Formulating a Research Question:

Where do I begin?Katie Pantano, PT, PhD

Associate ProfessorCleveland State University

Learning Objectives

By the end of this presentation you will be able to:

1. Define what a researchable question is.

2. Describe the necessary steps to take to determine whether a topic is relevant, researchable, and significant.

3. Understand and know how to use common tools in the profession that can assist a researcher in framing a precise and specific research question.

What is a “Researchable Question?”

• An explicit query about a problem that can be challenged,

examined, and analyzed.

• Goal is to produce new or useful information that targets

an important clinical problem about patient care that may be

personally encountered in clinical practice or is of concern by

any PT or health-care practitioner, or the community.

Where do I begin?

First Step: Is the information I want to know matter to the rest

of the profession… will it impact or make significant

contribution to the PT profession?

• A research question should be specific and narrow enough to

answer it, yet broad enough to be meaningful to the profession.

A good Research question:• Details the problem statement

• Further describes & refines problem under study

• Adds focus to the problem statement

• Guides data collection and analysis

• Sets/guides the context of a research design.

Formulating a Research Question & Goals

• Research is only as good as the research question

and plan on which the research question is based.

• Study findings should bridge the gap between what is

“already known” and “what needs to be known”.

• What discrepancies/inconsistencies regarding PT

practice need to be resolved or will improve patient

care?

Characteristics of well-written, clinically necessary research questions

• Importance – how important is the question you’re asking? Will it

make a difference to the PT profession or improve patient care?

• Extremely specific – want to explicitly and precisely identify the

variables and population of interest.

• Feasibility - can variables be measured (financially/ethically) in a

realistic time-frame? Must have necessary means to measure them.

• Contextuality – how well does the question fit into the framework of

prior knowledge or evidence? Want to avoid “reinventing the wheel”,

but can explore a different aspect related to a similar concept.

• Interesting: Researcher should be passionate about the topic! Want

to also engage the interest and attention of reviewers, PT colleagues

& community!

To Prepare for the Task….. A Literature Review is Necessary!

• A review of previous research is necessary to identify where gaps in knowledge

exist. Can also inform you on methods or data collection processes used and what

potential limitations, objections, or shortcomings occurred.

• This is an iterative process. In early phases of research, it is common that the study

design or the research question is changed.

• Want to pose “Background” and “Foreground” Questions(discussed later)

• Read a few general reviews that identify unanswered problems. Return to the

literature after defining your research question & proposed study design.

• Perusing the literature in depth is needed (but a formal systematic review is not

done until a clear research question is developed – to be discussed later).

Additional Processes www.clinicalevidence.com

Here’s a “basic” 5-step clinical questioning process for conducting a

literature review and finding the best available evidence: 2

1. Formulate a feasible Clinical Question

2. Search for answers (Literature Review)

3. Appraise the evidence (Literature Review)

4. Compare results of previous studies to your proposed research question and identify “gaps in knowledge”.

5. Reformulate your clinical question to address new, necessary knowledge and reapply the steps.

(It’s suggested that “SYSTEMS” be a resource starting point (e.g. a Diagnosis, such as obesity), followed by a summary of high-quality systematic reviews/meta-analyses, then individual studies.

How can researchers ensure that their question addresses all critical aspects of what is being investigated?

• A major and important way to formulate the optimal question format is to conduct a literature review.

• To understand an area of research that you are potentially interested in you may want to develop the following:

Clinical “Background” Questions: provides “THE BIG PICTURE”

Clinical “Foreground” Questions: provide “SPECIFIC” &“PRECISE” information about specific clinical situations.

Clinical Background Questions8

General preliminary questions that provide the “big picture”. Can use

the “7 W’s” for framing Background questions:

Example: “What is sleep hygiene and how does it affect physical

health in adolescents?”

• Who

• What

• for Whom

• Why

• Where

• When

• how Well.

Clinical Foreground Questions

A more focused, specific, complex question that provides

precise Information about a specific clinical situation.

Example: “What is the relationship between the quantity and quality of sleep and obesity in adolescents?”

Specific frameworks can help develop a foreground question, using the following mnemonics:

PICO or PICOM

FINER or FINERMAPS

PICO or PICOM7

Useful for clinical therapeutic research, particularly RCT’s and

pragmatic research; questions about therapeutic interventions

that are highly specific.

