Guidelines for the Submission of Case Reports to Physical Therapy (PTJ)

Physical Therapy (PTJ) promotes evidence-based practice and excellence in both clinical and basic research. PTJ documents basic and applied knowledge related to physical therapy, provides evidence to guide clinical decision making, publishes a variety of original research relevant to the field, and is a forum for diverse opinions that are based in scholarly argument. Our readership includes physical therapist clinicians, researchers, educators, and students and all health care professionals interested in rehabilitation. Like the profession it serves, PTJ strives to enhance the function, health, and well-being of all members of society. In 2005, PTJs impact factor was 1.672. Circulation in 2006 is approximately 70,000. As of April 1, 2007, mean time from initial submission to decision is 33.1 days. The following guidelines state requirements for case report submissions. These guidelines are intended to: Make the authors job easier. Help manuscript reviewers conduct their reviews. Improve the scientific quality and readability of papers published in PTJ.

Case reports describe various aspects of physical therapist practice (eg, examination, intervention, administrative approaches, risk management). They describe current activities and approaches. Case reports differ from research in that they do not test hypotheses or establish cause-and-effect relationships. Because many different aspects of physical therapy could be described in a case report, a one size fits all format is unrealistic. The PTJ Editors and Editorial Board, therefore, have established 7 focus-based case report formats. Case report authors are required to identify their focus and follow the format corresponding to that focus. PTJ endorses the Uniform Requirements for Manuscripts Submitted to Biomedical Journals put forth by the International Committee of Medical Journal Editors (ICMJE) (www.icmje.org).

Table of Contents
Section 1. General Guidelines for All Case Reports Section 2. Whats Your Focus? Diagnosis/Prognosis Clinical Measurement Procedures Intervention Application of Theory to Practice Risk Management Administrative/Educational Process Full Traditional Case Report 2 4 4 6 8 10 12 13 15

Section 1. General Guidelines for All Case Reports

These instructions apply to all types of case reports.
People-First Language PTJ promotes people-first language. That is, patients and subjects should not be referred to by disability or condition (eg, use patients who have had a stroke or patients with stroke, rather than stroke patients or stroke survivors). Terms that could be considered biasing or discriminatory in any way should not be used. PTJ follows the American Medical Association [AMA] Manual of Style, 9th ed, published by Williams & Wilkins (Baltimore, Md).

Scientific Writing Style

Measurements Please use the International System of Units. (English units may be given in parentheses.) Manufacturer Footnotes For all equipment and products mentioned in the text, place a footnote containing the manufacturers full address with ZIP code at bottom of the page on which the item is mentioned, and use consecutive symbols (*, , , , ||, #, **, , , , ||||, ##). All manuscripts must be formatted double-spaced, with pages AND lines numbered. Please use 12-point font. Most manuscripts undergo a masked review process, so you will submit both a masked copy and an unmasked copy. In the masked version, please remove author names and any affiliations within the article. Sections, in order of appearance: Title page The title should indicate that the manuscript is a case report. Titles should not be vague. For instance, instead of using physical therapy to refer to intervention, state specific interventions (eg, strengthening exercises). Abstract Word limit: 250 words or fewer Structure: Background and Purpose, Case Description, Outcomes, Discussion Body of article Word limit: 3,500 words (excluding abstract and references). Additional materials may be submitted in the form of an appendix that would appear only as supplemental data on the PTJ Web site if the paper is accepted. Sections: Background and Purpose Patient History and Review of Systems - Clinical Impression Examination - Clinical Impression Intervention Outcome Discussion Acknowledgments References 30 or fewer References should be indicated by numerical superscripts that appear consecutively

Formatting

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General Guidelines (continued)

