INFORMATIONAL NEEDS

BY YAMNA TANWEER
LECTURER
NIPARS
5 A’s of EBP Process
RELEVANT CLINICAL QUESTIONS
◦ The first step in evidence-based practice is to formulate a specific question. The question you
have concerning your practice should be formulated so it is possible to find a scientific answer
to the question
◦ Posing specific questions relevant to a patient’s problem provides a focus to thinking, and it
helps in the formulation strategies and in the process of critical appraisal of evidence

❖ Case scenario:
50 years old man present in OPD with a complain of back pain since 1 week . Pain is radiating in
nature and on MRI no sign of any neurological deficit is found . No any other co morbidities is
there . Patient complain of pain that is aggravating in nature during physical activity. Doctor
prescribed analgesic to relieve pain. He was then referred to you for treatment to relieve his pain
and restore physical functioning .
❑ Is heavy lifting the most likely cause of his problem?
❑ Could this problem, which I frequently see in my practice, be prevented?
❑ How can I decide if he has nerve root involvement?
❑ Which tests would be useful to rule out more serious conditions, such as malignancy?
❑ What is his principal underlying concern about the condition?
❑ If my aim is to improve his functional capacity, should I advise him to stay active or to
rest in bed?
❑ What does he feel about staying in bed or returning to work?
❑ What is the probability that the problem will resolve by itself within a month?
❑ What can I do to relieve his pain during this period?
❑ Is there anything I can do to speed up his recovery?
The most important clinical questions are those concerning:
• effects of intervention
• patients’ experiences
• the course of a condition (prognosis)
• the accuracy of diagnostic tests.
Categorization
We usually break questions about the effects of intervention into four parts (Sackett et
al 2000):
• Patient or problem
• Intervention or management strategy
• Comparative intervention
• Outcome
A useful mnemonic is PICO (Glasziou et al 2003)
P--Patient/Problem
I--Intervention
C--Comparison
O--Outcome
EFFECT OF INTERVENTION
❖ Case scenario:

A 45 years old man present in OPD with a complain of acute back pain . You are considering
whether to advise this man to stay in bed or to continue his daily routine as actively as possible.
He wants you to do something to relieve his pain and restore his physical functioning.

‘In patients with acute low back pain, does bed rest or advice to stay active produce greater
reductions in pain and disability?

Pico Model
Patient intervention comparison Outcome

Adult with acute low Bed rest advice to stay active Pain and disability
back pain
PROGNOSIS
When asking questions about prognosis you should specify (again) the patient or
problem, and the outcome you are interested in. The question may be about the expected
amount of the outcome or about the probability of the outcome. and it is worthwhile
specifying the time frame of the outcome as well
‘In patients with acute low back pain, what is the probability of being pain-free
within 6 weeks?

Diagnosis
When asking questions about diagnostic test accuracy it is useful to specify the patient or
problem, the diagnostic test and the diagnosis for which you are testing.
For example :
Our patient’s general practitioner has told him that he does not have sciatica. You first
interpret this to mean there were no neurological deficits, but after the patient describes
radiating pain corresponding with the L5 dermatome you are not sure.
Special tests:
You are aware that general practitioners often do not examine patients with low back
pain very thoroughly so you start thinking about doing further clinical examinations,
perhaps using Lasègue’s test amongst others, to find out if there is nerve root
compromise
‘In adults with acute low back pain, how accurate is Lasègue’s test as a test for
nerve root compromise?’

Patient/ Special test diagnosis intervention comparison outcome prognosis

problem
Adult with Lasègue’s Nerve root Bed rest advice to Pain and Probability
acute low test compromise stay active disability of being
back pain pain-free
within 6
weeks