Evidence Based Practice for Allied Health Sciences: Steps 1 & 2: Assess & Ask

Assess

• You have a research topic that your professor has assigned.
• You want to learn about a disorder that your cousin has.
• You have a patient who has come to the clinic and you are deciding how to treat her.

Each of these scenarios is an opportunity to use EBP.  You have just assessed that you need more information about a topic.

Ask

Background or Foreground Questions

When formulating your research question, the first step is to decide whether you are asking a background question or a foreground question.  The background question is usually asked because of the need for basic information. It is not normally asked because of a need to make a clinical decision about a specific patient and will not require the same type of search strategy that a foreground question will.

• Background
  • Descriptive
  • Broad
  • Basic or background information
  • Answers can often be found in textbooks or encyclopedias
  • Often has 2 variables
    • Patient (Who/What)
    • Outcome
  • Does not require PICO Question - Move to step 2
• Foreground
  • Analytic
  • Focused
  • May inform decisions about a patient or treatment
  • Requires basic knowledge of the topic
  • Answers can often be found in journals and conference materials
  • Has multiple variables (see PICO/PICOT below)

PICO/PICOT

Creating a research question is a simple idea, but can be a complicated task.  A well-built question is neither too broad nor too narrow.  One method is to create a PICO or PICOT question.  You may not have all of the information available when you start, but you should at least have the P and I before you start searching for information.  The worksheets linked below can be valuable when determining this information.  The answers to these questions can help you formulate your keywords for your search strategy.

P - Patient population (What differentiates your population?  age, sex, race, ethnicity, disease process, comorbidities)

I - Intervention (What action do you want to take with the population?  What has this population been exposed to that you wish to examine?)

C - Comparison (What are you comparing your intervention against - The control group?  The gold standard treatment?)

O - Outcome (What will be improved?  What is the desired outcome?)

T - Time (Does timing matter?  When should the patient follow up?  Is it day or night?  Is there a drug administration schedule?)

• If the outcomes will be determined a while after the intervention, you may be conducting a cohort study or a prospective study
• If the outcomes will be determined at the time of the intervention, you may be conducting a cross sectional study
• If the outcomes are determined prior to the intervention, you may be conducting a case-control study

Hall, H. R., & Roussel, L. A. (2016). Evidence-based practice. Jones & Bartlett Publishers

The table below explains the primary types of clinical questions and types of evidence to answer the question.

Re-used from: https://canberra.libguides.com/c.php?g=599346&p=4149723

Applying PICO to your Search:

Types of Studies: 

Therapy type of PICO question: 

Patient Problem or Population: In patients with osteoarthritis of the knee

Intervention or Exposure: is hydrotherapy more effective than 

Comparison or Control: traditional physical therapy

Outcome measure: in relieving pain? 

Keep in mind, there are other types of questions besides, therapy questions, but therapy is the most common one used for PICO examples.