Physical Therapy and Rehabilitation for Pets: Where's the Evidence?
Quite a few years ago a funny commercial appeared on television for Wendy’s, the famous American hamburger fast food chain. It featured a little elderly lady, picking up the top hamburger bun and peering down at the sandwich. She frowns, raises her chin and yells “Where's the Beef?!!!" Remember it? What good is a burger without a hefty amount of beef?
In today’s medicine, both human and non-human animal, the ‘beef’ is evidence!
The question of ‘Where’s the Evidence?’ is an essential part of providing care and receiving third party reimbursement. Evidence-based medicine is defined as “the effort to place all medical decisions on the strongest scientific proof available.”
Health care professionals are encouraged, even pressured, to practice evidence-based medicine.
Is this a good thing?
I’m not the ‘cookbook’ type in terms of being a therapist or in the kitchen! I tend toward creativity and intuition when planning treatment and also when cooking. I recognize the importance of considering the results of valid research studies (and tested kitchen recipes) as guidance in clinical decision-making. It shouldn't be the sole basis, but it should always be factored in.
Using evidence helps to critically assess the effectiveness of therapy and document reproducible results.
Yes, it’s a good thing.
Physical therapy and rehabilitation for animals is such a new field that there are not many veterinary studies in the literature on which to base decisions. Though there are some good studies, therapists must often go to the human field to find evidence to apply when making therapy recommendations.
Here are examples of studies and findings which support the effectiveness of various therapeutic interventions in animal rehabilitation:
1. Cranial Cruciate Ligament injury and surgery in dogs
Darryl Millis and David Levine (University of Tennessee College of Veterinary Medicine) study the effectiveness of early PT following ligament repair surgery 9 both TPLO and non-TPLO (VetSurg 26:254, 1997). A similar study on the effects of post-op rehab on limb function after CCL repair was documented in Journal of Am Vet Med 220: 2002, by Marolais, Dvorak and Conzemius. These and other studies document significant improvement postoperatively in dogs receiving PT compared to those cage-rested only. Millis et al. also conducted trials comparing dogs that received electrical stimulation (NMES) in their program compared to those who received exercise only. Increased muscle mass with greater thigh circumference was present in the dogs having NMES.
2. Degenerative Myelopathy (DM) and PT treatment
Kathmann and Cizinauskas compared survival time in dogs with suspected and confirmed (DM: Journal Vet Med, 2006). Dogs having daily controlled PT consisting of massage, assisted gait activity, range of motion exercises to the limbs, swimming exercises and underwater treadmill walking remained ambulatory longer than the control group having no PT. The variety of canines studied included German Shepherd Dogs, Bernese Mountain Dogs and mixed breeds.
3. PT for dogs diagnosed with Fibrocartilaginous Embolic Myelopathy (FCEM)
75 dogs having FCEM were studied with the treatment group receiving water exercise and standing in hydrotherapy pools, neuromuscular electrical stimulation (NMES), massage, stretching and functional strength exercises, with the control group receiving no PT (Gandini et al., Journal of Small Animal Practice, 2003). Dogs having PT treatment instituted immediately after diagnostic workup demonstrated improvement. PT treatment had a major influence on recovery rate of paralysis.
4. Use of Laser in Wounds
Meta-analysis, performed by Woodruff and Bounkeo showed significant positive result in wound repair for human beings receiving laser treatment (Photomed Laser Surgery Journal, 1997). Lucroy and Edwards posted a similar study involving dogs demonstrating rapid wound closure in canines receiving daily laser (Vet Surg Journal, 1998).
5. Carpal Ligament injury and bracing
Tomlinson posted a study evaluating the application of a carpal brace plus range of motion exercises and isometric strengthening in athletic performance dogs having unilateral (one limb only) carpal ligament injury (similar to the wrist joint in humans) with instability (Journal American Vet Med Assoc, 2014). Eleven out of fourteen dogs receiving PT and bracing returned to agility activity. All of the dogs had increased joint stability and decreased lameness.
In the coming months and years more studies will be performed and documented, providing greater insight into the effects of PT and rehabilitation for dogs and other animal species. Personally, (wishing I were 25 years younger) I would love to see studies in the following areas:
- The effect of PT treatment on partial cruciate ligament tears (non-surgical) consisting of Laser, NMES electrical stimulation and therapeutic exercise.
- Comparison of rapid onset of PT after injury (within 1 week) v. delayed onset (6 weeks post injury)
- Neuroplasticity: the effect of limb patterning, brushing and other sensory stimulation PT techniques on recovery of paralysis in spinal cord injury, FCEM, trauma to nerves, etc.
- Any studies on PT for species beyond canine and equine. I hope to see Physical Therapy expand further into feline, avian, caprine and many other species. During the years I serviced a zoo for rescued and neglected animals, there were unique opportunities to work with a wide variety of species.
If you are curious to know some of the most unusual ones, tweet me @animalPTsue and I’ll tell you! In the meantime, keep your veterinarians and therapists on their toes when treatment recommendations are made, asking:
“Hey, where’s the (beef) evidence?”