StudyLoop

Identify terms to fit your PICO question

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by

luna
in

To make your search as efficient as possible, it is a good idea to understand some of the basic principles of effective searching, which are:

  1. Carefully define your clinical question (you should have done this in step 1).
  2. Choose your key search terms.
  3. Broaden your search if necessary, with synonyms, truncation and/or wildcards.
  4. Use Boolean operators.

Consider your PICO question and convert this into a search strategy.  To do this, you should do three things:

  1. Underline the key terms – those most specific to your question
  2. Number the PICO elements in order of importance from 1-4
  3. Think of alternate spellings, synonyms and truncations

Example

Scenario: A 64 year old obese male who has tried many ways to lose weight presents with a newspaper article about ‘fat-blazer’ (chitosan). He asks for your advice.

Your question in PICO format might be:

Population/problem obese patients
Intervention/indicator chitosan
Comparator placebo
Outcome decrease weight

Question: In obese patients, does chitosan, compared to a placebo, decrease weight.

After converting into a search strategy you might end up with this:

Population/problem obese OR overweight (2)
Intervention/indicator chitosan (1)
Comparator placebo (4)
Outcome decrease weight OR kilogram* (3)

NOTE: ‘*’ is a truncation symbol that means further letters can be added to the word
OR finds studies containing either of the specified words/phrases, and broadens your search
AND finds studies containing both specified words/phrases, and narrows your search

Use these search terms to look for primary and secondary sources.

This mini tutorial shows you how to convert your search question into a search strategy that will work on any bibliographic database.

Look for secondary sources

  1. Guidelines (NICE, SIGN, National Guidelines Clearinghouse, New Zealand Guidelines Group, Open Clinical Practice Guidelines, Australian Clinical Practice Guidelines.)
  2. CATs (CAT Crawler)
  3. Online databases (Bandolier, Clinical Evidence, EBM Online, ACP Journal Club, Cochrane Library)
  4. Online databases specific to physiotherapy (PEDro, CEBP)
  5. Search several databases simultaneously use Trip Database
  6. Knowledge translation tools.

Clinical guidelines

Traditionally, clinical guidelines have been viewed with suspicion by anyone interested in working from the evidence base, as “guidelines” were often little more than one individual’s personal opinion. Over the past 5 years however, the approach to producing clinical guidelines has radically changed, with vast amounts of time and resources being poured into their development.

A clinical guideline focuses on the current understanding of a particular condition and makes use of a diverse range of academic literature to establish an approach to best practices, based on the outcomes of a large number of the studies available. They also inform the reader what level of evidence has been used to establish “best practice”, from systematic reviews of the literature (Level A) to expert clinical opinion (Level D). This allows the clinician to make up their own mind about how solid is the foundation upon which the guideline is built and how much weight to allocate it.

A few of the organisations responsible for developing guidelines are presented below (in no particular order). Since different organisations are tasked with developing different guidelines, you might have to look around until you find what you’re looking for. It should also be borne in mind that not only are new guidelines being developed all the time but old ones are typically reviewed every 2-3 years, so it’s always useful to ensure you have the latest version.

CATs

A critically appraised topic (or CAT) is a short summary of evidence on a topic of interest, usually focussed around a clinical question. Defined as a brief “summary of a search and critical appraisal of the literature related to a focused clinical question, which should be kept in an easily accessible place so that it can be used to help make clinical decisions”[1]. A CAT is like a shorter and less rigorous version of a systematic review, summarising the best available research evidence on a topic. Usually more than one study is included in a CAT. When professionals summarise a single study, the outcome is a critically appraised paper (or CAP). CATs and CAPs are one way for busy clinicians to collate and share their appraisals.

Read more about CATs

Online databases

There are an increasingly large number of online databases that serve as useful resources for both practising physiotherapists and students. They have content from a wide variety of journals, which saves researchers the sometimes painful job of trawling through individual publications. The following list is not comprehensive.

