This document discusses asking answerable clinical questions. It defines background questions, which seek general knowledge, and foreground questions, which seek specific information to inform patient care. Foreground questions are best formulated using the PICO framework - describing the patient population, intervention, comparison intervention, and outcome. Well-constructed PICO questions focus the search for evidence and help determine the appropriate study design to answer the clinical question. Formulating answerable clinical questions is an important part of evidence-based practice.

1. Asking Answerable Questions SohailBajammal October 6, 2011

2. Outline Types of questions Good questions Why do we need to ask good questions?

3. EBM (EBCP) Research Evidence Patients’ Preferences Clinical Expertise Clinical Circumstances Haynes et al. BMJ 2002;324:1350

4. Steps of Practicing EBCP

5. Types of Questions Background questions: About the condition 5W questions (who, what, when, why, where, how) General knowledge Look up the answers in textbooks Foreground questions: About the options Specific information Look up the answers in the literature (articles)

6. Back Pain Which of the following are background questions & foreground questions? What is the pathophysiology of back pain? What are the causes of back pain? How can we diagnose back pain? What is the best diagnostic test for back pain? What are the treatments available for back pain? What is the best treatment for back pain? B F B B B F B F

7. Is this a good foreground question? What is the best treatment for back pain?

8. Is this a good foreground question? In adult patients younger than 50 years old with acute low back pain (< 6 weeks), does bedrest reduce the risk of recurrence of pain within one year compared with physiotherapy? P: Adult patients <50yr with acute LBP I: Physiotherapy C: Bedrest O: Recurrence of pain within one year

9. Which is a better question? What is the best treatment for back pain? In adult patients younger than 50 years old with acute low back pain (< 6 weeks), does bedrest reduce the risk of recurrence of pain within one year compared with physiotherapy?

10. PICO P: Population (or problem) I: Intervention C: Comparison (control) O: Outcome

11. Questions Categories Diagnosis Prognosis Therapy (Treatment) Harm/Causation Prevention Cost (Economic) Qualitative

12. Class Activity 10 minuets Split into groups of 5 Think of a foreground question From the topics you studied the last 2 weeks PICO format What category? Be prepared to discuss with the group

13. Your PICO questions – 40 minutes

14. Why do we need to PICO? Keep the question patient-oriented POE (patient-oriented evidence) vs DOE (disease-oriented evidence) Make searching effective & focused Will help you in designing your search strategy Will make you think of what type of study you will be looking for What category

15. What we have discussed Types of questions: background & foreground Good foreground questions are PICO Why do we need to ask good questions?