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Evidence Based Practice

Use this guide to learn about the first four steps of Evidence Based Practice, get help writing your PICO question, and get started on your research.

Resource Types and Where to Find Them

Quality of Evidence Pyramid

McMaster University's 6S Pyramid.

(Image: Clinical Information Access Portal)

Health Information Resources

Similar to the Levels of Evidence pyramid in the Align step, there is also a hierarchical pyramid for types of health information known as the 6S Pyramid. The pyramid classifies individual primary studies as the most common, lowest quality of information, and secondary pre-appraised research as less common and higher quality.

6S Level Definition Resource examples

The individual patient’s characteristics are aut linked to the current best evidence that matches his or her specific circumstances and the clinician is provided with key aspects of management.

Clinical decision support tools in electronic health records

High-level evidence-based practice guidelines

Resource types: clinical reviews, practice guidelines, position statements

Websites: National Guideline Clearinghouse, professional organizations

Databases: UpToDate, Rehabilitation Reference Center


Summaries of evidence surrounding a specific topic

Study types: Meta-analyses, systematic reviews, other review types

Websites: PubMed Health

Databases: BMJ Clinical Evidence, Cochrane Library, PubMed, CINAHL


Critically-appraised journal articles

Study types: RCTs and high-quality studies with scores for internal and external validity

Websites: ACP Journal Club

Databases: PEDro, OTSeeker


Primary original research studies

Study types: all

Websites: Google Scholar, TRIP

Databases: PubMed, OvidMD, CINAHL

Foreground vs. Background Information

Foreground information is the complex, precise information often needed in order to answer a PICO question.  Before searching for foreground information, however, make sure you have a good understanding of each of the PICO concepts.  If you don't have adequate knowledge about one of your PICO concepts, you will need to pursue background information in order to fully understand the foreground information you find. 

Resources for background information

Click "Next" below to begin searching for resources.