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

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. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data relevant to the study are included in the article or uploaded as supplementary information.