in the text. If you use End Notes, please use version 6.0 or higher. References should be listed in consecutive order on a separate sheet at the end of the manuscript. Follow AMA style for reference style. Cite the reference number in the text each time an author is mentioned. Use MEDLINE/PubMed journal abbreviations. References should be listed in the order of appearance in the manuscript, not in alphabetical order. Tables should be formatted in Word, numbered consecutively, and placed together at the end of the manuscript, after the reference list. Please refer to recent issues of PTJ for style. Figures should be submitted as separate, high-resolution graphic files in tif, jpg, eps, or pdf format, with the resolution set at a minimum of 300 dpi. Rule of thumb: the larger the figure (eg, 8.5" 11"), the better. If electronic formats are not available to you, figures must be submitted as 5" 7" camera-ready glossies and mailed to the Editorial Office. Figures should be numbered consecutively. For helpful guidelines on submitting figures online, visit Cadmus Journal Services. Lettering should be large, sharp, and clear, and abbreviations used within figures should agree with PTJ style. Color photographs are encouraged, in sharp focus and with good contrast. Figure legends should appear together after the reference list and tables. Appendixes should be numbered consecutively and placed after the figure legends or at the very end of the manuscript. Use appendixes to provide essential material not suitable for figures, tables, or text. If the manuscript is accepted for publication, the review team may recommend that an appendix appear online only. Comments To allow authors to provide detailed descriptions of evaluation and intervention procedures, treatment progression algorithms, etc, the use of appendixes, online video clips, tables, and figures are encouraged. These will not be included in the 3,500 word limit.

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Section 2. Whats Your Focus?

There are 7 potential focuses for case reports: Diagnosis/Prognosis, Clinical
Measurement Procedures, Intervention, Application of Theory to Practice, Risk Management, Administrative/Educational Process, and Full Traditional Case Report.

Diagnosis/Prognosis
Emphasis is on the diagnostic or prognostic aspect of patient care. May cover the process and logic associated with differential diagnosis (ie, clinical decision making), unusual or difficult diagnostic/prognostic events, missed diagnoses, etc. Detail should be concentrated in the patient history and physical examination and in the conclusion or decisions made based on the examination. The case report should challenge readers to deduce the diagnosis and determine how the diagnosis relates to the care of the patient. Interventions and outcomes may be included but should not have as much detail.

Section
Introduction/ Background

Requirements
Scholarly discussion on the current issues related to the diagnostic/prognostic aspect of the case (eg, current state of knowledge, problems with differential diagnoses, mimicking or missed diagnoses). Rationale for why the approach needs to be demonstrated in a case. Purpose statement that clearly indicates the focus as related to diagnosis/prognosis (eg, The purpose of this case report is to demonstrate the diagnostic process in.). Detailed demographic characteristics and history (eg, chief complaints, other relevant medical history, prior or current services related to the current episode, comorbidities) that are relevant to the diagnostic/prognostic approach being demonstrated. Patient/family goals for physical therapy. Clinical Impression: Based on the data provided so far, explain what you believe is the primary problem, the potential differential diagnoses that need to be addressed, and any further information not provided in the initial patient interview or history that you requested from the patient. Include the reasons for asking for this additional information as it pertains to the diagnostic/prognostic aspect of the case. The plan for examination (eg, test selection) should be clearly described. State why, at this point, this particular patient is a good candidate for the purpose of the case report. Examination procedures should be consistent with the clinical impression above and with the diagnostic/prognostic issues that are the focus of the case. Procedures directly related to the diagnostic/prognostic process being demonstrated should be described so that readers can replicate them (figures, tables, and supplemental appendixes and videos can be used to provide adequate detail). Available studies on reliability and validity of measurements should be cited. If not available, provide acknowledgement of this fact. Reviewers may request a presumptive argument for the potential of reliability and validity in these cases. Clinical impression: Provide a statement confirming or denying initial

Patient History/ Review of Systems

Examination

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Diagnosis/Prognosis (continued)

impressions based on the examination data, and give a working diagnosis. Indicate the plan of action (eg, proceed with intervention, further testing, referral for other consultation). State why the patient continues to be appropriate for the case. If the decision is to proceed, state the plan for intervention based on the current data. Include the plan for follow-up evaluation of outcomes (measures, time points). If further examination is required, address this next, indicating the additional tests and why particular tests are chosen. Another clinical impression: State the revised course of action, based on the additional information. Summarize the physical therapy and/or medical interventions used (eg, surgery, radiation therapy). If physical therapy interventions were performed, provide a general description of the strategy and intervention tactics. Tables, figures, appendixes can be used to provide details. Include enough detail so that the reader understands what was done, but extensive details should not be necessary. Clearly link treatment intervention back to the diagnostic decision-making process. Briefly describe the outcome measures, and cite evidence for reliability and validity. If reliability and validity have not been established for a measure, acknowledge this, and make presumptive arguments that the measurements would be reasonably reliable and valid for the purpose of the case. Present the outcomes over the time points indicated in the follow-up plan above. Compare follow-up outcomes to baseline. Tables and figures can be used to enhance the description. Provide a scholarly, critical analysis of how the diagnostic dilemma, if any, was resolved, and how the diagnostic process guided further decision making from a treatment and/or prognostic perspective. Compare the case to other similar reports in the literature, and provide rationale for how this case makes a novel contribution and improves existing diagnostic decision-making strategies. Offer suggestions for future research.

