School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
BMJ Open. 2024 Sep 10;14(9):e086301. doi: 10.1136/bmjopen-2024-086301.
To appraise the quality of clinical practice guidelines (CPGs) and expert consensus statements on rehabilitation for patients with COVID-19, summarise recommendations of rehabilitation assessments and interventions and evaluate the heterogeneity of the recommendations.
Systematic review.
PubMed and Embase databases and five online guideline repositories: The National Guideline Clearinghouse, Guidelines International Network, Scottish Intercollegiate Guidelines Network, National Institute for Health and Clinical Excellence and WHO were searched from their inception to August 2024. In addition, we reviewed reference lists of eligible citations and searched the grey literature on the relevant websites.
We included CPGs and expert consensus statements which provided information about rehabilitation of patients with COVID-19. To be eligible, the CPGs and expert consensus statements were issued in English by a nationally or internationally recognised government authority, medical/academic society or organisation. If there were multiple versions of the guidelines, we included the latest one. The translations, interpretations and abstracts of guidelines were excluded.
All recommendations on rehabilitation assessments and interventions for COVID-19 were extracted and summarised. Two reviewers independently evaluated the methodological quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and two other reviewers assessed the reporting quality using the Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement of included CPGs and expert consensus statements. We used the Measurement Scale of Rate of Agreement to evaluate the heterogeneity of the recommendations in different CPGs and expert consensus statements.
A total of 31 CPGs and expert consensus statements were included. 14 guidelines provided recommendations for rehabilitation assessments. At the early, development, critical and recovery stages of COVID-19, the most frequently recommended were exercise therapy (25.8%, 35.5%, 25.8% and 58.1%, respectively). According to AGREE II, 17 included guidelines were assessed as low methodological quality (35%-56%), 10 guidelines were rated as moderate quality (46%- 62%) and four had high quality (69%-79%). Among 31 eligible guidelines, the reporting rate of 22 items in the RIGHT checklist ranged from 10% to 100%. The included guidelines were consistent with the reference guidelines (80%-100%). Only one guideline existed minor (60%-80%) disagreements in respiratory muscle training relative to the reference guideline.
Rehabilitation assessments and interventions should be implemented consistently throughout the entire process of COVID-19. The recommendations should be tailored to each stage of COVID-19. The methodological and reporting qualities of several guidelines remain suboptimal. Therefore, developers should adhere strictly to the AGREE II standard and RIGHT checklist to formulate and publish CPGs and expert consensus statements with high quality.
CRD42020190761.
评价针对 COVID-19 患者康复的临床实践指南（CPG）和专家共识声明的质量，总结康复评估和干预措施的建议，并评估建议的异质性。
系统评价。
从建库至 2024 年 8 月，我们检索了 PubMed 和 Embase 数据库以及五个在线指南库：国家指南清除库、国际指南网络、苏格兰校际指南网络、国家卫生和临床卓越研究所和世界卫生组织。此外，我们还查阅了合格引文的参考文献列表，并在相关网站上搜索了灰色文献。
我们纳入了提供 COVID-19 患者康复信息的 CPG 和专家共识声明。为了符合条件，CPG 和专家共识声明必须由具有国家或国际认可度的政府机构、医疗/学术协会或组织以英文发布。如果有多个版本的指南，我们将纳入最新的版本。指南的翻译、解释和摘要被排除在外。
我们提取并总结了所有关于 COVID-19 康复评估和干预措施的建议。两名审查员独立使用评估研究和评估指南的适用性 (AGREE) II 工具评估方法学质量，另外两名审查员使用医疗保健实践指南报告项目 (RIGHT) 声明评估纳入的 CPG 和专家共识声明的报告质量。我们使用协议一致性度量尺来评估不同 CPG 和专家共识声明中建议的异质性。
共纳入 31 项 CPG 和专家共识声明。14 项指南提供了康复评估的建议。在 COVID-19 的早期、发展、关键和康复阶段，最常推荐的是运动疗法（分别为 25.8%、35.5%、25.8%和 58.1%）。根据 AGREE II，17 项纳入的指南被评估为低方法学质量（35%-56%），10 项被评为中度质量（46%-62%），4 项具有高质量（69%-79%）。在 31 项合格指南中，RIGHT 清单中的 22 项报告率在 10%到 100%之间。纳入的指南与参考指南一致（80%-100%）。只有一项指南在呼吸肌训练方面与参考指南存在轻微（60%-80%）分歧。
康复评估和干预措施应在 COVID-19 整个过程中持续实施。建议应根据 COVID-19 的每个阶段进行调整。一些指南的方法学和报告质量仍然不尽如人意。因此，制定者应严格遵守 AGREE II 标准和 RIGHT 清单，制定和发布高质量的 CPG 和专家共识声明。
CRD42020190761。