The Cochrane Library

The Cochrane Collaboration is an organisation that provides a reliable source of evidence based health information that it publishes in the Cochrane Library. From their website, “It includes reliable evidence from Cochrane and other systematic reviews, clinical trials, and more. Cochrane reviews bring you the combined results of the world’s best medical research studies”. The Cochrane Library also publishes podcasts, which are mostly medical in nature but which also contain content relevant for physiotherapists. For example,podcast on rehabilitation after lumbar disc surgery.

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Online databases specific to physiotherapy

PEDro

The Physiotherapy Evidence Database is an initiative of the Centre for Evidence-Based Physiotherapy (CEBP) and was developed “…to give rapid access to bibliographic details and abstracts of randomised controlled trials, systematic reviews and evidence-based clinical practice guidelines in physiotherapy”. For randomized controlled trials (RCT), PEDro rates studies on a 0-11 scale (a higher number is better). The links page on PEDro contains links to other useful resources for anyone interested in exploring the evidence base in health-related literature.

The Centre for Evidence Based Physiotherapy (CEBP)

The Centre for Evidence Based Physiotherapy has a “…mission is to search, collect and disseminate available scientific evidence in the physiotherapy domain for physiotherapists, health care workers, patients and financiers of health care”. All of the papers on it’s website are freely available.

Knowledge translation tools

Physiopedia is a resource that gathers the evidence and creates useable information that aids the knowledge transfer process.

Many research groups are also now collating thier evidence into user friendly tools to assist the transfger of research evidence into practice.  Two groups doing this that have published their knowledge transfer tools in Physiopedia are lead by Alison Hoens and Anita Gross:

Look for primary sources

A number of searchable databases exist, including MEDLINE, CINAHL and PubMed. Search strategies entail using 1 or more key words that may be found in the article’s title or abstract.

Use methodological filters to target the right type of study. For instance, PubMED filters for:

