Practitioners of evidence-based practice (EBP) often use a special framework called PICO to form clinical questions and facilitate the literature search (evidence). The PICO Process or Framework makes defining a clinical question and seeking a solution easier, and .
A clinical question needs to be directly relevant to the patient or problem at hand. It needs to be phrased in a way that facilitates the search for an answer. Without a well-focused question, it can be difficult and time-consuming to identify appropriate resources and search for relevant evidence.
PICO is a mnemonic (a memory tool) for the important parts of a well-built clinical question. PICO stands for:
This table shows a basic outline of how the PICO Process can help you define an evidence-based care plan.
|Framework item||Think about||Example|
|Patient Problem (or Population)||What are the patient's demographics such as age, gender and ethnicity? Or what is the or problem type?||Work-related neck muscle pain|
|Intervention||What type of theraputic intervention is being considered? For example, is the intervention medication, exercise or rest, surgery?||Strength training of the painful muscle|
|Comparison or Control||Is there a comparable treatment to be considered? The comparison may be with another medication, another form of treatment such as exercise, surgery, or no treatment at all.||Rest|
|Outcome||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:
This guide about the PICO framework has been adapted from the original at the website of the University of Canberra Library.
Once you have clearly identified the main elements of your question using the PICO framework, it is easy to write your question statement. The following table provides some examples.
|Question Type||Patient Problem or Population||Intervention or Exposure||Comparison or Control||Outcome Measure|
|Therapy||In patients with osteoarthritis of the knee||is hydrotherapy more effective than||traditional physiotherapy||in relieving pain?|
|Prevention||For obese children||does the use of community recreation activities||compared to educational programs on lifestyle changes||
reduce the risk of diabetes mellitus?
|Diagnosis||For deep vein thrombosis||is D-dimer testing or||ultrasound||more accurate for diagnosis?|
|Prognosis||In healthy older women that suffer hip fractures||within the year after injury||what is the relative risk of death?|
|Etiology||Do adults||who binge drink||compared to those who do not binge drink||have higher mortality rates?|
Here are a basic and a more advanced document about how to use the PICO framework or formula. The first one has some excellent examples of fully formed PICO questions. The PDF link is a template for working your way through forming the elements of your question.
When forming your question using the PICO framework, it is useful to think about what type of question it is you are asking, (therapy, prevention, diagnosis, prognosis, etiology). The table below illustrates ways in which Problems, Interventions, Comparisons and Outcomes vary according to the type or domain of your question.
|Question Type||Patient Problem or Population||Intervention or Exposure||Comparison or Control||Example Outcome Measures|
|Therapy (Treatment)||Patient's disease or condition.||A therapeutic measure, eg., medication, surgical intervention, or life style change.||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.g., A lifestyle change or medication.||Another preventative measure OR maybe not applicable.||Mortality rate, number of days off work, disease incidence.|
|Diagnosis||Specific disease or condition.||A diagnostic test or procedure.||Current "reference standard" or "gold standard" test for that disease or condition.||Measures of the test utility, i.e. sensitivity, specificity, odds ratio.|
|Duration and severity of main prognostic factor or clinical problem.||Usually time or "watchful waiting".||Usually not applicable.||Survival rates, mortality rates, rates of disease progression.|
|Etiology (Causation)||Patient's risk factors, current health disorders, or general health condition.||The intervention or exposure of interest. Includes an indication of the strength/dose of the risk factor and the duration of the exposure.||Usually not applicable.||Survival rates, mortality rates, rates of disease progression.|