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Evidence-Based Practice: Step 1

A tutorial on evidence-based practice.

Steps in the Process

  • Step 1: FORMULATE an answerable question

    The first step in this tutorial helps you to refine your question by defining your clinical problem using a process called PICO. Through this process you will create an “answerable question”. This process will facilitate your search by helping you to identify keywords specific to the patient population, intervention, comparison group and outcomes that are appropriate to your patient care inquiry.

     

  • Step 2: SEARCH FOR the best evidence using the keywords from your PICO question

    The second step in this tutorial helps you to search for an evidence-based answer to your question using the keywords from your PICO question. Through the process you will become aware of four different types of information resources you can use in your search.

     

  • Step 3: ASSESS the validity and usefulness of the search results

    The third step in this tutorial helps you to evaluate your search results. Through this process you will identify the studies which are valid and useful to your question, and then identify and compare the study conclusions. If there are conflicting results, you must look at the evidence to find explanations for the differences and resolve them.

     

  • Step 4: APPLY the evidence

    The fourth step in this tutorial helps you to apply the evidence to your clinical scenario. Through this process you will determine if the evidence can be extrapolated to your patient and then communicate with your patient to make an informed decision.

    • Step 1: Formulate an Answerable Question

    Evidence-Based Practice Tutorial  

  • Part A. – IDENTIFY the clinical issue for which you would like more information

    The patient is a 25 year-old female who has a repetitive strain injury in her shoulder with considerable pain. She has been receiving massage therapy for the pain but is not getting the results she would like. She would like to try painkillers if they would be more effective than massage therapy.

     

  • Part B. – DEFINE your clinical problem using PICO

    P - the Patient’s disease
    I - the Intervention
    C - the Comparative intervention
    O - the desired Outcome

    Our example PICO:
    P - Adults with repetitive strain injury
    I - Massage therapy
    C - Painkillers
    O - Relief of pain

     

  • Part C. – WRITE your clinical question using the PICO components

    First describe the subject of the question by asking questions such as:
  • How would I describe a group of patients similar to this one?
  • What is the primary condition or disease?
  • Are there any co-existing conditions?
  • Is the sex, age or race of the patient relevant?

    Then define which intervention you are considering for the specific patient or population by asking questions such as:
  • What do you want to do for the patient? Prescribe a drug? Order a test?
  • What factor may influence the prognosis of the patient? Age? Co-existing problems?

    Then name a second intervention with which to compare the first by asking questions such as:
  • What is the main alternative to compare with the intervention?
  • Are you trying to decide between two drugs, a drug and no medication or placebo, or two diagnostic tests?

    Finally, define the type of outcome you wish to assess by asking questions such as:
  • What can you hope to accomplish, measure, improve or affect?
  • What are you trying to do for the patient? Relieve or eliminate the symptoms? Reduce the number of adverse events?

    Our example question: For adult patients with repetitive stain injury, is massage therapy more effective for pain relief than painkillers?