EVIDENCE-BASED

PRACTICE:
PICOT ANALYSIS
Evidence-Based Practice (EBP)
Process by which health care providers know how to
find, critically appraise, and use the best evidence
Why Evidence-Based Practice (EBP) ??
Health care delivery is filled with uncertainty and
many questions arise in every day practice…

What kind of guidance would be most helpful to my

patients?
What clinical assessments and interventions are of
the most benefit?
Common questions that arise in everyday
practice:
Which combination and sequence of intervention is
most effective?
Which patient symptoms predict better or worse
outcomes?
Which intervention is most effective and will
produce the best patient outcome?
If a diagnosis is left untreated, what might be the
outcome?
Evidence to Support Best Practices is
Constantly Changing
Formulating the Clinical Question

The “PICO” format is used to construct the clinical

question specifically
Using PICO format helps you find a needle in a hay
stack of research information
PICO Format
Patient Population
Intervention of Interest
Comparison intervention or status
Outcome
PICOT
(P) – Population refers to the sample of subjects you
wish to recruit for your study.
(I) – Intervention refers to the treatment that will be
provided to subjects enrolled in your study.
(C) – Comparison identifies what you plan on using as a
reference group to compare with your treatment
intervention. Many study designs refer to this as the
control group. If an existing treatment is considered the
‘gold standard’, then this should be the comparison
group.

(O) – Outcome represents what result you plan on

measuring to examine the effectiveness of your
intervention.

(T) – Time describes the duration of treatment

Patient Population
Consideration of the patient and population of
interest
Limit to age group or subgroup if possible
Intervention
Exposure
Treatment
Patient perception
Diagnostic test
Comparison
Could be true control, such as placebo or doing
nothing
Could be another treatment
Sometimes it is the usual standard of care
Outcome
Outcome may be very specific, e.g. death
Outcome may be something that has a variety of
measures, e.g. dehydration could be a measure,
also tachycardia, dry mouth, fever, restlessness and
irritability
Time Frame
Time horizon for measuring the outcome
 PICOT???
The Effects of Baby Massage on Attachment between Mother and their Infants.

Gürol A1, Polat S2.

Author information
Abstract
PURPOSE:
This study was conducted to examine the effect of baby massage on attachment between mothers and their
newborns.
METHODS:
This study was carried out from June 2008 to February 2010 in a quasi-experimental design (57 in the
experimental group, 60 in the control group). Between the dates of the study, all healthy primipara mothers
and their healthy babies were included. Data were collected regarding their demographic characteristics and
by using the Maternal Attachment Inventory (MAI). All mothers were assessed on the first and the last days of
the 38-day study period. In the experimental group, the babies received a 15-minute massage therapy
session everyday during the 38 days.
RESULTS:
There was no significant difference found in the pretest mean value baseline of the MAI score in both groups.
The posttest mean values of the MAI of the experimental group mothers (90.87 ± 10.76) were significantly
higher than those of control group (85.10 ± 15.50). There was a significant difference between groups
(p < .05).
CONCLUSION:
The results of the study have shown that baby massage is effective in increasing the mother-infant attachment.
PICO format example
Are 35 to 55 year-old women (p) who have high
blood pressure (I) at increased risk for acute
myocardial infarction (O) compared with women
without hypertension (C)
The PICO-T Question Components
Problem and Population
What is the disease or condition?
P What are the important characteristics of my patient?
Intervention
What is the intervention I am looking for?
Is it realistic (availability, cost, convenience, etc)?
Is this different from how I currently practice?
Comparison
What is the alternative to the intervention?
Outcome
Is it something patients care about?
Or is it something only physiologists/pharmacists care
about?
(Jackson, 2006; Flaherty, 2004)
Time
How long should we collect the data ?
Rating System for Evidence
Level I: evidence from systematic review, randomized control
trials (RCTs), or evidence-based reviews
Level II: evidence from one well-designed RCT
Level III: evidence from well-designed studies without
randomization
Level IV: evidence from other types of studies including case-
control and cohort studies
Level V: evidence from systematic reviews of descriptive and
qualitative studies
Level VI: evidence from one descriptive or qualitative study
Level VII: evidence from the opinion of authorities and/ or
reports of expert committees
Meynyk, B. & Fine-Overholt, E.. (2005). Evidence-Based Practice in Nursing and Healthcare. Lippincott, Wiliams & Wilkins.
A Rating System for Looking at Evidence in
Individual Studies
Level A: Randomized control trial (RCT)
Level B: (other evidence)
Well-designed, nonrandomized trial
Non-quantitative systematic review
Lower quality RCT’s, clinical cohort studies, case-control
studies
High-quality historical, less controlled studies, well-
designed epidemiological studies
Level C: consensus/expert opinion

Siwek, J. et al. (2002). Am Fam Physician 65, 251-258.

Searching for the Best Evidence:
Searchable Databases
CINAHL
MEDLINE: (PubMed)
National Guidelines Clearinghouse:
http://www.guideline.gov
Agency for Healthcare Research and Quality:
www.ahrq.gov/clinic/cpgsix.htm
National Institute of Nursing: http://ninr.nih.gov/ninr
REFERENCE
Riva, J. J., Malik, K. M. P., Burnie, S. J., Endicott, A. R.,
& Busse, J. W. (2012). What is your research
question? An introduction to the PICOT format for
clinicians. The Journal of the Canadian Chiropractic
Association, 56(3), 167–171.