence from observational studies.

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