Physiotherapy: Searching for Evidence
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The Research Question
• You cannot conduct an effective search without a well
• Think about the concepts within your research question
• Identify and list the keywords and their synonyms that
identify the concepts
• Consider the ‘level of evidence’ to be sought – the research
methodologies that will help eliminate bias
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Levels of Evidence
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Developing a search strategy: PICO
1. Break the research question down into concepts:
• Research / Study design - Consider adding another column
for the Research Design ie. which study type will give the
highest level of evidence to answer the question
2. Identify for each facet:
• Spelling variants
• Subject headings
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Do water therapies reduce or relieve pain in people with rheumatoid arthritis?
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Note: The PICO formula doesn’t always apply and that all elements don’t
always need to be present. It is a useful way to structure and focus your
question – makes it easier to identify search concepts
Intervention Comparison Outcome Research
water therapy n/a pain If applicable:
which study type
will give the
highest level of
Useful search tips
• Spelling variations: paediatrics or pediatrics
• Terminology: physiotherapy or physical therapy
• truncation *: rehabilitat* will find rehabilitate/s, rehabilitated
• Wildcard (? or #): Depending on the database a wildcard can
be either ? or # symbol e.g. organi?ation
• phrase searching “….”: e.g. “cerebral palsy”
• check the database online help guide for further information
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Linking terms: BOOLEAN operators
• AND retrieves records containing both of two
– Back pain AND exercise
• OR retrieves records containing any of the
terms (OR retrieves more records):
– Back pain OR back ache
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Example of a completed PICO map
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Intervention Comparison Outcome Research
• Electronic Indexes that help you identify journal
articles in your research area
• NO single database indexes every journal possible
in a subject area - only those that match their
• Efficient, effective and less biased searching
therefore requires multiple database searching
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Types of databases
• Citation databases:
Entries have the citation, subject headings and often an abstract,
sometimes they link to full text. Examples: CINAHL, Embase, MEDLINE
• Full Text databases:
Entries have the citation and abstract and in most cases the full text of an
article. Examples: Health & Medical Complete (Proquest), Informit Health
• Pre-appraised evidence databases:
– The Cochrane Library is a multi-database resource which varies in
output e.g. the Cochrane Database for Systematic Reviews contains
complete systematic reviews
– BMJ Best Practice incorporates Clinical Evidence which summarises
the current state of knowledge and uncertainty about the prevention
and treatment of clinical conditions, based on thorough searches and
appraisal of the literature.
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Accessing Physiotherapy databases
• On Campus:
– Library Web Page
> Subject Area - Health Sciences
• Off Campus: authentication as a La Trobe University
– University username and password
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• Systematic searches are a combination of using
the terminology of the database (Subject
Headings) combined with free text or keyword
searching (alternate terms encountered in the
• While there may be some overlap, you will also
find many different articles when using both ways
of searching for the same concept.
• Comprehensive systematic searching requires
subject heading and keyword searching!
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Systematic searching: Why use both methods?
Controlled Vocabulary (Subject Searching) Keyword Searching
MEDLINE, Embase, CINAHL (amongst others) are
indexed by subject experts who assign a subject
heading (or ‘tag’) that best describes the article.
These subject headings are from a fixed list of
terms that are arranged in a hierarchical structure
that show the relationships between terms. This
allows searching at various levels of specificity.
Words not taken from a specific list. Can use
words that you would normally use when
searching. Need to account for variations for
spelling, terminology & clinical descriptions.
More efficient & precise way of searching where
you retrieve only those records which list the
subject heading for your concept.
Broader way of searching where you will retrieve
records which mention your keywords but may or
may not be specifically about your concept.
Searches only the subject field. Searches words used by the author in other fields
such as the title or abstract.
Provides consistency in the description of the
content of the articles.
Useful for searching for a specific term or phrase
when there is not an appropriate subject heading.
Do not need to think of synonyms for your topic. Useful for searching topics that use new concepts
or terminology (subject headings take a while to
Controlled vocabulary & scope notes
• Subject Headings (Controlled vocabulary or Thesauri): used
to overcome differences in individual authors’ use of
terminology. e.g. back pain (CINAHL and MEDLINE), backache
– Click on the Subject Heading, scroll down to the ‘used for’.
Provides ideas for other keywords to use!
• Scope note: describes how the term is used in the database,
the “scope” of the term; the history of the indexing
• ‘Exploding’ a term: results will include the ‘exploded’ term
(e.g. back pain) plus the conceptually narrower terms in the
tree (low back pain)
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Use limits to refine your search
• Clinical Queries
• Time frame
• Language, gender, age, population
• Publication types
– CINAHL e.g. clinical-trial; masters-thesis; research; review;
– MEDLINE - e.g. controlled clinical trial; meta analysis; randomised
controlled trial; review literature; review, academic; review
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Too many results?
• Apply limits
• Use keywords which are more specific
• Ask for help with finding subject headings.
• Search for keywords in particular fields like
abstract or title.
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Not enough results?
• Try another keyword(s)
• Use broader search term(s)
• Remove the least important concept
• Consider possible variants of terms and use
truncation or wildcard
• Remove a date limit or any other limits you have
• Try another database
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Search results – finding the full text!
• Some databases will have the Full Text Finder icon or pdf link
• If not, search by the title of the journal via the Journal tab on
the library home page and follow the links to the full text:
– sometimes the library may only have a print copy
• If not held by the Library, request the article via Document
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• To access a variety of search options, click on Search, Search Manager or
Medical Terms (MeSH) to be directed to the appropriate search tab.
• Further information at: latrobe.libguides.com/healthdatabases >
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PEDro - www.pedro.org.au
• PEDro is the Physiotherapy Evidence Database
with over 23,000 randomised trials, systematic
reviews and clinical practice guidelines in
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Google Scholar - scholar.google.com/
• Search scholarly literature for articles, theses, books,
abstracts, professional societies, online repositories,
universities and other web sites across the world of
• You can access items held in the Library through
Google Scholar. See instructions
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• Click on the ‘Show conditions’ tab to browse information on the
management of a patient
• Under ‘Treatment’ click on ‘Evidence’ to view information from BMJ Clinical
Evidence (systematic reviews of key clinical questions)
BMJ Best Practice
Useful library guides
• Critical Appraisal
• Grey Literature for Health Sciences
• Systematic Reviews
• Health Databases
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