Intervention

Outcome

Discussion

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Clinical Measurement Procedures

Emphasis is on introducing a new clinical measurement procedure or modifying an existing procedure to deal with a specific problem or measurement issue. The difference between this category and diagnosis/prognosis is that the focus is on one specific procedure. Detail should be concentrated in the scientific rationale or theory for the procedure, the conditions under which the procedure should be used, and a thorough description of the procedure so that readers could replicate it (supplemental videos may be appropriate). The case demonstrates the clinical use of the test. If evidence of reliability or validity is not yet available in the literature, the authors should make strong theoretical and presumptive arguments that the procedure provides reliable and valid measurements and has the potential to influence decision making.

Section
Introduction/ Background

Requirements
Because this focus introduces a new measurement procedure or a modification to an existing procedure, the background information should be a scholarly discussion on the gaps in the literature for assessing the target problem or clinical outcome that would provide the rationale for either developing the new procedure or modifying an existing one. The background also should provide the underlying theoretical basis for the development of the new test or modification. This could be based on biological, physiological, biomechanical, psychosocial, measurement, or any other knowledge and theory. Purpose statement should clearly indicate that the focus relates to the clinical measurement procedure (eg, The purpose of this case report is to demonstrate the use of a new clinical measurement procedure for.). Demographic characteristics and history (eg, chief complaints, other relevant medical history, prior or current services related to the current episode, comorbidities) in sufficient detail to demonstrate that the patient is appropriate for the target measurement procedure. Clinical Impression: Based on the data provided so far, explain why you believe that the patient is a good candidate for the measurement procedure. Detail the examination plan for further determining whether the patient is appropriate for this type of measurement procedure (ruling in or ruling out relevant differential diagnoses). Statement confirming that the patient is appropriate for the measurement procedure, based on the examination data. Describe any tests needed to confirm this, as stated in the above clinical impression. Clinical Impression: Describe why the measurement procedure is appropriate for the patient and how the results will influence decision making. In this case format, the measurement procedure is viewed as the intervention. Describe the measurement procedure in detail. Details of how the measure was developed and how it is applied to the patient should be thorough so that others can replicate the procedure. Tables, figures, and appendixes can be used to enhance the detailed description. List the basic rules and criteria used to interpret the results or scoring of the procedure.

Patient History/ Review of Systems

Examination

Intervention (Measurement Procedure)

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Clinical Measurement Procedures (continued)

Clinical Impression: Present the results and interpretation of the measurement procedure. Describe how the results fit in with the other history and examination data to inform further decisions about interventions, referrals, etc. If the procedure results in intervention, describe the intervention plan. If an intervention or consultation was performed based on the result of the measurement procedure, report the outcome of the intervention or consultation. Compare outcome measures to pretreatment measures. Reflect back on how the measurement procedure helped identify the patients problem(s) and assisted in treatment planning and evaluating clinical outcomes. Presumptive arguments might be introduced for the procedures validity based on the case. Offer suggestions for further study of reliability and validity.

Outcome

Discussion

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Intervention
Emphasis is on the intervention aspect of patient care. May cover the development of a new intervention or a modification to an existing intervention to deal with a clinical problem. Detail is concentrated in the rationale for the new or modified intervention, the development process, the direct application to the patient, and the setting in which it is used. The patient history and examination should indicate why the patient is appropriate for the new or modified intervention. Outcome is included but should not have as much detail.

