Physical Therapy Research Guide

Clinical questions may be categorized as either background or foreground. Why is this important?

Determining the type of question will help you to select the best resource to consult for your answer.

Background questions ask for general knowledge about an illness, disease, condition, process or thing. These types of questions typically ask who, what, where, when, how & why about things like a disorder, test, or treatment, etc. Reference books and textbooks are often your best resources for answering background questions.

Foreground questions ask for scientific evidence to inform clinical decision about a specific patient or particular population. Quite often, foreground questions investigate comparisons, such as two drugs, two treatments, two diagnostic tests, etc. You'll look to journal articles to answer foreground questions.

Foreground questions may be further categorized into one of 4 major types: treatment/therapy, diagnosis, prognosis, or etiology/harm.

Two additional important elements of the well-built clinical question to consider are the type of foreground question and the type of study. This information can be helpful in focusing the question and determining the most appropriate type of evidence.

• Therapy: Questions about treatment or intervention to achieve some outcome. This may include drugs, therapy techniques, counseling, etc. The types of studies that provide evidence to help answer therapy questions may include: meta-analysis, systematic review, randomized control trial, cohort study, case-control study, case study.
• Diagnosis: Questions about identifying a condition in a patient. The types of studies that provide evidence to help answer diagnosis questions may include: control trial, cohort study.
• Prognosis: Questions about the progression of a condition or likelihood of a condition occurring. The types of studies that provide evidence to help answer prognosis questions may include: cohort study, case control study, case series, case report.
• Etiology/Harm: Questions abpit the causes of conditions or negative impacts from an intervention or other exposure.The types of studies that provide evidence to help answer etiology or harm questions may include: cohort study, case control study, case series, case report.

Knowing the type of foreground question can help you select the best study design to answer your question, Look for the study design that will yield the highest level of evidence. 

The PICO model is a helpful tool that assists you in organizing and focusing your foreground question into a searchable query. Dividing into the PICO elements helps identify search terms/concepts to use in your search of the literature.

P = Patient, Problem, Population (How would you describe a group of patients similar to you? What are the most important characteristics of the patient?)

I = Intervention, Prognostic Factor, Exposure (What main intervention are you considering? What do you want to do with this patient?)

C = Comparison (What are you hoping to compare with the intervention: another treatment, drug, placebo, a different diagnostic test, etc.? It's important to include this element and to be as specific as possible.)

O = Outcome (What are you trying to accomplish, measure, improve or affect? Outcomes may be disease-oriented or patient-oriented.)

Not every question will have all PICO elements, but the PICO model is designed to identify key terms to use while searching the databases.