I've been thinking about this topic a lot recently so I thought I'd turn it into a brief post.
Why do we devalue case studies, case reports and case series so much?
It is well known that RCTs, Meta-analyses, and Cochrane Reviews stand at the top of the "evidence-based food chain", but why do we give so little credit to single-case research? The other day, I posted the following video from Patch Adams:
"You treat a disease, you win, you lose. You treat a person, I guarantee you, you win, no matter what the outcome.".
For those of you in any medical profession, and for many of you who are high level strength and sport coaches, my guess is that the above statement reasonated well with you. I could be wrong but deep down, I think we would all agree that "the person" we are working with, is our utmost priority.
So why do we study disease so much more than we study people? Is it time and money? Likely. Logistics? Perhaps. Standardization? Probably.
Don't get me wrong, I do think we need the highest levels of evidence possible. But I truthfully think the relative intangibles - the personalities, the cognitive thought processes, and the normal activities of daily living - are what make each individual we work with unique.
With all the research both published and performed to date, there are so many more questions. How do we not have the answers?
In my mind, the answers are right in front of us. The patients. The athletes.
If we focus on the disease, be it systemic, orthopaedic or other, we'll miss the person.
If we focus on the person, "I guarantee you you will win, no matter what the outcome". (Though the outcome will likely be positive)
Standardization is important and thus, so are RCTs, meta-analyses, and cochrane reviews. But as found in the description for the book, "Single-Case Research Methods in Sport and Exercise Physiology",
"Single-case research is a powerful method for examining change in outcome variables such as behaviour, performance and psychological constructs, and for assessing the efficacy of interventions."