This systematic review has several limitations. Guidelines in other
languages besides English were not included. Moreover, only guidelines
available in public digital databases have been included. Thus, we could
have missed guidelines that may have been published in different forms,
such as conference reports, PhD thesis and books.
The AGREE-II tool used for the appraisal of the guidelines also has
several shortcomings, including the lack of standardization for the
scoring method, and also the absence of criteria to distinguish between
high and low quality evidence provided in a
guideline22. The lack of standardization in the
scoring system may amplify researcher bias. The team acknowledges
domains on ‘rigor of development’ and ‘clarity of presentation’ played a
more significant role in influencing the overall score of the
guidelines, although the appraisal tool indicated that all domains play
an equal role in appraising a guideline22.