Literature Search and Article Review

defining the question: PICO

1. patient (or problem)

2. intervention (or cause, prognosis)

3. comparison (or control)

4. outcome (what are you accomplishing)

when would you use PECO

for observational studies when you look at risk factors or the environment → E = Exposure

4 types of questions

1. therapy

2. harm

3. diagnosis

4. prognosis

therapy question

effect of different treatments

harm question

effect of harmful agents on patient function, morbidity, and mortality

diagnosis question

ability to distinguish those with and without a target condition or disease p

prognosis question

estimating the future course of a patient’s disease

search strategy for PICO

1. search for I

2. search for C

3. combine I and C

OR

1. search for P

2. search for O

3. combine P and O

article review: first pass

1. last paragraph of intro = purpose

2. last paragraph of discussion = conclusion

3. figures/tables

4. methods - experimental protocol

article review: intro

1. re-read purpose

2. does it progress in a logical fashion

3. does it provide a sound scientific basis for purpose

article review: methods

1. can the methods be replicated

2. subjects → number, description

3. experimental protocol

4. scientific procedures

subjects

• can the number included and variability of subjects meet the expectations of the purpose

• how does the subject pool limit the potential conclusion

• are the subjects similar to my patients/clients

experimental protocol/design

• manipulation of variables

• random assignment

• control groups

• blinding

• proper statistics

article review: results

1. figures and tables

2. are they able to stand alone

3. are they consistent with experimental design

4. are all data reported

article review: discussion

2. does it address the purpose?

3. does it cover all results?

4. are conclusions consistent and within scope of data

5. appropriate to speculate within reason

6. does it include most of the pertinent references

*significance or scientific worth is not determined by discussion

physiotherapy database (pedro) score

classifies the quality of an article

• 11 yes/no questions to assess quality

• quantifies whether results are meaningful and clinically relevant

numbers on pedro scale

0-3 = poor

4-5 = fair

6-8 = good

9-10 = excellent

quality assessment diagnostic accuracy studies (QUADAS) tool

classifies quality of an article

• evidence based tool to be used for quality assessment of diagnostic accuracy studies

• score greater than 7/15 = high quality, less then 7/14 = low quality

• some authors recommend articles to be 10/14 or higher for high-quality diagnostic accuracy