Physical Therapist Assistant

Always begin your research topic with a question. In healthcare, you will learn to write a PICO question for your research. 

A clinical question needs to be directly relevant to the patient or problem at hand and phrased in such a way as to facilitate the search for an answer. PICO makes this process easier. It is a mnemonic for the important parts of a well-built clinical question. It also helps formulate the search strategy by identifying the key concepts that need to be in the article that can answer the question.

PICO or PICOT:

P= PATIENT / PROBLEM / Population
How would you describe a group of patients similar to yours? What are the most important characteristics of the patient?

I = INTERVENTION
What main intervention, exposure, or prognostic factor are you considering? What do you want to do with this patient?

C = COMPARISON INTERVENTION, CONTROL
What is the main alternative being considered, if any?

O = OUTCOME
What are you trying to accomplish, measure, improve or affect?

The T usually stands for time and can be helpful in making sure you're thinking of the appropriate time frame for your intervention and/or outcomes.

PICO question format:

In a patient with (Problem), how does (Intervention) compare to (Comparison) with regard to (Outcome)?

For a patient with (Problem), how does (Intervention) compare to (Comparison) with regard to (Outcome)?

Examples of PICO questions:

1. Can closed kinetic chain shoulder exercises (intervention) increase the peak torque of shoulder internal- and external rotation (outcome) of a youth baseball player with subacromial impingement syndrome (patient)?

Alternatives:

For a youth baseball player with subacromial impingement syndrome (patient), does closed kinetic chain shoulder exercises (intervention) increase the peak torque of shoulder internal- and external rotation (outcome)

In adults with low back pain (patient), do spinal stabilization exercises (intervention) reduce pain and increase function (outcome) more effectively than manual therapy (comparison)?

Primary Question Types

• Therapy: how to select treatments to offer our patients that do more good than harm and that are worth the efforts and costs of using them.
• Diagnostic tests: how to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety, etc.
• Prognosis: how to estimate a patient's likely clinical course over time due to factors other than interventions
• Harm / Etiology: how to identify causes for disease (including its iatrogenic forms).

Other Question Types

• Clinical findings: how to properly gather and interpret findings from the history and physical examination.
• Clinical manifestations of disease: knowing how often and when a disease causes its clinical manifestations and how to use this knowledge in classifying our patients' illnesses.
• Differential diagnosis: when considering the possible causes of our patient’s clinical problem, how to select those that are likely, serious and responsive to treatment.
• Prevention: how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.
• Qualitative: how to empathize with our patients’ situations, appreciate the meaning they find in the experience and >understand how this meaning influences their healing.

From: Sackett, DL. Evidence-based medicine: how to practice and teach EBM.

Note: Meta-analyses and systematic reviews, when available, often provide the best answers to clinical questions.