April 2008

In praise of the case study

by Dr. Christopher Kent

For more than 112 years, millions of patients have experienced the benefits of chiropractic care. Yet, there is a paucity of published research supporting chiropractic procedures. Testimonials and anecdotes abound, but peer-reviewed publication is lacking. Dr. Matthew McCoy, editor of the Journal of Vertebral Subluxation Research (JVSR) has decided to do something about it.

Case studies have played a key role in the dissemination of clinical information since practitioners saw the value of sharing their patient experiences with colleagues. They provide "snapshots of reality" or a "slice of life," and arguably are the epistemological model that best reflects clinical reality. With the focus on the individual patient, and the complexities of the clinical encounter, case studies offer insights leading to more sophisticated experimental studies, and improved clinical outcomes. [1-8]

Case reports may include any of the following:

*** An original account of an individual who has rare features or an unusual or puzzling presentation.

*** A common or challenging condition with new insight into its pathogenesis or management.

*** A new technique or unique solution for a clinical problem.

*** An unanticipated association between two conditions.

*** An unexpected favorable or adverse event.

*** An unmet clinical or research need.

*** An educational purpose. [9-12]

McWhinney wrote, "An actual case brings things alive for us in a way that aggregated data can not do. We learn differently from individual cases. They stimulate the imagination, open up possibilities, provoke us, and perhaps disturb us. They fill in the gaps left by powerful generalizations, reminding us that every illness is unique in the same way. Empirical science is the key to one form of knowledge, the generalized knowledge that gives us power over nature; the key to wisdom however, is the knowledge of particulars." [13]

JVSR and Dr. McCoy have rendered a great service to the profession by providing the doctor in the field with a means of sharing clinical observations with professional colleagues, thereby leading to better clinical strategies. Accept the challenge, and do your part to contribute to the body of knowledge of our noble profession.

References

1. Nahum AM. "The clinical case report 'potboiler' or scientific literature." Head Neck Surg. 1979;1(4): 291-392.

2. Morgan PP. "Why case reports?" CMAJ 1985;133(5):353.

3. DeSouza LH. "One case at a time." Physiotherapy 1997;85"107-108.

4. Coccia CT. Ausman Jl. "Is a case report an anecdote? In defense of personal observations in medicine." Surg Neurol 1987;28:111-113.

5. Nathan PW. "When is an anecdote?" The Lancet 1967;2:607.

6. Reisenberg D. "Case reports in the medical literature." JAMA 198;.255:2067

7. Softer A. "Case reports in the Archives of Internal Medicine." Arch Intern Med 1976;136:1090.

8. Hooker EZ. "Research -- The case for case studies." Sci Nursing 1991;8.80-82.

9. Squires BP. "Case reports: What editors want from authors and peer reviewers." Can Med Assoc J 1989:141:379-380.

10. DeBakey L. DeBakey S. "The case report. I. Guidelines for preparation." International J Cardiol 1983;4:357-364.

11. Huth EJ. "How to Write and Publish Papers in the Medical Sciences." 2nd edition. Baltimore, MD. Williams and Wilkins. 1990. pp 69-76.

12. Gottschlich M: "Writing basics: elements of the case study." JADA 2000;10(11):1293-1295.

13. McWhinney IR: "The value of case studies." European Journal of General Practice 2001;7:88-89.

(Dr. Christopher Kent, president of the Council on Chiropractic Practice and vice president of the World Chiropractic Alliance, is a 1973 graduate of Palmer College of Chiropractic. The WCA's "Chiropractic Researcher of the Year" in 1994, and recipient of that honor from the ICA in 1991, he was also named ICA "Chiropractor of the Year" in 1998. He is director of research and a co‑founder of Chiropractic Leadership Alliance. An attorney as well as a chiropractor, Dr. Kent is a member of the California bar. With Dr. Patrick Gentempo, Jr., Dr. Kent produces a monthly audio series, "On Purpose," covering current events in science, politics and philosophy of vital interest to the practicing chiropractor. For subscription information call 800-892-6463.)