  • therapy
  • diagnosis
  • prognosis
  • aetiology
Related articles
Locating the Knowledge Sources in Evidence Based Practice – PhysiopediaIntroduction The second step in the evidence-based practice model involves finding the knowledge sources. This corresponds to the Acquire component of the 5 ‘A’s.[1] For more information on the evidence-based practice steps, please see: Defining the Evidence Based Practice Decision-Making Model. Locating the best evidence related to your PICOT clinical question can be challenging. There is a vast amount of information available on the internet, but clinicians face a number of challenges, including 1) determining which sources are reliable[2], 2) the amount of time it takes to find the relevant information[2], 3) deciding which information is of high-quality[2] and 4) knowing whether or not a selected resource or search will provide an answer.[3] Primary versus Secondary Research[edit | edit source] Primary research refers to a single research study conducted by a researcher or group of researchers which has been written up. Secondary research refers to synthesised findings and is usually in the form of a literature review. Secondary research, such as a literature review, usually reviews multiple primary research studies and summarises the research papers.[4] Database Searching Basics[edit | edit source] Start with a clearly defined clinical question using the PICOT format[5] refresh your memory of how to formulate your clinical question: Evidence Based Practice and Patient Needs Organise your keywords for your search according to the PICOT Table Use synonyms, related terms and / or truncation to broaden your search find relevant synonyms by searching online medical dictionaries or using the MeSH (Medical Subject Headings) function in PubMed[6] truncation – adding the first part of a keyword, usually followed by an asterisk (*) (Note: databases can have different truncation symbols, so check the help service of the database if you are uncertain). This way, any variant spelling of the word is searched. For example, rehabilit* will find rehabilitate; rehabilitates, rehabilitation, rehabilitated Use Boolean logical operators – AND/OR using Boolean operators leads to more focused results[4] AND – if all the search terms should be present in each article (different concepts and to be more specific) OR – if any of the search terms should be present in each article (same concept) This video demonstrates how to build a search using the PubMed advanced search builder: [7] If you would like to read more, please see: How to Perform a Simple Literature Search Remember to use the HELP files in databases to help you with your search strategy. Databases[edit | edit source] Choose the database that you want to search in. There are traditional databases and grey literature databases. With some of these databases, it is free to run a search, whereas others require a paid membership. Table 1. Examples of Traditional Databases (with links to their websites) Free to search Pubmed via Medline Cochrane Library Sciencedirect PEDro TRIP Pay to search Ebscohost Cinahl Scopus Web of Science Examples of Grey Literature Databases (with links to the websites where available): British Library EthOS Cochrane Central Register of Controlled Trials ClinicalTrials Google Scholar Databases with Free Articles[edit | edit source] Directory of Open Access Journals CORE Plos Journals Highwire ScienceOpen arXiv CiteSeer OpenDOAR The Social Science Research Network (SSRN) , Elsevier Paperity BioMed Central JURN Dryad Education Resources Information Centre (ERIC)   Semantic Scholar Zenodo Digital Library of the Commons Computer Science Bibliography EconBiz Scientific and Technical Information Programme Astrophysics Data System Artificial Intelligence (AI) Platforms[edit | edit source] Elicit SciSpace Semantic Scholar Research Rabbit Litmaps Connected Papers [8] [9] [10] Platforms with Synthesised, Evidence-Based Clinical Information[edit | edit source] UpToDate (paid) UpToDate (free) Medscape StatPearls Orthobullets Clinical Knowledge Summaries Physiopedia Platforms with Clinical Practice Guidelines[edit | edit source] National Institute for Health and Care Excellence Scottish Intercollegiate Guidelines Network (SIGN) Agency for Healthcare Research and Quality (previously National Guidelines Clearinghouse) National Centre for Complementary and Integrative Health – Clinical Practice Guidelines GuidelineCentral Guidelines International Network (GIN) Canadian Medical Association Infobase: Clinical Practice Guidelines Platforms with Systematic Reviews[edit | edit source] Cochrane Library Where to Find Full Text Papers[edit | edit source] Below are suggestions on ways to find full-text papers: Follow the link on the platform of the database that you searched Go straight to the journal or publisher’s website University library members – make sure you are logged into the university’s online library Google an article’s citation details E-mail the corresponding author Search for the author’s websites Request the paper from the author on ResearchGate or Academia.edu Find out if your university library has the option of inter-library loans Find a method that works best for you and save the articles you found and downloaded in a folder. Name them so you can easily find the article you are looking for.Critically Appraised Topics – PhysiopediaWhat is a Critically Appraised Topic (CAT) A critically appraised topic (or CAT) is a short summary of evidence on a topic of interest, usually focussed around a clinical question. Defined