PICO(T) Questions and an Evidence-Based Approach Essay
An evidence-based approach to solving clinical problems requires a systematic, model-based process. Evidence-based practice models ensure that the process of decision-making on diagnosis, treatments, and the entire patient care approach is based on the best evidence. Identification of the problem is usually the initial approach to problem-solving. Clinical inquiries are used to convert these health problems into answerable questions and guide the process of searching for the best evidence. PICO questions focus the search for literature evidence in the evidence-based process to a particular topic of interest and limit results to a piece of specific information desired by the researcher. The purpose of this paper is to explain a clinical issue of interest, formulate a PICO question, explain the best evidence to answer the PICO question, and explain the relevance of their findings to my clinical problem.
Clinical Issue of Interest
Pain is a common reason why patients seek medical care, and effective pain management can provide comfort, improve the patient experience, and increase patient satisfaction. Standard pain treatment often involves the use of medications, such as opioids and acetaminophen, which can have risks including abuse and liver damage (Brophy & Fillingham, 2022; Buelt & Narducci, 2021; (Kolasinski et al., 2020). Osteoarthritis (OA) is a common cause of chronic pain in adults and is typically treated with analgesics like opioids and acetaminophen, as well as nonsteroidal anti-inflammatory drugs (NSAIDs), which carry a risk of gastrointestinal bleeding.
Nonpharmacological treatment options, like relaxation techniques, are not always included as standard care for adults with osteoarthritis but may be a safer and more cost-effective alternative to medication (Buelt & Narducci, 2021). One example of a relaxation technique is yoga, which combines physical exercise with meditation and breathing techniques. However, the additional benefits of these techniques compared to standard care for older adults with osteoarthritis are not well established. Quality interventions, including both pharmacological and nonpharmacological approaches, can help to minimize flare-ups of osteoarthritic pain and improve patient outcomes.
Among older adults with osteoarthritis, (P) does nonpharmacological pain management interventions such as yoga (I) compared to standard pharmacological pain management with medications such as opioids and acetaminophen (C) reduce pain severity and improve function as measured by patient-reported pain scores and activity level (O) over the course of 6 months (T). This PICOT question will be used to guide the development of an EBP approach for the implementation of an evidence-based practice aimed at comparing the effectiveness of nonpharmacological pain management interventions to standard pharmacological approaches in older adults with osteoarthritis. The approach aims to determine whether nonpharmacological interventions are effective at reducing pain severity and improving function in this patient population over a 6-month time period.
Potentially Useful Sources of Evidence
The best evidence would come from credible sources such as research articles, reviews, websites, and guidelines. Research studies, such as randomized controlled trials (RCTs) and observational studies, that have examined the effectiveness of nonpharmacological pain management interventions in older adults with osteoarthritis will provide high-quality evidence. Systematic reviews and meta-analyses studies will provide the best quality evidence because they have synthesized the available evidence on nonpharmacological pain management interventions for older adults with osteoarthritis. To access these resources, databases such as PubMed, CINAHL, Cochrane Library, and BioMed Central (BMC) are valuable. These databases provide free and premium access to abstracts and full texts of research articles, guidelines, expert opinions, and books that would provide pieces of evidence of various qualities and levels.
Journals such as the Journal of the American Academy of Orthopedic Surgeons provide access to rheumatology journal articles. Websites such as the American College of Rheumatology website are credible sources with potentially useful evidence to answer the above PICOT question. The selection of these sources was based on criteria that assessed the authoritativeness, relevance, and purpose of their publications. The selected journals and debates contain peer-reviewed journals and other scholarly items that would meet the credibility criteria. The authoritativeness of the selected website makes it credible because the publisher is a professional association of rheumatology experts.
Findings from Selected Resources
Yoga, as a nonpharmacological therapy, involves medication and breathing exercises. It is an intervention involving mind-body exercises with the potential for managing knee, hip, ankle, and vertebral osteoarthritis. According to a randomized controlled trial study by Bennell et al. (2022), an unsupervised online yoga program showed effectiveness in the improvement of physical function among knee osteoarthritis patients after 12 weeks as compared with other patients who received their usual care without yoga. Improvement in knee pain was not reported by the patients in the intervention group. A systematic review and meta-analysis study by Lauche et al. (2019) found that yoga improved pain, physical function, and stiffness among OA patients. However, safety was not reported in the reviewed studies. These findings were compared with a control group that received exercise.
A randomized control by Zacharia et al. (2020) found that yoga participation by OA patients improved pain, physical activity, and physical function compared to OA patients in the control groups who didn’t participate in yoga. All three sources are credible, but the source by (Lauche et al., 2019) is the most credible because it answers the population, intervention, and outcomes. The outcomes assessed are similar to those in the PICOT question. Moreover, it is a high level of evidence item because it is a systemic review with meta-analysis (Fineout-Overholt, 2019). This makes its findings the highest level in the hierarchy.
