Asking a clinical question?
Framing a searchable focused clinical question!
Greetings!
Welcome to the sixth edition of the newsletter. This edition will dissect one of the steps involved in the EBP process (you can read the EBP process by clicking the link).
The most crucial step towards EBP is to formulate a relevant focused clinical question. We create our search strategies using this question and look for relevant evidence. A focused clinical question ensures that the evidence you gather is directly applicable to your specific clinical scenario. It allows you to target your search toward studies that address your patient population. By having a clear question in mind, you can critically appraise and apply the evidence to make informed decisions about diagnosis, treatment, or other aspects of patient care.
We can frame various types of clinical questions for different aspects of care for example an intervention-based question or a clinical question related to the diagnostic tests. Different types of clinical questions have certain kinds of studies that best answer them.
There are various formats (for example PICO, SPIDER, PEO, and COSMIN) that are used to design these questions. Subsequently, you can search for the question in diverse databases such as PubMed or Pedro. Once the relevant article concerning the patient is found, it should be subjected to a thorough critical appraisal.
One of the most widely used formats for formulating a clinical question is the PICO format.
P: Patient or Problem
I: Intervention
C: Comparison
O: Outcome
Example: In adult patients with type 2 diabetes (P), does regular exercise (I) compared to medication alone (C) result in better glycemic control (O)?
Another example can be: Is aerobic exercise (I) better than resistance training (C) in patients with hypertension (P) in reducing BP levels (O)?
You can also use PEO Format; this is useful for qualitative research questions. Questions based on this format identify three concepts.
P: Patient or Problem
E: Exposure
O: Outcome
Example: What are the attitudes (O) of health professionals (P) towards caring for older patients with dementia (E) in an acute setting (P)?
The SPIDER Format is another framework used to structure research questions, particularly in qualitative studies. SPIDER stands for Sample, Phenomenon of Interest, Design, Evaluation, and Research type. By combining these five elements, a SPIDER question can be formulated. However, it's important to note that the SPIDER format is primarily used in qualitative research.
Example SPIDER question:
Sample: Physiotherapists working in intensive care units
The phenomenon of Interest: Their experiences in providing end-of-life care to patients
Design: In-depth interviews
Evaluation: Perceptions of emotional impact and coping strategies
Research type: Exploratory
Using the SPIDER format, the question could be formulated as follows:
"What are the experiences of a physiotherapist working in intensive care units regarding the provision of end-of-life care to patients?
I hope these formats will give an outline of how to frame questions that are searchable and clinically relevant to your population.
You can also have a look at the video posted on youtube by PEDro titled “How to ask a clinical question in PICO format” by clicking on the video below.
I hope you enjoyed reading the newsletter. That’s all for this edition we will explore other steps of the EBP process in the upcoming editions.
I am also planning a free webinar to highlight how we use these clinical questions to look up relevant research papers!