Finally! Here it is, the survey results for how rehab practitioners are using exercise for their osteoarthritic patients. The survey was based on a blog I wrote about a month ago subsequent to reading a paper about why exercise is effective in reducing pain in people with osteoarthritis (OA).
Sixteen practitioners completed the 4-question survey.
Question one was tricky. Is ‘in-clinic’ therapist-led exercise for dogs with Osteoarthritis part of your treatment offering? One person said “nope’ and all others said, ‘yes’.
Question two: If yes, in what capacity? (i.e. UWT, Pool, Land Treadmill, Land-based exercise)
Ten respondents commented that they utilized underwater treadmill for their OA patients, 14 commented that they used land-based exercise, and 3 used a land treadmill. Two respondents provided additional comments: Could be anything from a crawl to front feet elevated with perturbations, it depends on the dog and the joints affected; Therapeutic exercise [could be] with and without "equipment"--cavalettis, steps, BOSU, etc.
Question three: Do you also prescribe home exercises? Or prescribe home exercises instead of therapist-led exercises? (please elaborate)
The participant that answered ‘nope’ to question one, commented, “We do home exercises.” Here are all of the other answers to this question:
- I just suggest walking as much as the dog is willing to walk
- 99% of cases are given home exercises. I would always try these with the dog myself before giving them to the owner to do
- Home exercises
- Yes, for sure! I evaluate the capacity of the team, we discuss financial and logistical resources, time, and what seems will be therapeutic and fun for that team. Often, I teach them the land based exercises to do at home, emphasizing correct posture and gait and we do underwater treadmill at the clinic because that's something they can't do at home.
- yes, every owner has things to work on at home and they are instructed to see how the dog is moving for the day and to work within the dog’s limitations which can change daily.
- Yes, additional home exercises (3-6) to complement in clinic activities
- BOTH in-clinic to assess patient response, and HEP with appropriate exercises (depending on the patient-client "team")
- We always send home exercises. I print out the exercises with pictures so owners are having their dogs perform them correctly.
- Home exercises and return weekly
- Practice exercises in the home, have owners practice them leave written instructions for home program
- Yes, every patient goes away with a small selection of HEP which are then progressed as able. We may actually do 5-10 different exercises in the session but I try not to send more than 3-4 home to do, just to increase compliance
- Always, every owner gets a home exercise program.
- Some of the therapist-led exercises will be set at home exercises, depending on owner skill set and enthusiasm.
- I also prescribe a home program
- We do prescribe home exercise programs to complement the gains achieved by manual therapy and UWTM sessions. Home Exercise Programs are devised by the vet rehab therapist or veterinary physiotherapist
Question four: Or do you take a different approach altogether? And if so, what is your strategy?
- I mainly do acupuncture, Homotoxicology with guna MD, I inject a cocktail of 2-3 guna products (poly, matrix and specific to joint hip, knee, small joints...) with B12 around painful joints and on acupuncture points, and many times I add a formula of Chinese Herbs.
- I probably don't stress enough the importance of the exercises and feel that compliance is sometimes poor.
- We use a combination of modalities, manual therapy, exercises, UWTM, HEP, nutraceuticals, home accommodations, etc. to address with anything that can improve the dogs pain level, mobility and function.
- We also add in modalities such as laser or shockwave therapy if the owners are able.
- Nope, I take the strategy you take as far as let's try a few weeks of rehab and see how your dog does and reassess after that. I think it is easier to get a client to buy in that reasoning vs let's do 12 sessions and then your dog should be good, lol!
- We also talk about the type/duration of the dog’s daily exercise/ walks and try and incorporate features that will build endurance and strength in appropriate muscle groups during those walks e.g. inclines, stepping over tree roots, walking thru long grass, over different surfaces etc.
Thank you to those of you that took the time to respond. Me? My approach to osteoarthritis therapy is for me (as the therapist) to do the manual therapies, modalities, and/or acupuncture in my treatment sessions. I’ll test and trial land based exercises in clinic to prescribe as home exercises. And if the owner is willing and interested, they can book in for underwater treadmill sessions to go along with the other therapies.
There you go! Hopefully this gives everyone some food for thought on using therapeutic exercise for osteoarthritis patients. Happy treatment planning this week!