Step 1: Develop the Question
a. Is this an important need for the client?
b. Is this important to you as the clinician?
c. Is this important to other clients?
A well-built question is clear, specific, and has 3-4 components. Components include:
P = specific client group or population
I = intervention (what you want to do)
C = comparison (with another option)
O = outcome (what you want to achieve)
This is referred to as the P.I.C.O. question.
(Lou and Durando, 2008, p. 97)[10]
a. Is this an important need for the client?
b. Is this important to you as the clinician?
c. Is this important to other clients?
A well-built question is clear, specific, and has 3-4 components. Components include:
P = specific client group or population
I = intervention (what you want to do)
C = comparison (with another option)
O = outcome (what you want to achieve)
This is referred to as the P.I.C.O. question.
(Lou and Durando, 2008, p. 97)[10]
PICO: Does constraint induced movement therapy (I) improve UE functional performance (O) compared to NDT therapy (C) in people with upper extremity (UE) paresis s/p CVA (P)?
It is important to note that not all questions have the “C” component. Perhaps you are not comparing the intervention you are interested in with another intervention. For example in the above PICO, perhaps there isn’t a comparison with NDT patterns and you are inquiring about the effectiveness of constraint induced movement therapy only. Your question would be considered a PIO question:
Does constraint-induced movement therapy (I) improve UE functional performance (O) in people with UE paresis s/p CVA (P)?
Developing a PICO/PIO question takes several attempts in order to clearly and precisely address the specific components of the question.
Now it's your turn. Read the following scenario. The question you develop will be used in the Test Your Skills section of the website (question #8). The article used to answer this question can be downloaded here.
It is important to note that not all questions have the “C” component. Perhaps you are not comparing the intervention you are interested in with another intervention. For example in the above PICO, perhaps there isn’t a comparison with NDT patterns and you are inquiring about the effectiveness of constraint induced movement therapy only. Your question would be considered a PIO question:
Does constraint-induced movement therapy (I) improve UE functional performance (O) in people with UE paresis s/p CVA (P)?
Developing a PICO/PIO question takes several attempts in order to clearly and precisely address the specific components of the question.
Now it's your turn. Read the following scenario. The question you develop will be used in the Test Your Skills section of the website (question #8). The article used to answer this question can be downloaded here.
| randomized_trial_moho_wellness.pdf |
Scenario: Management in your workplace decides it would like to start a wellness program initiative in local community centers. Occupational therapy has been asked to become involved in this initiative for healthy elderly people (65 years and older) in your community. You would like to use a Model of Human Occupation-based program, however are unsure of the evidence available. You decide you would like to compare this program with a crafts-based program to ensure an evidence-based wellness intervention. Write a PICO question for this scenario.
More About About Developing the Question:
Client/Population/Problem
Perhaps there is a unique quality in the client or group of clients you are targeting. This would involve a specific description of this uniqueness. For instance, perhaps you want to specifically target clients with right UE paresis rather than a generic statement, UE, as is written above. You may also want to consider a client’s diagnosis, gender, age, or ethnicity. Specificity will lead you to the right literature search and best answer to your question. Ultimately, when appraising your literature you will be asking how closely the population in the study resembles your client and do the results generalize to your client.
Intervention
What is it that you want to do, investigate? Perhaps you want to validate what you are already doing. Determining appropriate evidence-based assessments, prevention techniques, or management of your client’s condition may be the intervention you would like to investigate.
Comparison
Do you want to compare “what you want to do” with another option or perhaps a control group? Perhaps you’ll decide you don’t want to use a comparison.
Outcome
What do you want to accomplish? Is there a specific goal in a client’s recovery you want to target? Do you want to prevent something? For example, a cognitive intervention with the expected outcome of preventing a blood sugar crisis in a client with memory impairments. With this outcome you are addressing health. When you make decisions about how to write your question you are using your “clinical expertise”. This is why EBP includes the experience and skills of the clinician. Once your question is written, the next element that comes into play is how much available evidence there is to answer your question. This brings us to the next step…Acquire the Evidence
Click on this link to see the PICO questions relationship in acquiring the evidence [11] https://www.youtube.com/watch?v=QsIYwWwi_r4
You have the information to develop a well-built PICO/PIO question, now you are ready for Step 2!
Client/Population/Problem
Perhaps there is a unique quality in the client or group of clients you are targeting. This would involve a specific description of this uniqueness. For instance, perhaps you want to specifically target clients with right UE paresis rather than a generic statement, UE, as is written above. You may also want to consider a client’s diagnosis, gender, age, or ethnicity. Specificity will lead you to the right literature search and best answer to your question. Ultimately, when appraising your literature you will be asking how closely the population in the study resembles your client and do the results generalize to your client.
Intervention
What is it that you want to do, investigate? Perhaps you want to validate what you are already doing. Determining appropriate evidence-based assessments, prevention techniques, or management of your client’s condition may be the intervention you would like to investigate.
Comparison
Do you want to compare “what you want to do” with another option or perhaps a control group? Perhaps you’ll decide you don’t want to use a comparison.
Outcome
What do you want to accomplish? Is there a specific goal in a client’s recovery you want to target? Do you want to prevent something? For example, a cognitive intervention with the expected outcome of preventing a blood sugar crisis in a client with memory impairments. With this outcome you are addressing health. When you make decisions about how to write your question you are using your “clinical expertise”. This is why EBP includes the experience and skills of the clinician. Once your question is written, the next element that comes into play is how much available evidence there is to answer your question. This brings us to the next step…Acquire the Evidence
Click on this link to see the PICO questions relationship in acquiring the evidence [11] https://www.youtube.com/watch?v=QsIYwWwi_r4
You have the information to develop a well-built PICO/PIO question, now you are ready for Step 2!
