PICOT Research Question

Original Editor - Kapil Narale

Top Contributors - Kapil Narale  

Introduction[edit | edit source]

The PICOT research question is widely used throughout the medical field, whether you're a Clinician, Physician, or Student. Creating a detailed and purposeful research question is one of the first steps into investigating different sources of knowledge, and conducting one's own evidence based research to learn about a topic or condition, and further knowledge. This research is evidence based as it involves studies or reviews conducted by colleagues in the same or related disciplines. In turn, creating studies, and being able to conduct the research for further knowledge is a shared initiative between clinicians and researchers. [1]

Question Mark.jpg

It was developed by Physicians as an evidence based practice model as a way to consolidate any gaps in knowledge with patient interactions. As mentioned below, these would address factors such as diagnosis, prognosis, therapy, prevention strategies, and patient education. [2]

In exclaiming the important of mapping out a research question, it was noted by David L. Sackett, Officer of the Order of Canada and the founding Chair of Canada’s first Department of Clinical Epidemiology & Biostatistics at McMaster University, that: “one-third of a trial’s time between the germ of your idea and its publication in the New England Journal of Medicine should be spent fighting about the research question”. [1]

What is PICOT used for?[edit | edit source]

PICOT is used for creating or finding the best practice evidence based research. [1]

A PICOT question helps you,

  • form a question which focuses on an important issue for a patient or population
  • Identify important terms to use while searching for evidence
  • Filter for and select results directly related to your topic of interest

The PICOT question can fall under these categories: [3]

  • Therapy/Prevention
  • Diagnosis
  • Etiology
  • Prognosis

P[edit | edit source]

P represents Population/Patient/Problem [3] - this would indicate the type of person or population of people that you want to research about. Here, you can note their characteristics, and any health conditions that might be present, any health goals, or any other qualities. [1]

I[edit | edit source]

I represents Intervention - this would be the treatment, conditions, or changing factor present in the question you are creating. [1]

C[edit | edit source]

C represents Comparison - this would be the group you want to compare to, generally the control group, who receives no treatment, a general standard treatment, or a 'gold-standard' treatment. [1]

O[edit | edit source]

O represents Outcome - this is the result or outcome that you would like measured in your research question. This would indicate the result of the intervention in your question. [1]

T[edit | edit source]

T, is an optional component of PICOT which represents Time - the period, or duration of effect, that is a part of your research question. [1]

Creating a PICOT question[edit | edit source]

An example of a PICOT question developed from the Canadian Chiropractic Association, regarding neck pain is as follows,

"In adults with chronic neck pain, what is the minimum dose of manipulation necessary to produce a clinically important improvement in neck pain compared to supervised exercise at 6 weeks?" [1]

This was put together using the individual PICOT factors outlined, [1]

Icon of a person with a question mark for a head for amnesia, forgetfulness or dementia.png
  • (P) – Population: Adults 18 to 60 years of age, with a clinical diagnosis of chronic mechanical neck pain.
  • (I) – Intervention: Subjects randomized to have manipulation would receive standard rotary or lateral break diversified technique once, twice, or three times per week over 2, 4, or 6 weeks. They will also receive the same exercise program assigned to the control group, to eliminate a second variable in the study.
  • (C) – Comparison: A standardized supervised exercise program will be used as an active control group. All subjects will perform a standardized exercise program at each session during the 6 week period. The non-specific effects due to attending a clinic, will be minimized.
  • (O) – Outcome: Changes in neck pain, measured using the 100mm VAS for pain.
  • (T) – Time: The outcome would be measured weekly for 6 weeks.

Considerations[edit | edit source]

Although guidelines may be set by Professional Standards, Institutions, or Workplaces, there are some important considerations when designing a PICOT research question.

The detail of the literature search, including the breadth and quality of such detail would need to be considered. [1]

The targeted study design would need to be chosen.[1]

The exact patient population of the literature search will need to be chosen and defined. [1]

Each of the factors of the PICOT question will need to be clearly chosen and defined, to create the desired and an accurate and valid research question. [1]

Implications[edit | edit source]

It is interesting to note that there are some implications to using the PICOT research question method, of creating a study, more than researching to gather information. [1]

  • Many of these research questions are costly, time-constraining, and difficult to conduct, especially with an RCT study design.
  • Not every question that Clinicians would like answered are feasible with such a research methodology.

PICOT is not a useful methodology for non-clinical type of questions, such as Nursing theories. [3]

Not knowing how to correctly write a PICOT question can also be an issue with getting a successful outcome. The value of the question may be underappreciated, the purpose of the question may be misunderstood, or the approach to writing and using the PICOT formula may be taught incorrectly. With correctly creating the question, this would lead to an unbiased and effective search. [3]

If the question is not valued and created correctly, and with strength, there can many issues which can have a rippling effect through the EBP process, leading to recommendations which are not based on best evidence. [3]

Tips for Writing a Well-Designed PICOT Question[edit | edit source]

PICOT questions should not be wordy. Instead of writing, “hospitalized geriatric patients with dementia,” for the P, something simpler like, “geriatric patients with dementia” OR “geriatric dementia patients”, thus leading to a better search. [3]

The question should not have unnecessary words, but should only include key terms of interest. [3]

An "I" of "applying a sterile dressing" would be better replaced by "sterile dressing". Additional words such as “provide,” “implement,” “use,” “deliver,” or “apply,” add unnecessary words for the search engine to process. [3]

PICOT question should not be used to find evidence to support decisions that Clinicians have made, but rather should be used to find out the best practice. [3]

Instead of an "I" indicating "providing distraction activities", an "I" that indicated "interventions" or "strategies" would be better at finding effective search results, since your search should be the best practice that you or your colleagues are unaware about, or didn't know about. You wouldn't find the answer to a new question if you're only looking for a biased answer. [3]

PICOT questions should be written in the past tense, since you are looking find out about things that already occurred. However, research questions are written in the present tense. [3]

PICOT questions do not include directional terms, such as "increased" or "improved", as this will make the search biased. [3]

In addition, PICOT questions cannot be changed once written. Additional questions can be created, but you cannot changed a question that is already in use. [3]

It does take time and patient to write a good PICOT question, which will help make an productive and effective EBP search. [3]

Resources[edit | edit source]

Check out the series of pages under the Evidence Based Practice for creating research with best available evidence, and specifically check out the page Formulate an answerable question, for an in-depth explanation of the components of PICO.

The University of North Carolina has a great guide for creating and explaining PICOT questions, which can be found here: Forming Focused Questions with PICO: About PICO

This detailed instructional video from Binghamton University Libraries helps explain the components of PICO(T), and how to write a PICO(T) question: [4]

References[edit | edit source]

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 Riva John J, Malik Keshena M.P, Burnie Stephen J, Endicott Andrea R, Busse Jason W. What is your research question? An Introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic Association. 2012:56(3):167–171.
  2. UNC - University Libraries. Forming Focused Questions with PICO: Abut PICO. Available from: https://guides.lib.unc.edu/pico (accessed 27 August 2022).
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 Grand Valley State University - University Libraries. Nursing - Graduate: PICOT & Evidence Based Practice. Available from: https://libguides.gvsu.edu/c.php?g=108494&p=702791 (accessed 27 August 2022).
  4. Binghamton University Libraries. PICO: A Model for Evidence Based Research. Available from: (3) PICO: A Model for Evidence Based Research - YouTube (accessed 27 August 2022).