Practicum: Athletic Training
PICO
Evidence-Based Medicine
Frederic Murray
Assistant Professor
MLIS, University of British Columbia
BA, Political Science, University of Iowa
Instructional Services Librarian
Al Harris Library
frederic.murray@swosu.edu
APA
APA is a complex system of citation. When compiling the reference
list, the strategy below might be useful:
1. Identify the type of source:
Is it a book? A journal article? A webpage?
2. Find a sample citation for this type of source
Check a textbook or the OWL APA Guide:
http://owl.english.purdue.edu/owl/resource/560/01/
3. “Mirror” the sample
4. Make sure that the entries are listed in alphabetical order and that
the subsequent lines are indented (Recall References: Basics)
Article from a Database
•
Author, A. A., & Author, B. B. (Date of publication). Title of
article. Title of Journal, volume number, page range. Retrieved from
http://www.someaddress.com/full/url/
•
Smyth, A. M., Parker, A. L., & Pease, D. L. (2002). A study of
enjoyment of peas. Journal of Abnormal Eating, 8(3), 120-125.
Retrieved from
http://www.articlehomepage.com/full/url/
•
APA states that including database information in citations is not
necessary because databases change over time.
Article from a Database
• Include Permalink in Ebsco*
• DOI – Digital Object Identifier
•
Author, A. A., & Author, B. B. (Date of publication). Title of article. Title of Journal, volume number,
page range. doi:0000000/000000000000 or http://dx.doi.org/10.0000/0000
•
Brownlie, D. (2007). Toward effective poster presentations: An annotated bibliography. European
Journal of Marketing, 41, 1245-1283. doi:10.1108/03090560710821161
•
Wooldridge, M.B., & Shapka, J. (2012). Playing with technology: Mother-toddler interaction scores lower
during play with electronic toys. Journal of Applied Developmental Psychology, 33(5), 211-218.
http://dx.doi.org/10.1016/j.appdev.2012.05.005
DOI
• Author, A. A., & Author, B. B. (Date of publication). Title of
article. Title of Journal, volume number, page range.
doi:0000000/000000000000 or http://dx.doi.org/10.0000/0000
• Brownlie, D. (2007). Toward effective poster presentations: An
annotated bibliography. European Journal of Marketing, 41,
1245-1283. doi:10.1108/03090560710821161
• Wooldridge, M.B., & Shapka, J. (2012). Playing with
technology: Mother-toddler interaction scores lower during
play with electronic toys. Journal of Applied Developmental
Psychology, 33(5), 211-218.
http://dx.doi.org/10.1016/j.appdev.2012.05.005
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.
EBM
Clinical Expertise
Best Research
Patient Preferences
Why Evidence Based Medicine?
• Exponential Growth in Medical
Literature
• Impossible for Medical Practitioners to
keep up
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
what
what
what
P
I
C
O
about
about
about
about
the
the
the
the
Population?
Intervention?
Comparison?
Outcome?
PICO
The population/patient’s disorder or disease
The intervention or finding under review
A comparison intervention (if applicable)
The outcome
Pico: Example Question
• Among female high school athletes, does
a coach-led structured neuromuscular
warm-up program reduce lower extremity
injuries compared to standard nonstructured 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 warmups?
Population
?
Intervention
?
Comparison
?
Outcome
?
PICO Example
Population
female high
school athletes
Intervention
structured
neuromuscular
warm-up
program
Comparison
standard nonstructured
warm-ups
Outcome
reduce lower
extremity
injuries
Population
Intervention
Among female high school athletes, does a
coach-led structured neuromuscular warmup program reduce lower extremity injuries
compared to standard non-structured
warm-ups?
Comparison
Outcome
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 crosspins 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 complained
of acute onset of severe epigastric and right upper quadrant
abdominal pain shortly after completing a 50-m sprint. The
aching pain radiated to his upper back and was associated
with progressive vomiting without blood, bile, or "coffee
grind" emesis. He had been eating well before practice and
hydrating 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 & research your
question
– Export articles to Refworks
• Create APA Bibliography
Thanks!
Questions?
• Contact me:
• Frederic Murray
• 774-7113
• frederic.murray@swosu.edu