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  1. Structuring the research question and protocol
  2. From search to data extraction
  3. Risk of bias assessment, synthesis and reporting

Academy · Concepts & Definitions · Systematic review pipeline

The Systematic Review Process: The Full Sequence from Research Question to Published Paper

A systematic review follows a defined sequence of stages. The most common planning error is to begin the search before the earlier stages (the question, the protocol and its registration) have been finalized.

Pubrica AcademyWritten by a systematic review methodologist Reviewed byan information specialist Published10 October 2026 Last checked10 October 2026 Reading time9 minutes Sources2 peer-reviewed

The standard systematic review process comprises structuring the question (commonly with the Population, Intervention, Comparison, Outcome (PICO) framework or a close variant), writing and registering a protocol, running and documenting the search, screening records against pre-specified criteria, extracting data, assessing risk of bias, synthesising results and reporting against PRISMA 2020.

Learning objectives

  • The full sequence of stages in a systematic review, in the order in which they should occur.
  • Why registration should precede the search.
  • The position of risk-of-bias assessment relative to data extraction and synthesis.

Common misconceptions

  • “A review may be registered after the search is already underway.” PROSPERO and similar registries exist specifically to record the methods of a review before its results are known; registration after searching has begun undermines the purpose of registration, and some registries flag or reject late registrations.
  • “Risk-of-bias assessment follows synthesis, as a caveat on the results.” Standard practice, according to the Cochrane Handbook, is to assess risk of bias for each included study as part of data extraction and before synthesis, because the synthesis method (and whether a meta-analysis is appropriate at all) may depend on it.

Structuring the research question and protocol

The pipeline starts with structuring the research question, commonly using PICO (Population, Intervention, Comparison, Outcome) or a variant suited to the question type, then writing a full protocol specifying eligibility criteria, search strategy, and planned analysis methods. That protocol is then registered — PROSPERO is the most widely used registry for health-related systematic reviews, and the required sections of its current registration form, including the review question, eligibility criteria and planned methods, must be completed1. Registration should occur before the search begins, not after.

From search to data extraction

With the protocol locked, the search is run across the pre-specified databases and sources, results are deduplicated and screened in two stages (title/abstract, then full text) against the pre-set eligibility criteria, and data are extracted from each included study using a pre-piloted extraction form, per PRISMA 2020's reporting requirements for these stages2.

Risk of bias assessment, synthesis and reporting

Risk of bias is assessed for each included study, typically alongside or immediately after data extraction, using a tool appropriate to the study design (such as the Cochrane risk-of-bias tools for randomised trials). Results are then synthesised — narratively, and via meta-analysis where studies are sufficiently similar in design and outcome measurement — and the whole review is written up and reported against the PRISMA 2020 checklist, with the flow diagram documenting exactly how many records moved through each stage2.

Key points

Key points

The process is sequential for methodological reasons: the question and protocol come first, registration precedes the search, search and screening precede extraction, risk of bias is assessed for each study before synthesis, and the review is reported against PRISMA 2020 at the end. Omitting or reordering stages, particularly registering after searching, undermines the credibility of the review.

Practical application

Practical application

  1. The protocol should be finalized and registered before the search is run. Registration in PROSPERO or an equivalent registry should be completed before the search strategy is executed, not retrospectively.
  2. The data-extraction form should be piloted on a small number of studies before full extraction. Piloting identifies ambiguous fields and missing categories before they necessitate rework across dozens of studies.
  3. Risk of bias should be assessed at the study level before the synthesis method is decided. Whether a meta-analysis is appropriate, and how heterogeneity is handled, should be informed by the risk-of-bias assessment rather than decided independently of it.

Frequently asked questions

Some journals require it as a condition of considering a systematic review for publication; the target journal’s specific instructions should be consulted, since practice varies.

Yes, but substantive changes should be documented and dated in the registry record and disclosed in the final published review, rather than made silently.

A scoping review follows a similar but distinct process (PRISMA-ScR rather than PRISMA 2020) and generally maps the scope of literature rather than synthesising effect estimates.

References

  1. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement. BMJ. 2021;372:n71. read 10 October 2026. View on BMJ
  2. PROSPERO International Prospective Register of Systematic Reviews. University of York, Centre for Reviews and Dissemination. read 10 October 2026. View PROSPERO

Every source above is a peer-reviewed article, a publisher’s record of one, or a standard issued by the body that owns it. Each carries the date it was last read. Where a standard moves, this article is revised rather than left up with a note.

How to cite this article

Pick your referencing style and copy it. Your university or target journal may vary the punctuation — check its guide if it has one.

Pubrica Academy. (2026, October 10). The Systematic Review Process: The Full Sequence from Research Question to Published Paper. Pubrica. https://pubrica.com/academy/flowcharts/systematic-review-protocol-to-publication-flow/

This article is written to be learned from. Cite it if you are referring to what it says; if you are using the evidence behind it, cite the sources listed above instead.

Pipeline order checklist

Each stage should be confirmed as complete before the next begins.

[ ] Question structured (PICO or equivalent)
[ ] Protocol written, specifying eligibility criteria, search strategy, analysis plan
[ ] Protocol registered (e.g. PROSPERO) before search begins
[ ] Search run and documented across pre-specified sources
[ ] Screening completed in two stages against pre-set criteria
[ ] Data extraction form piloted, then full extraction completed
[ ] Risk of bias assessed per included study
[ ] Synthesis method chosen with risk-of-bias picture in view
[ ] Write-up reported against PRISMA 2020, with flow diagram

Pubrica AcademyWritten and maintained by Pubrica’s subject matter experts. Articles are revised when the underlying standards change, and each article states the date on which it was last reviewed.

How Pubrica can help

Pubrica supports systematic reviews across the full process, including protocol development, PROSPERO registration, search strategy, screening, extraction, risk-of-bias assessment and PRISMA-compliant reporting.

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