Survey of referring veterinarians' perceptions of and reasons for referring patients to rehabilitation facilities

Veterinarians' Self-Reported Needs and Attitudes on the Atlantic Canada Veterinary College and Associated Teaching Hospital in Relation to Continuing Education, Research, and Clinical Referrals

The relationship between veterinary colleges (VCs), associated veterinary teaching hospital referral centers (VTHs), and referring veterinarians (rVets) is important and complex. Despite this, there has been minimal research on rVets with respect to their regional VC and VTH. Our objectives were to evaluate rVets' attitudes and self-reported needs on their regional VC's VTH surrounding (a) continuing education, (b) collaborative research, and (c) referrals for specialty consultation and care. Participants (rVets) were invited to complete an online questionnaire (2018-2019). Respondents (n = 56) indicated multiple (24) unmet continuing education topic needs, of which dermatology and behavior were most selected. Many rVets (70%) reported an interest in collaborative research participation. Communication was frequently selected by respondents when asked what could be improved with respect to the VTH referral center process. Our work provides a benchmark attitudes and needs assessment, identifies areas for improvement, and may aid initiatives regionally, and likely externally, as adapted to other rVet-VC-VTH relationships.

Ground Reaction Forces and Center of Pressure within the Paws When Stepping over Obstacles in Dogs

Simple Summary

Physical therapy and rehabilitation are emerging in veterinary medicine, and more research is needed to understand the effect of various exercises on kinematics and kinetics in animals. This will allow the animal physiotherapist to best utilize these exercises as a therapeutic and even diagnostic tool. Walking over obstacles is a typical canine physiotherapy exercise; however, no studies investigating the kinetics have been conducted. The present study showed significant changes in ground reaction forces and center of pressure in dogs walking over obstacles compared to normal walking. This can reflect a challenge that the animals have to overcome in order to perform this exercise. The data can be used for further studies in diseased animals or in the future as a diagnostic tool.

Abstract

Walking over obstacles is a widely used physiotherapy exercise in dogs. Current research is limited to the effect of this exercise in kinematics and muscle activation in dogs. The present study assessed the influence of walking over obstacles on the ground reaction forces (GRFs) and center of pressure (COP) in dogs. Data of dogs walking over one and two obstacles over a pressure platform were retrospectively analyzed and compared to normal walking. Walking over one obstacle did not affect the GRFs and COP of the forelimbs; however, significant changes were observed for the hindlimbs, especially the leading hindlimb. Walking over two obstacles caused significant changes to only one value at the forelimbs, whereas multiple significant changes in the GRFs and COP values were observed at the hindlimbs. Walking over obstacles seems to be challenging even for healthy adult dogs. Further studies are needed to investigate how different heights of obstacles and distances between them can further challenge the animals. The combination of kinetics and kinematics during walking over obstacles may be used in future as a diagnostic tool in geriatric and neurological patients in order to assess their proprioception awareness or to assess the improvement after an intervention, e.g., physiotherapy treatment.

Canine Geriatric Rehabilitation: Considerations and Strategies for Assessment, Functional Scoring, and Follow Up

Geriatric animals account for half of the pet population in the United States with their numbers increasing annually. Furthermore, a significant percentage of veterinary patients with movement limitations could be grossly categorized as geriatric and living within the end stage of their predicted lifespans. Because mobility is correlated to quality of life and time to death in aging dogs, a major goal in optimizing canine geriatric health is to improve functional movement. Within the geriatric population, identifying disabilities that affect daily living and quality of life may be used by the rehabilitation practitioner to provide stronger prognoses, treatment goals, and outcome measures. Examples of such means are described within this review. In human medicine, the concept of “optimal aging”, or “healthy aging”, has emerged in which inevitable detrimental age-related changes can be minimized or avoided at various levels of physical, mental, emotional, and social health. Both environment and genetics may influence aging. Identifying and improving environmental variables we can control remain a key component in optimizing aging. Furthermore, diagnosing and treating age related comorbidities common to older populations allows for improved quality of life and is often directly or indirectly affecting mobility. Obesity, sarcopenia, and a sedentary lifestyle are a trifecta of age-related morbidity common to both people and dogs. Healthy lifestyle choices including good nutrition and targeted exercise play key roles in reducing this morbidity and improving aging. Disablement models act as essential tools for creating more effective physiotherapy plans in an effort to counter dysfunction and disability. Within these models, functional testing represents a standard and validated means of scoring human geriatric function as well as monitoring response to therapy. Because of the great need in dogs, this review aims to provide a reasonable and testable standardized framework for canine functional scoring. We believe a complete assessment of canine geriatric patients should comprise of identifying environmental variables contributing to health status; diagnosing comorbidities related to disease and aging; and characterizing disability with standardized methods. Only through this process can we construct a comprehensive, reasonable, and targeted rehabilitation plan with appropriate follow up aimed at healthy aging.

