Copyright © 2020 pubrica. All rights reserved 1

What is the Formulation of the Research Question in Systematic Review

Dr. Nancy Agens, Head,

Technical Operations, Pubrica

sales@pubrica.com

In Brief

Formulating a research question is the

challenging task for a researcher while

initiating a systematic review. This article

explains the different frameworks

available for formulating a high-quality

research question which includes PICO,

SPIDER, SPICE, ECLIPSE. A well-

formulated research question needs to

have extreme specificity and preciseness

that guides the implementation of the

systematic review while keeping in mind

the identification of variables and

population of interest.

I. INTRODUCTION

For a systematic review, formulating a

well-constructed research question is

mandatory. The first step in executing a

Systematic Review is to formulate the

research question. Without formulating a

well-focused research question, it can be

challenging and time-consuming to

identify suitable studies and search for

relevant evidence. Forming a good

research question is not a straightforward

process as it requires engaging with the

literature. Well-formulated research

questions will guide many aspects during

the review process, which includes

determining eligibility criteria, search

studies, data collection for included

studies, and presenting findings. There are

different techniques used for formulating a

research question.

Practitioners of Evidence-Based Practice

(EBP) often use a specialized framework,

called PICO, to form the question and

facilitate the literature search. A systematic

review question typically focused on

narrow parameters and usually fitted into

the PICO question format.

P – Patient | Population | Problem

Most important characteristics of

patients. Examples: Gender, age, and

disease or condition

I – Intervention or exposure

Main intervention. Examples: Drug

treatment, diagnostic and screening test

C – Comparison or control

Main alternative. Examples:

Standard therapy, placebo, no treatment

and gold standard

O – Outcome measures

What you are trying to accomplish,

improve, measure, affect. Examples:

Reduced mortality or morbidity, and

improved memory

For quantitative systematic review

question formation, PICO can be used

along with the variant such as PICOS (S-

Study design), PICOC (C-Context), and

PICOT (T-timeframe).

A well-formulated review question will

assist in determining the inclusion and

exclusion criteria, the process of data

collection, the design of the search strategy

and the presentation of findings. A quality

question will allow finding the study-

related information quickly, that are

relevant to the research studies and

accurately measures stated objectives. The

question also provides you with a checklist

for the main concepts to be included in

your search strategy.

Systematic review questions may be broad

or narrow in focus, but it is essential to

formulate the research question with care

to avoid lacking relevant studies or

collecting a potentially biased result set.

Several frameworks or models are

available to help the researchers develop a

research question, and some of the

alternatives are outlined below.

Copyright © 2020 pubrica. All rights reserved 2

Question Type Patient,

Population,

Problem

Intervention or

exposure

Comparison or

control

Outcome

measures

Therapy

(Treatment)

Patient's disease

or disease

condition

A therapeutic

measure such as

surgical

inventions,

medications or

change in

lifestyle

Standard care or

a placebo

Pain, mortality

rate, disability

Prevention Risk factors for

patient's and

common health

conditions

Preventive

measures

including

medications or

change in

lifestyle

Preventative

measures or NA

Disease

incidence, the

mortality rate

Diagnosis Specific disease

or disease

condition

Surgical

procedures or a

diagnostic test

The current

standard test for

that disease or

disease

condition

Sensitivity and

specificity

measures of the

test utility

The prognosis

(Forecast)

Time and

severity of

major

prognostic

factor of clinical

issues

Watchful

waiting

NA Rate of disease

progression,

survival rate,

the mortality

rate

Aetiology

(Causation)

Patient's risk

factors, general

health

conditions or

current health

disorders

The

intervention or

an exposure of

interest which

includes an

indication of

strength, dose

of risk factor

and the duration

of exposure

NA Rate of disease

progression,

survival rate,

the mortality

rate

Obtained from: https://canberra.libguides.com/systematic/question

For qualitative and mixed research studies,

SPIDER can be used as an alternative to

PICO

S – Sample

A qualitative research study is not

easy to generalize as the sample is

preferred over a patient

PI – Phenomenon of Interest

Rather than interventions, it looks

at the reasons for behaviour and decisions

D – Design

The type of research through

interview or survey

E – Evaluation

Outcome measures

R – Research type

Copyright © 2020 pubrica. All rights reserved 3

Quantitative, qualitative and mixed

methods

For qualitative evidence, SPICE can be

used

S – Setting (Where?)

Based on the location or

environment relevant to the research

P – Perspective or Population (for

Whom?)

The type of people that are being

studied

I – Intervention (What?)

The intervention, practice or

treatment that are used for evaluation

C – Comparison (compared with what?)

An intervention with which the

author compares the above comparator

E – Evaluation (with what result?)

The hypothetical result that is

intended to evaluate

For health policy and management

information, ECLIPSE can be used

E – Expectation

Improvement, Information or

Innovation

C – Client group

At whom the service is aimed

L – Location

where is the service located?

I – Impact

Outcomes

P – Professionals

who is involved in providing or

improving the service?

Se – Service

For which service are you looking

for information

Once you have a defined research

question, it is essential to make sure your

research is original, and it is not already

addressed. It can be identified through a

thorough search in the systematic review

databases (such as Cochrane Database of

Systematic Reviews, PROSPERO, The

Campbell Library, and Systematic Review

Data Repository (SRDR)) and be sure to

check with published reviews as well as

registered protocols.

In summary, a well-designed research

question is a starting point in conducting a

high-quality systematic review, as it will

determine the nature and scope of the

systematic review, and there are several

frameworks available for formulating a

research questing and search for a new

finding. Once the research question

formulation is done, it is very much

necessary to check with the database to

avoid repetition.

REFERENCE

1. Wilson, MC, Richardson, WS, Nishikawa, J &

Hayward, RS 1995, 'The well-built clinical

question: A key to evidence-based decisions', ACP

Journal Club, vol. 123, no. 3, pp. A12-A12.

2. Cooke, A, Smith, D & Booth, 2012, 'Beyond pico

the spider tool for qualitative evidence

synthesis', Qualitative Health Research, vol. 22, no.

10, pp. 1435-1443.

3. Cleyle, S & Booth, 2006, 'Clear and present

questions: Formulating questions for evidence-

based practice', Library hi-tech, vol. 24, no. 3, pp.

355-368.

4. Wildridge, V & Bell, L 2002, 'How clip became

eclipse: A mnemonic to assist in searching for

health policy/management information', Health

Information & Libraries Journal, vol. 19, no. 2, pp.

113-115.

5. Beyond PICO: The SPIDER tool for qualitative

evidence synthesis Qual Health Res October 2012

vol. 22 no. 10 1435-1443