It is the authors' experience that reviewing reference lists and conducting hand-searches are often considered the same, yet we argue that these processes are quite different and lead to different outcomes. As part of the search process, systematic reviewers often review reference lists of other studies or conduct hand-searches to identify additional primary studies. There is a substantial body of evidence pointing to the importance of thorough and prespecified search strategies involving multiple databases to locate relevant studies and minimize the potential for publication and language bias. While each aspect of systematic review methodology is important, the search process, when thorough and well produced, leads to a set of research evidence to consider for inclusion that minimizes bias. Well-conducted systematic reviews are the apex of the evidence hierarchy and routinely used for developing care guidelines and informing clinical decision making.
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