Relevance of These Findings
These findings provide evidence to answer the PICOT question by addressing the population, intervention, and outcomes. Even though they did not address the comparison item in the inquiry, the study outcomes outlined the benefits and harms of implementing the intervention into practice. The three resources used actual patients where randomization reduced bias in the findings. Implementation of their findings in practice will require careful interpretation because the settings for the studies and actual practice vary.
In this case, the PICOT question is focused on comparing the effectiveness of nonpharmacological pain management interventions to standard pharmacological approaches in older adults with osteoarthritis. Potential sources of evidence for answering this question include research studies, clinical practice guidelines, and systematic reviews and meta-analyses. The findings from the selected resources are based on high-quality evidence and provide support for the implementation of yoga as a nonpharmacological pain management intervention in practice, although the careful interpretation of the findings is necessary due to differences between the study settings and actual practice.
Bennell, K. L., Schwartz, S., Teo, P. L., Hawkins, S., Mackenzie, D., McManus, F., Lamb, K. E., Kimp, A. J., Metcalf, B., Hunter, D. J., & Hinman, R. S. (2022). Effectiveness of an unsupervised online yoga program on pain and function in people with knee osteoarthritis: A randomized clinical trial: A randomized clinical trial. Annals of Internal Medicine, 175(10), 1345–1355. https://doi.org/10.7326/M22-1761
Brophy, R. H., & Fillingham, Y. A. (2022). AAOS clinical practice guideline summary: Management of osteoarthritis of the knee (non arthroplasty), third edition. The Journal of the American Academy of Orthopaedic Surgeons, 30(9), e721–e729. https://doi.org/10.5435/JAAOS-D-21-01233
Buelt, A., & Narducci, D. M. (2021). Osteoarthritis Management: Updated Guidelines from the American College of Rheumatology and Arthritis Foundation. American Family Physician, 103(2), 120–121. https://www.aafp.org/content/dam/brand/aafp/pubs/afp/issues/2021/0115/p120.xml
Fineout-Overholt, E. (2019). A guide to critical appraisal of evidence. Nursing Critical Care, 14(3), 24–30. https://doi.org/10.1097/01.ccn.0000554830.12833.2f
Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., … Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the Hand, hip, and knee. Arthritis & Rheumatology, 72(2), 220–233. https://doi.org/10.1002/art.41142
Lauche, R., Hunter, D. J., Adams, J., & Cramer, H. (2019). Yoga for osteoarthritis: A systematic review and meta-analysis. Current Rheumatology Reports, 21(9), 47. https://doi.org/10.1007/s11926-019-0846-5
Zacharia, S., Taylor, E. L., Branscum, P. W., Cheney, M. K., Hofford, C. W., & Crowson, M. (2020). Effects of a yoga intervention on adults with lower limb osteoarthritis: A randomized controlled trial. American Journal of Health Studies, 33(2). https://doi.org/10.47779/ajhs.2018.60
Assessment 3 Instructions: PICO(T) Questions and an Evidence-
Create a 3-5 page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question.
PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.
It stands for:
- P – Patient/population/problem.
- I –
- C – Comparison (of potential interventions, typically).
- O – Outcome(s).
- T – Time frame (if time frame is relevant).
The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search. When applying the PICO(T) approach, the nurse can isolate the interventions of interest and compare to other existing interventions for the evidenced impact on the outcome of the concern.
You are encouraged to complete the Vila Health PICO(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.
Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.
As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.
PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that
would help inform the development of your initial question. When writing a PICO(T)-formatted research question, you want to focus on the impact of the intervention and the comparison on the outcome you desire.
For this assessment, please use a health care issue of interest from your current or past nursing practice.
If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment.
For this assessment, select a health care issue of interest and apply the PICO(T) process to develop the research question and research it.
Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your issues, as well explain how the evidence would help you plan and make decisions related to your question.
If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document (accessible from the “Create PICO(T) Ouestions” page in the Capella library’s Evidence Based Practice guide) might be helpful.
In your submission, make sure you address the following grading criteria:
- Define a practice issue to be explored via a PICO(T) Create a PICO(T)-formatted research question
- Identify sources of evidence that could be potentially effective in answering a PICO(T) question (databases, journals, websites, etc.).
- Explain the findings from articles or other sources of evidence as it relates to the identified health care
- Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T)
- Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the
current APA style.
Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:
- Assessment 3 Example [PDF].
Your assessment should meet the following requirements:
- Length of submission: Create a 3-5-page submission focused on defining a research question and interpreting evidence relevant to answering it.
- Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
- APA formatting: Format references and citations according to the current APA
Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
- Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and
- Explain the findings from articles or other sources of evidence that are relevant to the health care
- Competency 2: Analyze the relevance and potential effectiveness of evidence when making a
- Identify sources of evidence that could be potentially effective in answering a PICO(T)
- Explain the relevance of the findings from chosen sources of evidence to making decision related to a
- Competency 3: Apply an evidence-based practice model to address a practice
- Define a practice issue to be explored via a PICO(T) approach and develop a PICO(T)-formatted
- Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on
Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
- Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA
Use the scoring guide to understand how your assessment will be evaluated.