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Introduction | == Introduction == | ||
When assessing a canine patient, it is essential to determine the pet’s current functional level, its history, as well as its specific context and challenges or deficits that need to be addressed. A detailed subjective and objective assessment is necessary to ensure that the animal physiotherapist can correctly identify each patient’s challenges / dysfunctions and, from there, develop an appropriate clinical plan in order to achieve the best outcomes for a patient.<ref name=":0">van der Walt A. Assessment of the Canine Patient Course. Physioplus, 2021.</ref> | |||
There are three key domains to consider when assessing an animal patient:<ref name=":0" /> | |||
* Diagnosis | |||
* Client (i.e. owner) | |||
* Pet | |||
== Diagnosis == | |||
Animal physiotherapists will often receive referrals from a veterinarian that provide a specific diagnosis for the patient (e.g. cruciate ligament repair or spinal operation). This referral provides valuable information about the patient’s stage of healing, and prognostic expectations. It helps to guide the therapist's intervention. However, a thorough assessment is still necessary to ensure that all dysfunctions are identified and appropriately managed. <ref name=":0" /> | |||
== Client == | |||
The majority of information about an animal patient comes from the client or caregiver. Like conventional physiotherapy, important subjective questions include:<ref name=":0" /> | |||
* When did symptoms start? | |||
* What treatments / care have been given so far? | |||
* What makes symptoms better or worse? | |||
* Are the symptoms recent, chronic, or recurring<ref name=":1">Prydie D, Hewitt I editors. Practical Physiotherapy for Small Animal Practice. Chichester: John Wiley & Sons, Ltd, 2015.</ref> | |||
* Have there been previous injuries to this area and, if so, what treatment was sought?<ref name=":1" /> | |||
Other relevant information to obtain relates to the animal’s level of exercise, diet and nutrition and environment (i.e. is it a family pet or a sport or hunting dog? Have the owners had the pet since it was a puppy or is it a rescue dog?).<ref name=":1" /> | |||
Insight into carers’ ability to handle their pets can also be gained during the subjective interview.<ref name=":0" /> | |||
== Pet == | |||
The animal physiotherapist also has the opportunity to observe the pet while conducting the subjective interview. Prior to beginning the objective assessment, it is possible to observe:<ref name=":0" /> | |||
* The pet's demeanour | |||
* The pet's willingness to be approached / touched by the animal therapist | |||
* The pet's confidence to be around the animal therapist | |||
The pet may, however, behave differently in the clinic from how they behave at home. They may be over-excited and mask their symptoms or they may be nervous or insecure. It can, therefore, be difficult to obtain a clear picture of the pet’s normal behaviour during the initial consultation.<ref name=":0" /> | |||
== Building a relationship with the pet == | |||
It is important that the animal physiotherapist builds a positive relationship with the patient from the first encounter. Using treats can help to achieve this.<ref name=":0" /> | |||
NB: always obtain the owner’s consent and to ask about any allergies prior to offering treats to the pet.<ref name=":0" /> | |||
== Red and Yellow Flags == | |||
During the initial subjective interview, you will gain insight into whether or not any red or yellow flags exist. | |||
=== Red flags === | |||
Like conventional physiotherapy, red flags tend to be associated with any rapid deterioration in symptoms. Dogs may also refuse food at home or lose their appetite. If the animal therapist notes the presence of red flags, the patient should be referred back to the veterinarian.<ref name=":0" /> | |||
=== Yellow flags === | |||
Yellow flags can be client-related or pet-related.<ref name=":0" /> | |||