Section
Introduction/ Background

Requirements
Provide the underlying theoretical basis for the development of a new intervention or for the modification of an existing intervention, and provide relevant scholarly discussion on the gaps in the literature and in practice for treating the target problem. This would be based on biological, physiological, biomechanical, psychosocial, or any other knowledge and theory. Purpose statement should clearly indicate the focus of the case as it relates to the intervention (eg, The purpose of this case report is to describe the development and demonstrate the use of a new intervention for .). Demographic characteristics and diagnosis, patients chief complaints, other relevant medical history, prior or current services related to the current episode, and comorbidities in sufficient detail to demonstrate that the patient is appropriate for the intervention. Clinical Impression: Based on the data provided so far, explain why you believe the patient is a good candidate for the intervention. Detail the examination plan for further determining whether the patient is appropriate for this type of intervention (ruling in or ruling out relevant differential diagnoses, prognostic factors that suggest appropriateness for the intervention approach). In this case format, the examination section would be used to confirm that the patient is appropriate for the focus intervention. Provide descriptions of any tests needed to confirm this, as stated in the above clinical impression. Clinical Impression: Discuss why the patient is appropriate for use of the target intervention based on the examination data. Describe the plan for examination to determine the outcome of the intervention (measures to be used, follow-up time points), providing hypotheses of what should be observed if the intervention were to be successful. Describe the intervention in detail. Details of how the intervention was developed and how it is applied to the patient should be thorough so that others can replicate the procedure. Tables, figures, and appendixes can be used to enhance the detailed description. Provide the parameters of the intervention (ie, intensity, frequency, and duration) and rules for progression. State changes in treatment over time, along with the rationale for such changes. List any co-interventions that the patient may have received but that are not directly related to the purpose of the case; detailed descriptions may

Patient History/ Review of Systems

Examination

Intervention

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Intervention (continued)

not be necessary. Reviewers might ask for more detail if it is believed that the co-intervention would have a significant impact on the management of the patient. Outcome If not already in the examination section, provide operational definitions of the outcome measures and their purpose, and cite evidence for reliability and validity. Priority is given to validated outcome measures. If reliability and validity have not been established for a measure, acknowledge this, and make presumptive arguments that the measurements would be reasonably reliable and valid for the purpose of the case. Present the outcomes over the time points indicated in the follow-up plan above. Compare follow-up outcomes to baseline. Tables and figures can be used to enhance the description. Reflect back on how the intervention may have assisted in addressing the target problem. This should be done in the context of other cointerventions that may have been provided. The key points of development and application should be tied back to the rationale for the treatment and literature on previous treatment approaches for a similar problem. Suggestions for future research should be made.

Discussion

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Application of Theory to Practice

Case demonstrates how a theoretical principle was used to develop an intervention, evaluation procedure, administrative/educational process, etc. Detail is heaviest in fully explaining the theory, the implication of the theory for practice, the development of the intervention, test procedure, etc, based on the principles of the theory. The patient or setting is described in enough detail to show that it is appropriate for demonstrating application of the theory. Outcomes may be reported, but with less emphasis.

Section
Introduction/ Background

Requirements
Discuss thoroughly the theory to be demonstrated, citing the major references related to the theory. Discuss how you believe the theory could be applied to physical therapist practice, citing supporting literature. This discussion may relate to how the theory could be applied to an evaluation or intervention approach. The purpose statement should clearly indicate that the focus of the case is to demonstrate how the theory was applied to some aspect of physical therapist practice (eg, The purpose of this case report is to demonstrate how [name of theory] was used to develop an intervention approach for.). Demographic characteristics, diagnosis, patients chief complaints, other relevant medical history, prior or current services related to the current episode, and comorbidities in sufficient detail to demonstrate that the patient is appropriate for the demonstration of the theory application. Clinical Impression: Based on the data provided, explain why you believe the patient is a good candidate for the procedures. Describe the plan for examination to further determine whether the patient would be appropriate for this type of approach (ruling in or ruling out relevant differential diagnoses). Use the examination section to confirm that the patient is appropriate for the procedures. Describe any tests needed to confirm this, as stated in the above clinical impression. Clinical Impression: Discuss why the patient is appropriate for use of the approach based on the examination data. Describe the plan to determine the outcome of the intervention (measures to be used, followup time points), providing hypotheses of what should be observed if the approach were to be successful. Describe the approach (evaluation, intervention, or both) in detail. Details of how the intervention was developed should be in the context of the theory being demonstrated. Descriptions of the procedures should provide enough detail that readers can replicate them. Tables, figures, and appendixes can be used to enhance the detailed description. Where applicable, provide parameters such as intensity, frequency, and duration and rules for progression. State changes in treatment over time, along with the rationale for such changes. List any co-interventions that the patient may have received but that are not directly related to the demonstration of the theory; detailed descriptions may not be necessary. Reviewers might ask for more detail if it is believed that the co-intervention would have a significant impact on the management of the patient or on application of

