Formulating an Answerable Question
Evidence-based practice starts with a question:
What is the best intervention for this patient/client?
In clinical research, some questions are intended to lead toward a deeper understanding of the background of a disease or condition. Other studies ask foreground questions in order to analyze patterns and for predicting outcomes based on a given set of conditions.
Background Questions
- Background questions are asked to provide general knowledge that helps in understanding a disease, condition, or disorder
- A well-formulated background question has two basic components
- Uses a question root (who, what where, when, how, why)
- Includes an aspect of the condition or item of interest (disorder, test, treatment, or other health care aspect)
What are the effects of electrode size on patient comfort during large muscle NMES treatments?
Why are supraspinatus muscles the most commonly torn rotator cuff muscle?
When is it safe for adolescents to initiate a weight training program?
How does pulsed ultrasound enhance the inflammatory response in superficial soft tissue?
- Useful types of evidence to answer background questions can be found through text and web-based summary content which may include general statements about populations affected, incidence, causes, and/or prevention. Examples of reliable content sources for researching background questions include:
- WebMD
- UptoDate
- MedlinePlus
- Google and GoogleScholar
- APTA Rehabilitation Reference Center
- Basic search
- Diseases and Conditions
- Textbooks
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Foreground Questions
Foreground questions ask for specific knowledge to inform clinical decisions or actions. There are four general categories of foreground questions:
- Therapy/prevention - Questions which look to support or rule out a therapeutic approach (e.g., PT, bed rest, etc.)
- Diagnosis - Questions which look to support or rule out methods for diagnostic classification (e.g., carpal tunnel syndrome, herniated disc)
- Etiology - Questions which look to support or rule out the origin or contributing factors to the impairment, functional limitation, etc.
- Prognosis - Questions which look to support or rule out the conditions for recovery or progression of a condition/limitation.
A foreground question should contain for main elements in order to increase the specificity and applicability of the answer to the question. The acronym PICO is used to recall the four essentials of a foreground question:
PICO
Patient/Problem/Population - identifies who you are limiting your question to
Intervention - identifies the specific circumstances or conditions of treatment
Comparison - related to another patient/problem/population and/or intervention (e.g., control groups)
Outcomes - result of the intervention (e.g.., least, most, best, longest duration, fall frequency, patient satisfaction, etc.)
Now, go back to the LCC Research Guide to think about forming a good question
Answerable foreground questions rely on specific constraints or conditions to address a specific problem through standardized quantitative and/or qualitative measures. Once you have crafted a good question, you will be able to proceed with a directed search of the evidence to-date which addresses your clinical question. Useful resources (databases) to answer foreground questions are:
- Medline
- PubMed
- APTA Search tools
Many databases can be searched for specific levels of evidence on a research topic. Levels of evidence are discussed in more detail in this lecture.
The LCC Library offers access to many databases. In many cases, you have free access to full text articles if you access related databases through the LCC Library website. Your APTA membership is another great resource that you can take with you after you leave Lane and move into clinical practice.
This 6-minute video provides an example of how to use PICO strategies in APTA's Article Search and in PubMed to search keywords.
Other sources of evidence include links and publications through national authorities, like the Center for Disease Control and the National Institutes of Health (CDC, NIH)
