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.

Objective: What is the content and methodological quality of dementia guideline recommendations within the physiotherapy scope of practice?

Methods: Systematic review of clinical practice guidelines. Methods: MEDLINE, Embase, CINAHL, AgeLine, Google, guideline databases, and relevant websites (to January 2025). Methods: 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. 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.

Conclusions: Non-English language publications were excluded. Only recommendations presenting GRADE scores were synthesised. Conclusions: 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 PROSPERO CRD42023412107. CONTRIBUTION OF THE PAPER.