ASK
the question |
2. Construct a well built clinical question using PICO |
The first step in the EBP process is to take the identified concern or problem and construct a question that is relevant to the case and is phrased in such a way as to facilitate finding an answer.
Background questions concern general knowledge. These types of questions generally have only two parts:
- A question root (who, what, when, where, how, why) and
- A disorder, test, treatment, or other aspect of athlete care.
- Often these questions can best be answered by using a textbook or consulting a clinical database.
Foreground questions are specific knowledge questions.
- Affect clinical decisions, including a broad range of biologic, psychological, and societal issues.
- These are the questions that generally require a search of the primary medical literature and that are best suited to the PICO question format.
Source
Anatomy of a good clinical question: PICO
PICO is a mnemonic that helps one remember the key components of a well focused question. The question needs to identify the key problem of the athlete, what treatment or tests you are considering for the athlete, what alternative treatment or tests are being considered (if any) and what is the desired outcome to promote or avoid.
P= Patient (or Athlete) Problem:
How would you describe a group of athletes similar to yours? What are the most important characteristics of the athletes? This may include the primary problem, injury, or co-existing conditions. Sometimes the gender or age of the athlete might be relevant to the diagnosis or treatment of a problem or injury.
I= Intervention, prognostic factor or exposure:
Which main intervention, prognostic factor, or exposure are you considering? What do you want to do for the athlete? Implement a rehabilitation protocol? Order a test? Recommend surgery? Or what factor may influence the prognosis of the athlete - age, co-existing problems, or previous history?
C= Comparison:
What is the main alternative to compare with the intervention? Are you trying to decide between two treatments, rehabilitation or surgery, or two diagnostic tests? Your clinical question may not always have a specific comparison.
O= Outcome:
What can you hope to accomplish, measure, improve or affect? What are you trying to do for the athlete? Relieve or eliminate the symptoms? Reduce the number of adverse events? Improve function or decrease pain?
Variations
PIO and PICOT are variation of the PICO clinical question.
PIO
Sometimes a clinical question will have no comparison component; therefore it becomes a PIO question.
PICOT
Is timing an important part of your clinical question? If so, it becomes a PICOT question when the timeframe for an intervention or observation is part of the question.