* Client-related yellow flags may include pain catastrophising (associated with neuroticism)<ref>Kadimpati S, Zale EL, Hooten MW, Ditre JW, Warner DO. Associations between Neuroticism and Depression in Relation to Catastrophizing and Pain-Related Anxiety in Chronic Pain Patients. PLoS One. 2015; 10(4): e0126351. </ref>, negative expectations or a lack of understanding about the animal's condition<ref name=":0" /> | |||
* Pet-related yellow flags, specifically for dogs, may include aggressive behaviour. It is essential that the animal physiotherapist remain safe<ref name=":0" /> | |||
== Assessing Pain == | |||
There are several validated tools for reporting pain and disability in animals such as the Canine Brief Pain Inventory<ref>Essner A, Högberg H, Zetterberg L, Hellström K, Sjöström R, Gustås P. Investigating the Probability of Response Bias in Owner-Perceived Pain Assessment in Dogs With Osteoarthritis. Top Companion Anim Med. 2020; 39: 100407. </ref> and the Helsinki Chronic Pain Index.<ref>Hielm-Björkman AK, Rita H, Tulamo RM. Psychometric testing of the Helsinki chronic pain index by completion of a questionnaire in Finnish by owners of dogs with chronic signs of pain caused by osteoarthritis. Am J Vet Res. 2009; 70(6): 727-34.</ref> However, these measures always rely on reports by the human observer,<ref>Essner A. On assessment methods related to pain in dogs with osteoarthritis [dissertation]. Uppsala. Uppsala Universitet. 2018.</ref> which can impact their effectiveness. The pain VAS, for instance, is considered valid and reliable. However, it is not considered a useful measure for untrained owners to rate their pets’ pain levels as it has poor face validity.<ref name=":2">Hielm-Björkman AK, Kapatkin AS, Rita HJ. Reliability and validity of a visual analogue scale used by owners to measure chronic pain attributable to osteoarthritis in their dogs. Am J Vet Res. 2011; 72(5): 601-7. </ref> This means that, on testing, owners could not recognise their pets’ behaviour as signs of pain. The pain VAS was found to only have face validity once the owners saw their pets’ pain levels diminish and return.<ref name=":2" /> | |||
Because the carer’s personal beliefs and anxieties about pain and disability can bias the physiotherapy consultation, the animal physiotherapist must be able to gain a good understanding of the owner's expectations and beliefs about the pet’s pain and diagnosis.<ref name=":0" /> | |||
[[Category:Course Pages]] | |||
[[Category:Animal Physiotherapy]] | |||
Revision as of 06:18, 11 January 2021
Introduction[edit | edit source]
When assessing a canine patient, it is essential to determine the pet’s current functional level, its history, as well as its specific context and challenges or deficits that need to be addressed. A detailed subjective and objective assessment is necessary to ensure that the animal physiotherapist can correctly identify each patient’s challenges / dysfunctions and, from there, develop an appropriate clinical plan in order to achieve the best outcomes for a patient.[1]
There are three key domains to consider when assessing an animal patient:[1]
- Diagnosis
- Client (i.e. owner)
- Pet
Diagnosis[edit | edit source]
Animal physiotherapists will often receive referrals from a veterinarian that provide a specific diagnosis for the patient (e.g. cruciate ligament repair or spinal operation). This referral provides valuable information about the patient’s stage of healing, and prognostic expectations. It helps to guide the therapist's intervention. However, a thorough assessment is still necessary to ensure that all dysfunctions are identified and appropriately managed. [1]
Client[edit | edit source]
The majority of information about an animal patient comes from the client or caregiver. Like conventional physiotherapy, important subjective questions include:[1]
- When did symptoms start?
- What treatments / care have been given so far?
- What makes symptoms better or worse?