Systematic review of postoperative rehabilitation interventions after cranial cruciate ligament surgery in dogs

Objective

To critically evaluate the evidence for rehabilitation interventions following surgery for cranial cruciate ligament disease (CCLD) in dogs.

Study design

Systematic review.

Methods

Google Scholar and Pubmed databases were searched for studies evaluating postoperative CCLD rehabilitation interventions from 1990 until March 2020 per the international Prospective Register of Systematic Reviews (PROSPERO). Each study was assigned a level of evidence score from I to IV and a risk of bias (RoB) score by 2 reviewers, and by a third reviewer, when consensus was not reached.

Results

Nineteen studies met the inclusion criteria. Twelve comprised randomized, controlled trials (Level II), 6 were nonrandomized or nonblinded (Level III), and one was retrospective (Level IV). Nine studies had high RoB scores. Sixteen studies yielded positive results. Therapeutic exercise had the most studies with positive results but all had high RoB. Cold compression therapy had 3 supporting studies (2 Level II, low RoB). Extracorporeal shockwave yielded 2 positive Level II studies (low‐moderate and high‐moderate RoB) and photobiomodulation had 1 positive study (Level II, low RoB) with objective outcomes. A negative outcome was noted in 1 photobiomodulation study. There was 1 supporting study on electrical stimulation and there was none on low‐intensity pulsed ultrasound.

Conclusion

This systematic review supports the use of rehabilitation interventions in recovery of postoperative CCLD in dogs; however, many studies had a high risk of bias.

Clinical significance

There is a lack of class I level evidence in veterinary rehabilitation. This study supports therapeutic exercise and cold compression therapy for postoperative CCLD rehabilitation. Existing studies on other modalities are limited and demonstrate conflicting results.

Treatment of canine osteoarthritis with allogeneic platelet-rich plasma: review of five cases

Background:

Osteoarthritis (OA) is a major cause of chronic pain and lameness in dogs. Platelet-rich plasma (PRP) is a concentrate of growth and differentiation factors from the blood, which can be used in regenerative medicine strategies.

Aim:

The main aim of this study was to evaluate the effect of allogeneic PRP on the treatment of canine OA.

Methods:

Five dogs from several breeds, between 6 and 12 years old, and from both genders were studied. Clinical and imageological examinations diagnosed OA in the knee, tibiotarsal, elbow, and intercarpal joints. These dogs were refractory to medical therapy and to physical rehabilitation protocols that included shockwave therapy, laser therapy, electrostimulation, hydrotherapy, and diathermy.

Animals were treated with allogeneic PRP obtained from the blood of the five dogs, which was processed in a pool. Echoguided intra-articular PRP injection was administered under sedation and after aseptic field preparation. Lameness at walk and trot (five grades) and pain (five scores) were evaluated before treatment and 30, 60, and 90 days post-treatment.

Results:

All animals presented improvements at 30 and 60 days in both parameters. Four dogs showed a decrease of three grades of lameness after 90 days and there was complete absence of lameness in 2 days. Pain was reduced from severe and moderate to mild in all the dogs after 30 days, and among them, three revealed no pain after 90 days.

Conclusion:

This study sheds light on the applicability and safety of a single administration of allogeneic PRP in osteoarthritic dogs.

