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PHYT 7014: Systematic Reasoning and Scientific Investigation I: PICO

A guide to literature searching.

Four Elements of the Clinical Question

PICO: A mnemonic device to help formulate a clinical question and search strategy by identifying key concepts. 

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?

Patient

What are their most important characteristics?

  • primary problem
  • disease state
  • co-existing condition

Describe your patient specifically:

  • Sex
  • Age
  • Ethnicity
  • Socioeconomic factors

ALWAYS include this piece in your search.

Intervention

What do you want to do for the patient?

  • Order a test
  • Prescribe a drug
  • Order a procedure

Other considerations:

  • Main intervention
  • Prognostic factors
  • Exposures

Almost always include this piece in your search.

Comparison

What is the alternate intervention, if any?

  • A different drug
  • No medication
  • A Placebo
  • A different test
  • A different procedure

It is less common to include this piece in a search.

Outcome

What are you hoping to achieve, measure, or change for the patient?

  • Alleviate symptoms
  • Improve test results
  • Reduce adverse events
  • Improve function

Could also be the result NOT desired.

Sometimes include this piece in your search.

Example Questions

1. In an adult with knee osteoarthritis (patient), can aquatic exercise (intervention) reduce pain and disability (outcome)?

2. Is a home program (intervention) as effective as a perceptual-motor program (comparison) in improving sitting postural control (outcome) in infants with cerebral palsy (patient)?