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Practicum: Athletic TrainingPICOEvidence-Based Medicine
Frederic Murray Frederic Murray Assistant ProfessorAssistant ProfessorMLIS, University of British ColumbiaMLIS, University of British ColumbiaBA, Political Science, University of IowaBA, Political Science, University of Iowa
Instructional Services LibrarianInstructional Services LibrarianAl Harris Library Al Harris Library [email protected]@swosu.edu
Abstract Criteria
• You will formulate a clinical question (PICO) that relates lower extremity evaluation. You will then do a literature review over that question to find a professional peer-review journal article that provides sound reason and answers to your clinical question.
Today’s Class
• Learn about EBM and how to formulate a good clinical question using PICO
Evidence Based Medicine
• Evidence-based medicine (EBM) is using and carrying out practices based on the best available knowledge.
Clinical ExpertiseEBM Best Research
Patient Preferences
Why Evidence Based Medicine?
• Exponential Growth in Medical Literature
• Impossible for Medical Practitioners to keep up
• http://tinyurl.com/d9dvuz5
Why Evidence Based Medicine?
• There are 7827 articles relevant to family practice published every month
• That’s 260 articles a day (every day) to keep up….
Why Evidence Based Medicine?
• There are a lot of Evidence Based Review Sources that Synthesize and critically appraise healthcare literature
• They can be found in Your Library
RCT- Gold Standard• Randomized controlled trials are
the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome
– Random allocation to intervention groups– Patients and trialists should remain unaware of
which treatment was given until the study is completed-although such double blind studies are not always feasible or appropriate
– All intervention groups are treated identically except for the experimental treatment
The fundamental skill necessary to conduct evidence-based medicine is learning to design a Well-Built Clinical Question.
Step 1: Well Built Question• With clinical cases, there is often
a barrage of details to digest.
• To effectively search EBM resources, you need to decide what details are important.
PICO: Detailed P: Patient, population, predicament, or problem. Information involves demographics such as age, sex and race. Other important information could include social situations, resources and patient values, and the clinical setting.
I: Intervention, exposure, test, or other agent. What type of intervention is being considered? Is this a medication of some type or a form of diagnostic imaging such as radiograph or ultrasound imaging? Or is the intervention at this point a given special test the sports therapist is using to determine the pathology?
C: Comparison, intervention, exposure, test, etc., if relevant. The treatment itself can only be compared with something else other than itself. The comparison may be with another medication, another form of imaging such as magnetic resonance imaging, to a current standardized treatment or to no treatment at all.
O: Outcomes of clinical importance, including time when relevant. What would be the desired effect you would like to see? What effects are not wanted? Are there any side effects involved with this form of testing or treatment?
Manske, R. C., & Lehecka, B. J. (2012). EVIDENCE – BASED MEDICINE/PRACTICE IN SPORTS PHYSICAL THERAPY. International Journal of Sports Physical Therapy, 7(5),
461–473.
Step 1: Well Built Question • what about the Population?• what about the Intervention?• what about the Comparison?• what about the Outcome?
P The population/patient’s disorder or diseaseI The intervention or finding under reviewC A comparison intervention (if applicable)O The outcome
PICO
Pico: Example Question
• Among female high school athletes, does a coach-led structured neuromuscular warm-up program reduce lower extremity injuries compared to standard non-structured warm-ups?
PICO Example • Among female high school
athletes, does a coach-led structured neuromuscular warm-up program reduce lower extremity injuries compared to standard non-structured warm-ups?
Population ?
Intervention ?
Comparison ?
Outcome ?
PICO Example Population female high
school athletes
Intervention structured neuromuscular warm-up program
Comparison standard non-structured warm-ups
Outcome reduce lower extremity injuries
Among female high school athletes, does a coach-led structured neuromuscular warm-up program reduce lower extremity injuries compared to standard non-structured warm-ups?
Population
Intervention
ComparisonOutcome
PICO: A State of Mind
• A systematic way to identify important concepts in a case
• Formulate a question for searching
• Often you will often not have a comparison intervention
Framing Good Questions
• Describe the subject– How would I describe a group of patients
similar to this one?”
• Define which intervention– taping versus ice
• Define the type of outcome– changes in a physical sign– outcome of a diagnostic test– response to therapy
PICO: Case 1#
• A 29 year old man presented with history of injury to his right knee whilst playing sports resulting in a complete ACL tear. He underwent successful ACL reconstruction with a four strand hamstring tendon autograft. The graft was fixed on the femur using two bioabsorbable cross-pins and on the tibia with an Intrafix screw and sheath. The patient presented 13 months following the ACL reconstruction with symptoms of knee pain, locking and catching. He did not recall any specific injury to the knee which initiated these symptoms .
PICO: Case 2#
A 19-yr-old Division I college football player complainedof acute onset of severe epigastric and right upper quadrantabdominal pain shortly after completing a 50-m sprint. Theaching pain radiated to his upper back and was associatedwith progressive vomiting without blood, bile, or "coffeegrind" emesis. He had been eating well before practice andhydrating without any pain or bloating. He denied any fevers,chills, diarrhea, headaches, food intolerance, or recent travel.He also denied the use of alcohol, tobacco products, drugs,or supplements.
V. Class Exercise
Worksheet– Develop PICO Questions for the case
studies – Search library databases to answer
your question (1 source) – List Citation (APA)
Thanks!
