Stefan Elbers

210 Chapter 8 of regular updates, a living review provides the opportunity to accelerate this process. Disseminating findings via a web application also helps to increase the accessibility of data to patients, researchers, clinicians, policy makers, and guideline developers (e.g. Li, 2020; Salehi et al., 2021; Wissel et al., 2020). Although the systematic review in Chapter 2 does not include a Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to summary of findings or concrete practice guidelines, the project can be extended in that direction in several ways. First, the dashboard can be expanded with additional modules that improve the description, interpretation and understanding of the dataset. For example, living network meta-analysis is amethodology increasingly adopted in systematic reviews.Benefits include the possibility of combining direct comparisons (within-study) with indirect comparisons (different treatments between studies) in a single analysis, resulting in a complete presentation of all available evidence (Molloy et al., 2018; Vandvik et al., 2016). These types of analyses have been successfully incorporated in other living review projects (e.g. Créquit et al., 2020). Second, within each module, updates could include improved interaction and usability. More extensive filtering and organization options would allow users to create subgroups or to compare specific studies, based on their own interest. Another possibility is to extend existing modules with additional analyses, such as extra forest plots of standardized mean differences for studies that include control groups, or by incorporating updated reporting standards (Negrini et al., 2020). Third, it is possible to extend the dataset itself by adding outcome measures, such as fatigue, or by including more patient groups. For example, in the protocol for the living systematic review, we propose aligning the patient criteria with the ICD-11 definition of chronic primary pain, which could result in the inclusion of more trials. Importantly, GitHub version control and the workflow that prescribes that all changes will be submitted as protocol amendments ensures transparency and replicability throughout all stages of this project. Figure 1 depicts the current organization of the application and the various levels by which it could be extended in the future. The proposed workflow, combined with the aforementioned possibilities and possible future steps, indicates how a systematic review can be transformed into a living evidence synthesis community (Ravaud et al., 2020). Although it is not certain that this project will be the foundation of such an enterprise, it does provide insight into its feasibility and the actions required. One additional step towards integration of scientific evidence into clinical practice would be to use the outcomes from the analyses to continuously inform clinical practice guidelines. This would require living summary tables – for evaluating the