Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks

Several institutions responsible for developing Clinical Practice Guidelines (CPGs) drafted their own methodological handbooks including methodology for developing and updating their CPGs. Some of these handbooks are very influential and often used in smaller organizations [6,14]. 

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Even though the methodology developed greatly over the last years, the quality of CPGs is lagging behind [1,15,16]. A lack of compliance with state of the art methodology for developing CPGs has been found, and hence the methodological quality of CPGs remained very similar over the last two decades [17,18]. 

Little is known about the guidance for updating CPGs included in these handbooks. Therefore, the authors systematically reviewed CPGs methodological handbooks to identify and describe the methodological guidance about updating.