Asking well-built questions for evidence-based practice in augmentative and alternative communication

J Commun Disord. 2007 May-Jun;40(3):225-38. doi: 10.1016/j.jcomdis.2006.06.008. Epub 2006 Jul 28.


Evidence-based practice (EBP) is increasingly being advocated as the preferred approach to practice in augmentative and alternative communication (AAC). The EBP process involves multiple steps. The asking of a well-built question is the first step in the quest for answers. At the same time it is also often the first stumbling block for practitioners. To facilitate the asking of well-built questions it may be helpful to follow a template. The most frequently used template is PICO, which stands for patient, intervention, comparison, and outcome [Richardson, W., Wilson, M., Nishikawa, J., & Hayward, R. (1995). The well-built clinical question: A key to evidence-based decisions. ACP Journal Club, 123, A12-A13]. In this article, we examine the suitability of the PICO template for AAC in terms of the representativeness of the components, and the appropriateness of its subcomponents, and their terminology. Based on this analysis, we propose the PESICO template, which stands for person, environments, stakeholders, intervention, comparison, and outcome. This template is then illustrated with examples representing a range of decision-making areas in AAC. Finally, directions for future research are provided.

Learning outcomes: The reader will be able to: (1) appreciate the importance of asking well-built questions, (2) name the shortcomings of the PICO template, and (3) describe the components of the proposed PESICO template for asking well-built questions.

MeSH terms

  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Communication Methods, Total*
  • Decision Making
  • Evidence-Based Medicine*
  • Female
  • Goals*
  • Humans
  • Language Therapy / methods*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Patient Acceptance of Health Care
  • Patient Care Team
  • Professional-Patient Relations*
  • Social Environment
  • Speech Therapy / methods*