Formulating Research Questions in Physiotherapy

Understanding Research Questions in Physiotherapy

Formulating a clear, answerable research question is the cornerstone of evidence‑based practice (EBP) in physiotherapy. This course walks you through the main types of questions, the PICO framework, and essential steps of the EBP process, while also highlighting academic integrity.

1. Types of Research Questions

In clinical research, questions are grouped by the purpose they serve. Recognising the category helps you choose the right study design and outcome measures.

• Diagnostic questions: Ask how accurately a test identifies a condition (e.g., "Is the Hawkin’s Kennedy test valid for detecting shoulder instability?").
• Prognostic questions: Explore the expected course or outcome of a disease (e.g., "What is the typical recovery timeline after an ACL injury?").
• Therapeutic questions: Investigate the effectiveness of an intervention (e.g., "How effective is physiotherapy for headaches?").
• Epidemiological questions: Concern incidence, prevalence, or risk factors (e.g., "What are the risk factors for osteoporosis?").

Example: Which type of research question investigates the expected course of an illness? The correct answer is a Prognostic question.

2. The PICO Framework

PICO is a mnemonic that guides you in turning a clinical problem into a searchable question.

• P – Patient/Problem: Who is the patient? What condition?
• I – Intervention: What treatment or exposure are you interested in?
• C – Comparison: What is the alternative or control?
• O – Outcome: What result(s) matter?

Key point: In many questions, one element may be missing, and identifying that gap sharpens the query.

Example: "Should I opt for exercise therapy or massage for the pain in my frozen shoulder?" The missing component is the Outcome measure (e.g., pain reduction, range of motion).

3. Applying PICO to Real‑World Scenarios

Let's dissect a sample question:

"What is the effect of surgery + physiotherapy compared to physiotherapy alone on return to sport in patients with an ACL injury?"

• P (Patient): Patients with ACL injury
• I (Intervention): Surgery + physiotherapy
• C (Comparison): Physiotherapy alone
• O (Outcome): Return to sport

Notice how each component is clearly defined, making the question searchable in databases such as PubMed or PEDro.

4. The Evidence‑Based Practice (EBP) Cycle

EBP is a systematic process that integrates the best research evidence with clinical expertise and patient values. The first step is crucial:

• Step 1 – Formulate an answerable question: Translate a clinical problem into a PICO‑structured query.
• Step 2 – Search for the best evidence.
• Step 3 – Critically appraise the evidence for methodological quality.
• Step 4 – Apply the findings to patient care.
• Step 5 – Evaluate the outcome and reflect on the process.

Example: The first step asks you to "Translate a clinical problem into an answerable question", not to start searching immediately.

5. Research Question Categories in Practice

Physiotherapists often encounter questions about screening tools, treatment efficacy, and diagnostic accuracy.

• Screening for depression with a short questionnaire falls under a Diagnostic question because it evaluates the tool’s ability to identify a condition.
• Assessing the effectiveness of physiotherapy for headaches is a Therapeutic question.
• Exploring the validity of a physical test (e.g., Hawkin’s Kennedy) is also a diagnostic inquiry.

6. Academic Integrity: Avoiding Plagiarism

Maintaining ethical standards in research and writing is non‑negotiable. Plagiarism is defined as presenting someone else's work as your own without attribution. Proper citation, even when paraphrasing or summarising, protects both the original author and your credibility.

Common misconceptions:

• Rewriting a source in your own words *without* citation is still plagiarism.
• Using a direct quote *without* quotation marks and citation is plagiarism.
• Summarising a source *with* appropriate citation is acceptable.

7. Quick Review Quiz

Test your understanding with the following questions. Click the answer you think is correct; the correct choice is highlighted in bold.

• Which type of research question investigates the expected course of an illness? Answer: Prognostic question
• A physiotherapist wants to know if a short questionnaire can screen for depression. Which research question category does this belong to? Answer: Diagnostic question
• In the PICO framework, what does the 'C' component represent? Answer: Control group or comparison
• Which of the following is an example of a therapeutic research question? Answer: How effective is physiotherapy for headaches?
• Using PICO, which element is missing in the question: "Should I opt for exercise therapy or massage for the pain in my frozen shoulder?" Answer: Outcome measure
• What is the first step of the Evidence-Based Practice (EBP) process? Answer: Translate a clinical problem into an answerable question
• In the PICO example "What is the effect of surgery + physiotherapy compared to physiotherapy alone on return to sport in patients with an ACL injury?", what does the 'I' component stand for? Answer: Surgery + physiotherapy
• Which of the following best describes plagiarism? Answer: Presenting someone else's work as your own without attribution

8. Practical Tips for Crafting Strong Research Questions

• Be specific: Define the patient population, intervention, and outcome clearly.
• Use measurable outcomes: Choose outcomes that can be quantified (e.g., pain score, range of motion).
• Align with clinical relevance: Ensure the question addresses a real‑world problem you encounter in practice.
• Check feasibility: Consider whether the required data or resources are accessible.

9. Further Reading and Resources

To deepen your knowledge, explore these reputable sources:

• Cochrane Library – Systematic Reviews
• PEDro – Physiotherapy Evidence Database
• PubMed – Biomedical Literature
• American Psychological Association – Publication Manual (for citation guidance)

By mastering the art of question formulation, you empower yourself to locate high‑quality evidence, apply it responsibly, and ultimately improve patient outcomes in physiotherapy.