as a brief “summary of a search and critical appraisal of the literature related to a focused clinical question, which should be kept in an easily accessible place so that it can be used to help make clinical decisions”[1]. A CAT is like a shorter and less rigorous version of a systematic review, summarising the best available research evidence on a topic. Usually more than one study is included in a CAT. When professionals summarise a single study, the outcome is a critically appraised paper (or CAP). CATs and CAPs are one way for busy clinicians to collate and share their appraisals. Because they are client-centered and based on “real-life” clinical scenarios, CATs should appeal to clinical learners at all levels. Key parts of a CAT include:[edit | edit source] Purpose Reviewer Date of completion Date for review Well-built questions Search strategies and results Evidence retrieved Appraisal Conclusions Why do we need CATs?[edit | edit source] It is almost impossible for practitioners to keep up to date with all the new evidence for their field of clinical expertise.  All practitioners encounter questions that arise from real life clinical situations.  Evidence-based decision making in clinical scenarios demands time-efficient, up-to-date evidence review.  Critically appraised summaries of the best evidence for common clinical or educational questions address these needs.  The gold standard would be a systematic review, but this takes too much time and effort and is not practicable for clinicians. CATs as part of the EBP process[edit | edit source] CATs can form a structured part of the EBP process: 1. Develop a well-built question 2. Search for and select best evidence 3. Analyse the evidence – Write CAT 4. Apply the evidence to the clinical situation 5. Evaluating the application of the evidence – Revise CAT 6. Disseminating the findings  – Share CAT How to Construct a CAT[edit | edit source] Identify gaps in knowledge from client encounters Translate the problem into an answerable question Formulate a well-built question using the PICO framework Search for the best available evidence Examine and critically appraise the evidence Write the CAT using our Physiopedia Template Other CAT formats and approaches[edit | edit source] There are other different purposes of producing CATs which include: Answer explicit clinical question from real clinical situation.  This is the essence of EBP. Appraise a recently published article that is important; or summarize an article used to provide evidence as part of a guideline Validation Criteria for CATs[2][edit | edit source] Is the CAT valid? Was the CAT focused by a well-built question? What was the explicit and sensible process used to identify and select the evidence? Is it unlikely that relevant studies were missed? Was the evidence appraised the best available to answer the question? Were the appropriate validity criteria applied to the evidence appraised? Are the dates clearly stated? Date of search, date of publication, date of expiry. What is the CAT’s message? How strong is the message? Is it expressed in terms likely to be helpful in clinical management? Will the CAT’s message help me in the care of my clients? Can I apply the message in my client setting, to my clients? Were all clinically important outcomes, benefits, harms and costs discussed? Is the academic or training level of the authors or commentators clearly stated? Have the authors, site developers, and sponsors disclosed all competing interests? Is there a mechanism to contact the authors? Limitations of CATs[edit | edit source] Individual CATs can be wrong or inaccurate.  CATs appear first as drafts without peer review.  These first drafts may contain inferior evidence, or errors of fact, calculations, or interpretation. This can be turned into educational benefit whereby CATs can be revised in clinical or student projects. Individual CATs may have a short shelf life.  Cats can become obsolete as soon as newer, better evidence becomes available.  Without constant updating for newer, better evidence, their clinical bottom line becomes out of date.  Good quality CATs specify update date. Individual, one-article CATs contain only a single element of the relevant research literature.  These critically appraised papers (CAPs) are not comprehensive explorations for all useful articles and non-representative of the entire body of evidence.Systematic Reviews – PhysiopediaIntroduction A Systematic Review (SR) is a tool of quantitative research methodology that, through a systematic search and analysis of the literature, aims to answer to a research question. In fact, after identyfing all the literature relevant for contents and study design, it collects and analyses data from the studies included in the review. [1] A SR can include a meta-analysis, that allows to synthesize the quantitative data from the studies included into a single statistical analysis. The presence or not of a metanalysis depends mostly on criteria such as the homogeneity and quantity of the studies. [2] Systematic review methodology[edit | edit source] The following information reports the main steps of the process of carrying out a systematic review. [1] Research question formulation[edit | edit source] As for every work of research, the research question is the crucial step that guides the choice of the paradigm and of the methodology of research. The research question can come from a dilemma inherent to the clinical practice, a gap in the practical or theorethical knowledge, or a mix of these elements.