Patient History/ Review of Systems

Examination

Intervention (Application of Theory to Practice)

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Application of Theory to Practice (continued)

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the theory to practice. Outcome If not already presented in the examination section, provide operational definitions of the outcome measures and their purpose, and cite evidence for reliability and validity. If reliability and validity have not been established for a measure, acknowledge this, and make presumptive arguments that the measurements would be reasonably reliable and valid for the purpose of the case. Present the outcomes over the time points as indicated in the follow-up plan above. Compare follow-up outcomes to baseline. Tables and figures can be used to enhance the description. Reflect back on how the approach adequately demonstrates the application of the theory to practice. The key points of development and application of the approach should be tied back to the original theory. Discuss whether the outcomes might suggest that the theory was successfully applied. Refer to previous literature to justify that application of this theory to practice as presented in the case may enhance future practice. Suggestions for future research should be made.

Discussion

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Risk Management
Case describes risk management issues or demonstrates how risk management issues were handled. May cover topics such as accidents, adverse events, emergencies, and risk reduction strategies that are associated with physical therapist practice. Emphasis is on describing the nature of the risk, the rationale for dealing with the risk, methods for resolving or reducing the risk, and involvement of any other personnel or agencies.

Section
Introduction/ Background

Requirements
Background information should include a thorough review of the risk management issue (accidents, adverse events, emergencies), including the nature and prevalence of the problem and how it can affect physical therapist practice. Other consequences of the riskssuch as legal, punitive, or budgetary and financial burdensshould be discussed to justify the importance of the topic. The purpose statement should clearly indicate that the focus of the case is to demonstrate a risk management issue in practice (eg, The purpose of this case report is to describe an approach designed to prevent an adverse event X in the care of a patient with.). Detailed description of the patient involved (history, pertinent examination data, the plan of care, and any other events leading up to the risk management issue). Discuss the current best-evidence guidelines for the management issue and the expected consequences of deviating from the guidelines. Clinical Impression: Based on the data provided, explain why you believe the current situation represents the risk management issue. Describe what you believe needs to be done to correct, minimize, or prevent the risk at this point, and summarize the next course of action. Discuss plans for determining the outcome of the action plan. Describe in detail the steps taken to address the risk. Where applicable, cite literature that provides the rationale for the actions taken. If the steps involve the addition of an intervention, describe it in detail so that the reader can replicate it. If the steps involve interaction with other professionals, describe the purpose and nature of these interactions. Discuss the results of the actions taken to address the risk, consistent with the stated plan for determining outcome. If measurement procedures are used, they should be operationally defined, and evidence for reliability or validity should be cited, if available. If such information is not available, acknowledge this, and make a presumptive argument for validity. Reflect back on how well the actions used adequately addressed the risk. Care must be taken to keep this discussion in the context of the case and not make generalized conclusions about how to address the risk. Suggestions for future research should be provided.

Details of the Current Risk Management Issue

Actions Taken to Address the Risk

Outcome

Discussion

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Administrative/Educational Process
Case describes or demonstrates the development and implementation of new administrative/educational processes or modifications to existing approaches to address special problems or needs. Detail is concentrated in the rationale for the new or modified process, steps taken to develop the process, and the direct application of the process in the context of the intended target population and setting in which it would be used.

