Literature Reviews and Case Reports

Guy G. Simoneau, PT, PhD, ATC

Editor-in-Chief

L
iterature reviews and case reports contribute uniquely to the body of knowledge
in physical therapy and are essential to evidence-based practice. In this editorial,
I would like to highlight an example of each of these types of papers, published
in this month’s Journal: a literature review on patellofemoral joint pain syndrome
by Bizzini et al2 and a case report by Peterson7 on the treatment of a patient
with cervicogenic headache. My intention in focusing on these particular papers in the Jour-
nal is to provide a brief discussion of each type of publication and to call attention to what I
consider to be 2 notable contributions to our professional literature. The authors of this lit-
erature review and case report offer valuable clinical insights into the treatment of particu-
larly common and often chronic problems seen in clinical practice, but used 2 very different
approaches.

Bizzini et al’s2 systematic review of the literature provides a critical summary of the outcomes
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of clinical trials that have been published on the treatment of patellofemoral joint pain syn-
drome. The authors of this review have applied many of the key elements required for a
credible report, including a defined question, a thorough search of the literature, the appli-
cation of inclusion and exclusion criteria, and a systematic analysis of the quality of the clin-
ical trials retained for interpretation.1 The discussion of each approach for the treatment of
patellofemoral joint pain syndrome is placed within the perspective of the outcome of the
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

contributing clinical trials as well as the strength (rated research quality) of those trials. It is
therefore important to read this article carefully to fully appreciate the authors’ conclusions
and the complexity of the process leading to these conclusions.

A systematic literature review is certainly a suitable medium to synthesize and present the
current state of knowledge on a topic where significant literature exists. Reviews can also
therefore be the means of identifying gaps in the literature that need to be filled. One draw-
back of literature reviews is that the detail and even finer points of each of the studies are
rarely presented. Therefore, while literature reviews can present a concise summary of an
Journal of Orthopaedic & Sports Physical Therapy®

issue, they should still be considered a secondary source of information. A reader seeking a
more in-depth understanding of a particular study or an author who wishes to cite a study
included in a literature review should indeed seek out and read the primary source of infor-
mation—the original research article. Although objective evaluation criteria are used to de-
velop meaningful literature reviews, keep in mind that conclusions derived from a systematic
review of the literature are still in part based on 1 or more individual’s interpretation of the
available information. It is in fact not unusual that even high-quality systematic reviews on
the same topic arrive at different conclusions.4

While a systematic literature review sacrifices detail for the benefit of synthesizing data ac-
quired on a large number of individuals, case reports allow the author to provide a detailed
account of the evaluation and treatment of one patient with a specific pathology. Among
many other reasons, a case report may merit publication when a new treatment approach is
presented for which limited or no outcome data are currently available.3 In this issue of the
Journal, Petersen7 describes the treatment of a patient with a problem commonly seen (and
often, perhaps, misdiagnosed) in clinical practice—cervicogenic headache. In this case re-
port, the author uses outcome measures of headache frequency and intensity to monitor the
patient’s response to a treatment approach that combines joint mobilization techniques to
the upper cervical spine and exercises of the deep neck flexor and scapular musculature.

2 Journal of Orthopaedic & Sports Physical Therapy

 In her case report, Petersen stresses the importance of proper differential diagnosis of the
origin of the headache (a critically important first step in the role of physical therapists as
primary care provider). Subsequently, the author describes the need to determine the rela-
tive contribution of articular and muscular impairments to guide the treatment approach to
the patient. This case report (like any other case report) does not prove the effectiveness of
a treatment approach, nor can a cause-and-effect relationship between interventions and out-
comes be implied.6 But, I believe that Ms. Petersen (and Dr. Jull in the invited commentary

EDITORIAL
associated with this manuscript) communicate important clinical practice ideas related to the
management of patients with cervicogenic headaches. This article and related commentary
are valuable contributions along with other emerging literature5 that may lead to a better
understanding and management of this particular clinical problem, which is too often
chronic in nature.

Literature reviews and case reports both play a critical role in building our scientific and
clinical literature; but to truly appreciate their value, it is important that we recognize their
individual characteristics, strengths, and limitations.

1. Bhandari M, Guyatt GH, Montori V, Devereaux PJ, Swiontkowski MF. User’s guide to the orthopaedic
literature: how to use a systematic literature review. J Bone Joint Surg Am. 2002;84-A(9):1672–1682.
2. Bizzini M, Childs JD, Piva SR, Delitto A. Systematic review of the quality of randomized controlled
trials for patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2003;33(1):4–20.
3. Gottschlich M. Writing basics: elements of the case study. J Am Diet Assoc. 2000;100(11):1293–1295.
4. Hopayian K. The need for caution in interpreting high quality systematic reviews. BMJ.
2001;323(7314):681–684.
5. Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for
cervicogenic headache. Spine. 2002;27(17):1835–1843; discussion 1843.
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6. McEwen I. Writing Case Reports: A How-To Manual for Clinicians. Alexandria, VA: American
Physical Therapy Association; 1996.
7. Petersen SM. Articular and muscular impairments in cervicogenic headache: a case report. J Orthop
Sports Phys Ther. 2003;33:21–32.

Editor’s note: Due to delays involved in the processing of the Combined Sections Meeting
(CSM) abstracts, the CSM abstracts will be printed in the February 2003 issue of the Journal.
Copyright © 2003 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Journal of Orthopaedic & Sports Physical Therapy®

J Orthop Sports Phys Ther • Volume 33 • Number 1 • January 2003 3