While PICO can be a convenient acronym for building clinical questions, the framework has several limitations. This page lists these limitations and suggests ways to address them.
PICO primarily centers on intervention (or therapy) clinical questions. It can be less suitable for other question types.
PICO privileges research that is experimental or observational in nature. It does not account for complexities like considering feasibility, context, and sociocultural acceptability.
PICO is a tool used in evidence-based practice (EBP), which is an integration of clinician expertise, patient preferences and values, and the best available research evidence. EBP defines evidence according to a pyramid with randomized controlled trials recognized as the highest level of primary evidence. This hierarchy of evidence can exclude the voices of minority populations and the interests of those in non-dominant populations. Thus, EBP, while seemingly objective, often reflects White voices and assumptions of the majority. Therefore, the use of PICO to frame literature searches may prove successful for questions with dominant populations and result in evidence gaps for non-dominant populations.