Abstract des Autors

Evidence-based practice (EBP) is the integration of the best available research, clinical expertise, and a patient's values when making clinical decisions. The central principle of EBP is that each patient is unique, and decisions for the patient's care must be made at the individual, “n-of-1” level.2,3 As more evidence is presented to the clinician each year, whether that evidence actually results in enhanced outcomes for a patient with his or her unique values and preferences is unknown.
Traditionally, clinical case studies have served as a forum for clinicians to communicate unique findings and experiences when diagnosing or managing a condition. In the realm of EBP, the value of case studies is controversial: they simultaneously sit low on the levels of clinical evidence hierarchy (as anecdotal evidence) but also atop the evidence hierarchy as the hallmark of EBP, the n-of-1 study, in which an investigated medical process (eg, diagnosis, prognosis, therapy, harm) is tested systematically in a “real patient.”
Despite concerns about the internal and external validity of case studies with regard to the inherent biases introduced by only 1 patient or a few patients, case studies serve as educational narratives for the development of new insights in clinical practice, education, and research. Furthermore, case studies offer an excellent opportunity for clinicians to engage in scholarly activity and contribute to their profession's body of knowledge.3–5 Although case studies have historically been the primary mode of disseminating clinical information, fewer outlets for case studies are currently available, and many journal editorial boards are questioning the value and influence case studies have in furthering research and clinical practice.3 Additionally, the lack of consistent reporting standards for case studies across journals makes it more difficult to assess their value.6 The intention of the case study is noble (ie, sharing relevant reports of practice-based evidence [PBE]), but its clinical utility as a source for EBP is unclear.
In the past 20 years, systematic reviews and meta-analyses of the sports health care literature have been conducted to answer clinical questions related to a vast array of injury conditions and management strategies. Well-controlled clinical trials across the 5 major categories of evidence (observational, diagnostic, prognostic, etiologic, and therapeutic) offer the most unbiased results from individual studies. The next logical step in clinical research is to test the effectiveness and feasibility of the results from these high-level studies. Case studies offer a unique medium in which the results garnered from these sources of external evidence4 can be implemented. The sports medicine body of knowledge can be substantially enhanced through the reporting of clinical outcomes generated by evidence-based clinical decisions.
We have the opportunity to enhance the value of case studies by not only introducing what might be novel PBE but also confirming or refining our EBP. Therefore, case studies offer both an entry point into the development of clinical evidence and an endpoint of the implementation of evidence for enhancing clinical decisions and outcomes.3 The vision behind this case study paradigm shift is to provide a robust outlet for practicing clinicians to make meaningful Contributions to the Available Sources of Evidence (CASE) by reporting insights gleaned from using internal and external evidence for clinical decision making. It is from this perspective that we introduce the new Clinical CASE Reports paradigm.