Eclipse plot: a graphical visualization for risk of bias assessments in two steps

As Cochrane’s RoB-2 has been widely adopted in systematic reviews, its traffic-light-style plot has become the standard for risk-of-bias visualization. A new risk-of-bias tool, however, introduced a two-step framework for assessing risk of bias: the ROBUST-RCT tool. Through its framework, the reviewers first evaluate what occurred in the trial (step 1) and then assess the potential impact of these events on the outcome (step 2). This paper introduces a novel visualization tool specifically designed for ROBUST-RCT, namely the “eclipse plot”, which displays both the factual evaluation and the judgment. Therefore, it aims to empower readers of systematic reviews not only to passively accept the authors' judgments but also to form their own judgments about the study’s design and conduct. Finally, consistent with the tool’s aim of simplicity, beyond the R package (“eclipseplot”), an easy-to-use web tool is also available to ensure accessibility for non-coders.