|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:
Foreground questions are specific knowledge questions.
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.
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.
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?
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.
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?
PIO and PICOT are variation of the PICO clinical question.
Sometimes a clinical question will have no comparison component; therefore it becomes a PIO question.
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.
Two additional elements of the well-built clinical question are the type of question and the type of study. This information can be helpful in focusing the question and determining the most appropriate type of evidence.
The type of question is important and can help lead you to the best study design:
|Most common type of questions:
|Type of study:
how to identify causes of the problem/injury
|cohort > case control > case series
how to select and interpret diagnostic tests
|prospective, blind comparison to a gold standard or cross-sectional
how to select treatments that do more good than harm and that are worth the efforts and costs of using them
|randomized controlled trial > cohort study
how to estimate the athlete's likely clinical course over time (based on factors other than the intervention) and anticipate likely complications of the problem/injury
|cohort study > case control > case series
Press each button to see which kind of studies provide evidence for that type of question.