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Formulating a Clinical Question

Asking a well built clinical question is often harder than it first appears. However, once you master the art of asking focused and relevant questions, finding answers becomes more straight forward.

The major components of a well formulated question include the population or patient, intervention, comparison (which is optional) and outcome. These components are often represented by the acronym PICO.

The use of these components ensures that you focus your question and include the key variables that you can translate into a search for evidence.

PICO	Ask yourself	Example
Population (patient/problem)	How would I describe a group of patients similar to mine?	In adults with chronic idiopathic low back pain
Intervention	Which main intervention, prognostic factor, exposure am I considering?	does stabilization exercise
Comparison (optional)	What is the main alternative to compare with the intervention?	when compared to no treatment
Outcome	What can I hope to accomplish, measure, improve or affect?	reduce symptoms and disability?

There are four domains into which your good clinical question can fall:

• Therapy -- "how to select treatments for patients that do more good than harm and that are worth the efforts and costs of using them".
• Diagnosis -- "how to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety, etc".
• Prognosis -- "how to estimate a patient's likely clinical course over time and anticipate likely complications of the disorder".
• Etiology -- "how to identify causes for disease".

Definitions taken from Sackett, David L et al. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed. Edinburgh: Churchill-Livingstone, 2000, p. 19.

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