Low-Level Laser Therapy for Osteoarthritis Treatment in Dogs at Missouri Veterinary Practice

A qualitative survey was electronically distributed to practicing veterinarians in the state of Missouri to evaluate the frequency of use and economic impact of low-level laser therapy (LLLT) for the treatment of osteoarthritis (OA) in dogs in Missouri. The survey response rate was 10% (89/867). Approximately half (43%) of respondents had LLLT units, of which all used LLLT for OA treatment in dogs. In respondents without LLLT units, 20% referred patients for LLLT OA treatment. Training was most often obtained in-house by a representative of the LLLT unit manufacturer (76%). Treatment dose was largely unknown and chosen by predetermined settings on the LLLT unit (65%). In the majority of patients (84%), no treatment site preparation was performed. An average of four patients with OA were treated per wk with an average cost per treated joint of $28 (range: $15-45). This study provides insight into the current clinical use and estimated annual economic impact ($6.2 million per year) of treating a single OA joint in dogs with LLLT by Missouri veterinarians. The frequency with which LLLT is used in the treatment of OA combined with the variation in training and treatment protocols supports the need for further research regarding the application and efficacy of LLLT in dogs with OA.

Objective Comparison between Platelet Rich Plasma Alone and in Combination with Physical Therapy in Dogs with Osteoarthritis Caused by Hip Dysplasia

Simple Summary

Finding successful treatments against osteoarthritis without secondary effects and objectively assessing their effectiveness in dogs is always challenging. In this sense, the aim of this study was to objectively assess the efficacy of platelet rich plasma alone and in combination with physical therapy by using a force platform in dogs with hip osteoarthritis. Dogs receiving only the platelet rich plasma treatment showed a significant improvement in limb function, although the effect decreased after 180 days; in contrast, the combined therapy maintained the maximum level of efficacy throughout the study period. Our study proved that physical therapy does not increase the level of efficacy of platelet rich plasma therapy but objectively contributes to prolonging its effect for more than this time period.

Abstract

Osteoarthritis (OA) is one of the most significant joint diseases worldwide. There are different therapies for OA treatment, and a relatively new strategy is the use of plasma rich in growth factors (PRGF), a platelet rich plasma (PRP) derivative. The objective of this study was to objectively assess the efficacy and duration of the effect of an intraarticular injection of PRGF and a combination of PRGF + physical therapy. The objective assessment was provided using a force platform. The obtained parameters were peak vertical force (PVF) and vertical impulse (VI). A total of 24 dogs with lameness and pain associated to OA attributable to bilateral hip dysplasia were included in the study. Animals were divided into two study groups and evaluated at baseline and at 30, 90, and 180 days after intraarticular PRGF or PRGF + physical therapy. Significant differences were observed at every checkpoint with respect to basal time in both groups. However, after 180 days, the PRGF group showed a decrease in PVF and VI with respect to the values obtained at 90 days. However, the PRGF + physical therapy group maintained increased values of both PVF and VI values during the 180-day study period.

Recommendations for rehabilitation after surgical treatment of cranial cruciate ligament disease in dogs: A 2017 survey of veterinary practitioners

OBJECTIVE

To report current recommendations made by veterinarians for rehabilitation after surgical treatment of cranial cruciate ligament (CrCL) disease.

STUDY DESIGN

Anonymized electronic survey.

SAMPLE POPULATION

Veterinarians performing CrCL stabilization.

METHODS

An electronic survey was created to collect information on general attitudes toward postoperative rehabilitation and recommendations regarding therapeutic modalities and bandaging. Quantitative data are reported by descriptive statistical analysis, percentage of responses, or mean (±SD). The recommendations for postoperative bandaging beyond 24 hours and for postoperative rehabilitation after extracapsular stabilization compared with after tibial osteotomy were tested by using Cochran-Mantel-Haenszel tests, with P < .05 considered statistically significant.

RESULTS

The data analysis included 376 responses (13% response rate). Most (71%) respondents consistently recommended postoperative rehabilitation. Rehabilitation was more than twofold more likely to be recommended after extracapsular stabilization than after osteotomies (P = .0142). Most respondents did not recommend bandaging beyond 24 hours postoperatively (P = .00012).

CONCLUSION

Most respondents recommended either formal or informal postoperative rehabilitation therapy.

CLINICAL SIGNIFICANCE

If the survey respondents are representative of veterinarians performing CrCL surgery, the current attitude is supportive of postsurgical rehabilitation. Most respondents would welcome evidence-based guidelines for rehabilitation protocols.