The Case Report 

by

William R. Boone, Ph.D., D.C. Research Director, Association for Network Care

Practitioners of Network Spinal Analysis™ can do much to advance the scientific, professional and public communities’ awareness of the benefits of care. For each practitioner, the publication of case reports is essential to present others with information that may not be accessible otherwise. For example, it is often helpful to know if another practitioner has encountered a particular clinical situation or finding; and if so, what were the intricacies of patient or practice member care? Publication of case reports also serves to offer new information for review by others practicing the same concept. Outcomes of care are likely to never be known or disseminated unless the time and effort is taken to publish interesting findings.

The basic requirements for a case report are fundamentally the same for the numerous journals that publish them. I offer a few comments regarding each of the basic steps as a general overview of the process: A typical example of a case report will appear in the first issue of the Journal of Vertebral Subluxation Research (JVSR) in August, 1996. I hope that you will look over the report and consider how it may apply to your personal clinical experiences.

The first step involves the choice of a case that has some unusual feature. For example, positive changes that occur in individuals with conditions such as advanced osteoporosis, various forms of vision problems, or paralysis are of great interest. Other topics including etiologic factors, assessment methods, instrumentation, and legal issues are also important. 

It is generally mandatory at this point to obtain a written human consent form to be signed and dated by the patient. Since each human consent form is unique, it will be necessary to contact the Research Director for the ANC to obtain this form. The Research Director, Ralph Boone, Ph.D., D.C. can be reached either through the Association for Network Care office in CO at 303-678-8101 or by emailing direct to rboone@clear.net.nz. 

If you have an unusual case, or circumstances related to a case, the next step is to write a list of approximately ten key words that will help the journal of your choice to inter-relate your report to the interest of other researchers seeking information. These key words will also help you in fulfilling the next step. That step involves searching the literature to see if others have reported similar situations or, in general, to alert you to the extent of awareness which exists within the scientific and professional community in regard to your case report and its related areas (defined by the key words). Literature searches on a given topic can also be organized through a chiropractic or other library for a nominal fee. 

Once you have decided on the case and reviewed the literature concerning the topic, the next step involves writing an Introduction. The introduction describes, in succinct language, the nature of the case, its unique (or interesting) features and why they are of interest. The introduction also allows the author to express the findings of others (gained from the literature), which may be relevant to the case in question.

It will become apparent to anyone writing a case report that the better the clinical records, the easier it will be to accomplish this feat. For example, if the case in question involves a patient, or practice member, with a severe medical condition, it will be necessary to have medical records, and other information such as MRI scans, radiographs, EMG readings, etc. It is also important, when possible, to collaborate with other health care professionals who might be involved with the same patient in order to confirm or offer additional insight regarding the patient’s condition and/or health status before NSA care. This allows for more meaningful interpretation of the subject's changes during NSA care.

The patient’s clinical records, as well as yours, including case history, chiropractic examination, report of findings, S.O.A.P. notes, and other assessment information are essential for the next step, which is to describe the Methods employed relative to the case. This would involve stating that you were a NSA practitioner, according to the protocols described by Dr. Epstein’s article in the August issue of JVSR (thus, you do not have to describe the concept of NSA, since it has already been done and published). You would then describe the examination procedure utilized. This may include stating that you took a case history, conducted a patient examination, and obtained imaging studies (if indeed this was done). The Methods section is purely descriptive, but it gives enough information to allow readers to understand how and to what extent you assessed the patient. It would be important in this section to describe the plan of care. That is, how long they might have been in Level One, Two, or Three (once again, it is only necessary to reference the paper of Dr. Epstein in JVSR, as all is described in that article). Needless to say, never disclose the identity of the patient unless you have his/her permission, in writing, to do so.

Following the Methods section, the case report would describe the results of NSA care. This section would likely first include a brief statement regarding “clinical impression.” This would be derived from the findings of the assessment procedure. This concept would be followed throughout the clinical impression description. 

The remainder of the Results section would involve reporting exactly what the findings were. That is, (as an example) if the patient demonstrated an improvement in osteoporosis, or any other “condition,” while under NSA care, that is of interest. Unless the evidence is very direct, it would not be appropriate to state that NSA brought about the change, as that would require a more elaborate study. However, it is important to report changes that occurred during NSA care. The implication that NSA care is important is enhanced if the medical regimen, or other interventions, remained the same during the course of NSA care. Consequently, these data should be included in the case report. If the findings are best expressed in a table, or figure, then employ them. Never leave the reader guessing! Always ask yourself, “Would I understand this report?”

The last item, but perhaps the most important, is the Discussion. It is in this section that the author has the opportunity to coalesce information in the literature, as well as the findings of the case study to make a point. If there is convincing evidence that NSA did impact on changes observed, that should be stated. If it is not so evident, then it can be inferred. Nevertheless, it should always be addressed at the level to which it is most appropriate; that is, direct evidence or inference.

The final step deals with Conclusions. In this section it is appropriate to come to a conclusion(s) based on your findings and information gleaned from the literature. It is important since other practitioners will follow in your footsteps. In this regard, take a sentence or two to propose your view; that is, what is needed for further study, how the present case report may have been improved, and how others may contribute to the existing body of knowledge relative to the topic involved.

If you need assistance, contact the ANC. Click Here for contact information. You will be advised how to acquire help to prepare a manuscript of your most interesting cases. Although it will be an effort, it is important to remember that the message of NSA will not likely permeate throughout the universe on its own. Your help in publishing case reports is needed to allow others to learn of the impact of NSA on those receiving care.

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