Weekly assignment

Subject: scientific inquiry and research methodology

ID: 8590

Submitted by: Laiba

PICO:

Without a well-focused question, it can be very difficult and time consuming to identify
appropriate resources and search for relevant evidence. Researchers often use a specialized
framework, called PICO, to form the question and facilitate the literature search.

When forming a question using PICO, keep the following points in mind:

 The Patient 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.
 A Comparison is not always present in a PICO analysis.
 Outcomes should be measurable as the best evidence comes from rigorous studies with
statistically significant findings.
 An Outcome ideally measures clinical wellbeing or quality of life, and not alternates such
as laboratory test results.

PICO elements change according to question type:

When forming a question using the PICO framework it is useful to think about what type of
question it is, (therapy, prevention, diagnosis, prognosis, etiology).

In the following table the Problems, Interventions, Comparisons and Outcomes vary according to
the type of question.

Patient
Question Intervention or Comparison
Problem or Example Outcome Measures
Type Exposure or Control
Population  
Therapy Patient's A therapeutic Standard care, Mortality rate, number of days
(Treatment) disease or measure, e.g. another off work, pain, disability.
condition. medication, surgical intervention, or
intervention, or life a placebo.
style change.
Prevention Patient's risk A preventive Another Mortality rate, number of days
factors and measure, e.g. A preventative off work, disease incidence.
general health lifestyle change or measure OR
condition. medication. maybe not
applicable.
Diagnosis Specific A diagnostic test or Current Measures of the test utility i.e.
disease or procedure. "reference sensitivity, specificity, odds
condition. standard" or ratio.
 "gold standard"
test for that
disease or
condition.
Prognosis Duration and Usually time or Usually not Survival rates, mortality rates,
(Forecast) severity of "watchful waiting". applicable. rates of disease progression.
main
prognostic
factor or
clinical
problem.
Etiology Patient's risk The intervention or Usually not Survival rates, mortality rates,
(Causation) factors, current exposure of interest.  applicable. rates of disease progression.
health Includes an
disorders, or indication of the
general health strength/dose of the
condition. risk factor and the
duration of the
exposure.

Question writing:

Once the main elements are clearly identified of the question using the PICO framework, it is
easy to write the question statement. 

Following are the examples:

Question Patient Problem or Intervention or Comparison or Outcome

Type   Population Exposure   Control Measure
Therapy In patients with is hydrotherapy more traditional In relieving
osteoarthritis of the effective than physiotherapy pain?
knee
Prevention For obese children does the use of compared to Reduce the risk
community educational programs of diabetes
recreation activities on lifestyle changes mellitus?
Diagnosis For deep vein is D-dimer testing or ultrasound More accurate
thrombosis for diagnosis?
Prognosis In healthy older within the year after What is the
women that suffer injury relative risk of
hip fractures death?
Etiology Do adults    who binge drink compared to those who Have higher
do not binge drink mortality rates?