PICO(T) is a mnemonic used to describe the four elements of a good clinically oriented question:
P = Population/Problem: How would I describe the problem or a group of patients similar to mine?
I = Intervention: What main intervention, treatment, prognostic factor or exposure am I considering?
C = Comparison: Is there an alternative or usual care/treatment to compare with the intervention?
O = Outcome: What do I hope to accomplish, measure, improve or affect
In some questions, a T = Timeframe, Type of Study or Type of Question is added to the PICO framework to help find more specific evidence.
Questions are commonly either concerned with the efficacy of an therapy/intervention (such as drug treatments, clinical therapies, or lifestyle changes), diagnosis (concerning the ability of a test to accurately diagnose), or a prognosis (concerned with likelihood or risk).
Fill in the blanks with information from your clinical scenario:
THERAPY / INTERVENTION
In_______________, what is the effect of ________________on _______________ compared with _________________?
Examples:
In people with osteoarthritis in the feet, what is the effect of stretching exercises on reducing pain compared with rest?
In bedridden persons, what is the effect of repositioning at frequent intervals (compared to less frequent repositioning) on reducing pressure ulcers over a 90 day period?
DIAGNOSIS OR DIAGNOSTIC TEST
Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?
Examples:
Is d‐dimer assay more accurate at ruling out deep vein thrombosis compared to ultrasound?
Is 3D mammography screening more accurate in identifying breast neoplasms compared with conventional 2D mammography screening?
PROGNOSIS
Does ____________ influence ______________ in patients who have _____________?
Examples:
Does dietary carbohydrate intake influence healthy weight maintenance (BMI <25) in patients who have family history of obesity (BMI >30)?
Does vitamin D supplementatoin influence fatigue in people who have multiple sclerosis?
PREVENTION
For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?
Examples:
For people with mild median nerve pain, does a night-time wrist brace reduce the future risk of carpal tunnel syndrome compared with no brace?
For older adults, does a yoga exercise intervention reduce the risk of falling compared with other exercise programs?
ETIOLOGY
Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________
with/without______________?
Examples:
Are children who have been exposed to regular second hand smoke at increased risk for lung cancer compared to children without second hand smoke exposure?
In the table below, we model how to move from a PICO question to a search strategy to use in the next step of the process, ACQUIRE.
We start by forming our PICO question, then generate keywords and synonyms for search terms, and then use Boolean operators (AND and OR) to map out a search strategy.
The P (patient or population) and the I (intervention or treatment) are generally searched first.
The C (comparison) and O (outcome) are less often included in a search.
For this example our patients are older adults who may find an intervention to assist with food safety helpful so that they may continue to live safely and healthfully in their homes.
PICO: In older adults, what is the effect of a food safety educational intervention on improving food handling and general nutritional status.
You will likely need to modify your search strategy as you search the databases and discover additional search terms, terms that cause many false-hits, and search results that are not as planned. Searching is an iterative process.
Copy the search strategy into a database, linking synonym terms with OR and PICO aspects or facets with AND.
Start searching with P and I (usually) and add additional PICO aspects as needed.
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