[3] The systematic review is an approach that can be included in quantitative methodologies, because it shares the main features of this methodology, such as hypothesis testing, numerical data collection and analysis and the role of the researcher detached from the research. Search strategy and location of studies[edit | edit source] The search strategy is the way in which the researcher runs the elctronic search to select the articles to include in the review. There is not a list of search strategies among which we can choose one. In fact, a systematic review is supposed to describe in details the search strategy that was used, as it influences the quality of the study. The most important elements of a search strategy are: – balancing sensitivity and specifity. Where sensitivity means finding a high proportion of relevant studies, and specificity means finding a low proportion of irrelevant studies. [1] – selecting databases (the presence of a thesaurus improves the coverage) [4] – identifying MeSH terms to search, related to the research question or research framework (for example PICO). – using database-appropriate syntax (for example parentheses, Boolean operators, field codes, variations in search terms) Moreover, a search can also include other actions rather than electronic database search, such as reference lists checking and direct searching on key journals. Inclusion and exclusion criteria[edit | edit source] Inclusion and exclusion criteria interest the contents of the studies selected and their design. For the contents the PICO (Population, Intervention, Comparison, Outcomes) framework can be used. It summarizes the main components to consider when selecting studies. On the base of the objectives of the research, the researcher puts some inclusion and exclusion criteria for each of these components. The PICO framework is a useful tool for the inclusion/exclusion startegy, but it is not mandatory, as there are other strategies that are effective (for example the SPIDER framework for qualitative evidence synthesis). It is up to the researcher to adopt the most appropriate strategy for the research question. About the study design, the researcher decides a priori what types of studies to include and exclude, for example RCT, quasi experimental trials, cohort studies or combinations of them. More criteria can be added, for example language restrictions, free-acces studies, or published versus unpublished studies.[1] After having obtained a list of titles and abstracts, the studies that meet inclusion criteria are then reviewed in full. To ensure inter-rater reliability the review process has to be done by two or more researchers. All reviewed studies should be recorded with thier own reasons dor inclusion and exclusion. [1] Study selection[edit | edit source] Study selection starts with the review of the abstracts that have been retrieved by the search strategy. The full-text of the studies that seem to meet inclusion criteria are obtained and reviewed. This process is preferrably done by at least two reviewers to establish inter-rater reliability. A useful strategy is for authors to keep a log of all reviewed studies with reasons for inclusion or exclusion. In case more information about the study is required study authors may be contacted for information needed for data pooling (e.g., means, standard deviations). Translations may also be required. Data extraction[edit | edit source] The data extraction follows the identification of eligible studies. The aim of this step is to gain information about the included studies, and, in the case of a metanalysis, to obtain the quantitative data to carry out the statistical analysis. The information to be extracted from the studies are choosen by the researcher. The goal is to provide all the information necessary to generalise the results.[5] Quality assessment[edit | edit source] A systematic reviews evaluates the quality of the studies included through a risk of bias assessment. Different study designs have different risk of bias assessment tools. Here some examples of tools that can be used for three study designs: – RCT: Cochrane Risk of Bias tool (ROB) – case control studies: JBI Checklist for Case-Control Studies – cohort studies: CASP- Cohort Studies Data analysis and synthesis[edit | edit source] For meta-analyses, statistical programmes are commonly used to calculate effects sizes. An example of a statistical programme for data review analyses is the Review Manager (RevMan) endorsed by the Cochrane Collaboration. Reporting of effect sizes is combined with a 95 % confidence interval (CI) range, and presented in both quantitative format and graphical representation (e.g., forest plots). Forest plots visually depict each trial as a horizontal diamond shape with the middle representing the effect size (e.g., SMD) and the end points representing both ends of the CI. These diamonds are presented on a graph with a centre line representing the zero mark. Often the left side of the graph (< zero) represents the side favoring treatment, while the right side (> zero) represents the side favouring the control condition. At the bottom of the graph is a summary effect size or diamond representing all of the individual studies pooled together. Ideally, we would like to see this entire diamond (effect size and both anchors of the CI) falling below zero, indicating that the intervention is favoured over the control. In addition, most programs also calculate a heterogeneity value to indicate whether the individual studies are similar enough to compare. In this case, it is preferable to have