Asking Questions

Robert M. Rowell, DC, MS

ASKClinically relevant question

ACQUIREBest available evidence

APPRAISEQuality and importance

APPLYEvidence in patient care

EBCPEvidence Cycle

ASSESS

Finding, Evaluating, and Applying Evidence

• EBP is essentially about:– Recognizing clinical problems – Asking good clinical questions – Finding, critically evaluating, analyzing, and

synthesizing evidence– Applying the most relevant evidence to clinical

decisions and patient care recommendations

Types of questions

Background Questions

Foreground Questions

Clinical Experience

Student Experienced Clinician

Background Questions

• About the disorder, syndrome, condition

• Often phrased with 2 components1. Question: root + verb

• “What causes…

2. The condition• …Lyme disease?”

Foreground Questions

• About patient care = clinical questions

• Has 4 components (PICO)P: Patient or problem

I: Intervention

C: Comparison

O: Outcome

Questions

Diagnosis

Etiology? Risk Factors?

Prognosis

Therapy

PICO Questions

• Therapy– Is one therapy better than another?

• Diagnosis– What’s the best way to diagnose your patient?

• Prognosis– What’s the most likely outcome for the patient?

• Harm– What’s the impact of a risk factor?

Therapy PICO

Patient or Population

Intervention

Comparison

Outcome

Do post-partum women with SI joint pain treated with spinal manipulation (adjustments) have decreased pain and disability compared with those treated with core stabilization exercises?

Post-partum women with SI joint pain

Spinal manipulation

Core stabilization exercises

Decreased pain and disability.

How would I describe a group of patients similar to mine.

What main intervention am I considering

What is the main alternative to compare with the intervention

What can I hope to accomplish, measure, improve or affect

Diagnostic test PICO

Patient or population

Intervention

Comparison

Outcome

In adults with low red blood cell count will serum ferritin blood testing compared to bone marrow biopsy rule out iron deficiency anemia.

Adults with low red blood cell count

Serum ferritin blood test

Bone marrow biopsy

Rule out iron deficiency anemia

Describe the patient

New diagnostic test

Usual diagnostic test (Gold Standard test)

Condition to be detected

Prognosis PICO

Patient

Intervention

Comparison

Outcome

Among adult type II diabetics with elevated HbA1c is there an increased risk of amputation?

Describe the patient

Prognostic Factor

No Prognostic Factor (or left blank)

Health State

Adults with type II diabetes (NIDD)

Elevated Hemoglobin A1c

Normal Hbg A1c

Increased risk of amputation

Harm PICO

Patient

Intervention

Comparison

Outcome

Among adults exposed to tobacco smoke is there an increased risk of lung cancer?

Describe the patient

Exposure

Lack of exposure(or left blank)

Health State

Adults

Tobacco smoke

No smoke

Lung Cancer

Harm PICO

Patient

Intervention

Comparison

Outcome

Among elderly adults who perform resistance exercise is there a decreased risk of falling?

Describe the patient

Exposure

Lack of exposure(or left blank)

Health State

Elderly adults

Resistance exercise

No resistance exerciseDecreased risk of falls

Questions are important

• The question dictates where to look.– Background question: text book, etc– Foreground question: scientific health care

literature

• The better the question is phrased, the better the answer!