by Kathryn Cowley

It is well recognised that physical therapies are an important part of rehabilitation for patients suffering from acute injuries, and are a great tool for management of chronic pain. With as many as 1.7 million dogs in the UK suffering from osteoarthritis, both veterinary clinics and therapy centres alike are seeing huge number of patients that would benefit from the combined care from a physical therapist and a veterinary professional. Unfortunately, in many cases, there is a real lack of communication between these two sectors and this is almost certainly having a negative impact on patient care.

The question is how do we improve this situation?

As with many things, education is they key. A fundamental essential is that the importance of rehabilitation is taught at veterinary and veterinary nursing schools as well as being reiterated after graduation in continuing professional development (CPD) courses.

Currently the syllabus for these courses is filled with essential clinical learning, and the wish to include more disciplines has been a met with concern. However, course structures are continuously changing and there is hope for future inclusion of more material about rehabilitation and complementary therapies. There is an opportunity for therapists to fulfill this deficit in understanding.

It is common place for veterinary clinics to receive short CPD training in house over a lunch break. This may be an opportunity for you and your business to offer short introductions to how your therapy could fit into that practice. Perhaps holding an evening event, where you invite the staff from multiple local clinics to see your facility and receive some training, may work better for you. Guiding them around your facilities and explaining how the chosen therapy will affect their client will help forge the link between you and your local practices, ultimately helping to increase footfall through your business.

Continuing with the importance of continued education, it would be prudent for those associations that award qualifications to physical and complementary therapists

start working in conjunction with veterinary specific CPD providers, such as those who produce well attended webinars for vets and nurses. This would allow for wider relevant audiences to be reached.

Why are these collaborations slow to take hold?

Being a vet myself, I can understand the reluctance to refer for treatment with a therapist of non veterinary training. It is heavily influenced by the lack of understanding of the level of knowledge and training that the physical therapists have, and how to choose a centre that offers good quality care. There is an honest concern that poor treatment could be performed at a physiotherapy or hydrotherapy centre recommended by themselves. This will reflect poorly on them, and could have the potential to have more dramatic repercussions.

Advertising the qualifications and accreditations that the therapists hold would add to the vets confidence in said therapist. This is an opportune moment to mention that like with the UK vet schools increasing from 6 to 9 in recent years, the same is happening with nurse, and therapist training centres, but on a much greater scale.

The surge in animal physiotherapy, rehabilitation and complementary therapy qualifications makes it very difficult for veterinarians to have faith in a new therapist, because they simply are not familiar with the qualification system.

Displaying well recognised and respected associations is essential. For example if your hydrotherapists are members of C.H.A or NARCH make sure this is known and ensure that your local clinics understand what this means, including that fact that insurance companies will potentially cover costs for patients treated by therapists who are members of these organisations. (Financial constraints certainly impact on some owners willingness to undertake such treatments). It’s reassuring for a vet to know that they are recommending referral to a highly trained professional.

While promotion of physical therapy treatments to the veterinary team is certainly part of the battle, promotion of these techniques to dog owners themselves is also

important. If owners are armed with the knowledge of how such treatments could improve their dogs pain management, rehabilitation and ultimately their quality of life, they are more likely to ask about them during a veterinary consultation, prompting the discussion and possible referral.

Social media is a great way of reaching out to dog owners, letting them know about their local

centres and the general benefits of treatments. In other sectors of veterinary care, referral to a specialist requires completion of a referral form, giving all the details of the pets condition, medications and previous treatments. Once treatment has been carried out by the specialist, a report is then issued back to the patient's primary vet so they are kept informed of the patients treatment and progress. While most therapy centres do require a veterinary surgeon to give permission for treatment this is not always the case and it is even more rare for therapy centres to then send reports back to the patients vet with updates.

This simple, written communication is key. It could make a huge difference to how cases are managed and monitored, as it allows the veterinary clinic to reinforce the advice given to that individual patient by the therapist.

When writing these reports its useful to include information such as: • Your finding on examination e.g. areas of muscle wasting or trigger points

• What treatment has been carried out
• What advice the owner has been given, including any exercises advised to be carried out at home and frequency of repeat treatments
• Areas of concern brought to you by the owners - owner may bring up points to you that they fail to mention during a veterinary consult

Consistency of care between both divides could also be vastly improved by use of consistent monitoring tools which can be used in both the veterinary and therapy consultations as well as by the owner at home. The information gained through various monitoring and pain scoring techniques can then be shared between all parties involved in looking after that animal.

Canine arthritis management (CAM), an independent veterinary driven initiative aims to promote a more holistic and proactive approach to chronic pain management and have created just such a tool described above.The 5x5x5 system places emphasis on that individual patients markers of pain, be those physical or behavioural changes. It helps engage the owner in monitoring and allows quicker reaction to deterioration or improvement in their condition. This tool, along with a guide to its use, is available via their website, www.caninearthritis.co.uk, free of charge.

There are also other tools available, such as the LOAD scoring technique by Liverpool University. Find one that works best for you and your client and re-evaluate this at each appointment.

In summary, more can be done to promote the use of complementary therapies in arthritis management.

CAM aims to help this positive progression through providing a variety of resources which the owner can be referred to, including a website and forum. Ensuring owners know about reliable sources of online information such as this, will help to get them thinking differently about how they would like to manage their pets condition and hopefully start to see themselves, their physical therapist and vet as part of one team.

Chronic pain due to arthritis is one of the leading causes of elective euthanasia in dogs the UK but with a more consistent and proactive, team approach from the veterinary team, pet owners, and physical therapists, we can change this.