non-significant findings for heterogeneity. It is still possible to pool studies when significant heterogeneity exists, although these results should be interpreted with caution or reasons for the heterogeneity should be explored. Interpretation of the synthesis of study results is the last step in the writing process. This process usually involves summarising the findings, and providing clinical and future research recommendations. Dissemmination of findings[edit | edit source] Some SRs (e.g. from the Cochrane Collaboration) are automatically published full text in the online database. Abbreviated versions of the review may also be published in relevant academic journals, as long as they are clearly indicated as such. In some cases, plain language summaries are also prepared for families and patients. Reporting[edit | edit source] Reporting of SRs and meta-analyses should be conducted in a clear, accurate and transparent manner. [6] The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and its update in 2020 provide guidance and a checklist of items that details reporting recommendations for SRs and meta-analyses of health, social or educational interventions interventions, irrespective of the design of the included studies. [6] Review updates[edit | edit source] Reviews should be regularly updated to ensure they are always up-to-date and relevant. Systematic Reviews in Healthcare[edit | edit source] SRs have a relevant role in Evidence Based Practice (EBP) because they are on the top of the pyramid in the hierarchy of evidence. As a result, conclusions are often used to guide assessment and treatment choices in routine clinical practice. SRs are also a key component of the content of Clinical Practice Guidelines (CPGs), which provide guidance and recommendations at a higher level of decision-making. As the results and conclusion of systematic reviews in healthcare are often not net and exclusive mostly due to the heterogeneity of studies, as a user of research it is important to analyse and interpret the all the information given by the systematic review. In fact, we can gain useful information for evidence based practice from the whole process of research of a systematic review, for example from the research question that identifies a gap in the knowledge and from the presence or not of studies on a topic and from their quality. Resources[edit | edit source] Cochrane – an international network providing and supporting best evidence for healthcare decisions. COSMIN – an international multidisciplinary initiative aiming to improve the selection of outcome measurement instruments both in research and in clinical practice by developing methodology and practical tools for selecting the most suitable outcome measurement instrument. PEDro – a free Physiotherapy Evidence Database including among others systematic reviews and meta-analyses on physiotherapy practice. PRISMA – Transparent Reporting of Systematic Reviews and Meta-analysesHow to Perform a Simple Literature Search – PhysiopediaIntroduction Finding the best evidence requires a systematic and strategic approach. It might be overwhelming at first, but searching literature can be mastered by learning the basic skills. Developing a search strategy starts with identifying the search topic, formulating a question then determining key words. There is a few basic techniques that apply on most databases, however, each one has some differences. It is always helpful to go through help pages of the database you are going to use. You can end up with a great number of results which is time consuming so you need to know how to critically appraise the literature to find the best answer for your preset question[1]. Where to Start[edit | edit source] There are many places to start looking for up to date literature, including hundreds of databases and online journals (some of which can incur a charge for articles and subscriptions; but we want to keep it simple and take a quick initial look to check what evidence is out there. A few great places to start are Cochrane Library, PubMed and Google Scholar.  You can also check databases and journals that are physiotherapy-specific such as: PEDro and Journal of Physiotherapy. When you find a paper that is relevant to your search it’s helpful to check the reference list for further evidence. Grey literature is another source for searching evidence. Grey Literature refers to data or studies published by government, academic, business and industry sectors but not available commercially. You can search these websites individually or using Google’s advanced search to further narrow your search results[1]. Formulating the Question[edit | edit source] There are two methods that you can use to formulate search questions: PICO Method: P – Population / Problem I – Intervention / Indicator C – Comparator O – Outcome 6Ws Method: What? Who? Which? Where? When? Why? How? Identifying Key Words[edit | edit source] For a quick search you can only pick 2 or 3 key words that will help us narrow down our search.  For example: I want to know; How effective are eccentric exercises in treating Achilles Tendinopathy? If we put the whole question into the search engine this gives us 35 results – A manageable number of papers to look through but of which 14 potentially are not completely relevant to our question.  So we pick the key words: Achilles Tendinopathy and Eccentric Exercise If we put this term into PubMed this gives us 140 results (at time of writing this page). A little too many to look through for a quick search. So we can apply some very simple constraints to our search to help us narrow down the number of papers but also keep the results relevant to our question: Boolean Searches[edit | edit source] When you rely on specific modifiers to do a search.  