Cochrane Handbook for Systematic Reviews of…

Cochrane Handbook for Systematic Reviews of Interventions

The Cochrane Handbook for Systematic Reviews of Interventions is the methodological standard maintained by Cochrane (founded 1993, named after epidemiologist Archie Cochrane) that specifies how a systematic review of a health intervention must be planned, conducted, and reported to qualify as a Cochrane Review. It requires a registered protocol with a PICO-structured question, a comprehensive pre-specified search strategy across multiple databases, dual independent screening and data extraction, formal risk-of-bias assessment (the RoB 2 tool for randomized trials, ROBINS-I for non-randomized studies), GRADE-based certainty-of-evidence rating, and, where studies are sufficiently similar, meta-analysis. Reviews that follow the Handbook are published in the Cochrane Database of Systematic Reviews (CDSR) within the Cochrane Library and are maintained as living documents, updated as new evidence emerges.

ByCASRAI Editorial Board

· Last updated 23 Jul 2026

Worked examples

Is an instance

A Cochrane Review Group registers a protocol for a review of a drug's effect on hospital readmission, then follows the Handbook chapter-by-chapter: dual reviewers screen search results independently, assess each included randomized trial with the RoB 2 tool, pool comparable outcomes in a meta-analysis, and grade the certainty of the pooled estimate using GRADE before the review is published in the Cochrane Database of Systematic Reviews.

Is an instance

A review is designated a 'living systematic review' under Handbook Chapter 22 guidance: rather than being a single fixed publication, it is re-searched and updated on a defined schedule (e.g. monthly) as new trials are published, with the CDSR record versioned each time the conclusions are revisited.

Looks similar, but isn't

Not an instance

A paper titled 'a systematic review of X' published in a general medical journal that follows the PRISMA 2020 reporting checklist (which governs how a review is written up and reported) is not automatically a 'Cochrane Review' — PRISMA is a reporting standard, not the Cochrane Handbook's methodology, and the paper was not produced through a Cochrane Review Group's editorial process or published in the Cochrane Database of Systematic Reviews.

The Cochrane Handbook for Systematic Reviews of Interventions is the core methodological guidance produced by Cochrane, the international network of researchers, clinicians, and patients that has produced systematic reviews of health interventions since 1993. Work on the Handbook began the same year the organization was founded, with the first version published in 1994; the current edition (Version 6, the first major revision since the first print edition in 2008) is maintained online and updated on a rolling basis at training.cochrane.org/handbook.

What the Handbook actually specifies

Where a reporting checklist like PRISMA 2020 tells authors how to describe and report a completed review, the Cochrane Handbook is a methods manual: it specifies how the review should be *done* at each stage. Chapters cover, among other things, formulating a PICO-structured question and protocol (Chapters 1–2), searching for studies, selecting studies and collecting data, assessing risk of bias in randomized trials with the RoB 2 tool and in non-randomized studies with ROBINS-I, statistical methods for combining results including fixed-effect and random-effects meta-analysis (Chapter 10) and network meta-analysis (Chapter 11), assessing risk of bias due to missing evidence such as publication bias (Chapter 13), and using the GRADE approach to rate the certainty of a body of evidence in Summary of Findings tables (Chapter 14).

Cochrane Review vs. a generic systematic review

Not every review that calls itself "systematic" is a Cochrane Review. A review earns that designation by being developed through a Cochrane Review Group’s editorial process, following the Handbook’s methods requirements, and being published in the Cochrane Database of Systematic Reviews (CDSR) — the primary journal of the Cochrane Library. A researcher can still follow Handbook methodology closely for a review published elsewhere without it being a formal Cochrane Review; conversely, a paper that follows PRISMA’s reporting checklist has met a reporting standard, not necessarily the Handbook’s conduct standard. See systematic review for the general definition.

How it relates to PRISMA and PROSPERO

These three are frequently confused because they all sit in the systematic-review workflow, but they do different jobs: the Cochrane Handbook is the methodological standard for how to conduct the review; PRISMA 2020 is a reporting checklist for how to write up and report it once complete; and PROSPERO is the international registry where a protocol is prospectively recorded before the review begins, regardless of whether the review is a formal Cochrane Review. A Cochrane Review typically satisfies all three: Handbook-compliant conduct, PROSPERO or Cochrane’s own protocol registration, and PRISMA-compliant reporting.

Living systematic reviews and updating

Cochrane Reviews are treated as living documents rather than one-off publications. Handbook guidance on living systematic reviews describes ongoing surveillance of the evidence base with scheduled re-searches, so that a review’s conclusions and its forest plots/GRADE ratings can be revised as new trials publish, rather than left static until a full re-review years later.

References

Cochrane. "Cochrane Handbook for Systematic Reviews of Interventions (current version)." training.cochrane.org/handbook/current.
Cochrane. "About the Cochrane Database of Systematic Reviews." cochranelibrary.com/cdsr/about-cdsr.
Cochrane. "What are systematic reviews?" cochrane.org/evidence/what-are-systematic-reviews.
Page MJ et al. "The PRISMA 2020 statement." BMJ 2021;372:n71.

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