Literature review

The clinical questions defined by the panel were transformed into the PICOt epidemiological format so that they could be answered by systematic literature review (Table 1). We evaluated the efficacy and safety of pulmonary rehabilitation and non-pharmacological interventions to improve two typical problems of ILD: refractory cough and GORD.

Abbreviations: ILD, interstitial lung disease; GORD, gastro-oesophageal reflux diseases; SRs, systematic reviews. RCTs=randomised clinical trials.

The reviews conducted were hierarchical, i.e., for each question, existing SR papers were first identified and assessed for bias. We only proceeded to search for primary studies in cases where the evidence was not sufficiently robust, direct, and consistent to answer the question posed. A search strategy was established for each question including terms related to ILD, pulmonary rehabilitation, refractory cough, or GORD, both MeSH and free text, filtered by study type "systematic review" (Table 2). Articles were peer-selected by title and abstract using Rayyan® software and then read in detail to check for eligibility.

Abbreviations: ILD, interstitial lung disease; GORD, gastro-oesophageal reflux diseases; SR, systematic review.

The methodological quality of the reviews selected was assessed using the AMSTAR-2 tool, excluding those whose quality was low, very low, or critically low.(10) If the evidence was not sufficiently solid, direct, and consistent to answer a specific question, a search for primary studies was carried out. The methodological assessment was performed using the Cochrane Rob 2 risk of bias tool and Jadad's scale for the risk of bias.(11,12) In order to facilitate informed decisions by the panel, tables including information from the selected studies were prepared using the GRADE methodology.(13) For this purpose, the most relevant results were selected and the level of evidence for each specific question was assigned. The GRADE system classifies the quality of evidence into four levels: high, moderate, low, and very low.