Section
Introduction/ Background

Requirements
The background should provide enough review of the literature to justify the development or demonstration of the process. Explain what has been done or not been done currently or in the past that justifies a change in the paradigm or a modification of an existing paradigm. The purpose statement should clearly indicate that the focus of the case is to demonstrate an administrative/educational process (eg, The purpose of this case report is to describe the development and demonstrate the implementation of an X management approach in outpatient physical therapy clinics to.) Provide details about the setting for which the process will be developed and in which it will be implemented. The description may include previous or current data about the setting sufficient to justify why this setting needs the process and why the facility is appropriate for it. State directly why this setting is appropriate for the demonstration of the process, based on the data provided in this section. Provide a detailed description of the steps taken to develop the process. The rationale for each developmental step should be supported by the literature or other solid rationale. Discuss any other special considerationssuch as, but not limited to, stakeholder consultationsthat were taken into account in developing the process. Describe the plan to determine the outcome of implementing the process (measures, follow-up time points), providing hypotheses of what should be observed if the approach were to be successful. Provide details of how the approach was implemented in the target setting. Discuss the technical aspects of implementing the process, and identify the time-dependent factors (eg, frequency, duration). Describe any training procedures that were used for those involved in implementation of the process. Explain what was done to get acceptance by staff involved with implementing the process. Discuss the outcomes of the actions taken to implement the process, consistent with the stated plan for determining outcome. If measurement procedures are used, they should be operationally defined, and evidence for reliability or validity should be cited if available. If such information is not available, acknowledged this, and make a presumptive argument for validity. Reflect back on how well the implementation of the focus achieved its goals, based on the outcome data. Care must be taken to keep this discussion in the context of the case and not make generalized

Target Setting

Development of the Process

Application of the Process

Outcome

Discussion

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Administrative/Educational Process (continued)

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conclusions about use of the process in other settings. Discuss any difficulties encountered during the development and implementation of the process that could have affected the outcome. Refer to previous literature to justify that the application of the process in the case may or may not enhance administrative/educational processes in physical therapy. Suggestions for future research should be made.

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Full Traditional Case Report

Case describes the overall management of an unusual case or a condition that is infrequently encountered in practice or poorly described in the literature. The entire care of the patient from start to finish is described, with no one aspect of care receiving greater focus.

Section
Introduction/ Background

Requirements
Scholarly presentation of the importance of the topic and the rationale for the case. Cite background literature concerning the clinical problem and the evaluation and treatment procedures that will be emphasized, culminating in a purpose statement that is supported by the background information. Demographic characteristics, diagnosis, other relevant medical history, prior or current services related to the current episode, comorbidities, patients chief complaints. Patient/family goals for physical therapy. Clinical Impression: Based on the data provided so far, explain what you believe to be the primary problem, the potential differential diagnoses that need to be addressed, and the plan for examination (tests to be used, etc), and state why this particular patient is a good candidate for the purpose of the case report. Examination procedures should be consistent with the clinical impression above. Procedures that might not typically be used by physical therapists should be described so that readers can replicate them (figures, tables, and supplemental videos and appendixes can be used to provide adequate detail). Provide citations for more commonly used procedures. Cite available studies on reliability and validity of measurement. If such studies are not available, acknowledge this fact. Reviewers may request a presumptive argument for the potential of reliability and validity in these cases. Clinical Impression: Provide a statement confirming or denying the initial impression, based on the examination data. Indicate the next plan of action (eg, proceed with intervention, further testing, referral for other consultation). State why the patient continues to be appropriate for the case. If the decision is to proceed, state the plan for intervention based on the current data. Provide the plan for follow-up evaluation of outcomes (measures, time points). Another clinical impression: If further examination is required, discuss it, and state the revised course of action. The interventions indicated in the plan of action from the section above should be described so that the reader can replicate the interventions (figures, tables, and supplemental videos and appendixes can be used to provide adequate detail). Purpose statements for each of the interventions should be provided. Provide parameters such as intensity, frequency, and duration and rules for progression. State changes in treatment over time, along with the rationale for such changes.

Patient History/ Review of Systems

Examination

Intervention

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Full Traditional Case Report (continued)

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List any co-interventions that the patient may have received but that are not directly related to the purpose of the case; detailed descriptions may not be necessary. Reviewers might ask for more detail if it is believed that the co-intervention would have a significant impact on the management of the patient. If not already presented in the examination section, provide operational definitions of the outcome measures and their purpose, and cite evidence for reliability and validity. If a measure is used for which reliability and validity are not yet known, acknowledge this, and make presumptive arguments that the measurements would be reasonably reliable and valid for the purpose of the case. Present the outcomes over the time points indicated in the follow-up plan above. Compare follow-up outcomes to baseline. Tables and figures can be used to enhance the description. Summarize how the case demonstrated the intended purpose. Relate what happened to other cases in the literature and/or to the background given at the beginning of the case report. Avoid any definitive cause-and-effect statements about interventions. Avoid making definitive generalizations to other patients. Speculate on potential implications for clinical practice. Offer suggestions for future research.

Outcome

Discussion

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