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A Little Love for Case Reports

April 12, 2019 • Research • Mark Shepherd

Peer reviewed case reports have been a common study design published in the medical literature.Although they are at the lower end of the levels of evidence pyramid, I still have gotten valuable information from a well written, peer reviewed case report.


As seen in the level of evidence pyramid, we often put high value on randomized control trials (RCTs) or systematic reviews, but these trials often do not provide an in-depth write-up of what was done so that the everyday clinician can reproduce the assessment or intervention.

We also may not get an understanding of the reasoning process utilized in these types of “high grade” trials.I look back on some of the most valuable articles and many of these are case reports.

A key factor for this value was that these case reports (and sometimes series) often were describing assessments and/or interventions that were already shown to be effective by RCTs and/or systematic reviews.

They were not novel.They were not rare cases.They provided a glimpse into the reasoning approach and specific parameters that an intervention was provided.

This is helpful for the everyday clinician.

What is worrisome to me is my sense that case studies and even case series are becoming less prevalent in the PT literature.I remember when JOSPT would publish quite a few, but now these seem to be less and less.I have heard that some reviewers are denying case reports because they are not about the use of a “novel” technique or describing a rare condition or presentation.When were these the only criteria needed to publish a case report?May we look back on Childs’ 2004 JOSPT editorial on case reports where he stated,

“Case reports are useful for a number of purposes, including:

  • Describing clinical scenarios that have not been previously reported in the literature
  • Demonstrating the clinical usefulness of a procedure for which outcome data are lacking
  • Describing integration of the best available evidence to select the appropriate examination procedures and interventions for a particular patient
  • Describing the decision-making process in a patient who experienced an adverse outcome as a result of physical therapy practice to help other clinicians minimize the risk of harm
  • Defining standard of care practice in a patient with a particular condition”

Note the two bullets in bold.

Nowadays I feel like every other journal publication I see has more and more systematic reviews or meta-analyses.I understand that these are important, but can we have a little love for case reports?If journals deny cases for lacking a novel technique we may be pushing folks to find open source predatory journals to publish in.

So, am I off base for thinking this way?

Does anyone else notice these trends?



Mark Shepherd

Mark is a physical therapist with nine years of experience. He is dedicated to helping students become the best clinicians they can be and is a firm believer that residency and fellowship offer critical mentorship opportunities for young clinicians. Current Roles: Program Director, Fellowship in Orthopaedic Manual Physical Therapy, Bellin College Program Coordinator, Evidence In...

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Bre Reynolds

Commented • April 17, 2019

Thanks for this commentary! I have shared similar conversations with colleagues and it is nice to know we are not alone. We can all agree evidence informed clinical reasoning is not standard practice. There is room for this type of research and it may have an impact on clinical practice.

Charles Nichols

Commented • April 14, 2019

Mark, I agree. The pyramid should be turned upside down for evaluating patient treatment and are much more pragmatic for the clinician. The RCT's basically eliminate almost all of the typical patients treated in our clinic, The RCT may good for looking at a specific test but are much less useful for evaluating treatment and when they do show a treatment effect, it usually a smaller effect. Thanks for posting!


Commented • April 13, 2019

As a CI, I find that my students get a lot from case studies and case series. It gives me the chance to springboard into discussions of pattern recognition and treatment/program planning.

Mark Shepherd

Commented • April 12, 2019

Thanks for reading, Kelley! It is good to know that there are these discussions about this amongst editorial boards. I know that some of this may be in regard to impact factors as case reports are less cited. However they may be more clinically meaningful for application purposes. There is a balance here that I imagine can be though to fine tune. Thanks again.

Kelley Fitzgerald

Commented • April 12, 2019

Mark you are not wrong in your observation. There has been a lot of discussion on editorial boards I have been involved with on the usefulness (or not) of case reports and the groups are divided in their opinions. I agree with your perspective on this and I would encourage you to write a letter to the editor of these journals expressing your thoughts. It would not hurt for them to hear from the grassroots on this topic.

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