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Physical Therapy

A helpful Library Guide for Physical Therapy students, faculty, and staff.

Step 1: Formulate Your Question

The first step of evidence-based practice (EBP) is to identify a gap in your knowledge and convert it to a focused and searchable clinical question. PICO is a common question format used in the health sciences to create clinical questions. PICO is an acronym, illustrated by the below graphic. 

P - patient, population, problem; I - intervention, exposure, test; C - comparison; O - outcome
Not every PICO question will use each PICO component. Other PICO questions will include additional components, such as T for Time, or S for Study Design. It all depends on the question you are asking. Here is an example PICO question: 

For long term patients (P), how does the use of therapy dogs (I) during their stay compared with mindfulness initiatives (C) affect patients’ emotions (O)? 

To learn more about adapting PICO or using other question frameworks, follow this link. 

Step 2: Turn Your Question into Search Terms

Once you have your question, you can use your PICO components to help you build your search. This is a big task, but creating a table can help you begin.

Creating a simple table like the one to the right, can be a really helpful guide to keeping your thoughts organized. 

  1. Create a row in your table for each component of your PICO question.  
  2. Come up with a list of synonyms related to each component of your PICO question, the more the better (remember that not all authors use the same terms you may think to use).
    • Pro Tip: As you find articles that are highly relevant to what you want to research, look through that article's keywords. This is a really good way to "mine" for more synonyms, and get more relevant articles!
  3. Does the database you are using have a "controlled vocabulary?" If it does, make sure that you include those concepts as both a controlled vocabulary term and a keyword. For example, the database PubMed uses Medical Subject Headings, or MeSH terms, as shown in the table. Make sure to include those in your search strategy for best results with PubMed. 
    • To learn more about finding and using MeSH terms, check out the tutorials available on this page. 

Step 3: Combine Your Search Terms with Boolean Operators

Once you have your search terms, you will start putting together a search strategy. This tells the database what you want to search. AND, OR, and NOT (Boolean Operators) are the tools you will use to combine your search terms and PICO components. Each has a unique function and does something different to your search, as illustrated in the image below: 

cats AND dogs, venn diagram filled in in the overlapping part: The article I need must have information about both cats AND dogs. It must mention both; cats OR dogs, venn diagram filled in completely on left, right, and overlapping parts: The article I need can be about cats OR dogs OR both. Really as long as it's one or the other, I'm good; cats NOT dogs, venn diagram filled in on left side but not overlapping or right sides: I need an article about cats, but definitely NOT about dogs. I suppose it could include other animals as well as cats

  • Use OR to combine your synonyms
  • Use AND to combine your PICO concepts
    • Pro Tip: You will want to use as many synonyms as possible in addition to the database vocabulary. Why? Some researchers use the term "dog," others may use "canine," and still others maybe a specific breed like Golden Retrievers. You want to make sure you get ALL the relevant results possible for your research.

Remember that databases search terms not meanings. If you search with a "NOT dogs" everything that has the four letters DOGS will be excluded, whether it is an author's name, journal abbreviation, or found in the title/abstract.

Step 4: Combining Your Search Terms and Boolean Operators

Now that you have your search terms and the Boolean Operators you will use, you can build your search string. Using the question from the table above, the search strategy will look something like this: 

(Long Term Patients OR Long Term Care OR Extended Hospital Stay OR Length of Stay[MeSH])
AND
(Therapy dogs OR Therapy Canine OR Animal Therapy OR Animal Assisted Therapy[MeSH]) 
AND
(Mindfulness OR Self-care OR Self Care OR Mindfulness[MeSH]) 
AND 
(Feelings OR Attitude OR Emotions OR Emotional State OR Mood OR Emotions[MeSH])