Writing a Case Report

Download the full article ‘Expanding Your Practice With Research: Writing a Case Report’ from Leisa Bellmore

Many practitioners think that research is something that is beyond their abilities, something for academics rather than practitioners. The reality is that, with some guidance, the more basic forms of research are possible for any practitioner. In fact, practitioners are in the ideal situation to do case reports and case studies.

Research studies can be quite complex, requiring specialised skills and significant time and funding. Case reports, however, are based on a practitioner’s own experience working with one patient. We have all had patients who have presented unique issues or complex health histories, with whom we’ve seen particularly favourable health outcomes, or who have not responded as expected to treatment. Any of these situations could be the basis of a case report.

The purpose of a case report is to inform other practitioners, to build knowledge in a particular subject area and to provide the author with an opportunity for reflection. Case reports can also add to the evidence base for Shiatsu and provide a basis for further research studies.

Case Report vs. Case Study

First things first – what exactly is a case report? The terms ‘case report’ and ‘case study’ are sometimes used interchangeably, but it is important to note they are not the same thing (Porcino 2016) . There are commonalities, as well as significant differences between the two. Both case reports and case studies involve a single patient.

Both can be published in peer-reviewed journals. Important to note is that written informed consent from the patient is essential for both of these types of studies.

There are two major differences between case reports and case studies. First, ethics approval from a research ethics board is necessary to do a case study, but is not essential for a case report. The other way in which these types of research differ is that a case report is retroactive while a case study is prospective. So a case study is planned in advance and follows the patient’s condition over the course of the chosen intervention. A case report, however, looks back on the effect an intervention had on a
patient you have already worked with.

For further information, you may wish to view the Shiatsu Research Network’s freely available webinar ‘Creating Evidence in Your Practice: Writing Case Reports’ or explore the Massage Therapy Foundation Case Report Hub, which has numerous free resources.

Writing a Case Report

As with any type of research, an organised, systematic approach is necessary. There are specific steps that one must follow to successfully complete a case report, which are outlined below.

Choose a Case

First you must identify an appropriate case. Things you might consider to help you decide on a case are:

  • Have I had any particularly interesting cases recently?
  • Have I had an unexpected outcome from a treatment?
  • Have I worked with anyunusual conditionsrecently?
  • Have I worked with a patient with a particularly complex health history?
  • Have I seen particularly significant health outcomes with a patient?
  • Is there a condition I find particularly interesting, one that I specialise in or one I encounter frequently in my practice?
  • Is this case unique? Has there been much research on this subject?

If the case you choose is not interesting or unique, it decreases your chances of publication.

Informed Consent from Patient

While ethics approval from a research ethics board is not necessary for a case report, consent from your patient is, and is a requirement for publication. Once you decide on a subject, inform your patientthat you would like to write a case report on your work with them. Explain that their name and any identifying information would not be included, however details of their health history and their treatment with you would. You can also explain the benefits of writing a case report (to other practitioners, to the profession, and to patients with similar issues). Give the patient a participant information sheet with all of the above information so that they may review it prior to signing. You should also provide them with a copy of your case report for their review prior to submitting it for publication so they can ensure there is no identifying information.

Do a Literature Search

You will want to find information on the condition you are treating and on Shiatsu for this particular condition. Given the limited evidence base for Shiatsu, you could also consider other handson therapies for this condition. A literature search involves looking for supporting research on various databases, such as PubMed. Look for studies in peerreviewed journals. Peer-reviewed means that several qualified people reviewed it to ensure the study and the manuscript meet certain standards. You may also consider articles published in non-peer reviewed journals and books, as well as conference presentations if there is limited material on your subject. You should also gather background information on your subject from reputable sources. For example, if you wish to do a case report on a patient with osteoarthritis, you could consult the website of the Arthritis Society for information on the condition, symptoms, impact on quality of life, statistics, etc.

