Strata Academy
PROSPERO Amendments & Protocol Deviations Explained
When to amend your registration, how to document protocol changes, and what examiners and journals expect in the final manuscript
Quick answer
Amend PROSPERO when inclusion criteria, outcomes, search sources, or analysis plans change materially. Minor clarifications can stay in the manuscript only. Always report 'differences from protocol' in your final review — unexplained outcome switching is a serious integrity concern.
1. What counts as a protocol deviation?
A protocol deviation is any difference between what you registered on PROSPERO and what you actually did. Some deviations are justified and transparent; others — especially post-hoc outcome changes — undermine credibility.
Material deviations typically include: changing the primary outcome, widening or narrowing inclusion criteria after screening, adding databases mid-search, switching from fixed to random effects after seeing heterogeneity, or dropping risk-of-bias assessment you pre-specified.
Minor clarifications — spelling out operational definitions, adding secondary outcomes that do not replace the primary, or correcting typos — may not need a formal PROSPERO amendment but should still appear in your methods or appendix.
UK dissertation examiners increasingly download your PROSPERO PDF. Treat the registration as a contract you can explain, not a box you ticked once.
- Material — amend PROSPERO and report in manuscript
- Minor — document in methods; amendment optional
- Undocumented — red flag for selective reporting
- Post-hoc — changes driven by results without protocol update
2. When to submit a PROSPERO amendment
Submit an amendment before implementing the change when possible. If you have already screened 200 records and realise your age criterion was wrong, stop, amend, and document how many records were re-screened.
PROSPERO's amendment workflow creates a version history. Readers can see what changed and when — this is a feature, not a confession. Transparent updates are preferable to silent drift.
Common student scenarios requiring amendment: supervisor feedback narrows the population; librarian adds Embase after a pilot search; you pre-specify ROBINS-I for non-randomised studies you initially excluded; subgroup analysis becomes primary after feasibility discussion (with justification, not after peeking at results).
Do not amend retrospectively to match what you already published in a draft chapter. Align the record to honest methods, then align the manuscript.
3. How to amend a PROSPERO record (practical steps)
Log in to PROSPERO, open your registration (CRD420xxxxxx), and select the amendment option. You will be prompted to identify which fields changed and provide a brief reason.
Write amendment notes in plain language: 'Primary outcome changed from HbA1c at 12 weeks to HbA1c at 24 weeks because no included trial reported 12-week data; amendment submitted before full-text screening completed.'
Save the amended PDF and note the amendment date in your project folder. Reference both the original registration date and latest amendment date in your dissertation methods.
Allow time for editorial review — same as initial registration. Do not leave amendments to the week before submission.
- Identify which PROSPERO fields differ from current practice
- Draft a one-paragraph rationale (supervisor sign-off helps)
- Submit amendment via PROSPERO portal
- Download updated PDF; update dissertation methods and PRISMA checklist
- Add a 'differences from protocol' subsection in results or discussion
4. Reporting deviations in your manuscript
PRISMA 2020 expects transparency about protocol changes. Include a table or subsection listing: registered plan, final method, reason for change, and whether the change was amended on PROSPERO before implementation.
For each deviation, state whether it could introduce bias (e.g. narrowing inclusion after seeing study characteristics) or is unlikely to (e.g. adding a secondary outcome).
If you ran sensitivity analyses to test robustness after a deviation — such as repeating meta-analysis with the originally registered outcome — report those results explicitly.
Dissertation examiners reward honesty. A well-explained deviation with amendment date is stronger than hoping nobody checks PROSPERO.
5. Research integrity and selective reporting
Selective reporting means presenting outcomes or analyses that favour a desired conclusion while omitting others. Protocol registries exist partly to detect this. Comparing PROSPERO to ClinicalTrials.gov for included RCTs is standard in Cochrane reviews — examiners may expect similar rigour in student work.
Outcome switching is the most common integrity concern in student dissertations: registering outcome A, finding non-significance, then writing up outcome B as primary. Amendment after the fact without a blinded rationale does not fix this.
If you discover your question is infeasible mid-project, discuss with your supervisor whether to amend scope, convert to scoping review, or stop. Transparent re-scope beats silent shortcutting.
University research integrity policies apply to systematic reviews. When unsure, ask your supervisor before changing methods.
6. Common student scenarios (and what to do)
Scenario A — Too many hits after search: narrow inclusion criteria with supervisor agreement, amend PROSPERO before further screening, document how many records were re-assessed.
Scenario B — No RCTs found: if you registered RCT-only, amend to include quasi-experimental designs with ROBINS-I, or re-scope the question with a new registration.
Scenario C — Meta-analysis not possible: amend analysis plan to narrative synthesis only; do not claim pooling was 'always intended' if PROSPERO stated meta-analysis.
Scenario D — Supervisor suggests extra subgroup: if suggested before any analysis, amend with rationale; if suggested after you have seen forest plots, document as post-hoc exploratory analysis, not pre-specified primary subgroup.
7. Pre-submission checklist
Before dissertation or journal submission, download the latest PROSPERO PDF and compare field-by-field to your methods section. Mismatches must be explained or corrected.
Verify PRISMA flow numbers match your final eligibility criteria — not the original draft criteria.
Confirm primary and secondary outcomes in the abstract match the amended registration.
Include PROSPERO ID and amendment history in the abstract and methods. Link to the public record.
- PROSPERO PDF matches methods section
- Differences-from-protocol table completed
- All amendments dated before implementation where feasible
- Supervisor has reviewed deviation narrative
- PRISMA checklist updated for final methods
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