NURS 350 The Clinical Issue and Research Questions Using PICOT

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NURS 350 The Clinical Issue and Research Questions Using PICOT

NURS 350 The Clinical Issue and Research Questions Using PICOT

PICOT is an acronym used to help develop clinical research questions and guide you in your search for evidence:

P = Patient population

I = Intervention or issue of interest

C = Comparison of interventions or comparison of interests

O = Outcome

T = Time frame

For example, you may wish to research if the timing of IV tubing changes affects the development of CLABSI, using this PICOT model:

In _____(P), what is the effect of _____(I) on ____(O) compared with _____(C) within ______ (T)?

In patients on the acute care medical surgical floor (P), what is the effect of changing continuous IV tubings every 96 hours (I) on the incidence of CLABSI (O) versus every changing continuous IV tubings every 48 hours (C) during a 6-month tracking period (T)?

Assignment Directions

Begin by selecting a topic in nursing or medicine that is of interest to you. Next, use PICOT to format possible research questions about that topic. Provide three possible PICOT research questions related to the chosen topic (each question will have a different direction on the same topic).

Include the following:

Provide a brief description of the topic and background information.

Explain the significance of the topic to nursing practice.

Provide three clearly stated PICOT questions.

Your paper should:

Include a Title page and a Reference page.

Be 2–3 pages (not including the title page and reference list).

Use current APA Style to format your paper and to cite your sources.

Review the rubric for further information on how your assignment will be graded.

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RCT Design Example Using PICOT

Dosage effects of spinal manipulative therapy for chronic neck pain

Neck pain is second in frequency only to low back pain among musculoskeletal complaints reported in the general population and among those presenting to manual therapy providers., Chronic neck pain (i.e. neck pain lasting longer than 90 days) is a common reason for presenting to a chiropractor’s office, and such patients often receive spinal manipulation or mobilization. Recent systematic reviews of RCTs and prior observational studies have shown increases in cervical range of motion,, and decreases in self-rated neck pain, following cervical spine manipulation. In 2010, the Cochrane systematic review concluded, “Optimal technique and dose need to be determined.”

Despite evidence of benefit, there is a limited understanding of the optimal dose for neck manipulation; as such, frequency and duration of this treatment varies greatly between clinicians. Although patient characteristics and clinicians’ beliefs likely account for some of this variation, it seems likely that many cases of mechanical neck pain will require a minimal number of spinal manipulative therapy (SMT) treatments to derive benefit and that no further benefit will result after a certain upper threshold is reached. To properly examine the dose effects of manipulation for neck pain, it is necessary to consider three treatment factors:

  1. frequency

  2. intensity

  3. total number of manipulations

 

A factorial design RCT allows investigators to consider more than one treatment factor at a time and examine possible interactions between them. This trial design allows for determination of, not only, the effects of frequency and duration, but also whether it is more effective to provide a certain number of manipulations over shorter or longer durations (i.e. an interaction between the two factors). Considering a 3×4 factorial design, patients would attend 1, 2, or 3 sessions per week (i.e. the first ’factor’ of frequency) with manipulation provided over a duration of 2 weeks, 4 weeks, 6 weeks, or not at all (i.e. the second ‘factor’ of duration). To improve generalizability of findings, neck manipulation could be performed using standard rotary or lateral break diversified technique, which is the most common manually applied neck manipulation in chiropractic practice. Pain relief is a common concern among patients presenting with neck pain and detection of a resulting difference of 13 mm on the 100mm Visual Analog Scale (VAS) line is considered a clinically important change in intensity for patients with chronic pain.

Research Question: In adults with chronic neck pain, what is the minimum dose of manipulation necessary to produce a clinically important improvement in neck pain compared to supervised exercise at 6 weeks?

  • (P) – Population: Adults 18 to 60 years of age, with a clinical diagnosis of chronic mechanical neck pain who have not received cervical SMT in the past year. Patients with non-mechanical neck pain or contraindications to cervical manipulation will be excluded.

  • (I) – Intervention: Subjects randomized to have manipulation would receive standard rotary or lateral break diversified technique once, twice, or three times per week over a period of 2, 4, or 6 weeks  These subjects would also receive the same exercise regimen given to the control group to eliminate exercise as a second variable affecting outcomes.

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