Lincoln Memorial University Libraries: Nursing Guides & Resources: PICO Questions

What is a PICO Question?

A PICO question is a structured framework used in evidence-based practice to formulate clinical research questions. This framework helps in developing focused and answerable clinical questions, making it easier to search for evidence and make informed decisions. PICO stands for:

PICO Examples

Smoking Cessation

Patient/Problem (P): Adults who smoke
Intervention (I): Nicotine replacement therapy (NRT)
Comparison (C): No intervention or placebo
Outcome (O): Smoking cessation

PICO Question: In adults who smoke, how effective is nicotine replacement therapy compared to no intervention or placebo in achieving smoking cessation?

Hypertension Management

Patient/Problem (P): Adults with hypertension
Intervention (I): Low-sodium diet
Comparison (C): Regular diet
Outcome (O): Reduction in blood pressure

PICO Question: In adults with hypertension, does a low-sodium diet compared to a regular diet reduce blood pressure?

Postoperative Pain

Patient/Problem (P): Patients undergoing knee surgery
Intervention (I): Use of ice packs
Comparison (C): No use of ice packs
Outcome (O): Reduction in postoperative pain

PICO Question: In patients undergoing knee surgery, does the use of ice packs compared to no use of ice packs reduce postoperative pain?

Diabetes Management

Patient/Problem (P): Adults with type 2 diabetes
Intervention (I): Metformin
Comparison (C): Sulfonylurea
Outcome (O): Control of blood glucose levels

PICO Question: In adults with type 2 diabetes, how does metformin compared to sulfonylurea control blood glucose levels?

PICO Clinical Scenario Examples

Pediatric Asthma

Scenario: You are a nurse in a long-term care facility and are interested in the best method to prevent pressure ulcers in immobile patients.

Patient/Problem (P): Children with asthma
Intervention (I): Inhaled corticosteroids
Comparison (C): Leukotriene receptor antagonists
Outcome (O): Reduction in frequency of asthma attacks

PICO Question: In children with asthma, how do inhaled corticosteroids compared to leukotriene receptor antagonists affect the frequency of asthma attacks?

Postpartum Depression

Scenario: You are a primary care physician, and you want to know if counseling can help reduce symptoms of postpartum depression in new mothers.

Patient/Problem (P): New mothers with postpartum depression
Intervention (I): Counseling or psychotherapy
Comparison (C): No counseling
Outcome (O): Reduction in symptoms of postpartum depression

PICO Question: In new mothers with postpartum depression, how does counseling or psychotherapy compared to no counseling affect the reduction in symptoms of postpartum depression?

Chronic Pain Management

Scenario: You are a pain management specialist, and you want to know if a new type of physical therapy can reduce chronic lower back pain better than standard physical therapy.

Patient/Problem (P): Adults with chronic lower back pain
Intervention (I): New type of physical therapy
Comparison (C): Standard physical therapy
Outcome (O): Reduction in pain levels

PICO Question: In adults with chronic lower back pain, how does a new type of physical therapy compared to standard physical therapy affect pain levels?

Diabetes Foot Ulcers

Scenario: You are an endocrinologist and want to know if regular foot exams can reduce the incidence of foot ulcers in diabetic patients.

Patient/Problem (P): Diabetic patients
Intervention (I): Regular foot exams
Comparison (C): No regular foot exams
Outcome (O): Incidence of foot ulcers

PICO Question: In diabetic patients, how do regular foot exams compared to no regular foot exams affect the incidence of foot ulcers?

PICO Resources

The TRIP (Turning Research Into Practice) Database is a clinical search engine that helps health professionals find high-quality research evidence quickly. The TRIP Pro's PICO question feature aids in formulating precise clinical questions and searching for relevant evidence effectively.

The Ovid PICO Resource helps healthcare professionals create structured clinical questions using the PICO format, enhancing literature searches and evidence-based practice.

Limitations to PICO

Formulating questions to explore complex interventions within qualitative evidence synthesis
"Formulating questions to explore complex interventions within qualitative evidence synthesis" by Booth et al. discusses strategies for developing precise questions in qualitative evidence synthesis. It emphasizes capturing the complexity of interventions, including context and outcomes, to enhance the rigor and relevance of the synthesis process.
CE: Beyond PICO—A New Question Simplifies the Search for Evidence
"Beyond PICO—A New Question Simplifies the Search for Evidence" introduces the PPCO framework (problem, population, change, outcome) as an alternative to PICO. Designed for evidence-based practice quality improvement (EBPQI) in nursing, PPCO aims to simplify evidence searches and provide a universal approach to question development for various nursing issues.
Using the full PICO model as a search tool for systematic reviews resulted in lower recall for some PICO elements
"Using the full PICO model as a search tool for systematic reviews" by Frandsen et al. found that employing the complete PICO framework (population, intervention, comparison, outcome) resulted in lower recall for some PICO elements. This study, published in the Journal of Clinical Epidemiology, highlights limitations in using PICO for systematic review searches.
Evaluation of PICO as a Knowledge Representation for Clinical Questions
"Evaluation of PICO as a Knowledge Representation for Clinical Questions" by Huang, Lin, and Demner-Fushman assesses the effectiveness of the PICO framework (population, intervention, comparison, outcome) in representing clinical questions. The study, conducted at the University of Maryland, explores how well PICO facilitates evidence retrieval and supports clinical decision-making.