Gather Your Information

To compile information for your case report, it is crucial that you have documented the patient’s health history and your treatment notes in a comprehensive and ordered manner. If your documentation is not thorough or there is important information missing, you may not be successful with publication. You will need basic patient demographic information as well as detailed information regarding their current health and health history.
You will also need detailed information regarding your Shiatsu treatments:

  • How many sessions were there?
  • How long was each session?
  • How frequently did you treat this patient?
  • Did you use any other modalities?
  • What specifically did you do?
  • Did you focus on particular areas or particular meridians or was it a more general treatment?
  • Did it vary from session to session?
  • Did the patient receive any other treatments during this time?
  • Did the patient practice any self-care to complement your treatment?

If you regularly use measurement tools with patients, such as MYMOP (Measure Yourself My Outcome Profile) or a Visual Analog Scale, these can be helpful but they are not essential. There are many ways of documenting change. If, for example, your patient has frozen shoulder, you may note their range of motion before and after each treatment. If you have a patient who experiences migraine, you may note how many attacks they have in between each treatment.

Write Your Case Report

All case reports should follow the same structure. They should include the following sections:

Title, Abstract, Introduction, Methods, Results, Discussion and Conclusion. Each section should include specific information.

Title

Ensure your title is clear and concise. It should let the reader know what type of study this is and what your case report is about.

Abstract

The abstract is a summary of your case report. It includes all of the sections of the case report itself, without the references. This is always written after your whole case report is written.

Introduction

The introduction includes all background information necessary for the reader to understand why you did this case report. It would include information about the condition or issue you addressed, why this is important and why you chose to treat it using Shiatsu.

Case Presentation

This section would provide information about the patient involved and would detail your treatment with them. Basic demographical information and any relevant details of the patient’s current health and health history would be outlined. Information about your Shiatsu sessions would include the length and number of treatments, the frequency and the specifics. It should also include some information about your training and experience. If you were using specific measurement tools you would discuss this here, too.

Results

The results section outlines any objective or subjective changes in your patient’s condition over the course of treatment. These should be presented in an unbiased manner without interpretation.

Discussion

In this section you would discuss how your case relates to other research, how the results were similar or different. Note anything that was surprising or unexpected. Here you would discuss what your results mean. In the discussion you would also note any limitations of your case study, as well as any future directions for study.

Conclusion

The conclusion is a short summary of your case report. No new information should be presented here.

References

Your reference list should follow the citation style required by the journal to which you are submitting your manuscript. Ensure all references are complete and accurate.


Prior to beginning your writing, consult the CARE guidelines for writing a case report (Munk & Boulanger, 2014) and follow the CARE checklist for case reports. These documents will guide you through the process and ensure your case report is detailed and thorough.

Publish Your Case Report

To ensure your case report reaches a wide audience, you will want to publish it in a peerreviewed, open access journal. Open access means it is freely available online. Look for a journal that publishes studies on bodywork or on the condition you are exploring. Check that the journal you are considering publishes case reports as not all do. Ensure that the journal you are considering is reputable. Some are predatory in nature and publish indiscriminately. These should be avoided. The journal’s website should provide information, such as the database they are indexed in, that can guide you. For further information on predatory journals see www.beallslist.net.

Review the submission requirements of the journal you are considering prior to writing your case report. Each journal has specific requirements for each type of research study. This will often comprise a list of what to include, as well as formatting requirements and a word limit. Most journals have a publishing fee and some have a submission fee. Part of the peer-review process includes feedback from reviewers and the editor, with changes either necessary or suggested prior to publication. Don’t be discouraged by this. Ultimately, it will improve your manuscript. They may feel your manuscript is not a good fit for their journal and you may have to find a more appropriate one. You should also consider sharing your research through a poster presentation at an appropriate conference. You may look at conferences specific to Shiatsu or complementary and alternative medicine or ones related to the condition your case study focused on.