- Are the symptoms recent, chronic, or recurring[2]
- Have there been previous injuries to this area and, if so, what treatment was sought?[2]
Other relevant information to obtain relates to the animal’s level of exercise, diet and nutrition and environment (i.e. is it a family pet or a sport or hunting dog? Have the owners had the pet since it was a puppy or is it a rescue dog?).[2]
Insight into carers’ ability to handle their pets can also be gained during the subjective interview.[1]
Pet[edit | edit source]
The animal physiotherapist also has the opportunity to observe the pet while conducting the subjective interview. Prior to beginning the objective assessment, it is possible to observe:[1]
- The pet's demeanour
- The pet's willingness to be approached / touched by the animal therapist
- The pet's confidence to be around the animal therapist
The pet may, however, behave differently in the clinic from how they behave at home. They may be over-excited and mask their symptoms or they may be nervous or insecure. It can, therefore, be difficult to obtain a clear picture of the pet’s normal behaviour during the initial consultation.[1]
Building a relationship with the pet[edit | edit source]
It is important that the animal physiotherapist builds a positive relationship with the patient from the first encounter. Using treats can help to achieve this.[1]
NB: always obtain the owner’s consent and to ask about any allergies prior to offering treats to the pet.[1]
Red and Yellow Flags[edit | edit source]
During the initial subjective interview, you will gain insight into whether or not any red or yellow flags exist.
Red flags[edit | edit source]
Like conventional physiotherapy, red flags tend to be associated with any rapid deterioration in symptoms. Dogs may also refuse food at home or lose their appetite. If the animal therapist notes the presence of red flags, the patient should be referred back to the veterinarian.[1]
Yellow flags[edit | edit source]
Yellow flags can be client-related or pet-related.[1]
- Client-related yellow flags may include pain catastrophising (associated with neuroticism)[3], negative expectations or a lack of understanding about the animal's condition[1]
- Pet-related yellow flags, specifically for dogs, may include aggressive behaviour. It is essential that the animal physiotherapist remain safe[1]
Assessing Pain[edit | edit source]
There are several validated tools for reporting pain and disability in animals such as the Canine Brief Pain Inventory[4] and the Helsinki Chronic Pain Index.[5] However, these measures always rely on reports by the human observer,[6] which can impact their effectiveness. The pain VAS, for instance, is considered valid and reliable. However, it is not considered a useful measure for untrained owners to rate their pets’ pain levels as it has poor face validity.[7] This means that, on testing, owners could not recognise their pets’ behaviour as signs of pain. The pain VAS was found to only have face validity once the owners saw their pets’ pain levels diminish and return.[7]
Because the carer’s personal beliefs and anxieties about pain and disability can bias the physiotherapy consultation, the animal physiotherapist must be able to gain a good understanding of the owner's expectations and beliefs about the pet’s pain and diagnosis.[1]
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 van der Walt A. Assessment of the Canine Patient Course. Physioplus, 2021.
- ↑ 2.0 2.1 2.2 Prydie D, Hewitt I editors. Practical Physiotherapy for Small Animal Practice. Chichester: John Wiley & Sons, Ltd, 2015.
- ↑ Kadimpati S, Zale EL, Hooten MW, Ditre JW, Warner DO. Associations between Neuroticism and Depression in Relation to Catastrophizing and Pain-Related Anxiety in Chronic Pain Patients. PLoS One. 2015; 10(4): e0126351.
- ↑ Essner A, Högberg H, Zetterberg L, Hellström K, Sjöström R, Gustås P. Investigating the Probability of Response Bias in Owner-Perceived Pain Assessment in Dogs With Osteoarthritis. Top Companion Anim Med. 2020; 39: 100407.
- ↑ Hielm-Björkman AK, Rita H, Tulamo RM. Psychometric testing of the Helsinki chronic pain index by completion of a questionnaire in Finnish by owners of dogs with chronic signs of pain caused by osteoarthritis. Am J Vet Res. 2009; 70(6): 727-34.
- ↑ Essner A. On assessment methods related to pain in dogs with osteoarthritis [dissertation]. Uppsala. Uppsala Universitet. 2018.
- ↑ 7.0 7.1 Hielm-Björkman AK, Kapatkin AS, Rita HJ. Reliability and validity of a visual analogue scale used by owners to measure chronic pain attributable to osteoarthritis in their dogs. Am J Vet Res. 2011; 72(5): 601-7.
