Questions can be created to answer a question in practice, or as an aim for research, so you must be clear which goal you are aiming for!
For both, you must first think of the question in narrative format, that describes the purpose and aim of your review.Then you need to break down the narrative question (using PICOT, SPICE, ECLIPSE or SPIDER tools) so you can identify each concept that needs to be searched for. To create a good research question, there are different tools you can use as a guide to identify the different concepts your question is made up of. Each of them is best suited to a different type of aim and question:
PICOT tool (Riva et al 2012) for clinical quantitative diagnosis-type questions, where there are two well-defined alternatives you are comparing. Eg. Does medication A more effectively reduce glaucoma in adults aged over 70 than medication B?
SPICE tool (Booth 2004, 2006) for intervention qualitative evidence-type questions, especially where there’s policy or practical implications to consider, such as whether a policy/intervention has improved patient health or not. Eg. Do hip fracture patients who stay in hospital for over four days recover more quickly on wards where staff have completed a training course in compassionate care?
ECLIPSE tool (Wildridge & Bell 2002) for health service questions, especially where exploring relevant information rather than comparing two options. Eg. Has the new advertising campaign run by the Stop Smoking Service resulted in increased smoking cessation amongst smokers as reported by GPs ?
SPIDERtool (Cooke et al 2012) for qualitative-type questions, focusing on study design and samples more than interventions. Eg What are young parents’ experiences of attending antenatal education?
Examples of questions produced from these tools can be foundhere. Fink (1998) asserts that a good search will attempt to use MeSH terms (Medical Subject Headings), which are a bit like using a thesaurus to find similar words so you can ensure you’re not missing out anything in your search because someone else calls it by a different name!
Lots of different information sources are available to OTs when they are searching for evidence to guide their Evidence Based Practice. The different types each have different levels of usefulness related to patient care.
Some example sources and their uses are:
Guidelines – help OTs to make decisions quickly as you do not need to search and review literature yourself. Someone eg NICE has done this (plus taken into account the cost/benefit) already for you.
Protocols – defined steps or rules used to describe the process for a particular treatment or assessment. Often specific to local contexts; stricter and hold more weight legally than a guideline.
Blogs – useful to understand public opinion around a certain issue; can read a wide range of opinions and see what evidence is used to back each up (or question whether any has!). Is this where patients have researched healthcare in the absence of journal access, and does this explain their viewpoints?. Some professional organisations also have blogs, such as this BMJ evidence based nursing blog.
Theories – explanations of phenomena. They can be tested to see if they work in practice via research hypotheses, so in this way evidence could prove or disprove theory.
“the conscientious, explicit and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health (and social) care decisions” (Sackett et al. 2000: 71-72)
Evidence based practice will be important to me when I am making clinical decisions on my caseload as an Occupational Therapist.
It is also important to me a ‘civilian’ and someone who uses the NHS healthcare system in the UK. When I last visited the doctor, the antibiotics he prescribed would have been chosen from 100s available on the market, and it’s likely his decision was influenced (or dictated?) by the research done on the best antibiotic for my particular problem. It won’t have been one that would 100% guaranteed cure my problem, but the evidence would have pointed to the fact that there was very high chance it would. So s/he tried that one first. Read more ›