Table 1.

SPIRIT checklist

Section/item	Item No	Description	Addressed on page number
Administrative information
Title	1	Descriptive title identifying the study design, population, interventions and, if applicable, trial acronym	Title page
Trial registration	2a	Trial identifier and registry name. If not yet registered, name of intended registry	Abstract, 7
Protocol version	3	Date and version identifier	27
Funding	4	Sources and types of financial, material and other support	28
Roles and responsibilities	5a	Names, affiliations and roles of protocol contributors	Title page, 28
	5b	Name and contact information for the trial sponsor	26
	5c	Role of study sponsor and funders, if any, in study design; collection, management, analysis and interpretation of data; writing of the report; and the decision to submit the report for publication, including whether they will have ultimate authority over any of these activities	27
	5d	Composition, roles and responsibilities of the coordinating centre, steering committee, endpoint adjudication committee, data management team and other individuals or groups overseeing the trial, if applicable (see Item 21a for data monitoring committee)	25
Introduction
Background and rationale	6a	Description of research question and justification for undertaking the trial, including summary of relevant studies (published and unpublished) examining benefits and harms for each intervention	5–7
Objectives	7	Specific objectives or hypotheses	7
Trial design	8	Description of trial design including type of trial (e.g. parallel group, crossover, factorial, single group), allocation ratio and framework (e.g. superiority, equivalence, noninferiority, exploratory)	7
Methods: Participants, interventions and outcome
Study setting	9	Description of study settings (e.g. community clinic, academic hospital) and list of countries where data will be collected. Reference to where list of study sites can be obtained	7–8
Eligibility criteria	10	Inclusion and exclusion criteria for participants. If applicable, eligibility criteria for study centres and individuals who will perform the interventions (e.g. surgeons, psychotherapists)	8–10
Interventions	11a	Interventions for each group with sufficient detail to allow replication, including how and when they will be administered	13–15; Table 3; Fig. 2
	11b	Criteria for discontinuing or modifying allocated interventions for a given trial participant (e.g. drug dose change in response to harms, participant request or improving/worsening disease)	23–24
	11c	Strategies to improve adherence to intervention protocols, and any procedures for monitoring adherence (e.g. drug tablet return, laboratory tests)	24
	11d	Relevant concomitant care and interventions that are permitted or prohibited during the trial	15
Outcomes	12	Primary, secondary and other outcomes, including the specific measurement variable (e.g. systolic blood pressure), analysis metric (e.g. change from baseline, final value, time to event), method of aggregation (e.g. median, proportion) and time point for each outcome. Explanation of the clinical relevance of chosen efficacy and harm outcomes is strongly recommended	17–22, Table 2
Participant timeline	13	Time schedule of enrolment, interventions (including any run-ins and washouts), assessments and visits for participants. A schematic diagram is highly recommended (see figure)	Fig. 1, Table 2
Sample size	14	Estimated number of participants needed to achieve study objectives and how it was determined, including clinical and statistical assumptions supporting any sample size calculations	25
Recruitment	15	Strategies for achieving adequate participant enrolment to reach target sample size	10–12, 24
Methods: Data collection, management and analysis
Data collection methods	18a	Plans for assessment and collection of outcome, baseline, and other trial data, including any related processes to promote data quality (e.g. duplicate measurements, training of assessors) and a description of study instruments (e.g. questionnaires, laboratory tests) along with their reliability and validity, if known. Reference to where data collection forms can be found, if not in the protocol	11–12, 17–24
	18b	Plans to promote participant retention and complete follow-up, including list of any outcome data to be collected for participants who discontinue or deviate from intervention protocols	13, 15, 25
Data management	19	Plans for data entry, coding, security and storage, including any related processes to promote data quality (e.g. double data entry; range checks for data values). Reference to where details of data management procedures can be found, if not in the protocol	24
Statistical methods	20a	Statistical methods for analysing primary and secondary outcomes. Reference to where other details of the statistical analysis plan can be found, if not in the protocol	25
	20b	Methods for any additional analyses (e.g. subgroup and adjusted analyses)	25–26
Methods: Monitoring
Data monitoring	21a	Composition of data monitoring committee (DMC), summary of its role and reporting structure, statement of whether it is independent from the sponsor and competing interests, and reference to where further details about its charter can be found, if not in the protocol. Alternatively, an explanation of why a DMC is not needed	23–24.26
	21b	Description of any interim analyses and stopping guidelines, including who will have access to these interim results and make the final decision to terminate the trial	23–24
Harms	22	Plans for collecting, assessing, reporting and managing solicited and spontaneously reported adverse events and other unintended effects of trial interventions or trial conduct	24
Auditing	23	Frequency and procedures for auditing trial conduct, if any, and whether the process will be independent from investigators and the sponsor	n/a
Ethics and dissemination
Research ethics approval	24	Plans for seeking research ethics committee/institutional review board (REC/IRB) approval	27
Protocol amendments	25	Plans for communicating important protocol modifications (e.g. changes to eligibility criteria, outcomes, analyses) to relevant parties (e.g. investigators, REC/IRBs, trial participants, trial registries, journals, regulators)	27
Consent or assent	26a	Who will obtain informed consent or assent from potential trial participants or authorised surrogates and how (see Item 32)	10–12
	26b	Additional consent provisions for collection and use of participant data and biological specimens in ancillary studies, if applicable	n/a
Confidentiality	27	How personal information about potential and enrolled participants will be collected, shared and maintained in order to protect confidentiality before, during and after the trial	26–27
Declaration of interests	28	Financial and other competing interests for principal investigators for the overall trial and each study site	29
Access to data	29	Statement of who will have access to the final trial dataset and disclosure of contractual agreements that limit such access for investigators	n/a
Ancillary and post-trial care	30	Provisions, if any, for ancillary and post-trial care and for compensation to those who suffer harm from trial participation	n/a
Dissemination policy	31a	Plans for investigators and sponsor to communicate trial results to participants, healthcare professionals, the public and other relevant groups (e.g. via publication, reporting in results databases or other data sharing arrangements), including any publication restrictions	n/a
	31b	Authorship eligibility guidelines and any intended use of professional writers	n/a
	31c	Plans, if any, for granting public access to the full protocol, participant-level dataset and statistical code	n/a
Appendices
Informed consent materials	32	Model consent form and other related documentation given to participants and authorised surrogates	On request