P = Patient/Problem

I = Intervention

C = Comparison (some resources call this the “Control”) when a new therapy is compared with an existing one.

O = Outcome – the effect of the intervention (outcome)

M = Methodology

Facts about the Process

• After determining a foreground question, a PICO approach can be followed.

• Dissecting the question into parts makes it easy and searchable.

• Several relevant categories of questions can be asked concerning:

PT Treatment or Therapy

Prevention

Diagnosis

Prognosis

Etiology

• Information obtained from the PICO approach can assist in formulating and developing a researchable question. MORE INFO COMING!!!

Examples of using PICO:

P: In patients with knee OA

I: is hydrotherapy more effective (TREATMENT or THERAPY)

C: than traditional PT

O: in relieving joint pain?

P: For obese children

I: do community recreational activities (PREVENTION)

C: compared to educational programs on lifestyle changes

O: reduce the risk of diabetes mellitus?

More Examples:

P: For DVT

I: is D-dimer testing or (DIAGNOSIS)

C: Ultrasound

O: more accurate for diagnosis?

P: In healthy older women that suffer hip fractures

I: within one year after injury (PROGNOSIS)

C: none

O: what is the relative risk of death?

P: Do adults

I: who binge drink (ETIOLOGY)

C: compared to those who do not binge drink

O: have higher mortality rates?

Sorting out the Question Type and PICO Parameters

You can plug in information from your own clinical

question and area of interest to study….

THERAPY: In____________, what is the effect of ___________on __________ compared with _______? PREVENTION: For ______, does the use of _______reduce the future risk of ____ compared with ____? DIAGNOSIS OR DIAGNOSTIC TEST: Is _____ more accurate in diagnosing ______compared with _____? PROGNOSIS: Does ________ influence ______________ in patients who have ______________? ETIOLOGY: Are _______ who have_______ at_________ risk for/of _____ compared with/without____? MEANING: How do ____________ diagnosed with ____________ perceive _______________?

FINER or FINERMAPS4

F = Feasible: Do you have access to the target population, equipment, tools, statistical

know-how, Internal/external support (e.g. OPTA grant), other resources? A pilot study can test

procedures & determine if you really want to do the study or can fine-tune protocol. Do you

have enough time to do the study ? Ask ethical board if pilot study approval is needed.

I = is the study Interesting?

N = are the ideas Novel?

E = can study be performed Ethically?

R = how Relevant is the research question: does it provide new or novel information?

Requires a lit review to determine gaps/discrepancies. Is it possible to answer those questions?

M = how Manageable is it to carry out the study?

A = is the information Appropriate?

P = Potential value & Publishability If goal is to publish/present findings, it’s important to

know the research rigor needed (qualitative vs. quantitative methods are very different from

each other). Need to establish research design/methods early on for power and validity.

S = is the research design and study implementation Systematic?

Types of Research Questions7

• The type of specific and answerable research question asked

has critical implications for the study Methods. The study design

must match the type of research question! Types include:

• Descriptive “What impact do PPExams have on MS injury prevention in

female high school athletes?” Has to do with prevalence, incidence.

• Predictive (pragmatic research evaluates interventions or diagnostic

procedures that may impact future actions regarding patient care).

“How well does quadriceps muscle strength predict the likelihood of

developing knee OA after age 65?”

• Causal – Randomized Controlled Trials (RTC’s), longitudinal studies, etc.

A study of treatment effectiveness. “Is functional dry needling more

effective for treating chronic low back pain than cupping?

Logistics of a Research Question

Simple Research questions have 2 basic components: 1 stem, 1 topic.

Example: “What are the concerns of patients following organ transplant-ation? ” Stem is: “What are,” Topic is: concerns of patients after organ transplantation.

Complex questions have more than 1 stem and topic: “What is the relationship of age and educational level to positive adaptation following organ transplantation?”

• “Pruning” a research question: cutting away anything unnecessary, so only the essence remains. Avoid being too ambitious. Refine the research question into something interesting and feasible.

• Ask yourself: “What will this paper add to the body of existing literature” ? The best approach is to “begin at the end”, that is, to think about the conclusion you hope to support when you publish your research findings.

