Date Presented 04/03/2025
This study presents the application of a new three-axis model to categorize case studies presented in the American Journal of Occupational Therapy over the past 30 years in an attempt to indicate the role of case studies in OT literature and evidence-informed practice.
Primary Author and Speaker: George Tomlin
Additional Authors and Speakers: Ashlea D. Cardin, Jessica McHugh Conlin, Aimee Piller, Bonnie Riley
PURPOSE: Case studies are usually relegated to the lowest level in evidence hierarchies. Yet they have a long tradition in health care literature, and may particularly document the holism, inclusivity, uniqueness, and complexity of OT practice. The purpose of this study was to determine how case studies make a distinct contribution to professional knowledge, using a new model for categorizing case studies.
DESIGN: Narrative content analysis of 103 case studies published in AJOT from 1990-2023.
METHOD: A coding book was used to rate case studies as ‘1’ or ‘2’ on features derived from 3 axes: (1) frequency such a case would be encountered in current professional practice (rare = 2), (2) complexity of the causes of the client’s occupational challenges (complex = 2), and (3) complexity of the OT intervention (multidimensional = 2).
RESULTS: 93.2% of case studies had some feature of novelty or complexity: 35.9% portrayed a rare/novel diagnosis, 63.1% displayed complex problem causes, and 83.5% involved multi-dimensional OT interventions. In 55.3% of the articles both the causes and the interventions were complex.
CONCLUSION: The predominance of novelty/complexity among the articles supports the claim that case studies mostly describe professional decisions and outcomes in those therapy situations that are less amenable to group experimental studies (infrequent/novel, complex causes, complex interventions). The value of the 3-axis model of case studies was supported.
IMPACT STATEMENT: Case studies provide a distinct source of evidence supporting inclusive, client-centered practice.
References
McQuaid, L., Thomson, K., & Bannigan, K. (2023). Exploring the contribution of case study research to the evidence base for occupational therapy: A scoping review. Systematic Reviews, 12(B), 132. https://doi.org/10.1186/s13643-023-02292-4
Hercegovac, S., Kernot, J., & Stanley, M. (2020). How qualitative case study methodology informs occupational therapy practice: A scoping review. OTJR: Occupation, Participation and Health, 40(1), 6–16. https://doi.org/10.1177/1539449219850123
Miller, C., Barnett, M. L., Baumann, A. A., Gutner, C. A., & Wiltsey-Stirman, S. (2021). The FRAME-IS: A framework for documenting modifications to implementation strategies in healthcare. Implementation Science, 16, 36. https://doi.org/10.1186/s13012-021-01105-3
