Doctor of Nursing Practice

Understanding the PICO(T) Framework for Effective Research

The PICO(T) framework is a powerful tool used in evidence-based practice to formulate clinical questions and guide research searches. By clearly defining the elements of your question, you can effectively search for relevant studies and gather high-quality evidence. Here's what each letter in PICO(T) stands for:

• Patient or Population: Who is the patient or population group you are interested in? Consider characteristics like age, gender, condition, or risk factors.
• Intervention: What is the intervention, treatment, or exposure you want to study?
• Comparison: What is the alternative to the intervention? This might be a placebo, a different treatment, or no treatment at all. Note that a comparison is not always necessary.
• Outcome: What results or outcomes are you interested in? This could include improvement in symptoms, reduction in risk, or any other measurable effect.
• Time: Over what period is the outcome observed? The time element is not always included, but it can be relevant for certain studies.

Using PICO(T) helps you to create a focused and structured research question, which in turn makes your search for evidence more efficient and productive.

Breaking Down a PICO(T) Example: Reducing Falls in the Elderly

Let’s apply the PICO(T) framework to a specific example: studying the effectiveness of balance training in reducing falls among the elderly.

• P: Elderly individuals at risk of falls
• I: Balance training exercises
• C: No specific fall prevention program (optional)
• O: Reduction in fall incidence
• T: Time is not specified in this example

The clinical question we are exploring is: "In elderly individuals at risk of falls, does balance training exercises compared to no specific fall prevention program reduce the incidence of falls?"

You can now take each part of this question and enter it into its own search box in a database like CINAHL.

Using a Database with Multiple Search Boxes

In databases like CINAHL, you'll often find multiple search boxes available. This allows you to enter each PICO(T) element separately, which helps the database return more relevant results.

• In the first search box, enter terms related to the Population: elderly 
• In the second search box, enter terms related to the Intervention: balance training.
• In the third search box, enter terms related to the Outcome: fall reduction.

Expanding Your Search with Related Terms

To ensure you capture as many relevant studies as possible, consider adding related terms to each of your original search terms. This is where the use of "OR" becomes crucial.

For example:

• Population: elderly OR older adults OR geriatric
• Intervention: balance training OR balance exercises
• Outcome: fall reduction OR fall prevention

By placing OR between related terms, the database understands that it should bring back results that include any of these terms. Remember to use OR in capital letters so the database recognizes it as a command to search for any of the listed terms.

Example Search in CINAHL

Below is a screenshot of how this search would look in CINAHL, using both the main terms and their related terms to maximize your search results.