Evidence-Based Practice: Ask

PICO

It is important you have a clear, well-formed, focused question.Idea [Image adapted from: Pixabay, https://pixabay.com/en/light-bulb-idea-light-bright-1133639/, copied under CC0 1.0, https://creativecommons.org/publicdomain/zero/1.0/deed.en]

Benefits of doing this include:

  • it makes searching for evidence easier
  • you can easily apply the key concepts in your question to your search.

Watch the following video:

How you frame your question is critical.

Dr. Saravana Kumar, Senior Lecturer in Physiotherapy, UniSA, explains the different question types, and the body of evidence required for each (3:44):

Background questions

These ask for general knowledge about a condition or disease. They are:

  • not related to an intervention, but useful to develop a better understanding of a condition.
  • asked because of the need for basic information, not normally to make a clinical decision about a specific patient.

How effective is dry needling for treating myofascial pain?

P Population (patient)
What are the characteristics of the patient or population? OR
What is the condition or disease you are interested in?
myofascial pain
O Observation
Observation or evidence of characteristics, or a treatment.
dry needling

Foreground questions

These ask for specific knowledge to inform clinical decisions or action. They use a structured framework, such as: PICO(T), or PECO(T). Some examples:

  • Does pole dancing improve aerobic fitness in middle aged adults?

  • In older adults with knee osteoarthritis are NSAIDS more effective than exercise in reducing pain?

  • Is a paleo diet more effective than a Mediterranean diet for weight reduction in obese adults?

  • What is the evidence for the effectiveness of self management of diabetes?

The PICO framework is useful for developing an answerable clinical question. For example:

Is a paleo diet more effective than a Mediterranean diet for weight reduction in obese adults?

P Population (patient)
What are the characteristics of the patient or population? OR
What is the condition or disease you are interested in?
obese adults
I/E Intervention or Exposure
What do you want to do with the patient (e.g. treat, diagnose, observe etc.)?
paleo diet
C Comparison
What is the alternative to the treatment (e.g.placebo, different drug, surgery)?
mediterranean diet
O Outcome
What is the relevant outcomes (e.g. morbidity, complications)?
weight reduction

Use the PICO worksheet to get started with your question. If you are using another framework, adapt it.


Watch the following video (created by the Centre of Evidence-Based Practice, Oxford University) to see PICO mapping in practice. Some additional videos are also linked to below.

You do not have to have a comparator when using PICO. For example:

What is the evidence for the effectiveness of self management of Diabetes Mellitus Type II?

P Population (patient)
What are the characteristics of the patient or population? OR
What is the condition or disease you are interested in?
Diabetes Mellitus Type II
I Intervention or Exposure
What do you want to do with the patient (e.g. treat, diagnose, observe etc.)?
self management
O Outcome
The outcome is normally implicit so it may not be necessary to search for it.
effectiveness

 

You can use PICO for an diagnosis question. For example:

In adults with lateral ankle sprains, how useful are x-rays in confirming the diagnosis?

P Population (patient)
What are the characteristics of the patient or population? OR
What is the condition or disease you are interested in?
adults with lateral ankle sprains
I Intervention or Exposure
What do you want to do with the patient (e.g. treat, diagnose, observe etc.)?
x-rays
O Outcome
The outcome is normally implicit so it may not be necessary to search for it.
confirming diagnosis

If your research question is qualitative you may need to focus gathering of research which describes a particular phenomenon or topic of interest. You can adapt people in the following way: 

PICo

P=Population, I=Interest area, Co=Context. Useful for qualitative questions.

Qualitative example: What are women's experiences with bullying in the workplace?

P Population (patient)
What are the characteristics of the patient or population?
women
I Interest
What is the phenomena that relates to a defined event, activity, experiences or process.
experiences with bullying
Co Context
Refers to the context or the environment.
workplace

Here are some different frameworks you may want to use:

PICO(T) Population (patient), Intervention, Comparison (control) and Outcome. Add a Timeframe if required. Used particularly for treatment type questions.
PECO(T) A variation of PICO where E= Exposure and T=Timeframe if required.
PIPOH Developed in the context of practice guideline adaptation. Includes P= Professionals/Patients, O= Outcome and H= Healthcare Setting.
SPICE S= Setting (where), P= Perspective (for whom), I= Intervention (what), C= Comparison (compared with what), E= Evaluation (Booth 2006).
SPIDER S= Sample, P= Phenomenon of interest, D= Design, E= Evaluation, R= Research type. Useful for qualitative or mixed method studies (Cooke, Smith and Booth 2012).
ECLIPSE E= Expectations, C= Client group, L= Location, I= Impact, P= Profession, SE= Service (Wildridge & Bell 2002).
PESTLE P= Political, E= Economic, SSocial, TTechnological, E= Environmental, L= Legal (CIPD 2010).
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Test your knowledge

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Preliminary searching

Before you finalise your question, check if:

  1. a systematic review has been done before / recently.
  2. there is enough evidence (studies) for your question.

Start with some preliminary (scope-out) searches. This will help you develop, focus and refine your question.

Search the following places for existing systematic reviews:

Further resources