Kinesiology Subject Guide

Clinical questions can be divided into two types:

"Background" questions

• As for general knowledge about a condition, test, or treatment
• Have two essential components:
  • A question root (who, what, where, when, how, why) and a verb
  • A disorder, test, treatment, or other aspect of healthcare

"Foreground" questions

• Ask for specific knowledge to inform clinical decisions or actions
• Have 4 essential components (generally stated in PICO format)

Straus, S. E., Glasziou, P., Richardson, W. S., & Haynes, R. B. (2011). Evidence-based medicine: How to practice and teach it.(4th ed.) (p.15). Edinburgh: Churchill Livingstone/Elsevier.

The PICO (or PICOT*, or other similar acronyms) format is a way to formulate an answerable clinical question. 

The components of this type of question are:

Patient population/disease: characteristics might include age, gender, ethnicity, or those with a specific disorder

Intervention or issue of interest: examples might include therapy, exposure to disease, a prognostic factor, or a risk behavior

Comparison intervention or issue of interest: examples might include an alternative therapy, placebo, or no intervention/therapy; no disease; a different prognostic factor; or absence of a risk factor

Outcome: examples might include the outcome expected from a therapy, risk of disease, accuracy of diagnosis, or rate of occurrence of an adverse outcome

Time*: Possibilities could be the time it takes for the intervention to achieve the outcome, or the time over which populations are observed for the outcome to occur

Fineout-Overholt, E., & Stillwell, S. B. (2011). Asking compelling, clinical questions. In B. M. Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare: A guide to best practice (p. 30). Philadelphia, PA: Wolters Kluwer Health.

Central issues in clinical work, where clinical questions often arise

1. Clinical findings: how to properly gather and interpret findings from the history and physical examination.
2. Etiology/risk: how to identify causes or risk factors for disease (including iatrogenic harms).
3. Clinical manifestations of disease: knowing how often and when a disease causes its clinical manifestations and how to use this knowledge in classifying our patients’ illnesses.
4. Differential diagnosis: when considering the possible causes of our patients’ clinical problems, how to select those that are likely, serious, and responsive to treatment.
5. Diagnostic tests: how to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, safety, expense, etc.
6. Prognosis: how to estimate our patient’s likely courses over time and anticipate likely complications of the disorder.
7. Therapy: how to select treatments to offer our patients, that do more good than harm and that are worth the efforts and costs of using them.
8. Prevention: how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.
9. Experience and meaning: how to empathize with our patients’ situations, appreciate the meaning they find in the experience, and understand how this meaning influences their healing.
10. Improvement: how to keep up-to-date, improve our clinical and other skills, and run a better, more efficient clinical care system.

Straus, S. E., Glasziou, P., Richardson, W. S., & Haynes, R. B. (2011). Evidence-based medicine: How to practice and teach it. (4th ed.) (p. 18). Edinburgh: Churchill Livingstone/Elsevier.

Question type: Intervention or therapy
Definition: To determine which treatment leads to the best outcome
Template: In (P), how does (I) compared with (C) affect (O) within (T)?

Question type: Etiology
Definition: To determine the greatest risk factors or causes of a condition
Template: Are (P) who have (I), compared with those without (C), at __ risk for (O) over (T)?

Question type: Diagnosis or diagnostic test
Definition: To determine which test is more accurate and precise in diagnosing a condition
Template: In (P), are/is (I) compared with (C) more accurate in diagnosing (O)?

Question type: Prognosis or prediction
Definition: To determine the clinical course over time and likely complications of a condition
Template: In (P), how does (I) compared with (C), influence (O) over (T)?

Question type: Meaning
Definition: To understand the meaning of an experience for a particular individual, group, or community
Template: How do (P) with (I) perceive (O) during (T)?

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Asking the clinical question: A key step in evidence-based practice. The American Journal of Nursing, 110(3), pp. 58-61. doi: 10.1097/01.NAJ.0000368959.11129.79

Appreciation to Duke University Medical center Library & Archives, upon whose guide, Evidence-Based Practice (https://guides.mclibrary.duke.edu/ebm/home), this page is partially based.