{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:05:22Z","timestamp":1790661922973,"version":"4.1.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Long COVID is projected to affect 0.6 to 1.0% of the population between 2025 and 2030. This study reviewed the methodological quality, clinical applicability and content of the care recommendations issued for adults \u226518\u202fyears with long COVID in clinical practice guidelines (CPGs) and scientific statements (SSs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Registered in PROSPERO (CRD420261324906). PubMed, Scopus, trip, five guideline repositories and national health portals were searched between February and April 2026, and PubMed and Scopus were updated on 2 September 2026. Eligible documents were CPGs and SSs on adults with suspected or confirmed long COVID, published in English or Spanish. Screening and full-text review were duplicated independently; data were extracted by one reviewer and verified by a second. Methodological quality was appraised with AGREE II, reporting the six standardised domain scores separately, each rescaled within its domain and never summed into an overall score; applicability was appraised with AGREE-REX. A narrative synthesis covered five predefined care domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty documents were appraised, 19 from the initial search and one from the update. From the 19 initial documents, 510 recommendations were extracted across five NICE-derived domains, mostly clinical management (63.3%) and care planning (29.6%). Quality was uneven (rigor of development 16.7\u201397.9%; applicability 0.0\u201395.8%; editorial Independence median 100%), and only one document reported a GRADE-compatible evidence-to-decision framework. Four documents were prioritised and contributed 99 recommendations; they scored higher than the remaining corpus in all six domains, yet applicability remained their weakest (68%). AGREE-REX showed recommendations directed far more clearly at clinicians than at patients or decision-makers. Content converged on shared decision-making, multidisciplinary rehabilitation, patient-centered care and return-to-work support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Guidance on long COVID is abundant but methodologically uneven, and the unevenness is concentrated in how evidence is linked to recommendations and in applicability. The corpus offers well-formulated clinical content whose evidence-to-decision reasoning and implementation requirements are seldom reported, and it therefore requires formal contextual adaptation, for example through GRADE-ADOLOPMENT, before use. Key limitations are the scarcity of guidance from low- and middle-income countries and the diversity of development methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD420261324906<\/jats:ext-link>\n                      , Identifier CRD420261324906.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1930005","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:48:24Z","timestamp":1790660904000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Methodological quality and clinical applicability of long COVID guidelines and scientific statements: a systematic review using AGREE II and AGREE-REX"],"prefix":"10.3389","volume":"14","author":[{"given":"Ricardo","family":"Montoya Monsalve","sequence":"first","affiliation":[{"name":"Research Group \u201cPsicolog\u00eda, Salud y Sociedad\u201d, School of Social Sciences and Humanities, CES University","place":["Medell\u00edn, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sof\u00eda","family":"Campuzano Cortina","sequence":"additional","affiliation":[{"name":"School of Social Sciences and Humanities, CES University","place":["Medell\u00edn, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Jim\u00e9nez C\u00e1rdenas","sequence":"additional","affiliation":[{"name":"CES University","place":["Medell\u00edn, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-026-36189-8","article-title":"Association of long COVID with health-related quality-of-life outcomes","volume":"16","author":"Gandhi","year":"2026","journal-title":"Sci Rep"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1038\/s43856-026-01516-7","article-title":"Long COVID disability burden in US adults","volume":"6","author":"Bonuck","year":"2026","journal-title":"Commun Med"},{"key":"ref3","volume-title":"Addressing the Costs and Care for Long COVID: The Long Shadow of the Pandemic","year":"2026"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e260374","DOI":"10.1001\/jamanetworkopen.2026.0374","article-title":"Long COVID and recovery among US adults","volume":"9","author":"Shah","year":"2026","journal-title":"JAMA Netw Open"},{"key":"ref5","volume-title":"Long COVID in Adults\u2014A Current Review of the Long-Term Health Effects Following SARS-CoV-2 Infection","author":"N\u00fcbel","year":"2026"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13643-026-03178-x","article-title":"Living evidence syntheses for long COVID therapeutics: combining rigorous protocols to build efficiency while maintaining rigor","volume":"15","author":"Atkins","year":"2026","journal-title":"Syst Rev"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e000100","DOI":"10.1136\/ihj-2021-000100","article-title":"Systematic review of post-COVID-19 syndrome rehabilitation guidelines","volume":"4","author":"Marshall-Andon","year":"2023","journal-title":"Integr Healthc J"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1606084","DOI":"10.3389\/phrs.2023.1606084","article-title":"An overview of long COVID support services in Australia and international clinical guidelines, with a proposed care model in a global context","volume":"44","author":"Luo","year":"2023","journal-title":"Public Health Rev"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1186\/s12913-026-14268-w","article-title":"Between silence and solutions: a global guideline review of long COVID