Case Reports: Slices of Real Life to Complement Evidence

Abstract

With the growing emphasis on evidence-based practice, are case reports outdated relics of the professional literature? Clinicians, educators, and students increasingly ask this question when they see that case reports appear near the bottom of the hierarchy of evidence—listed above only expert opinion.1 It's true that case reports cannot establish cause-and-effect relationships between interventions and outcomes. It's also true that case reports cannot prove reliability or validity of measurements and cannot identify prognostic variables. What, then, do case reports contribute to evidence-based practice? Case reports are descriptions of practice. Although most case reports published in Physical Therapy describe one or more patients, case reports can focus on any aspect of physical therapy that has not already been described well in the professional literature. Dr Jules Rothstein, our Editor in Chief, wrote that without descriptions of practice, “the world cannot possibly understand the patient management of which we are so proud, colleagues cannot engage in dialogue designed to improve patient care, and researchers are deprived of knowledge about the nuances of practice—which means that the research they conduct cannot be as applicable to practice as it needs to be.”2(p1062) No other type of written professional communication gives the replicable, detailed, and credible descriptions of practice that case reports provide. They describe every step in the physical therapist patient/client management process: …