Why use pico

Work-related neck muscle pain I ntervention What type of intervention is being considered? For example is this a medication of some type, or exercise, or rest? Strength training of the painful muscle C omparison or Control Is there a camparison treatment to be considered? The comparison may be with another medication, another form of treatment such as exercise, or no treatment at all.

Rest O utcome What would be the desired effect you would like to see? What effects are not wanted? Are there any side effects involved with this form of testing or treatment? Pain relief When forming your question using PICO , keep the following points in mind: Your P atient is a member of a population as well as a person with or at risk of a health problem. So, in addition to age and gender, you may also need to consider ethnicity, socioeconomic status or other demographic variables.

O utcomes should be measurable as the best evidence comes from rigorous studies with statistically significant findings. An O utcome ideally measures clinical wellbeing or quality of life, and not alternates such as laboratory test results. A therapeutic measure, eg. Standard care, another intervention, or a placebo. Mortality rate, number of days off work, pain, disability.

Prevention Patient's risk factors and general health condition. A preventive measure, e. Another preventative measure OR maybe not applicable. Mortality rate, number of days off work, disease incidence. Diagnosis Specific disease or condition. Abrir menu. Number and size of randomized trials reported in general health care journals from to Int J Epidemiol.

Rev Latino-am Enfermagem maio-junho;13 3 History and development of evidence-based medicine. World J Surg May;29 5 Evidence-based medicine: how to practice and teach EBM. Londres: Churchill Livingstone; Stevens KR. Systematic reviews: the heart of evidence-based practice. What is evidence-based medicine? Langenbecks Arch Surg October; 5 Flemming K. Critical appraisal. Searchable questions.

NT Learn Curve April 7; 3 2 Evidence-based clinical practice. Part II—Searching evidence databases. Evidence based clinical practice. Part 1—well structured clinical questions. Wyatt J, Guly H. Identifying the research question and planning the project.

Emerg Med J July;19 4 Stone PW. Popping the PICO question in research and evidence-based practice. Appl Nurs Res August;15 3 Clarifying a good question will help to determine a credible answer, but another important issue to be addressed is that of the certainty of the answer.

To this end, the use of the GRADE [3] approach to assess certainty or the quality of a body of evidence , is a critical element. This should be considered from the outset in relation to any research question. The first step consists of highlighting those PICO elements, and in particular comparisons and outcomes that are critical for decision making and differentiating these from those that are important but not critical and those that are not important.

In addition, for many outcomes it will be useful to pre-determine what constitutes a minimum important difference or effect, in order to support interpretation of the results of the analysis and inform decision making.

A key part of the GRADE approach is related to the nature of the studies that are contributing data to help answer the question. For therapeutic interventions, the randomised controlled trial remains the most reliable means of determining effectiveness in most cases. This evidence rating may subsequently be lowered or for non-randomised studies raised according to different factors lower: limitations of design, inconsistency, indirectness, imprecision or publication bias and raise: large effect, dose response, plausible confounding.

The final GRADE rating of the evidence for each outcome from high, where we are very confident that the real effect lies close to the effect estimate, to very low, where we are very uncertain about the estimate will determine how we use the data obtained in response to our question.

Many of the questions that clinicians come across in clinical practice are addressed in Cochrane Clinical Answers. Those have been created to inform decision-making at the point of care, mimicking the questions that clinicians may face and obtaining answers from Cochrane Reviews, by filtering the data and bringing to the forefront the most clinically relevant aspects of the review.

Cochrane Clinical Answers also provide the specific PICO and the outcome data for each of the comparisons reported, and a quality of the evidence if GRADE has been used or a summary of the risk of bias assessment for each outcome. Hence while they make the information a clinician will be most interested in more accessible, they also increase the usage of Cochrane Reviews to inform healthcare decisions. In a world where health data are increasingly available, designing a well-constructed question is a key element to get credible answers, although, as data are increasingly coming from different and multiple sources from regulatory agency databases and repositories rather than scientific journals, or wearable devices, smartphone apps and social-networking sites , building a clear and focused question may be only the first step in a complex sequence of events that lead to a desired answer.