The Cochrane Collaboration

Defining a research questionProfessor Peter SandercockUniversity of Edinburgh

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OutlineFinding a good questionFraming your questionRefining it

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Wikipedia: research questionAresearch questionis themethodologicalpoint of departure of scholarly research in both thenaturalandsocial sciences. The research will answer the question posed. At anundergraduate level, the answer to the research question is thethesis statement. The answer to a research question will help address a "Research Problem" which is a problem "readers think is worth solving

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#Where do new questions come from?Your boss/ supervisorThe newsEveryday observations (lab or clinical)SerendipityPrevious single experiments or clinical trialsSystematic review of all relevant experimentsCochrane reviews implications for research

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Is the question important?*Burden of diseaseHow common is the problem?How much death/ disability does it cause?Do other people agree its important?The public/ patient advocates/charities Politicians (something's got to be done)Health professionalsIs it a priority topic for research funding bodies?What impact will the treatment have on burden?How feasible is the treatment?A small effect in a large % of patients will have greater impact than a large effect in a small %*vital to get this right in grant applications

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#Getting it rightFrame the question on the back of an envelopeThink about PICODiscuss it for a reality check with peersWrite it downIts often an iterative process and the final form of the question often ends up looking very different!

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#Frame your question: (PICO)*Patient (eg person with depression)

Intervention (drug, procedure etc)

Comparison (placebo, open control, standard therapy etc)

Outcome (depression symptoms, suicide)*PICO for trials. Elements different for other research designs e.g. measuring prognosis

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Mead implications for researchfuture research should look in more detail at what types of exercise could most benefit people with depression, and the number and duration of sessions which are of most benefit. Further larger trials are needed to find out whether exercise is as effective as antidepressants or psychological treatments.

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#Trial inclusion criteria broad or focused?Broad: All patients with depression Results widely applicableRecruitment easyFocused: patients requiring admission to hospital for depression who have failed conventional treatmentResults less widely applicableHard to recruit

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E-learning platform of the World Stroke OrganizationSystematic review: broad or narrow?Subjects: any disease stage, or acute treatment onlyIntervention: all in class (any anticoagulant) or one specific (eg heparin) Comparison: investigational vs any other comparator or investigational vs control onlyStudy type: Any design vs RCT onlySearch: all languages vs English only

#What outcome to measure?Physiology Blood pressureCortisol levelPathology (e.g. tumour size)Impairment Muscle weakness, Joint range of movementFunction Independence in ADLAbility to workEventNon-fatal pulmonary embolusAdmission to hospitalDeath

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Which measure of outcome would this patient want the trial treatment to achieve?Improvement in:

Arm strength?

Ability to get dressed?

Ability to live independently?

Living longer?

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Beware the deceptively simple (blockbuster) question, e.g. does therapy improve arm function after stroke?It might bring you to your knees!

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#Its huge!Our searches identified 1840 records, from which we included 40 completed reviews (19 Cochrane; 21 non-Cochrane), covering 18 individual interventions and dose and setting of interventions. The 40 reviews contain 503 studies (18,078 participants). We extracted pooled data from 31 reviews related to 127 comparisons.

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#Refine and designScience is cumulative; can YOUR planned research add reliable evidence to what is already known?Systematic review of evidence = chapter 1 of PhD thesis!

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Systematic review of randomised trials of exercise for depression(Mead et al Cochrane Database 2013)

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#Final thoughtsTake time to get your question rightGet it right and you improve the design of your researchincrease your chance of getting fundingTake an important step towards getting your results published

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