1. Asking Questions
Robert M. Rowell, DC, MS

2. EBCP Evidence Cycle ASK ASSESS ACQUIRE APPRAISE APPLY
Clinically relevant question
ASSESS
ACQUIRE
Best available evidence
EBCP
Evidence Cycle
APPRAISE
Quality and importance
APPLY
Evidence in patient care

3. Finding, Evaluating, and Applying Evidence
EBP is essentially about:
Recognizing clinical problems
Asking good clinical questions
Finding, critically evaluating, analyzing, and synthesizing evidence
Applying the most relevant evidence to clinical decisions and patient care recommendations

4. Types of questions Foreground Questions Background Questions Student
Experienced Clinician
Clinical Experience

5. Background Questions About the disorder, syndrome, condition
Often phrased with 2 components
Question: root + verb
“What causes…
The condition
…Lyme disease?”

6. Foreground Questions About patient care = clinical questions
Has 4 components (PICO)
P: Patient or problem
I: Intervention
C: Comparison
O: Outcome

7. Questions
Diagnosis
Prognosis
Etiology? Risk Factors?
Therapy

8. PICO Questions Therapy Diagnosis Prognosis Harm
Is one therapy better than another?
Diagnosis
What’s the best way to diagnose your patient?
Prognosis
What’s the most likely outcome for the patient?
Harm
What’s the impact of a risk factor?

9. Therapy PICO Patient or Population Intervention Comparison Outcome
How would I describe a group of patients similar to mine.
Post-partum women with SI joint pain
What main intervention am I considering
Spinal manipulation
What is the main alternative to compare with the intervention
Core stabilization exercises
What can I hope to accomplish, measure, improve or affect
Decreased pain and disability.
Do post-partum women with SI joint pain treated with spinal manipulation (adjustments) have decreased pain and disability compared with those treated with core stabilization exercises?

10. Diagnostic test PICO Patient or population Intervention Comparison
Outcome
Adults with low red blood cell count
Describe the patient
Serum ferritin blood test
New diagnostic test
Usual diagnostic test (Gold Standard test)
Bone marrow biopsy
Condition to be detected
Rule out iron deficiency anemia
In adults with low red blood cell count will serum ferritin blood testing compared to bone marrow biopsy rule out iron deficiency anemia.

11. Prognosis PICO
Patient
Intervention
Comparison
Outcome
Describe the patient
Adults with type II diabetes (NIDD)
Prognostic Factor
Elevated Hemoglobin A1c
No Prognostic Factor (or left blank)
Normal Hbg A1c
Health State
Increased risk of amputation
Among adult type II diabetics with elevated HbA1c is there an increased risk of amputation?

12. Harm PICO
Patient
Intervention
Comparison
Outcome
Describe the patient
Adults
Exposure
Tobacco smoke
Lack of exposure
(or left blank)
No smoke
Health State
Lung Cancer
Among adults exposed to tobacco smoke is there an increased risk of lung cancer?

13. Harm PICO
Patient
Intervention
Comparison
Outcome
Describe the patient
Elderly adults
Exposure
Resistance exercise
Lack of exposure
(or left blank)
No resistance exercise
Health State
Decreased risk of falls
Among elderly adults who perform resistance exercise is there a decreased risk of falling?

14. Questions are important
The question dictates where to look.
Background question: text book, etc
Foreground question: scientific health care literature
The better the question is phrased, the better the answer!