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Evidence-Based Practice: Forming a Clinical Query

EBP's 5-Step Process

Ask a question

Find the best evidence

Evaluate the evidence

Apply the evidence in conjunction with clinical experience and patient values

Evaluate the outcomes

Johnson C. Evidence-based practice in 5 simple steps. Journal of Manipulative & Physiological Therapeutics. 2008;31(3):169-170. Accessed September 4, 2019.

How to create a PICO Question


Formulating a strong clinical question is the first step in the research process.  PICO is a way of building clinical research questions that allow you to focus your research, and to create a query that better matches most medical databases.

  • Patient – Describe your patient or population.  What are the most important characteristics?  Include information on age, race, gender, medical conditions, etc.
  • Intervention – What is the main intervention or therapy you are considering? The can be as general as treat or observe, or as specific as a specific test or therapy.
  • Comparison Intervention – An alternative intervention or therapy you wish to compare to the first.
  • Outcome – What are you trying to do for the patient?  What is the clinical outcome?  What are the relevant outcomes?

Example: In a (describe patient) can (intervention A) affect (outcome) compared with (intervention B)?

  • In a 50 year old man with diabetes is weight loss and exercise or medication better at maintaining healthy blood sugar levels?
    • Patient - 50 yr old man with diabetes
    • Intervention - weight loss and exercise
    • Comparison - medication
    • Outcome - maintaining blood sugar levels

Background and Foreground Questions

Background Questions - are considered general knowledge questions, topics that you learn about as part of your coursework and experience

Example: What causes gallstones?

Foreground Questions - are specific questions regarding a specific patient or population, frequently formulated in the PICO format and inform clinical decisions