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❶Pain relief is a common concern among patients presenting with neck pain and detection of a resulting difference of 13 mm on the mm Visual Analog Scale VAS line is considered a clinically important change in intensity for patients with chronic pain. Chiropractic research capacity in Canada in — Phase 3.

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Foregrounded questions generally begin with "how" — "how does X affect Y? Choose your patient population for the study. Factors to consider include age, gender, health conditions, medication regimen and access.

Determine your intervention — the activity you will undertake for your specific patient population. Since you are basing the research on evidence-based practice, you need to compare two different techniques that your hospital or clinic use, or compare your existing practice with a new idea.

The ideas could stem from patient observation and feedback, newly published research findings, the need for cost-saving methods, or activities undertaken at another facility. Choose your comparison group, people who will not experience the new intervention. If you are testing a medication regimen, your comparison could be the use of a different medication to treat the same problem.

Your patient population would receive the new intervention while your comparison group would receive the current standard medication. Usually this group is the status quo, although you could use the PICOT framework to compare two different methods, such as the effect of art therapy versus music therapy.

While a comparative group is technically optional in the PICOT framework, it is rare that researchers do not use one. Predict the possible outcome of the question you are examining. Since you are grounding your research in evidence-based practice, you are using the study to prove your predetermined belief. If you are looking at changing a medication regimen, for example, you may believe the outcome will show that medicine A is more effective than medicine B.

In adult patients with total hip replacements Patient population how effective is PCA pain medication Intervention of interest compared to prn IM pain medication Comparison intervention in controlling post operative pain Outcome during the perioperative and recovery time? The IM pain medication would be called the control group.

It would be unethical to have a control group that received NO pain medication. Many times the control group means they get "business as usual! What is the duration of recovery O for patients with total hip replacement P who developed a post-operative infection I as opposed to those who did not C within the first six weeks of recovery T? Are kids P who have obese adoptive parents I at Increased risk for obesity O compared with kids P without obese adoptive parents C during the ages of five and 18 T?

Time is implied in two weeks and 24 hours old. In OR nurses doing a five minute scrub P what are the differences in the presence and types of microbes O found on natural polished nails and nail beds I and artificial nails C at the time of surgery T? Another methodology, used to look for associations between respondent characteristics and outcomes of interest, is a cross-sectional survey. This methodology is faster and less expensive to do in comparison to a RCT since it considers one time-point of individuals in various spectrums of the variables of interest.

However, this design can also can be prone to recall problems by respondents who self-report information if investigators ask about events in the past. A case-control study is most appropriate when attempting to identify associations between patient characteristics and outcomes that take a long time to occur or are very rare. For example, the study by Cassidy et al.

While these study designs are common in clinical research today, they are not exhaustive of all designs available. Systematic reviews will be familiar to most as a study design aimed at summarizing bodies of studies; but other less familiar individual patient focus designs, such as N-of-1 RCT, 17 also exist which are amenable to the PICOT format depending on the research question that is being posed.

How detailed should the literature search be in breadth and quality level? What study design best fits the research question? Should the patient population include very similar types of patients or will there be more of a real-world wide variety of participants?

Will the intervention be very specific and rendered by a clinical expert or will there be a combination of tailored interventions rendered by a non-clinician with a more general skill set? Will the comparison be against usual care i. Will the outcomes measured be from validated instruments on a form or more from direct patient verbal communication and will these results be presented in a way most important to clinicians, patients or policy-makers?

And if so, what amount of difference and how many patients would be required to both statistically and clinically conclude the intervention was effective? Will measurement of outcomes occur at multiple times or once at 5 days, 6 months or 10 years? While these considerations are clearly complex and not inclusive of the entire process, to develop a strong research question framed in the PICOT format, it is an important basis to understand both the clinical area of investigation and the current literature that exists.

As highlighted by the example above, it is necessary to review the type and quality of research that has already been performed in the area of interest to guide development of a question. When initially synthesizing the literature, some key entry questions to examine include:.

In our example design, the literature search identified existing knowledge in the respective area. A recent high-quality Cochrane review reported on previously completed RCTs in the area, strengths and weaknesses of these studies and offered direction as to gaps in current understanding that would benefit from further research exploration.

Only after a thorough literature synthesis and investigation into these answers should a research question be formulated — in some instances a systematic review methodology may actually align best with the PICOT framework for your research question. Turning an idea into a good research question requires it to be feasible, interesting, novel, ethical and relevant.

The question should be of interest to many in the clinical area to drive both team momentum for the project and dissemination of the results. Generating new knowledge in large existing gaps of healthcare provides the opportunity to help large volumes of patients who previously may have had poorer clinical outcomes. Practically, ethical considerations have to be accounted for in related study designs to ensure subjects are not harmed by the study. Finally, reflection is required on how well the study design will apply to the real world.

Who will the research help? What is the benefit? There should be a definitive and strong rationale for the purpose of the research. A well-thought-out focused research question leads directly into hypotheses; the predictions about the nature and direction of the relationship between the variables under study.

Hence, the question acts as the foundation of the study. The importance of moving from studies to empirically supported treatments to evidence-based practices may very well rest on whether or not a clinician views the research as relevant to their daily practice.

It is common for clinicians to express frustration that researchers are not asking questions that are of most relevance to practice. Similarly, researchers often find that clinicians have difficulty distilling the important concepts they would like investigated in a way that can be feasibly researched. To support both clinical and academic interests, an important clinical research question should therefore be one that is developed in conjunction with a diverse team.

This expertise should align with the best research methodology available and propose a project feasible to complete through study that will adequately answer the research question asked. In Canada, the Canadian Chiropractic Research Foundation has reported that there are currently 12 university-based research chairs, 15 PhD candidates and 14 Masters students.

Clinicians interested in research pursuits, related to patient care, should consider the use of a literature search and the PICOT format when engaging clinical researchers. This approach will provide clinicians and researchers an initial basis for mutual understanding, communication and direction to help answer clinical study questions of most relevance. No funds were received for the preparation of this manuscript.

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Not all research questions that clinicians wish answered are feasible using this research methodology and the use of a PICOT format is also applicable to other study designs. The clinical research question being asked ideally determines the best research design for a study.

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Picot is a wordplay that can assist to create a clinical question and direct the search for obtaining evidence. The PICOT question is made in a formula (format) of creating re-searchable and answerable inquiry. Writing such a question appears simple, but may not be easy as it seems.

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The PICOT question format is a consistent "formula" for developing answerable, researchable questions. When you write a good one, it makes the rest of the process of finding and evaluating evidence much more straightforward. PICO (alternately known as PICOT) is a mnemonic used to describe the four elements of a good clinical question. It stands for: P--Patient/Problem I--Intervention C--Comparison O--Outcome. Many people find that it helps them clarify their question, which in turn makes it easier to find an answer.

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A strategy aimed at asking good clinical questions that will help in developing a research question. PICOT is a technique medical researchers use to develop a clinical research question. It may form part of a formal funding or research proposal, or medical staff may use it to carry out a small-scale experiment.