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?