A comparison of patient, intervention, comparison, outcome (PICO) to a new, alternative clinical question framework for search skills, search results, and self-efficacy: a randomized controlled trial


  • Lorie A. Kloda Associate University Librarian, Planning & Community Relations, Library, Concordia University, 1455 boulevard de Maisonneuve O. LB-331.17, Montreal, QC, H3G 1M8 http://orcid.org/0000-0003-1429-1497
  • Jill T. Boruff Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, 809 Sherbrooke Street West, Montreal, QC, H3A 0C1 https://orcid.org/0000-0002-0338-7322
  • Alexandre Soares Cavalcante Doctoral (PhD) Candidate, Faculty of Education, McGill University, Montreal, QC




Evidence-Based Practice, Information Literacy, Randomized Controlled Trial, Clinical Questions, Information Needs, Rehabilitation Sciences


Objective: In educating students in the health professions about evidence-based practice, instructors and librarians typically use the patient, intervention, comparison, outcome (PICO) framework for asking clinical questions. A recent study proposed an alternative framework for the rehabilitation professions. The present study investigated the effectiveness of teaching the alternative framework in an educational setting.

Methods: A randomized controlled trial was conducted with students in occupational therapy (OT) and physical therapy (PT) to determine if the alternative framework for asking clinical questions was effective for identifying information needs and searching the literature. Participants were randomly allocated to a control or experimental group to receive ninety minutes of information literacy instruction from a librarian about formulating clinical questions and searching the literature using MEDLINE. The control group received instruction that included the PICO question framework, and the experimental group received instruction that included the alternative framework.

Results: There were no significant differences in search performance or search skills (strategy and clinical question formulation) between the two groups. Both the control and experimental groups demonstrated a modest but significant increase in information literacy self-efficacy after the instruction; however, there was no difference between the two groups.

Conclusion: When taught in an information literacy session, the new, alternative framework is as effective as PICO when assessing OT and PT students’ searching skills. Librarian-led workshops using either question formulation framework led to an increase in information literacy self-efficacy post-instruction.


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Original Investigation