Improving question formulation for use in evidence appraisal in a tertiary care setting: a randomised controlled trial [ISRCTN66375463].
BACKGROUND
The specificity of clinical questions is gauged by explicit descriptions of four dimensions: subjects, interventions, comparators and outcomes of interest. This study determined whether adding simple instructions and examples on clinical question formulation would increase the specificity of the submitted question compared to using a standard form without instructions and examples.


METHODS
A randomised controlled trial was conducted in an evidence-search and appraisal service. New participants were invited to reformulate clinical queries. The Control Group was given no instructions. The Intervention Group was given a brief explanation of proper formulation, written instructions, and diagrammatic examples. The primary outcome was the change in the proportion of reformulated questions that described each the dimensions of specificity.


RESULTS
Fifty-two subjects agreed to participate in the trial of which 13 were lost to follow-up. The remaining 17 Intervention Group and 22 Control Group participants were analysed. Baseline characteristics were comparable. Overall, 20% of initially submitted questions from both groups were properly specified (defined as an explicit statement describing all dimensions of specificity). On follow-up, 7/14 questions previously rated as mis-specified in the Intervention Group had all dimensions described at follow-up (p = 0.008) while the Control Group did not show any changes from baseline. Participants in the Intervention Group were also more likely to explicitly describe patients (p = 0.028), comparisons (p = 0.014), and outcomes (p = 0.008).


CONCLUSIONS
This trial demonstrated the positive impact of specific instructions on the proportion of properly-specified clinical queries. The evaluation of the long-term impact of such changes is an area of continued research.
Villanueva
E V
EV
Centre for Clinical Effectiveness, Monash Institute of Health Services Research, Melbourne, Victoria, Australia. Elmer.Villanueva@med.monash.edu.au
Burrows
E A
EA
Fennessy
P A
PA
Rajendran
M
M
Anderson
J N
JN
D000488:Allied Health Personnel / Q000592:standards; D019317:Evidence-Based Medicine / Q000592:standards* / Q000639:trends; D005500:Follow-Up Studies; D006761:Hospitals / Q000592:standards* / Q000639:trends*; D006801:Humans; D009720:Nurse Clinicians / Q000592:standards; D010820:Physicians / Q000592:standards; D018401:Sample Size; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards; D013995:Time; D016896:Treatment Outcome