Student library · Evidence skills
Writing a Case Report
It is the first thing most physiotherapists publish and the format with the weakest standards. Of 55 case reports examined against the CARE checklist, none followed it fully, and none included the patient's own perspective on the outcome.
In one line. A case report describes what happened to one patient. It can establish that something is possible, raise a hypothesis, or document a rare presentation or an unexpected harm. It cannot establish that a treatment works, because there is nothing to compare against and no way to separate the intervention from natural recovery.
That limitation is not a weakness to apologise for. It is the reason the format exists, and stating it plainly is one of the items most reports omit.
Write for the ICF, not just the pathology. Physiotherapy case reports carry a specific obligation that medical ones do not: a concise but comprehensive description of the patient's functioning. A methodological paper written for this profession argues that quality guidance for physiotherapy case reports should be built on the World Health Organization's International Classification of Functioning, Disability and Health, precisely because uniform standards for case reporting are otherwise absent. [1] Body structure, activity and participation each deserve a line.
What the evidence shows
| Question | Finding | Source and quality |
|---|---|---|
| How well are case reports actually written? | Poorly. Of 55 case reports, none fully followed the CARE guidelines; only 56.4% met 23 descriptors and none met more than 29 of 36 | A single clinical topic, so the sample is narrow, but the direction is unambiguous [2] |
| What gets left out? | Patient symptoms were not described in 40.0%. The abstract failed to identify the main outcomes in 47.3%. Only 49.1% gave the strengths and limitations of management. None included patient-assessed outcomes or the patient's perspective | Same study. By contrast, 96.4% reported the intervention and its effect, and all reported age and diagnostic methods [2] |
| Did publishing the CARE guideline improve things? | No measurable change. Mean reporting quality was 14.3 (SD 2.6) before and 14.7 (SD 2.7) after, P = 0.39 | 201 case reports across five journals. No significant differences by journal or by the first author's country either [3] |
| Do journals require a reporting guideline? | Mostly not. Of the 50 journals publishing the most case reports, 76% do not adhere to any reporting guideline | Content analysis of author guidance. Thirteen distinct case-report formats were identified across those journals [4] |
| What do journals ask for instead? | Four themes: the reason for publication or content value; patient consent and confidentiality; word-count limits; and a recommended structure | Same analysis. Consent is one of the few requirements that is near-universal [4] |
| Does poor reporting matter clinically? | The authors of one assessment argue it does: reporting was generally poor, and they state the information may mislead providers, with clinical applications potentially detrimental to patient care | A rare-disease literature where case reports carry more weight than usual, because randomised evidence does not exist [5] |
| Is there a physiotherapy-specific standard? | Not a uniform one. The profession's own methodological paper notes that few resources exist to help physiotherapists with the mechanics and quality standards of a case report, and that uniform standards are absent | Its proposal is to anchor those standards in the ICF model [1] |
Where students get this wrong
1. Claiming the treatment worked
One patient improved after an intervention. So would many patients with no intervention at all. A case report can say "this patient improved during a programme of X" and cannot say "X caused the improvement". The finding that only 49.1% of reports discussed the strengths and limitations of management [2] is the measurable version of this error: half of published reports never state what their design cannot show.
2. Leaving the patient out of the outcome
Not one of the 55 reports included patient-assessed outcomes or the patient's perspective. [2] For a physiotherapy case report this is close to disqualifying — the whole justification for the format is a rich account of one person, and the person's own view of whether anything got better is the part no chart can supply. Ask them, quote them, and record it as an outcome.
3. Describing the pathology and skipping the functioning
Reports reliably contain age, diagnosis and intervention — all 55 gave age and diagnostic method, and 96.4% gave the intervention. [2] What they omit is what the person could and could not do. Structuring the report around the ICF forces body structure and function, activity, and participation onto the page, which is what a reader in your profession actually needs. [1]
4. Assuming the journal will enforce quality
Three quarters of the journals publishing the most case reports adhere to no reporting guideline at all. [4] Acceptance is not a quality signal, and the absence of a required checklist means the standard of your report is entirely your own decision. Use the CARE checklist even where nobody asks for it.
5. Believing a guideline fixes reporting by existing
Mean quality scores were statistically unchanged before and after CARE was published (14.3 versus 14.7, P = 0.39). [3] Guidelines change practice when journals require them and authors use them, not on publication. That is a useful general lesson about implementation, and it recurs across the clinical library.
6. Writing the abstract last and carelessly
In 47.3% of reports the abstract did not identify the main outcomes. [2] The abstract is the only part most readers see and the only part indexed in full. If a reader cannot tell from your abstract what happened to the patient, the report will not be found by the people it could help.