care and services in Australia","volume":"26","author":"Luo","year":"2026","journal-title":"BMC Health Serv Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.jclinepi.2018.11.030","article-title":"Systematic reviews of clinical practice guidelines: a methodological guide","volume":"108","author":"Johnston","year":"2019","journal-title":"J Clin Epidemiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"105906","DOI":"10.1016\/j.ijsu.2021.105906","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"88","author":"Page","year":"2021","journal-title":"Int J Surg"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s13643-018-0768-8","article-title":"A decision tool to help researchers make decisions about including systematic reviews in overviews of reviews of healthcare interventions","volume":"8","author":"Pollock","year":"2019","journal-title":"Syst Rev"},{"key":"ref13","year":""},{"key":"ref14","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.jclinepi.2019.09.022","article-title":"Validation of five search filters for retrieval of clinical practice guidelines produced low precision","volume":"117","author":"Lunny","year":"2020","journal-title":"J Clin Epidemiol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2502611","DOI":"10.1183\/13993003.02611-2025","article-title":"Clinical practice guideline for long COVID prevention and treatment","volume":"68","author":"Cao","year":"2026","journal-title":"Eur Respir J"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1002\/pmrj.12745","article-title":"Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of cognitive symptoms in patients with post-acute sequelae of SARS-CoV-2 infection (PASC)","volume":"14","author":"Fine","year":"2022","journal-title":"PM R"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"566","DOI":"10.3947\/ic.2022.0141","article-title":"Preliminary guidelines for the clinical evaluation and management of Long COVID","volume":"54","author":"Kim","year":"2022","journal-title":"Infect Chemother."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"478","DOI":"10.3947\/ic.2025.0151","article-title":"Clinical practice guideline recommendations for post-acute sequelae of COVID-19","volume":"57","author":"Seo","year":"2025","journal-title":"Infect Chemother"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1503\/cmaj.091714","article-title":"Development of the AGREE II, part 1: performance, usefulness and areas for improvement","volume":"182","author":"Brouwers","year":"2010","journal-title":"CMAJ"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1186\/s13012-020-01036-5","article-title":"Assessment of the quality of recommendations from 161 clinical practice guidelines using the appraisal of guidelines for research and evaluation-recommendations excellence (AGREE-REX) instrument shows there is room for improvement","volume":"15","author":"Florez","year":"2020","journal-title":"Implement Sci"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1002\/pmrj.12976","article-title":"Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with post-acute sequelae of SARS-CoV-2 infection (PASC)","volume":"15","author":"Melamed","year":"2023","journal-title":"PM R"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1016\/j.jacc.2022.02.003","article-title":"ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults: myocarditis and other myocardial involvement, post-acute sequelae of SARS-CoV-2 infection, and return to play: a report of the American College of Cardiology Solution set Oversight Committee","volume":"79","author":"Gluckman","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1159\/000517255","article-title":"Swiss recommendations for the follow-up and treatment of pulmonary long COVID","volume":"100","author":"Funke-Chambour","year":"2021","journal-title":"Respiration"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1016\/j.cmi.2022.02.018","article-title":"ESCMID rapid guidelines for assessment and management of long COVID","volume":"28","author":"Yelin","year":"2022","journal-title":"Clin Microbiol Infect"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e815","DOI":"10.3399\/BJGP.2021.0265","article-title":"Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study","volume":"71","author":"Nurek","year":"2021","journal-title":"Br J Gen Pract"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"pzac090","DOI":"10.1093\/ptj\/pzac090","article-title":"Development of a novel care rehabilitation pathway for post-COVID conditions (long COVID) in a provincial health system in Alberta, Canada","volume":"102","author":"Manhas","year":"2022","journal-title":"Phys Ther"},{"key":"ref27","volume-title":"COVID-19 Rapid Guideline: Managing the Long-Term Effects of COVID-19","year":""},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1122141","DOI":"10.3389\/fpubh.2023.1122141","article-title":"Italian good practice recommendations on management of persons with long-COVID","volume":"11","author":"Giuliano","year":"2023","journal-title":"Front Public Health"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e6610","DOI":"10.5195\/ijt.2024.6610","article-title":"The Delphi method: developing a telerehabilitation practice guideline for patients in Indonesia with long COVID","volume":"16","author":"Paramita","year":"2024","journal-title":"Int J Telerehabil"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"789","DOI":"10.23736\/S1973-9087.23.08315-6","article-title":"Evidence-based position paper on physical and rehabilitation medicine professional practice for persons with COVID-19, including post COVID-19 condition: the European PRM position (UEMS PRM section)","volume":"59","author":"Ceravolo","year":"2023","journal-title":"Eur J Phys Rehabil Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1588","DOI":"10.1002\/pmrj.13085","article-title":"Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of mental health symptoms in patients with post-acute sequelae of SARS-CoV-2 infection (PASC)","volume":"15","author":"Cheng","year":"2023","journal-title":"PM R"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"120827","DOI":"10.1016\/j.jns.2023.120827","article-title":"Evaluation and treatment approaches for neurological post-acute sequelae of COVID-19: a consensus statement and scoping review from the global COVID-19 neuro research coalition","volume":"454","author":"Frontera","year":"2023","journal-title":"J Neurol Sci"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1016\/j.apmr.2022.10.001","article-title":"Rehabilitation of neuropsychiatric symptoms in patients with long COVID: position statement","volume":"104","author":"Sacks-Zimmerman","year":"2023","journal-title":"Arch Phys Med Rehabil"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s42466-022-00191-y","article-title":"Neurological manifestations of post-COVID-19 syndrome S1-guideline of the German society of neurology","volume":"4","author":"Franke","year":"2022","journal-title":"Neurol Res Pract"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"115","DOI":"10.24875\/ACM.21000287","article-title":"Consensus document of the Mexican Society of Cardiology for post-COVID-19 cardiovascular clinical follow-up","volume":"93","author":"Ayala-Le\u00f3n","year":"2022","journal-title":"Arch Cardiol Mex"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1002\/pmrj.12684","article-title":"Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients","volume":"13","author":"Herrera","year":"2021","journal-title":"PM R"},{"key":"ref37","volume-title":"Datadot. COVID-19 Cases | WHO COVID-19 Dashboard","year":""},{"key":"ref38","volume-title":"Long COVID\u2014Household Pulse Survey\u2014COVID-19","year":"2025"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1038\/s43856-025-00759-0","article-title":"A nationwide study of risk factors for long COVID and its economic and mental health consequences in the United States","volume":"5","author":"Kim","year":"2025","journal-title":"Commun Med (Lond)"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/s13690-025-01553-z","article-title":"Minority health social vulnerability index and long COVID illness among a statewide, population-based study of adults with polymerase chain reaction-confirmed SARS-CoV-2","volume":"83","author":"Ryu","year":"2025","journal-title":"Arch Public Health"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1186\/s12916-025-04039-5","article-title":"Cumulative social disadvantage and its impact on long COVID: insights from a U.S. national survey","volume":"23","author":"Xiang","year":"2025","journal-title":"BMC Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1946","DOI":"10.1186\/s12889-025-23185-2","article-title":"Inequalities in worsening work and income decrease\/cessation in SARS-CoV-2 infection in adults and elderly people: the population-based SulCovid-19 study","volume":"25","author":"Vieira","year":"2025","journal-title":"BMC Public Health"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1186\/s12889-025-21393-4","article-title":"Healthcare utilization patterns before and after a long COVID diagnosis: a case-control study","volume":"25","author":"DeVoss","year":"2025","journal-title":"BMC Public Health"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1186\/s12939-025-02635-8","article-title":"Healthcare gaps and inequities following hospitalisation for COVID-19 in Brazil\u2019s universal healthcare system: a patient-engaged survey of long COVID healthcare needs, use and barriers","volume":"24","author":"Portela","year":"2025","journal-title":"Int J Equity Health"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1186\/s12913-025-12590-3","article-title":"Health and social service provider perspectives on challenges, approaches, and recommendations for treating long COVID: a qualitative study of Canadian provider experiences","volume":"25","author":"Nguyen","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1186\/s12913-025-12677-x","article-title":"The impact of long COVID on UK healthcare workers and their workplace: a qualitative study of healthcare workers with long COVID, their families, colleagues and managers","volume":"25","author":"Al-Oraibi","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1186\/s12916-025-04335-0","article-title":"\u201cHave you considered that it could be burnout?\u201d\u2014psychologisation and stigmatisation of selfreported long COVID or post-COVID-19 vaccination syndrome","volume":"23","author":"B\u00fcchner","year":"2025","journal-title":"BMC Med"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1677","DOI":"10.3390\/children9111677","article-title":"Social, academic, and health status impact of long COVID on children and young people: an observational, descriptive, and longitudinal cohort study","volume":"9","author":"Gonzalez-Aumatell","year":"2022","journal-title":"Children (Basel)"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1057\/s41285-025-00232-x","article-title":"Vulnerability in the shadows: on the role of institutionalised solidarity and visibility as preconditions of long COVID solidarity","volume":"23","author":"Sharon","year":"2025","journal-title":"Soc Theory Health Illn"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1336","DOI":"10.1186\/s12913-025-13469-z","article-title":"Individuals\u2019 perceptions of long Covid: a phenomenological approach to an online health community narratives","volume":"25","author":"Rochette","year":"2025","journal-title":"BMC Health Serv Res"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1930005\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:48:26Z","timestamp":1790660906000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1930005\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":50,"alternative-id":["10.3389\/fpubh.2026.1930005"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1930005","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"article-number":"1930005"}}