This will help you find the closest results to the key words/ phrases you are looking for.   You can include the following modifiers in your search: quotes, parenthesis, AND, OR and NOT You can use these terms in between your key words to make your search more specific.  They must be in CAPITAL LETTERS!  AND  “Achilles Tendinopathy” AND “Eccentric Exercise”   Will bring up everything in the search with both Achilles Tendinopathy and Eccentric Exercise.   If you do not put the AND, the search engine will automatically assume that there is an AND between the words.   OR “Achilles Tendinopathy” OR “Eccentric Exercise” This search gives us 691 results on PubMed. These papers include just Eccentric Exercise or just Achilles Tendinopathy .   This is also useful if we want to search for something which has more than 1 name like Physiotherapy and Physical Therapy.  The search will bring up all articles with either “Physiotherapy” OR “Physical Therapy”  NOT “Achilles Tendinopathy” NOT “Achilles rupture”   If you want to exclude a certain term from your search you can use the word NOT just before the term.  This means that your search results will exclude any article containing that term.   Quotation marks (“speech marks”)[edit | edit source] If you are searching for an exact phrase, like “Achilles Tendinopathy” you can put the phrase in quotation marks to group the words together. This will allow a search to be performed with the words in the exact order you typed them.  You can use the quotation marks in addition to other modifiers. If we enter Achilles Tendinopathy (without quotation marks) into the search engine, PubMed will automatically link the words using AND, which isn’t what we want (Achilles AND Tendinopathy). We want to use the term as a phrase to allow PubMed to search for the words linked together, so we use “Achilles Tendinopathy”.  The same again for Eccentric Exercise, we want to search for this together as a phrase “Eccentric Exercise”. When you apply this together “Achilles Tendinopathy” AND “Eccentric Exercise”  PubMED will give you 44 results of which are all relevant. Now go and have a go. Remember each database or search engine can be a little bit different so be sure to check out the help page. Parentheses/ Nesting ( )[edit | edit source] If you want to do a complex search you can combine terms and modifiers.  The parentheses enables the search engine to search for certain phrases/terms first, thus the term ‘nesting’ is used.     You will use parentheses to group phrases joined by OR, when another Boolean operator is used in the same search.   “Achilles Tendinopathy” AND “eccentric exercise” AND (physiotherapy OR “physical therapy”) Thus the results will have the first two phrases somewhere in the article, and either physiotherapy or physical therapy.  [2][3] Limiters/Filters[edit | edit source] Limit by date, gender, language, articles that include an abstract, etc. You can specify a full text search or limit to a search of abstract and title. Truncation and Wildcards[edit | edit source] Truncation can be applied to identify all possible endings, for example: pharm* will identify pharmacology, pharmacy, pharmaceutical. Wildcards are used to identify different spelling and plurals, for example: behavio?r, wom?n. Not all databases use truncation and wildcards so it’s helpful to check their help pages before using these constraints. [4] Identifying key research in your results and summarizing[edit | edit source] So now you should have been able to find a manageable amount of relevant articles from your search. Now you need to have a look through and see which articles might be worth reading.  A good place to start with this is in the abstract of the article, which is normally free to access and gives a brief overview of the subject, their methods and their findings. Sometimes we are unable to access the full journal without a subscription, but this is ok, we can still draw some conclusions from the abstract.  There are different levels of evidence available which is also a useful thing to look at in the abstract. The video below describes this in more detail:  [5] When looking at a systematic review it is important to look at the credibility of the review.[6] This can be done by reviewing the following: [6] Did the study design or execution lead to any misleading results? Was the eligibility criteria appropriate? Did the authors do a thorough literature search? Was all the results sufficiently summarized? So you have found a great article that is relevant and is a good level of evidence, what now? You should share this with colleagues or in the discussion forum of the course you might be taking in Physiopedia. What people need to know is a short summary of 1 or 2 sentences with the main points from the article, with a reference to the article so we can go and find it. Click here on how to reference a piece of work.   