OBJECTIVES: To evaluate the development and quality of actionable statements that qualify as good practice statements (GPS) reported in COVID-19 guidelines. DESIGN AND SETTING: Systematic review . We searched MEDLINE, MedSci, China National Knowledge Infrastructure (CNKI), databases of Grading of Recommendations Assessment, Development and Evaluation (GRADE) Guidelines, NICE, WHO and Guidelines International Network (GIN) from March 2020 to September 2021. We included original or adapted recommendations addressing any COVID-19 topic. MAIN OUTCOME MEASURES: We used GRADE Working Group criteria for assessing the appropriateness of issuing a GPS: (1) clear and actionable; (2) rationale necessitating the message for healthcare practice; (3) practicality of systematically searching for evidence; (4) likely net positive consequences from implementing the GPS and (5) clear link to the indirect evidence. We assessed guideline quality using the Appraisal of Guidelines for Research and Evaluation II tool. RESULTS: 253 guidelines from 44 professional societies issued 3726 actionable statements. We classified 2375 (64%) as GPS; of which 27 (1%) were labelled as GPS by guideline developers. 5 (19%) were labelled as GPS by their authors but did not meet GPS criteria. Of the 2375 GPS, 85% were clear and actionable; 59% provided a rationale necessitating the message for healthcare practice, 24% reported the net positive consequences from implementing the GPS. Systematic collection of evidence was deemed impractical for 13% of the GPS, and 39% explained the chain of indirect evidence supporting GPS development. 173/2375 (7.3%) statements explicitly satisfied all five criteria. The guidelines' overall quality was poor regardless of the appropriateness of GPS development and labelling. CONCLUSIONS: Statements that qualify as GPS are common in COVID-19 guidelines but are characterised by unclear designation and development processes, and methodological weaknesses.

American College of Physicians Philadelphia Pennsylvania USA

Amsterdam University Medical Centers University of Amsterdam Amsterdam Netherlands

Centre de Recherche du Centre Hospitalier Affilié Universitaire de Québec CHA Hôpital de l'Enfant Jésus Université Laval Quebec Quebec Canada

Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada

Clinical Pharmacology Department of Medicine Stellenbosch University Stellenbosch Western Cape South Africa

Clinical Research Institute American University of Beirut Beirut Lebanon

Cochrane Campbell Global Ageing Partnership London UK

Cochrane Canada Hamilton Ontario Canada

Cochrane Germany Cochrane Germany Foundation Freiburg Germany

Cochrane South Africa South African Medical Research Council Cape Town Western Cape South Africa

Czech National Centre for Evidence Based Healthcare and Knowledge Translation Institute of Biostatistics and Analyses Masaryk University Brno Czech Republic

Deparatment of Family Medicine University of Ottawa Ottawa Ontario Canada

Department of Anesthesiology and Critical Care Medicine Université Laval Québec City Québec Canada

Department of Biomedical Sciences Humanitas University Milan Italy

Department of Clinical Epidemiology and Public Health Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau Barcelona Spain

Department of Health Product Policy and Standards World Health Organization Geneve Switzerland

Department of Health Research Methods Evidence and Impact McMaster University Hamilton Ontario Canada

Department of HIV Hepatitis and Sexually Transmitted Infections World Health Organization Geneva Switzerland

Department of Internal Medicine American University of Beirut Beirut Lebanon

Department of Medicine McMaster University Hamilton Ontario Canada

Department of Medicine University of Ottawa Faculty of Medicine Ottawa Ontario Canada

Department of Pediatrics Post Graduate Institute of Medical Education and Research Chandigarh India

Iberoamerican Cochrane Center Biomedical Research Institute Sant Pau CIBERESP Barcelona Spain

Instituto de Salud Carlos 3 Agencia de Evaluación de Tecnologías Sanitarias Madrid Spain

Internal Medicine Division of Nephrology and Hypertension University of Kansas School of Medicine Kansas City Kansas USA

Joanna Briggs Institute University of Adelaide Adelaide South Australia Australia

Joint Research Centre European Commission Ispra Italy

Medical Center University of Freiburg Institute for Evidence in Medicine Freiburg Germany

Methods Centre Bruyère Research Institute Ottawa Ontario Canada

Michael G DeGroote Cochrane Canada and McMaster GRADE Centres McMaster University Hamilton Ontario Canada

National Institute for Health and Care Excellence London UK

School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada

WHO Collaborating Center for Infectious Diseases Research Methods and Recommendations McMaster University Hamilton Ontario Canada

Yealth Network Beijing Yealth Technology Co Ltd Beijing China

doi: 10.1136/bmjebm-2022-111962 PubMed

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