THE VALUE OF CASE REPORTS AS CLINICAL EVIDENCE Case Reports as Clinical Evidence
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Abstract
Objective: To demonstrate that under certain conditions case reports may be considered by chiropractors as high-level clinical evidence.
Methods: To present a narrative of contemporary views of the hierarchical biomedical evidence pyramid and then apply from Western philosophical thinking the qualitative principles of ‘aboutness’ and ‘consilience’ to the preparation of a chiropractic case report and demonstrate the manner in which these tools increase the report’s evidential value.
Discussion: The common biomedical evidence pyramid is reported by some to be flawed with little application in chiropractic practice; indeed, some health disciplines are forming new evidential hierarchies presenting a need in chiropractic to reconsider the evidential value of case reports. Palmer case reports have been a consistent feature of chiropractic and should now be written in accord with the CARE Guidelines. When written in this manner and interpreted through the philosophical lenses of aboutness and consilience, the significance to clinicians has the potential of being elevated without compromising evidence-based care.
Conclusion: Case reports represent high evidential value for chiropractors. Appropriately utilised, case reports have the potential to improve the methodological design of clinical trials, thereby improving patient care.
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