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A Systematic Critical Appraisal of Clinical Practice Guidelines for Non-Pharmacological Conservative Management of
Erfan Shafiee1, Joy MacDermid1, Tara Packham2
1School of Physical Therapy, University of Western Ontario, London, Ontario, Canada.
Purpose:
Several clinical practice guidelines (CPGs) have been developed for complex regional pain syndrome (CRPS). The aim of our study was to appraise CPGs for non-pharmacological conservative management of CRPS.
Materials And Methods:
We systematically searched five electronic databases, from inception to January 2025, to include CPGs that focused on non-pharmacological conservative management of CRPS. We used AGREE-II to evaluate the quality of the CPGs. Recommendations, aims, and treatment algorithms of the CPGs were presented in a narrative format, thematic analysis, and matrixes to summarise, categorise, and compare the findings of the guidelines.
Results:
Nine CPGs met the inclusion criteria, including three updated versions of previously published guidelines. After accounting for updates, six unique guidelines were appraised. Two were rated as high-quality, two as moderate-quality, and two as low-quality. All CPGs scored > 60% in the AGREE-II domains of scope/purpose and clarity of presentation, while rigour of development was the lowest-scoring domain, with only two guidelines achieving ≥ 60%. No guideline addressed updating procedures. The most common interventions recommended by CPGs were pain management (100%) followed by functional restoration (83%), stress-loading (67%), psychotherapy (67%), edema management (67%), gentle active movements (67%), vocational rehabilitation (67%), normal functional activities (67%), general PT interventions (67%), and isometric-isotonic strengthening (67%).
Conclusion:
The methodological quality of many CPGs for non-pharmacological management of CRPS is low, particularly in the domain of rigour of development. Recommendations across guidelines are variable, often lacking detail, consistency, and integration of supporting evidence. Pain management, functional restoration, and inter/multidisciplinary care were the most commonly recommended considerations, while guidance on treatment frequency, dosage, and implementation strategies was limited.
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