Patient Intervention Comparison Outcome (PICO)
PICO: A mnemonic to help formulate a clinical question and a search strategy by identifying key concepts.
PICO allows you to develop focused relevant questions.The Centre for Evidence Based Medicine states that “one of the fundamental skills required for practising EBM is the asking of well-built clinical questions. To benefit patients and clinicians, such questions need to be both directly relevant to patients’ problems and phrased in ways that direct your search to relevant and precise answers”.
Characteristics of PICO Questions include:
1. Structures and guides the search for literature evidence
2. Promotes a relevant, direct, and clear search
3. Answers- what do I want to know about?
4. Focuses the question by identifying the components in the question
5. Defines the concepts that will be used when performing a complex literature search
6. Promotes access to professional evidence that is relevant to the question
7. Determines if the identified evidence is able to effectively address the question
8. Focuses on elements to support and update clinical practice
9. Provides the information needed to make a decision whether or not the intervention in the PICO question should be implemented
PICO- a question formula that allows you to define your research question and determine the key components of your research.
|P||Patient/Population/Problem||Describe your patient or the problem – be specific|
|I||Intervention/Indicator||Treatment, cause, prognostic factor, etc.|
|C||Comparison/Control||Compared to another treatment or standard of care (optional)|
|O||Outcome||Improvement or negative effects?|
P: Population / Patient
Who or What? Patient, Population, Problem.
How would you describe a group of patients similar to your group?
What are the most important characteristics of the patient? Primary problem; disease; co-existing conditions.
Consider sex, age and/or race of a patient as this may be relevant to the diagnosis or treatment of a disease.
I: Intervention / Indicator
How: Intervention, prognostic factor or exposure – Drug, procedure, diagnostic test, exposure.
Which main intervention, prognostic factor, exposure are you considering?
What do you want to do for the patient? Prescribe a drug? Order a test? Order surgery?
What factor might influence the prognosis of the patient? Age; co-existing problems.
What exposure has the patient experienced? Asbestos; cigarette smoke.
C: Comparator / Control
What is the main alternative? Comparison or intervention?
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; two diagnostic tests.
Your clinical question may not always need a specific comparison.
What are you trying to accomplish, measure, improve, effect, achieve?
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; improve function or test scores.
Always evaluate the outcomes in regard to the current issue and to future situations.
It is important to note that not all questions have the “C” component. Perhaps you are not comparing the intervention you are interested in with another intervention. For example in the above PICO, perhaps there isn’t a comparison with NDT patterns and you are inquiring about the effectiveness of constraint induced movement therapy only. Your question would be considered a PIO question.
Examples of PICO
1. You have a patient who has difficulty exercising due to COPD and you wonder if pursed lip breathing techniques may improve their endurance.
P = patients with COPD
I = pursed lip breathing
C = regular breathing
O = improved exercise endurance
“In patients with COPD, does using pursed lip breathing, as compared to regular breathing, improve exercise endurance?”
2. You are working with a recent stroke patient who is having balance issues and you are considering using virtual reality in their therapy.
P = recent stroke, balance issues
I = virtual reality
C = no virtual reality
O = improved balance
“In recent stroke patients, how does using virtual reality affect or improve balance?”
3. Your patient is a recent veteran who is experiencing insomnia and you wonder how effective sleep restriction therapy might be in improving her sleep patterns.
P = insomnia
I = sleep restriction therapy
C = no therapy
O = improved sleep patterns
“In recent veterans with insomnia, how effective is sleep restriction therapy at improving sleep patterns?”