LibGuides: Evidence-Based Clinical Practice: Asking a clinical question & PICO

Overview

PICO is a method for extracting the key concepts from a clinical question.

Resources for PICO

'PICO-D Management'; a decision-aid for evidence-based chiropractic education and clinical practice
Includes a table for applying the PICO-D Man decision-aid in clinical practice.
PICO Search Exercise "Warm-Up"
A step-by-step approach for using PICO to form a search strategy. From the Centre for Evidence-Based Medicine.
What Is Your Research Question? An Introduction to the PICOT Format for Clinicians
Riva JJ et al. What Is Your Research Question? An Introduction to the PICOT Format for Clinicians. J Can Chiropr Assoc. 2012; 56(3): 167-171.

Search Modifiers

Quotation Marks

Search results will contain exactly the terms inside the quotation marks

Example: "lower back pain"

Parenthesis

Called nesting when used with Boolean operators to group synonyms and related terms together. Many databases will process search terms left to right. Use parentheses to "nest" concepts that should be processed as a unit and then incorporated into the overall search.

Example: chiropractic AND (adjustment OR manipulation)

Asterisk

Truncation with an asterisk retrieves alternate word endings

Example: teach* retrieves: teach, teacher, teaches, teaching

The PICO Strategy

PICO stands for: Patient/Problem, Intervention, Comparison and Outcome. When considering a clinical problem, use PICO to analyze the most important concepts to research.

P	Patient or Problem: Demographic characteristics of the patient such as age, sex; condition or other factor, such as: congestive heart failure, hypoglycemic, smoker, obese
I	Intervention: Treatment, prognostic factor, exposure, such as a drug, test, surgery, adjustment
C	Comparison: Are you trying to decide between two treatments/drugs/procedures, etc.? (optional/placebo/”sham”)
O	Outcome: What is desired for the patient?

Example: In adult patients with whiplash following a car accident, how effective is chiropractic care compared to exercise in restoring range of motion?

P	adult, whiplash injury
I	chiropractic care
C	exercise
O	restoring range of motion

Note: Not all parts of PICO will apply to every clinical question. For example, not every clinical question needs a comparator and sometimes it can be challenging to find research that compares two different interventions in the same article. Instead, you might find implicit comparisons between standard care, placebo, or non-intervention.

Search strategy

1. Using your PICO question, identify the key words - those terms that are most specific to your question.

Example: In adult patients with whiplash injury following a car accident, how effective is chiropractic care compared to exercise in restoring range of motion?

2. Brainstorm synonyms for those words.

Adult
Whiplash
Chiropractic care: spinal manipulation, musculoskeletal manipulation, manual therapy
Exercise: physical activity

3. Create a search strategy by using Boolean operators to connect your search terms.

Example: adult AND whiplash AND (chiropractic OR spinal manipulation OR musculoskeletal manipulation OR manual therapy) AND (exercise OR physical activity)

4. Test your search strategy in your chosen database and review your results.