Continue on Your Research Journey

If you find doing a case report to be an interesting experience, you may wish to pursue further research opportunities. If so, there are a multitude of resources that may help you along. Connecting with other health practitioners with similar interests may lead to productive and rewarding alliances. Though a case report is a small piece of research, it can create opportunities for you as a practitioner or be the catalyst for a research path.

References

Porcino, A. (2016). Not birds of a feather: Case reports, case studies, and single-subject research. International Journal of Therapeutic Massage and Bodywork: Research, Education, and Practice, 9(3), 1-2. https://doi.org/10.3822/ijtmb.v9i3.334

Munk, N., & Boulanger, K. (2014). Adaptation of the CARE guidelines for therapeutic massage and bodywork publications: Efforts to improve the impact of case reports. International Journal of Therapeutic Massage and Bodywork: Research, Education, and Practice, 7(3), 32–40. https://doi.org/10.3822/ ijtmb.v7i3.251

Resources to Help You Write a Case Report

2013 Care Checklist of the Care Case Report Guideline
For further reading regarding the detailed writing process see here.
Shiatsu Research Network webinar for the European Shiatsu Congress Online: Creating Evidence in Your
Practice

Massage Therapy Foundation Case Report
Hub with numerous free resources, including a Case Report Webinar series, podcasts about case reports and infographics.

More online learning ressources for getting deeper into research

Foundations of Evidence-Based Practice in Healthcare [The Ohio State University] {Free Resource}
Research Methodology (Research Seminar in Educational Sciences) [Vrije Universiteit Brussel] {Free Resource}

Massage Therapy Foundation

Writing Case Reports: Free Five-Part Webinar Series {Free Resource}

Basics of Research Literacy {Paid Resource}

Courcera {Free Resources with Paid Certificates}

Methods and Statistics in Social Sciences Specialization [The University of Amsterdam]

  1. Quantitative Methods
  2. Qualitative Research Methods
  3. Basic Statistics
  4. Inferential Statistics
  5. Methods and Statistics in Social Science – Final Research Project

Survey Data Collection and Analytics Specialization [The University of Maryland & the University of Michigan]

  1. Framework for Data Collection and Analysis
  2. Data Collection: Online, Telephone and Face-to-face
  3. Questionnaire Design for Social Surveys
  4. Sampling People, Networks and Records
  5. Dealing With Missing Data
  6. Combining and Analyzing Complex Data
  7. Survey Data Collection and Analytics Project (Capstone)

Understanding Research Methods [The University of London & SOAS University of London]

Writing in the Sciences [The Stanford University]

Design and Interpretation of Clinical Trials [The Johns Hopkins University]

Introduction to Systematic Review and Meta-Analysis [The Johns Hopkins University]

Understanding Clinical Research: Behind the Statistics [The University of Cape Town]

Data Management for Clinical Research [Vanderbilt University]

Measuring Causal Effects in the Social Sciences [The University of Copenhagen]

Improving your statistical inferences [Eindhoven University of Technology (TU/e)]

Clinical Epidemiology [Utrecht University]

Epidemiology in Public Health Practice [The Johns Hopkins University]

EdX {Free Resources with Paid Certificates}

Scientific Methods and Research [Ural Federal University]

Introduction to Social Research Methods [The University of Edinburgh]

Statistics: Unlocking the World of Data [The University of Edinburgh]

Fundamentals of Clinical Trials [Harvard University]

Advanced Literature Searching in the Health Sciences [The University of Michigan]

Social Work: Research [The University of Michigan]

Measuring Health Outcomes in Field Surveys [Massachusetts Institute of Technology]

Qualitative Research Methods: Conversational Interviewing [Massachusetts Institute of Technology]

Lean Research Skills for Conducting Interviews [Massachusetts Institute of Technology]

Introduction to Probability – The Science of Uncertainty [Massachusetts Institute of Technology]

Data Analysis in Social Science—Assessing Your Knowledge [Massachusetts Institute of Technology]

Fundamentals of Statistics [Massachusetts Institute of Technology]

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