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Systematic Reviews in the Health Sciences

This guide will introduce you to the Systematic Review process.

What is Hand-searching?

Hand-searching (also handsearching and hand searching) is a manual method of scanning select journals from cover to cover, page-for-page for relevant articles in case they were missed during indexing. It is a methodical process of searching journal contents page by page (and, by hand) including articles, editorials, letters from readers, etc., to identify the relevant studies and complete the non-indexed searching in the databases. According to the Cochrane Handbook"...involves a manual page-by-page examination of the entire contents of a journal issue or conference proceedings to identify all eligible reports of trials.

"Handsearching may include checking the reference lists of journal articles, a technique called snowballing. In 2013, Craane et al found that "...hand search[ing] plays a valuable role in identifying randomised controlled trials" beyond Medline and Embase.

Craane B., Dikstra PU. (2012 Feb) Methodological quality of a systemtic review on physical therapy for temporomandibular disorders: influence of hand search and quality scales.  Clinical Oral Investigations 16(1) 295-303.

Who does the Hand-searching?

Hand-searching is typically carried out by a trained hand-searchers and must be documented along other search strategies. Recent research by health librarians suggests that hand-searching is still a requirement for the systematic review. Although keyword searching and reference harvesting reduce the need of doing hand-searches, it is thought that hand-searching (due to non-existent, incomplete and / or inaccurate indexing) supplements the structured, documented searches in the biomedical databases.

There is a law of diminishing returns with searching online, and it may be necessary for searchers to consider hand-searching when it becomes clearer it will be more effective than searching online.

Hand-searching in Systematic Reviews

Hand-searching is a manual process of screening pre-defined and pre-selected peer-reviewed biomedical journals, conference proceedings and other publications for relevant materials that have been missed during the indexing process. Hand-searching is widely considered necessary in the systematic review because it:

  • locates relevant articles poorly or inaccurately indexed or unindexed;
  • allows researchers to scan content quickly for relevant studies from the high-impact journals, and
  • ensures that relevant studies are not overlooked

Hand-searching increases the likelihood that no major relevant studies will be missed. Due to selective indexing in some databases and search tools and a tendency not to index supplements or special issues such as conference abstracts, handsearching is important for many if not most major research projects where comprehensive retrieval is required

Documenting Hand-searching

Specific titles and date ranges searched for a systematic review should be included in the search strategies section. It should include journal titles, listed in alphabetical order, and the months and years that have been searched.

In addition, any websites that have been consulted, whether it be for the purposes of browsing for information, searching for grey literature or locating experts in the field, should also be documented.


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