Quick Summary: How to begin writing your research question

• State the question in your own words

• Write down the Research Question as completely as possible

• Divide your question into concepts.

• Narrow to 2-3 concepts (avoid words that don’t add meaning)

• Specify the population to be studied

• Refer to the topic or intervention to be investigated

• Reflect on the outcome of interest (is it meaningful?)

Other important points while framing a research question

Make reference to a population when a relationship is expected

among a certain type of subjects

RQ’s and Hypotheses should be written as specific as possible.

Stick to what will be studied, not the implications of the study

Name the variables in the order in which they occur and will be

measured.

Avoid the words significant/”prove”

Avoid using two different terms to refer to the same variable.

Potential problems and solutions while formulating a research question

FOOD FOR THOUGHT…good & “not-so-good” examples

More Ideas about Research Questions

• Hypotheses start from previous knowledge and experience.

• When they are challenged by anomalies, clinicians and scientists and researchers seek new explanations.

• Build onto your experiences: engage in informal conversations with experienced colleagues and professionals in the field and outside of the profession.

• Be alert to new ideas! (journal clubs, national meetings, etc. What tests, questions or irregularities strikes your mind, that have defied your expectations?).

• Have a skeptical attitude about prevailing beliefs or unresolved issues.

When in doubt….seek advice!

Novice clinical investigators may be challenged, intimidated or

overwhelmed by the research process, so:

Seek the support of a research mentor:

Can be a local mentor or a well-known researcher in the PT

profession! Usually willing to share their own successes and

failures and pitfalls of conducting research!

If you don’t consider yourself “a writer”(or a statistician!)?….inquire about recruiting willing colleagues in or outside of the PT profession. For

writing skills, ask if the ideas you want to convey in your research

question, abstract or article are clear & easy to understand. Practice

will make perfect! Other alternatives are to hire or consider research

collaborators to assist you in your project! It can be collaborative & fun!

Take Home Messages

• A researchable question is simple and well-defined, as well as

specific, and relevant (will the findings makes a difference to your

colleagues, profession and/or community?)

• A researchable question explores gaps in knowledge that exist in

current evidence.

• Well-defined researchable questions need to be matched to the

right study design.

• A research project should be ethical and financially feasible and

of interest to the researcher conducting the study!

References

1. Conducting a literature review: [Conducting%20a%20Literature%20 Review%20 YouTube] Conducting a Literature Review YouTube (https://www.youtube.com/watch? v=1GPAoQiUFMU) Accessed: April 20, 2021

2. Gray M, Bliss DZ, Bookout K, et al. Evidence-based nursing practice: a primer for the WOC nurse. J Wound Ostomy Continence Nurs. 2002;29:283-286.

3. Higgins J, Green S, editors. Chapter 5: Defining the review question and developing criteria for including studies. In: Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011.

4. Hulley SB, Cummings SR.In: Hulley SB. Designing Clinical Research. Baltimore: Williams & Wilkins; 2007).

5. Israel H, Richter RR. A guide to understanding meta-analysis. J OrthopSports Phys Ther 2011;41(7):496-504. doi:10.2519/jospt.2011.3333

6. Kamper SJ. Engaging with research: linking evidence with practice.

J Orthop Sports Phys Ther. 2018;48(6):512-513.

doi:10.2519/jospt.2018.0701

7. Kamper SJ. Types of research questions: descriptive, predictive, or

causal. J Orthop Sports Phys Ther. 2020;50(8):468-469.

doi:10.2519/jospt.2020.0703

8. McKibbon K, Marks S. Posing clinical questions: framing the question

for scientific inquiry. AACN Clin Iss. 2001;12:477-481.

9. Physical Therapy, Movement & Rehabilitation Sciences: Evidence

Based Practice: What does PICO mean and what are the best

databases to use for a PICO search? Searchhttps://subjectguides

.lib. neu.edu/c.php?g=336073&p=2262575 Accessed: April 20, 2021

10. Vandenbroucke JP, Pearce N. From ideas to studies: how to get

ideas and sharpen them into research questions. Clin Epidemiol.

2018;10:253-264. Published 2018 Mar 6. doi:10.2147/ CLEP.S142940.

QUESTIONS?