Resources[edit | edit source] Introduction to literature searching Use this template to help you through this simple literature searching: Template: Simple_Literature_Search Other Physiopedia pages which may be of use: Implement the evidence Evaluate the outcomeFormulate an answerable question – PhysiopediaRelated Pages Evidence Based Practice (EBP) Step1: Formulate an answerable question Step 2: Find the best available evidence Step 3: Appraise the evidence Step 4: Implement the evidence Step 5: Evaluate the outcome Description[edit | edit source] Every time we see a patient, we need new information about some element of the diagnosis, prognosis or management. Because our time to try to find this information is often limited, we need to be very efficient in our searching. To achieve this efficiency, we need to become skilled at formulating clinical questions[1]. This first step in evidence-based practice is to formulate a specific question. The question you have concerning your practice should be formulated so it is possible to find a scientific answer to the question. Posing specific questions relevant to a patient’s problem provides a focus to thinking, and it helps in the formulation of search strategies and in the process of critical appraisal of evidence.[2] Types Of Question[edit | edit source] Background Questions Background questions ask for general knowledge about a disorder and contain two essentials components[3]: A question root (who, what, where, how, why) A disorder or aspect of a disorder Textbooks answer background questions.  Not all topics are covered, easy to use, relatively inexpensive and can be opinion-based rather than evidence-based, written by experts in their fields. Foreground Question Foreground questions are descriptive and ask for specific knowledge about managing patients with a disorder.  These types of questions have a number of essential components (PICO analysis)[4]: P – Patient/problem I – Intervention C – Comparison or control O – Outcome PICO Questions[2][edit | edit source] Before we begin the hunt for evidence that relates to our clinical questions,we need to spend some time making the questions specific. Structuring and refining the question makes it easier to find an answer. One way to do this is to break the problem into 4 parts: Patient or Problem Intervention (cause, diagnostic test, treatment etc) Comparison intervention Outcome Patient or Problem Intervention Comparison Intervention Outcome Description of the patient or the target disorder of interest Could include: Exposure Diagnostic test Prognostic factor Therapy Patient perception etc. Relevant most often when looking at therapy questions Clinical outcome of interest to you and your patient Patient or Problem: This involves identifying those characteristics of the patient or problem that are most likely to influence the effects of the intervention. If you specify the patient or problem in a very detailed way you will probably not get an answer, because the evidence is usually not capable of providing very specific answers.  So a compromise has to be reached between specifying enough detail to get a relevant answer, but not too much detail to preclude getting any answer at all. Intervention : This includes the intervention that we are interested in and what we want to compare the effect of that intervention to. Type of treatment (drug, procedure, therapy) Intervention level (dosage, frequency) Stage of intervention (preventative, early, advanced) Delivery (who delivers the intervention? where?) Comparison intervention: This is relevant when looking at most ‘Therapy’ questions.  It compares the effect of an intervention to no intervention, or to another alternative intervention. There may not always be a comparison Outcome: The clinical outcome or effects you are interested in, for example: improvement of symptoms, reducation of pain, improved quality of life, cost effectiveness and benefits for the service provider. There are two additional elements that round out the well-built clinical question. These help in focusing the question and determining the most appropriate type of clinical evidence[5]: Type of Question : this is a question about — Harm or Exposure :  Diagnosis : How to select and interpret diagnostic tests Therapy : How to select treatments to offer patients that do more good than harm and that are worth the efforts and costs of using them Prognosis : How to estimate the patient’s likely clinical course over time and anticipate likely complications of disease Aetiology : How to identify causes for disease, including genetics Type of Study : what type of study would provide the best answer — Randomised Controlled Clinical Trials Meta-Analysis Cohort Studies Case Series Case Control Cross Sectional Example[edit | edit source] You are presented with this scenario: A 47 year old patient presented with unilateral low back pain after lifting some heavy boxes at work.  On examination you find that he has stiffness and pain on all movements and on unilateral joint palpation L2-L3.  You think that specific unilateral mobilisations would help to clear the joint symptoms in several sessions but have read in the literature recently that exercise therapy alone may be more cost effective. Think about the questions that might arise from this scenario: Can joint mobilisations reduce pain and stiffness in the lumbar spine. Is exercise therapy alone likely to create the same results. Patient or Problem Intervention Comparison Intervention Outcome Unilateral low back pain Unilateral mobilisations Exercise therapy Reduced pain and stiffness on movement We can now use this to formulate our clinical question: In a 47 year old man with unilateral low back pain, is exercise therapy alone more effective than joint mobilisations at reducing pain and restoring range of movement? Resources[edit | edit source] Check out the PICOT Research Question page for another explanation on using the PICOT formula, with some additional tips.

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