PICO #1 & Search Strategy Worksheet

Name: Taylor Mills

1. Define your question using the PICO strategy

Elements of a Good Question Your Scenario:

Patient, Population Or Problem: Describe Fifty-year-old middle-aged male with a unilateral R THA
key patient features.

Anterior surgical approach

Previous history of spinal surgery in 1995 (microdiscectomy

between L4 and L5 due to herniated disk due to traumatic
event)

No medical comorbidities
Intervention: What main intervention, treatment, Body weight harness treadmill system for pre-gait training
prognostic factor, exposure, etc. am I considering?

Comparison (If appropriate): What is the Not using body weight support treadmill system. Basically,
alternative treatment (intervention, prognostic factor,
exposure, no treatment, etc.)? using standard physical therapy with ROM, strength, and/or
ambulation training.

Outcome: What are you trying to accomplish, Improve ambulation distance using the 2-minute walk test
improve, or affect? Remember you must be able to
measure an outcome.

2. Use the PICO elements to formulate an answerable clinical question.

The Question is: Is using a body-weight harness treadmill system more
effective at improving ambulation distance using the 2-minute
walk test in middle-aged males with a unilateral THA than
performing standard physical therapy interventions of gait
training and therapeutic exercise, without a body weight
treadmill system?

3. Plan your Search Strategy

a. How would you categorize this question?

 Therapy □ Prevention □ Diagnosis □ Etiology □ Prognosis

 b. i. What type of evidence would best answer this question (Meta-Analysis,
Systematic Review, RCT, Cohort Study, Case Control Study, Case
series or Report, Editorials, Letters, Opinions, Animal Research, in
Vitro/Lab Research, etc.). ii. If you do not find this, what would be your
next choice? iii. What type do you think you will find?
A systematic review of randomized control trials would be the best type of evidence to find for
this question involving interventions/therapy. If I could not find this, I would look for a single
clinical randomized control trial study. I am hoping to find a systematic review of randomized
control trials, but I think I may mostly find random control trials on this topic.

c. What are your key inclusion criteria (sex, age, species, years . . .)?

1. Using body-weight treadmill system as an intervention

2. Having a total hip arthroplasty
3. Having a unilateral THA
4. Middle aged (50 years-old)
5. Male
6. Anterior approach THA
7. Includes 2-minute walk test as an outcome measure
8. No main comorbidities, such as DM, HTN, CHF

What are your exclusion criteria (any confounding or irrelevant terms you
want to exclude)?
1. Not using body-weight treadmill system as an intervention
2. Bilateral THA
3. Studies involving an average age for THA of 65+ years old
4. Posterior surgical approach for THA
5. Females

d. Where will you search (EBM Reviews, PEDro, CINAHL, etc.), which
will be your first choice, and why? If this does not work, where next?
Need to say why you picked this one over the others.

I will search PubMed first because my topic about total hip arthroplasty is a common
population that is treated across multiple medical disciplines, so I thought I would start here
using a broad source. I could continue to refine my search until I chose an article. I could also
try looking at CINAHL because this is more specific to my topic and is a database for allied
health professionals. I could use an advanced search with this database as well. I am not
familiar with PEDro, but we just learned about this in class and it is a database specifically
for physiotherapists, so I may also want to familiarize myself with this database and look for
articles here.
 e. Include a clear description of how you refined your search and
ultimately reached a decision on an article. Explain why you made your
choice.
PubMed: My key words were “total hip arthroplasty or hip replacement” and “body weight
supported treadmill training.” I only had one article appear from 2009, but this was a systematic
review of clinical randomized control trials. If this had given me a lot of results, I would have
further advanced my search by limiting the publication date from 2014-2019 and added in more
key words.

Because I had limited results, I then went to CINAHL. I used the same key words “total hip
replacement or total hip arthroplasty” and “body weight supported treadmill training.” I only got
3 sources from this, but they all involved using body weight treadmill training with patients who
had neurological conditions. These articles were not an appropriate fit to my inclusion criteria
about THAs.

Then I tried PEDro. I used “body weight supported treadmill training” in the title, chose
“skill training” in the therapy section, “thigh or hip” for the body part, “orthopaedics” for the
subdiscipline, and a published date from 2000 to 2019 to start my search. I found one article
again and this was the same systematic review of randomized controlled trials that I found using
the PubMed database. From here, I decided that there may be limited resources on this topic
because using body weight supported treadmill training is more commonly used as an
intervention with patients who have neurological conditions; not THAs. Because I had started
getting the same results, I decided to use this article.

f. List the article in correct AMA format using AMA Stat! or the AMA
manual as your guide and using the correct journal title abbreviations.

Di Monaco M, Vallero F, Tappero R, Cavanna A. Rehabilitation after total hip arthroplasty: a

systematic review of controlled trials on physical exercise programs. Eur J Phys Rehabil

Med. 2009;45(3):303-17. https://www.minervamedica.it/en/journals/europa-

medicophysica/article.php?cod=R33Y2009N03A0303. Accessed June 28, 2019.

 PICO & SEARCH STRATEGY ASSESSMENT

Student Name: ____________________________

1. Clinical Question/PICO (15 points) _________________

2. Search Strategy and Explanation of Rationale (20 points) __________________

a. Category of Question
b. Type of Evidence
c. Inclusion and Exclusion Criteria
d. Choice of places to search

3. Selection of Article (15 points) __________________

a. Description of search results and selection process
b. Article selection
c. Article in correct AMA format