Clinical practice guidelines for dementia contain few recommendations relevant to the physiotherapy scope of practice and are of varying quality: a systematic review

Background: The content and quality of dementia guideline recommendations relevant to physiotherapy remains unknown. Clinical question: What is the content and methodological quality of dementia guideline recommendations within the physiotherapy scope of practice? Design: Systematic review of clinical practice guidelines. Data sources: MEDLINE, Embase, CINAHL, AgeLine, Google, guideline databases, and relevant websites (to January 2025). Study selection: Guidelines in English, screened through a three-phase process by two independent reviewers, were eligible if recommendations were relevant to adults with dementia and within the physiotherapy scope of practice. Data appraisal and synthesis methods: Guideline characteristics and recommendation content were extracted. Recommendations using GRADE methodology with certainty of evidence and strength of recommendation scores were synthesised. Quality was assessed using AGREE II and AGREE-REX. Results: Twenty-one relevant guidelines were identified. Twelve used GRADE methodology, eight presented GRADE scores. Thirty-three recommendations with GRADE scores met the physiotherapy scope of practice, categorised into ten topics: exercise (n = 11), acupuncture (n = 1), psychosocial and environmental interventions (n = 1), tailored activities (n = 2), carer support (n = 3), pain management (n = 5), falls risk management (n = 1), outcomes and outcome measures (n = 4), care planning (n = 1), and care setting transitions (n = 4). Methodological quality of guidelines and recommendations varied significantly. Limitations: Non-English language publications were excluded. Only recommendations presenting GRADE scores were synthesised. Conclusion: Current dementia guidelines partially reflect the physiotherapy scope of practice. Varying methodological quality and inconsistent rating methods challenge interpretation and implementation. Robust physiotherapy-specific guidelines are needed to demonstrate the value of physiotherapy for people with dementia, and inform clinical practice, education, and policy. Systematic Review Registration Number: Systematic Review Registration Number PROSPERO CRD42023412107. Contribution of the Paper: • There are no published physiotherapy-profession specific dementia clinical practice guidelines. • The representation of physiotherapy scope of practice within dementia clinical practice guideline recommendations is minimal. • There are discrepancies between what physiotherapy interventions are provided to people living with dementia in clinical practice, and what physiotherapy interventions are supported by dementia guideline recommendations.