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A tool can prepare a list of appraisal questions suited to a study design, or extract statements
about the sample, the measurement, and the limitations. But we should not ask it to give a
final quality score from the abstract alone. Serious appraisal needs the full text, and

sometimes supplementary materials, a protocol, or a pre-registration.

FIGURE 7-4: A TRANSPARENT PATH FOR SCREENING STUDIES AND DOCUMENTING EXCLUSIONS

What to notice: The path shows how many unique records there were, what was excluded,
what was read in full, and what was included. Every exclusion must be tied to a clear
criterion.

Source: Prepared by the author, drawing on the structure of established reporting flow
diagrams without reproducing an official template [2][3].

7.4.1 Protocol and Pre-registration: Protecting Decisions From Hindsight
A protocol is a short or detailed document written, as far as possible, before execution. It

defines the question, the databases, the initial queries, the inclusion and exclusion criteria,
the de-duplication plan, the method of screening, the extraction fields, the approach to
appraising quality or risk of bias, and the plan for synthesis or analysis. Having one does not

prevent learning during the search, but it makes changes visible and justified.

In systematic reviews and confirmatory analyses, pre-registration or publishing the protocol
reduces the risk of changing the question or the analysis after seeing the results [19]. If the
plan changes, we do not bury the change; we write what changed, why, when, and what its

effect was. Protocol reporting guidance helps in covering the essential items [18][31].

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