Steps of critical appraisal and PICO

Steps of critical appraisal and PICO

1. process of critical appraisal requires us to review all the above aspects of validity (internal and external) as well as the issue of reliability

   • steps below show an example of the critical appraisal process, which is the core part of EBP:
     • 1.We start with a clinical question or problem about some real clinical issue that we need to answer.
       • 2.The question is then put into what is called a PICO format (see box below for details).
         • 3.The PICO helps us to clarify the issues to be reviewed and develop the correct search strategies to find the literature by using the relevant library databases
           • 4.Once we have completed our literature search and found the best study to review, we can use the steps for critical appraisal to check its internal and external validity.
             • 5. final step is the clinician's overview of all the evidence from the literature search, but now includes his/her clinical experience plus what the patient/client brings to the clinical relationship
               • e.g. patient does not want to take NSAIDs for her arthritis).
             • steps or questions we use for critical appraisal will differ depending on what type of study design was used in each of the articles we find in the literature search
       • I might be nursing a patient who asks me 'Is glucosamine better that non-steroid anti-inflammatory drugs (NSAIDs) in treating arthritis in women like me (>50 years)?'

2. PICO

   • Population
     • the population or patient group you are interested in.
     • t might be women aged 50 years and over living in rural areas.
   • Intervention
     • relates to the treatment terms or phrases in your question
       • does a specific drug or type of occupational therapy intervention work?
   • Comparsion
     • relates to alternative treatment that you might want to compare the current intervention with (if this is appropriate to your question).
       • the comparison could be another drug or a placebo
   • Outcome
     • is about what you trying to accomplish, measure, improve or affect for your clinical problem or patient.
       • improved mobility in women with arthritis.

3. E.g of PICO

   • P
     • Pregnant women with type 2 diabetes.
   • I
     • Insulin pump therapy.
   • C
     • Conventional insulin therapy.
   • O
     • Improved management of blood glucose levels.
   • The prob
     • A pregnant woman with type 2 diabetes is concerned about the effect that her current treatment may have on her pregnancy and unborn child. Her GP has heard that insulin pump therapy may be a more successful treatment than conventional insulin therapy. However, the GP wants to get his facts right, so searches the literature.
   • The Question
     • 'Are insulin pumps more effective than conventional therapies in managing type 2 diabetes in pregnant women?'