The first step in the EBP process is to ask a clinical question that can be answered with evidence-based research. To help us take our clinical problem and turn it into a focused and answerable question, we can use the PICO formula.
PICO, or PICO(T), stands for:
- P - Population/Patient/Problem
- I - Intervention or prognostic factor
- C - Comparison
- O - Outcome
- T- Time (added when there is a time component to the question)
Once you've identified each aspect of your PICOT, here is a formula that you can use to turn it into a question:
THERAPY
In __________________(P), what is the effect of __________________(I) compared to _____________ (C) on ________________(O within _____________(T)?
INTERVENTION
In ____________________(P), how does ____________________ (I) compared to ____________________(C) affect _____________________(O) within ___________(T)?
PROGNOSIS/PREDICTION
In ______________ (P), how does ___________________ (I) compared to _____________(C) influence __________________ (O) over _______________ (T)?
DIAGNOSIS OR DIAGNOSTIC TEST
In ___________________(P) are/is ____________________(I) compared with _______________________(C) more accurate in diagnosing _________________(O)?
ETIOLOGY
Are____________________ (P), who have ____________________ (I) compared with those without ____________________(C) at ____________ risk for/of ____________________(O) over ________________(T)?
MEANING
How do _______________________ (P) with _______________________ (I) perceive _______________________ (O) during ________________(T)?
The first step in the evidence-based practice (EBP) process is to identify the clinical problem or question for which you are seeking evidence. Asking a focused and relevant question about your client's situation will inform your search. One widely used approach to frame a clinical question is known as PICO, which stands for
Population Intervention Comparison Outcome
The PICO elements are as follows:
- Population: What are the characteristics and/or condition of the group? This may include specific diagnoses, ages, or severity levels (e.g., autism spectrum disorder, mild hearing loss).
- Intervention: What is the screening, assessment, treatment, or service delivery model that you are considering (e.g., instrumental swallowing assessment, high-intensity treatment, hearing aids)?
- Comparison: What is the main alternative to the intervention, assessment, or screening approach (e.g., placebo, different technique, different amount of treatment)? Note: In some situations, you may not have a specific comparison in your PICO question.
- Outcome: What do you want to accomplish, measure, or improve (e.g., upgraded diet level, more intelligible speech, better hearing in background noise)?
Once you've identified the population, intervention, comparison, and outcome for your situation, you can establish your PICO question.
Quick Tip:
There is no one "correct" way to construct a PICO question. Your clinical question should include elements specific to each client's unique circumstances and values.
| Children with severe to profound hearing loss | Cochlear implants | Hearing aids | Speech and language development | For children with severe to profound hearing loss, what is the effect of cochlear implants compared with hearing aids on speech and language development? |
| Young adult with a stroke | Cognitive rehab | Not applicable | Return to work | What is the effect of cognitive rehabilitation on vocational outcomes in individuals who experience a stroke? |
Quick Tip:
Sometimes, you have a clinical situation that may have more than one PICO question. Write them all down to tackle one search at a time. Your clinical question(s) should be specific enough to guide your search—but not too specific that you are unable to find any evidence.
Evidence-based practice (EBP) is a process that involves locating and applying research findings to clinical practice. The process starts when a clinical problem or question arises in relation to the care of the patient.
The EBP process follows a series of steps which are listed in sequence below.
| Construct a well-built clinical question derived from the case |
| Select the appropriate resources and conduct a search in order to acquire the evidence |
| Appraise the evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice) |
| Integrate evidence with clinical expertise and patient preferences and apply to practice |
| Evaluate the performance and success of the change in practice |
The steps can also be a circular process, where assessing the effects leads to consideration of another clinical question, another search for information, and so on.
Module 2 covers the EBP step of ‘Ask the Question’ using the PICO method, Module 3 focuses on the ‘Acquire the Evidence’ step, and Module 4 covers the last 3 steps of EBP.