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Evidence-Based Practice in Rehabilitation

Developing a Well-Built Clinical Question

Clinical practice problems surround us. Some typical questions we might ask are:

  • Does this practice work? Is there something more effective?
  • How can we practice more efficiently?

Clearly defining the specific problem will help focus your search to find the best available evidence.

    

Background questions

These questions are used to gain a better understanding about the health condition and to identify search terms.. The essential components of background questions are:

1) A question root (who, what, where, when, how, why)

 2) A disorder, test, treatment

Examples:

  • What causes diabetes?
  • When might complications after stroke occur?

Textbooks, monographs, or web resources are good sources of answers to background questions.

Foreground questions

These are designed to ask about specific information for clinical decision-making and thus focus your search. Foreground questions are often asked in a format called PICO::

1) Patient and/or Problem

2) Intervention

3) Comparison intervention (if relevant)

4) Clinical Outcomes.

An example of a PICO question is:

  • In an older patient with X disorder, is giving Y treatment rather than Z treatment more likely to result in a shorter stay in hospital?

Finding relevant journal articles, using bibliographic databases such as PubMed, CINAHL or Web of Science will usually answer foreground questions.

Melnyk & Fineout-Overholt Question Templates

Another way to frame the question is to use the templates developed by Melnyk and Fineout-Overholt.

THERAPY QUESTIONS

In_______________, what is the effect of ________________on _______________ compared with _________________?

PREVENTION QUESTIONS

For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?

DIAGNOSIS OR DIAGNOSTIC TEST QUESTIONS

Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?

PROGNOSIS QUESTIONS

Does ____________ influence ______________ in patients who have _____________?

 ETIOLOGY QUESTIONS

Are ______________ who have _______________at risk for/of ____________ compared with _____________ with/without______________?

MEANING QUESTIONS

How do _______________ diagnosed with _______________ perceive __________________?

 

Adapted from Melnyk BM and Fineout-Overholt E. (2011). Evidence-based practice in nursing & healthcare: aA guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.