Evidence-Based Practice: 4 Steps to Creating a Research Question
November 5, 2014
“Finding the right information in the most efficient manner is vital to successfully practicing evidence-based decision making in management and leadership.”4
Part of being a scholarly practitioner includes being able to access and review research literature, evaluate the literature and use that evidence to guide day-to-day practice. These activities form a cornerstone of evidence-based practice.
Physiotherapy Alberta is committed to supporting quality care and evidence-based practice among our members. We routinely present research through our Research in Focus articles and the Evidence Corner section of our newsletter PT Alberta, but what do you do if you need evidence to guide your practice and you can’t find it from these sources?
Evidence-based practice can help you make decisions regarding:
The most effective way to use your resources.
Development of a new program or service and what it will include.
Building a case for physiotherapy involvement in an area of practice.
The best treatment option for a recurring clinical problem.
Defining your Research Question
The key to an effective literature search is formulating a specific, clear research question. Although several methods of forming research questions have been described,2 the best known format is the PICO method.1 PICO is an acronym for Patient/Population/Problem, Intervention, Comparison, and Outcomes.1 This format will serve as a good starting point for most searches and will help to “clarify the purpose of the literature search and assist the... leader to select studies that are relevant.”4
Spending some time at the start of your search formulating an answerable research question that reflects your patient population, practice setting and circumstances will ultimately save you hours of work reviewing articles that may not provide an answer to your question. In other words, carefully defining your PICO question is a worthwhile investment.
Define your population. Define the population in as much detail as possible (depending upon the homogeneity of that population). This may include a description of age, gender, patient living arrangement, condition and stage of the condition. For example, you could seek information about falls prevention interventions in “the elderly”, but an alternate search would be to consider fall prevention interventions among “community dwelling females aged 65-90 who sustained a hip fracture from a fall within the last 12 months.” Either search will provide results, but the latter will limit the results to a more relevant, readable set of articles.
Define the intervention you are interested in reviewing. Again, make this definition as clear as possible and include the parameters of the treatment that you are interested in, if possible. Following our fall prevention example, the treatment could be “physiotherapy” but a more meaningful search would be “an eight week physiotherapist-led multidisciplinary, education and exercise program.” Again, providing details about the ‘dose’ of the intervention can be helpful, depending on the amount of research that has been published on the topic.
Choose your comparison. The next consideration is what you want to compare your selected treatment option to. For example, no treatment, exercise alone, or education alone. To choose your comparison, you may want to compare the intervention you are studying to other treatment options available in your community.
Define what you want altered. What are you trying to alter? What outcomes are you interested in? For example, the number of falls a patient experiences in a year, hospital readmission rates, repeat fracture rates, or costs of services? Again, knowing the outcome you are trying to effect will help to narrow the search.
Make a PICO Grid
Sometimes it is helpful to create a PICO grid to help define and focus your question and to guide your selection of search terms. For example:
- community dwelling
- aged 65-90
- sustained a hip fracture within the last 12 months
-education and exercise
-repeat fracture rates
Your search produced little to no results
It is possible to define your question too narrowly. When this happens and your search provides no results, you may wish to expand your search by removing some of the details or limiters that you placed on your initial search. Using the falls prevention example above, perhaps expanding your population to include both males and females aged 65+ would provide you with some relevant research.
How much evidence is enough?
Another important question is how much evidence is enough? While those involved with writing systematic reviews can spend months (if not longer) reviewing multiple studies, most clinicians do not have this time to invest. Given that “in EBP the use of knowledge is not derived from one single study but involves a systematic search for and a critical appraisal of the most relevant evidence to answer a clinical problem,3” reviewing a few high quality articles that are relevant to your question is clearly preferable.
Finding “good evidence”
In a perfect world you would enter your search terms and yield one high-quality systematic review that directly correlates to your patient population and the treatment protocol in question. However, it is far more common that either no relevant research is found, or a large body of somewhat relevant research is obtained. Therefore, the reader needs to make some judgement calls about what constitutes the “best evidence” to use in clinical decision making. Choose evidence that is the closest match to the question and has the best quality of research.
We would like to hear what you have to say. Have you used the PICO method to form a research question? Did it help to refine your search? How are you applying EBP to your practice? Share your comments via email at firstname.lastname@example.org or on twitter @PTAlberta.
As always, the focus of this series is to address evidence-based practice related questions, and to create a dialogue between Physiotherapy Alberta and members, with the goal of facilitating evidence-based practice and knowledge translation. Our intent is not to be the expert lecturer on the topic, but to be a knowledgeable voice in the conversation. Upcoming articles in this series will discuss how to formulate search terms and conduct searches to find evidence, the hierarchy of research, and how to select the “best” research to guide your clinical decisions.
Law M, MacDermid J. Introduction to evidence-based practice. Evidence-based rehabilitation: A guide to practice. Thorofare: SLACK Incorporated. 2008.
Kloda LA, Bartlett JC. A characterization of clinical questions asked by rehabilitation therapists. Journal of the Medical Librarians Association 2014; 102(2): 69-77.
Neville K, Horbatt S. Evidence-based practice: Creating a spirit of inquiry to solve clinical nursing problems. Orthopaedic Nursing 2008; 27 (6): 331-337
Hastings C, Fisher CA. Searching for proof: Creating and using an actionable PICO question. Nursing Management 2014; August: 9-12.