Evidence-based recommendations for the rehabilitation and management of the ageing population with spinal cord injury: a systematic review of clinical practice guidelines.

The criteria for what counted as an 'ageing-related' recommendation were somewhat arbitrary, potentially excluding relevant guidelines that used terms like 'chronic SCI'. The review only included guidelines in English and German, potentially missing relevant recommendations from other regions. The authors assessed the quality of individual recommendations but not the overall quality of the guidelines themselves, meaning high-quality guidelines with poor specific recommendations were treated similarly to low-quality ones. Most recommendations were derived from evidence for the general population or younger SCI patients, which may not be appropriate for older adults with SCI due to different physiological reserves and comorbidities.

The authors declared no conflicts of interest with any financial organization. However, one author (Inge Eriks-Hoogland) was an author of one of the included clinical practice guidelines, though she was not involved in the eligibility or quality assessment stages of this review.

Do not assume that 'strong' recommendations for older adults with SCI are backed by high-quality evidence. Most are based on low or very low quality evidence, often extrapolated from younger populations or the general elderly, and may not account for the specific complexities of ageing with a spinal cord injury.