Living evidence: a new approach to the appraisal of rapidly evolving musculoskeletal research

Practising appropriate evidence-based medicine requires a continuous flow of high-quality, peer-reviewed research. The emergence of new research has increased exponentially in some fields of sport and exercise medicine. As an example, between 2008 and 2018, the number of yearly publications related to the anterior cruciate ligament has more than doubled (from 650 to 1380 per year!), showcasing the breakneck speed at which new evidence is produced.1

Current practice

Systematic reviews and meta-analyses are considered the standard of data collection and appraisal and are based on manual screening of studies available in the literature at a given time. However, it is increasingly clear that clinical guidelines developed using such methods are unable to incorporate evidence from the deluge of new studies every month and may be outdated by the time of publication. A future challenge in musculoskeletal medicine is to promote efficient evidence synthesis from rapidly advancing fields by creating platforms for the near real-time assessment of new data. This ambitious goal requires rigorous appraisal of studies to maintain high-quality, cyclically updated clinical guidelines derived from continuously synthesised evidence.

Need for living evidence

Living evidence involves continuous updating of meta-analyses and clinical practice guidelines as new data are available in rapidly evolving fields of medicine, resulting in a series of ‘living meta-analyses and practice guidelines’.2 3 Do …

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