Answering clinical questions with PEDro
Geraldine Wallbank and Dr Josh Zadro explain how to make the most of your search through the Physiotherapy Evidence Database.
The Physiotherapy Evidence Database (PEDro) is a trusted global resource that gives physiotherapists support to implement evidence-based practice.
Indexing more than 66,000 articles, PEDro focuses on evidence that can be directly applied in practice— evidence-based clinical practice guidelines, systematic reviews and randomised controlled trials.
All trials are appraised using the PEDro scale to help users quickly find trials with higher methodological quality to inform clinical decision-making.
Effective searching in PEDro starts with formulating a clear clinical question to determine the best search terms to use.
This will help PEDro give you more appropriate search results.
Below are two clinical scenarios and some tips to illustrate how to optimise searching PEDro to answer your clinical question.
| Clinical scenario 1 | Clinical scenario 2 |
| A 68-year-old man attends your clinic complaining of pain in the shoulder that came on when he stumbled and fell in the garage. He is now finding it difficult to raise his hand above his head. Your examination reveals no deformity of the shoulder and a painful arc between 45 and 100 degrees of shoulder abduction. | A 72-year-old woman with Parkinson’s disease attends your rehabilitation clinic. She lives independently at home but reports increasing fear of falling, especially when moving around the community. She has not had a recent fall but feels her balance is worsening. Her goal is to maintain her independence and confidence while walking. |
Define your question using ‘PICO’
Break down your question into four essential components using the ‘PICO’ framework.
P Population. What is the condition or population group of interest (eg, acute stroke, workers)?
I Intervention. What treatment are you interested in?
C Comparison. What are you interested in comparing the intervention to (eg, placebo, usual care)?
O Outcome. What measurable outcome are you interested in improving (eg, falls, pain, walking speed)?
For each of the components, generate a list of possible terms to search.
| Clinical scenario 1 | Clinical scenario 2 |
| P could be subacromial impingement, rotator cuff, shoulder pain | P is Parkinson’s disease |
| I could be strengthening exercises, stretching exercise | I could be visual cues, auditory cues, balance training |
| C could be education | C could be usual care |
| O could be range of motion, pain | O could be fall, risk of falls, fall prevention |
| An example PICO question is ‘In older people with subacromial pain syndrome, does strengthening exercise reduce pain compared to rest?’ | An example PICO question is ‘In people with Parkinson’s disease, does training using visual or auditory cues reduce the risk of having a fall compared to usual care?’ |
Use the Advanced Search page
PEDro's Advanced Search page is designed to help you conduct a precise search.
PEDro has three search page formats—advanced, simple and consumer.
The advanced search option is designed to help you to conduct a search with precision.
The Advanced Search page provides 13 fields.
There are six drop-down field options, indicated by an arrow symbol (therapy, problem, body part, subdiscipline, topic and method), and seven free-text fields.
Conduct your search
On the Advanced Search page, you do not need to complete every field.
Specifying terms in one to three fields is usually enough.
The simplest search on the Advanced Search page involves using the drop-down fields for each of the PICO components.
This can help you gauge the volume of articles for your clinical question.
Enter the PICO components from your clinical question in the free-text fields if using the drop-down fields does not provide enough precision.
You do not need to enter all four of the PICO components—usually two components are enough.
Start by entering terms for the population and intervention in the ‘abstract and title’ field.
You need to use English words and characters in the free-text fields when searching PEDro.
This is because most of the database is in English.
For example, searching for incontinência in the ‘abstract and title’ field will return no articles.
Tweak your search
Finding the right results may involve making a few tweaks.
If your search still returns too many articles after using the free-text fields, you can make your search terms more specific (eg, replace ‘shoulder pain’ with ‘subacromial shoulder pain’ in the ‘abstract and title’ field), change the fields you use to enter a search term or add another PICO component.
If you get too few results, you can check that you have spelt the terms correctly and are using English words and characters, remove the term for a PICO component, change the field you use to enter a search term or make a search term less specific (eg, you could replace ‘femoroacetabular impingement syndrome’ with ‘hip impingement’ in the ‘abstract and title’ field).
Other searching tips
Boolean operators
Boolean operators such as ‘and’, ‘or’ and ‘not’ are not supported in PEDro free-text fields and do not need to be specified.
When you run a search with two or more terms in one of the free-text fields, PEDro automatically uses ‘and’ to combine terms.
The use of parentheses ( ) is not supported in PEDro free-text fields.
Wildcards
Wildcards are used to replace a letter(s) with a symbol to represent more than one version of that word.
An asterisk (*) can be used to replace any number of letters (including no letters) that form part of the start or end of a word.
For example, Parkinson* will retrieve articles that contain Parkinson, Parkinson’s or Parkinsonism and *edema will retrieve articles containing oedema, lymphedema or lymphoedema.
Phrase searching
Phrase searching is done by placing double quotation marks (“ ”) around search words.
Using phrase searching makes your search precise and allows you to search for articles that contain all words between the double quotation marks together and in that order, such as ‘treatment of lateral epicondylitis’.
This will not retrieve articles containing the words separately (eg, ‘treatment of epicondylitis’) or in a different order (eg, ‘treatment of epicondylitis of the lateral elbow’).
Review your results
The PEDro search results are displayed as a list of article titles with hyperlinks to further information including abstracts.
PEDro returns the results from your search on the ‘Search Results’ page.
The results are listed in a table and organised so that higher quality and more recent articles are listed at the top.
Clinical practice guidelines are listed first, followed by systematic reviews (with Cochrane Reviews listed ahead of reviews published in other journals) and finally clinical trials (listed from higher to lower PEDro scale scores).
Scan the list of article titles to find articles related to your question, starting at clinical practice guidelines, systematic reviews and higher-quality trials.
Click on a title hyperlink to view its ‘Detailed Search Results’ page.
Read the abstract to check whether the article answers your clinical question.
You can then access the full-text copy of the research article to appraise the quality and applicability of research to your clinical question.
Full-text articles may be accessed for free or you may need a subscription to the journal or to pay to view the article.
This is determined by journal publishers.
For each article, PEDro offers up to five full-text links, listed in order of the likelihood that the full text can be accessed for free.
Find out more under ‘Skill building campaigns’ and visit pedro.org.au/english/learn for other PEDro tutorials and videos.
>> Geraldine Wallbank APAM is a physiotherapist and the manager of PEDro, based at the Institute for Musculoskeletal Health, the University of Sydney and Sydney Local Health District.
>> Dr Josh Zadro APAM is a physiotherapist, NHMRC Emerging Leadership Fellow and University of Sydney Robinson Fellow at the School of Health Sciences, University of Sydney. Josh is a member of the PEDro Education and training committee.
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