What the evidence supports — and what it does not
Supported
- Using the CARE checklist whether or not the journal asks. [2][5]
- Structuring a physiotherapy case report around the ICF. [1]
- Recording patient-assessed outcomes and the patient's perspective. Almost universally missing. [2]
- Stating the strengths and limitations of management explicitly. Only half of reports do. [2]
- Obtaining and documenting informed consent. One of the few near-universal journal requirements. [4]
Not supported
- Any claim that the intervention caused the outcome.
- Treating publication as a quality signal. 76% of journals require no guideline. [4]
- Assuming reporting has improved because CARE exists. P = 0.39. [3]
- Using a case report to support a treatment recommendation. Poor reporting may actively mislead. [5]
- Assuming a uniform physiotherapy standard exists. It does not. [1]
How certain is this?
Evidence grade: Low to moderate.
The individual studies are sound but each examines a narrow clinical literature — splenic metastasis, [2] dental trauma, [3] neonatal diabetes [5] — so the precise percentages should not be read as figures for physiotherapy case reports, which have not been audited this way. What makes the picture credible is that four independent assessments in four unrelated fields reach the same conclusion.
The journal-policy analysis is the broadest of them, covering the 50 journals that publish the most case reports, [4] and it explains the others: where three quarters of journals require no guideline, poor adherence is the expected result rather than a surprise.
The physiotherapy source is a methodological proposal rather than an empirical study, [1] and is cited here for its argument and for its statement that uniform standards are absent, not as evidence of reporting quality.
What would change the grade: an audit of physiotherapy case reports against CARE, which does not appear to exist.
Common questions
Is a case report worth writing at all?
Yes, for the right question. It is the appropriate design for a rare presentation, an unexpected adverse event, an unusual response, or a documented instance of something thought impossible. It is the wrong design for "does this treatment work". Write it for what it can show, and say in the discussion what it cannot.
What goes in that most people forget?
Four things, in order of how often they are missing: the patient's own perspective and patient-assessed outcomes (absent from all 55 reports in one assessment), the symptoms as the patient described them (missing in 40.0%), the main outcomes in the abstract (missing in 47.3%), and the strengths and limitations of management (present in only 49.1%). [2] Put all four in and your report is already better than most of the published literature.
Do I need patient consent?
Yes, and get it in writing. Consent and confidentiality were one of the four themes that journal author guidance consistently emphasises, [4] and unlike most reporting requirements it is close to universal. Consent is also an ethical requirement independent of what any journal asks for. Do not submit without it, and do not assume de-identification removes the need.
Which checklist should I use?
CARE, and use the full version rather than a summary. Note that studies have scored it in different ways — one used a 23-item checklist [5] and another scored 36 descriptors [2] — so quote the version you used. For a physiotherapy report, add an ICF-structured account of functioning, which CARE does not specifically require. [1]
How does this fit with the rest of evidence skills?
It is the same discipline seen from the writing side rather than the reading side. The reason trial design and GRADE matter is that readers cannot assess what authors do not report. Writing one good case report teaches you more about appraisal than reading twenty.
References
- Davenport TE. Clinical Case Reporting in the Peer-Reviewed Physical Therapy Literature: Time to Move Toward Functioning. Physiotherapy Research International. 2015 Dec;20(4):220–30. doi:10.1002/pri.1562 PMID 24375956 Methodological paper
- Dragnev NC, Wong SL. Do we CARE about the quality of case reports? A systematic assessment. Journal of Surgical Research. 2018 Nov;231:428–433. doi:10.1016/j.jss.2018.07.027 PMID 30278963 Reporting quality assessment
- Seguel-Moraga P, Onetto JE, E Uribe S. Reporting quality of case reports about dental trauma published in international journals 2008-2018 assessed by CARE guidelines. Dental Traumatology. 2021 Apr;37(2):345–353. doi:10.1111/edt.12630 PMID 33222392 Before-and-after reporting quality study
- Taheri A, Adibi P, Sabbagh Jafari M, et al. The reporting requirements of case reports and adherence of case report reporting guidelines in medical journals: an analysis of the authors' guide sections. Journal of Medical Case Reports. 2023 Jan 5;17(1):2. doi:10.1186/s13256-022-03710-2 PMID 36604759 Content analysis of journal policies
- Jia P, Wang L, Yang X, et al. The quality of reporting in case reports of permanent neonatal diabetes mellitus: a cross-sectional study. BMC Medical Research Methodology. 2024 May 20;24(1):117. doi:10.1186/s12874-024-02226-1 PMID 38769533 Reporting quality assessment
About this resource
How to use this
Written to be learned from, not memorised.
This page is about what a case report can honestly claim, which is the part of the format least often taught and most often got wrong. Faculty may use this page in teaching with attribution. It carries its review date and its next review date, so you can see at a glance whether it is current before you put it in front of a cohort.