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Create an effective case report
This is an excerpt from Massage Therapy: Integrating Research and Practice by Trish Dryden & Christopher Moyer.
Telling a Story: The Content of a Case Report
Writing a CR can seem daunting. What background information is necessary? How detailed should the methods section be? What kind of language is best? These questions are easier to answer when you have a clear understanding of the likely audience for your CR. Imagine describing a massage treatment to healthcare professionals, such as nurses or physicians. They are not trained in MT, but they are familiar with anatomy, physiology, and client care. Consider the details they would want and need to know to best understand the case, and be sure to include them.
Keep in mind that a CR is similar to a conversation; essentially, it is a structured form of storytelling (see table 20.2). Set out to command attention, use clear language, and earn the audience's trust and interest.
CRs have the same basic structure as other research articles, but also have some unique features. What follows is an overview of the major sections.
Introduction
The introduction gives the reader the necessary background information needed to understand the current study's methods, evaluate the client's clinical condition, and interpret the significance of the results. It is essential to include a review of the relevant literature in this section. As you decide which sources and information to include, consider the following questions. What information would a fellow clinician need to treat this client? What consensus or controversies exist related to the condition, the specific population, or the MT modalities being investigated? How does this background data support the research question? An effective introduction is thorough but is not necessarily exhaustive. By the end of the introduction, a CR reader should have a clear sense of what is known, what remains to be discovered, and why the topic matters. These, in turn, lead logically to the research question itself, which should be explicitly stated for the sake of clarity.
Methods
The methods section should provide enough detail that a skilled colleague could carry out a similar study. This means including a well-rounded profile of the client, a lucid description of the treatment plan and any deviations from that plan, and a clear account of the measurements used. Basic details are important. At a minimum, be sure to indicate session length and frequency, the specific modalities applied, when and how measurements were taken, relevant details of the participant's health history, and the goals of treatment.
Box 20.1
Description of Massage Techniques
An often overlooked aspect of massage CRs is a sufficiently detailed description of technique (Moyer, Dryden, and Shipwright 2009). In much of the research literature, massage is treated as a uniform practice, yet any practicing therapist knows that an immense variety of applications can be made in a single massage session. Detailed descriptions of massage applications make for a better definition of massage, better research methods, and a better-informed health care world.
Examples of Methods to Discuss in a CR
- Which body regions were the focus of the massage, and approximately how much time was spent on each region?
- Which structures were specifically targeted? (Muscles, fascia, bones, viscera, nerves?)
- What was the intention behind the overall treatment approach? To create more mobility and functionality? To reduce stress and pain? To foster body awareness or trauma recovery?
- Were any aspects of communication with the patient worth mentioning?
- Were there important elements in the therapist's body mechanics or hand shape?
Results
A good treatment summary is concise and is more detailed on key points. Special attention should be paid to those aspects of MT that are frequently under-represented in the literature. These include the utterances and behaviors of the client, as well as the author's qualitative observations. In addition to your narrative summary of the results, you should also consider graphical, tabular, and quantitative methods for presenting your findings effectively. These approaches, when done well, allow for efficient use of journal space and can add to the clarity and interpretability of your results. Finally, keep in mind that it is essential to avoid prejudging the data. A good results section is balanced, pertinent, and compelling, but does not contain your conclusions. These belong in the discussion
section.
Discussion
The discussion section is your opportunity to offer aninterpretation of results. It is important to restate the research question and to make a balanced appraisal of any conclusions to be drawn from the results. Keep in mind that an individual CR cannot definitively prove anything by itself, nor is that its purpose. Authors can and should report their hunches, assert likelihoods, and otherwise opine on what happened, but they should avoid the temptation to state these as proven fact (Gleberzon 2006).
This section also presents the opportunity to reflect on the study's design and execution. Were there unforeseen challenges? Could certain methods have been improved? In hindsight, how effective was the clinical approach? What kinds of studies or questions would be most appropriate for future research? Discussion of such issues shows that you have been thoughtful in completing your research. It can guide future clinicians in most effectively contributing to the base of research evidence.
Finally, you may want to take the opportunity to place your findings into the context of the profession or health care in general. If appropriate, you might indicate how you think the MT profession could employ your CR's techniques or clinical approaches in similar cases. You could also outline the lessons your CR offers to health care, MT educators, or the public.
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