Masterclass
A guide to writing a case report of an osteopathic patient

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Abstract

Case reports provide a valuable insight into osteopathic practice. They allow for the description of diagnoses, interventions and management strategies for complaints that present to practice. Although case reports are traditionally associated with descriptions of rare or unique cases, reports of more common presentations to osteopaths are exceptionally useful. The purpose of this Masterclass is to describe how to construct a case report for the journal, and many other medical journals. The Masterclass outlines how to use the Case Report (CARE) guidelines and provides examples from published case reports related to osteopathic practice. We hope that this Masterclass will encourage practitioners to consider publishing case reports to expand the professions’ evidence base and inform future research.

Introduction

Case reports are designed to disseminate elements of the patient case history, examination, treatment and ongoing management with the aim of informing clinical practice. Case reports also provide valuable teaching material, demonstrating both common and unusual presentations which may confront the clinician, alongside adverse events, cases where care has failed and differential diagnosis considerations [1]. Since the majority of clinical interactions occur in private practice, not in teaching or research facilities, it relies on the clinician to record and share their experiences. As such, case reports may assist the clinician to reflect on their experiences and develop their critical appraisal skills through construction of a case report.

Published patient case reports provide essential sources of information for the optimum care of patients. Case reports can describe important scientific observations that are missed or are undetectable in clinical trials [2]. Further, case reports may also contribute to reducing the gap between published advances in care and practice traditions, in addition to forming the basis of future research questions. These research questions have the potential to inform subsequent work including case series’, cohort studies and clinical trials.

Novelty is a criterion commonly cited by authors and editors when validating the importance of a case report [3]. A truly unique case is, however, considered a rare event in clinical practice. Cases that are innovative, increase the awareness of an unusual condition, describe a rare presentation of a common condition, or identify novel treatment and diagnostic strategies, are valuable for the sharing of good practice and as a means for their author(s) to reflect on their clinical and treatment decisions.

There are numerous examples of case reports in the osteopathy literature. Throughout this Masterclass, reference is made to some of these case reports as examples of how elements of the report can be described. Case reports by Ross, Macfarlane, and Vaughan [4] and Bennett, Macfarlane, and Vaughan [5] describe the osteopathic management of common musculoskeletal complaints – Achilles tendinopathy and subacromial impingement syndrome respectively. Conversely, case reports by Raiher [6] (transient hip osteoporosis) and Testa, Rondoni, and Francini [7] (calcaneal osteoid osteoma) report on more unusual presentations with a focus on diagnosis. Leach [8] is an example of osteopathic care for a non-musculoskeletal issue. These examples demonstrate the breadth of case reports describing osteopathic practice.

Many journals now recommend the use of the Case Report (CARE) guidelines as a structure for case reports. These guidelines ensure that consistent information is provided about patients when constructing a case report and are available at https://www.care-statement.org/. The purpose of this Masterclass is to encourage practitioners to consider publishing case studies about patients from their clinical practice using the CARE guidelines. The International Journal of Osteopathic Medicine (IJOM) has a dedicated section for these submissions as do a number of other journals. In this Masterclass we describe case report submissions in the context of IJOM and osteopathy care, explore the different sections of the CARE guidelines, and outline how a case report can be constructed using the headings in these guidelines. We also provide profession-specific examples for each section to highlight how these may be constructed.

Section snippets

Title

The title of the case report should reflect the aspect of the patient case that forms the majority of the report. This may be the clinical history and diagnosis, investigations or the intervention provided and its outcomes. The CARE guidelines require the inclusion of the words ‘case report’ or ‘case study’ and these are generally included at the end of the title. The case study by Bennett et al. [5] ‘The use of osteopathic manual therapy and rehabilitation for subacromial impingement syndrome:

Discussion

This section of the report is designed to summarise the presentation, interventions and outcomes of care with particular reference to the literature. We encourage authors to be somewhat understated, and apply a critical lens, in their attribution of the outcome of care being directly related to the intervention, or making vague links to theoretical anatomical and physiological mechanisms as a justification for the treatment outcome. That said, it is possible to propose potential mechanisms

Conclusion

The journal actively encourages the submission of case reports. These publications serve an important purpose for the profession in describing aspects of practice that may not be otherwise be reported on, and increase our knowledge as to the effects of osteopathy care on a range of conditions effecting the neuromusculoskeletal system (and beyond). Development of case reports should not be onerous and are designed to reflect the care provided in clinical practice in addition to being a valuable

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