Creating a PICOT question

 

An example of a PICOT question developed from the Canadian Chiropractic Association, regarding neck pain is as follows,

"In adults with chronic neck pain, what is the minimum dose of manipulation necessary to produce a clinically important improvement in neck pain compared to supervised exercise at 6 weeks?" [1]

This was put together using the individual PICOT factors outlined, [1]


 	
(P) – Population: Adults 18 to 60 years of age, with a clinical diagnosis of chronic mechanical neck pain.
 	
(I) – Intervention: Subjects randomized to have manipulation would receive standard rotary or lateral break diversified technique once, twice, or three times per week over 2, 4, or 6 weeks. They will also receive the same exercise program assigned to the control group, to eliminate a second variable in the study.
 	
(C) – Comparison: A standardized supervised exercise program will be used as an active control group. All subjects will perform a standardized exercise program at each session during the 6 week period. The non-specific effects due to attending a clinic, will be minimized.
 	
(O) – Outcome: Changes in neck pain, measured using the 100mm VAS for pain.
 	
(T) – Time: The outcome would be measured weekly for 6 weeks.

Considerations
Although guidelines may be set by Professional Standards, Institutions, or Workplaces, there are some important considerations when designing a PICOT research question.

The detail of the literature search, including the breadth and quality of such detail would need to be considered. [1]

The targeted study design would need to be chosen.[1]

The exact patient population of the literature search will need to be chosen and defined. [1]

Each of the factors of the PICOT question will need to be clearly chosen and defined, to create the desired and an accurate and valid research question. [1]
Implications
It is interesting to note that there are some implications to using the PICOT research question method, of creating a study, more than researching to gather information. [1]

 	
Many of these research questions are costly, time-constraining, and difficult to conduct, especially with an RCT study design.
 	
Not every question that Clinicians would like answered are feasible with such a research methodology.

PICOT is not a useful methodology for non-clinical type of questions, such as Nursing theories. [3]

Not knowing how to correctly write a PICOT question can also be an issue with getting a successful outcome. The value of the question may be underappreciated, the purpose of the question may be misunderstood, or the approach to writing and using the PICOT formula may be taught incorrectly. With correctly creating the question, this would lead to an unbiased and effective search. [3]

If the question is not valued and created correctly, and with strength, there can many issues which can have a rippling effect through the EBP process, leading to recommendations which are not based on best evidence. [3]