Quality of systematic reviews on physiotherapy interventions for musculoskeletal disorders is critically low: a meta-epidemiological study

ABSTRACT Question How good is the quality of systematic reviews on the effectiveness of physiotherapy for musculoskeletal conditions? Are there any factors associated with quality? Design This is a meta-epidemiological study on systematic reviews with meta-analysis (SR-MA) of randomised controlled trials (RCT). Methods MEDLINE, Cochrane Database of Systematic Reviews (CDSR), CINAHL, and PEDro were searched for SR-MA of RCT on physiotherapy in musculoskeletal disorders in the last ten years. Two independent researchers screened and extracted the records and analysed the full-texts. The quality of SR-MA was quantified with AMSTAR-2 tool on a sample of 100 studies, randomly selected from the records retrieved. Disagreements were solved by consensus. Results The number of eligible publications increased over the past ten years. However, the methodological quality was critically low in as many as 90% of the studies retrieved and did not increase with time. The last author’s H-index was the only quality predictor among the variables analysed. Conclusion The methodological quality of the SR-MA of RCT is unacceptably low. Given the frequent application of physiotherapy in musculoskeletal disorders, there is an urgent need to improve secondary research by adopting more rigorous methods. Registration Open Science Framework ( https://osf.io/bc8zw/ )