Send to

Choose Destination
J Clin Epidemiol. 2017 Nov;91:47-53. doi: 10.1016/j.jclinepi.2017.08.009. Epub 2017 Sep 11.

Living systematic reviews: 4. Living guideline recommendations.

Author information

Department of Internal Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon. Electronic address:
Cochrane Germany, Medical Center - University of Freiburg, Freiburg, Germany.
Department of Infectious Diseases and Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Clinical Research Institute, American University of Beirut, Beirut, Lebanon.
Department of Medicine and Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada.


While it is important for the evidence supporting practice guidelines to be current, that is often not the case. The advent of living systematic reviews has made the concept of "living guidelines" realistic, with the promise to provide timely, up-to-date and high-quality guidance to target users. We define living guidelines as an optimization of the guideline development process to allow updating individual recommendations as soon as new relevant evidence becomes available. A major implication of that definition is that the unit of update is the individual recommendation and not the whole guideline. We then discuss when living guidelines are appropriate, the workflows required to support them, the collaboration between living systematic reviews and living guideline teams, the thresholds for changing recommendations, and potential approaches to publication and dissemination. The success and sustainability of the concept of living guideline will depend on those of its major pillar, the living systematic review. We conclude that guideline developers should both experiment with and research the process of living guidelines.


Living guidelines; Living systematic review; Prioritizing recommendations; Updating guidelines; Updating systematic reviews

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center