New service at one of oldest practices - Veterinary Practice
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InFocus

New service at one of oldest practices

JOHN BONNER reports on a Scottish practice with a new post-operative rehabilitation centre

BUILDING the first practice in Scotland with an on-site postoperative rehabilitation centre is only the first phase of the Lothian-based Links Veterinary Group’s development plan.

In the next stage, its staff hope to lay the foundations for a better understanding of the role of physiotherapy in restoring both function and quality of life for veterinary patients.

One of Scotland’s oldest practices, the Links group was established in 1885 at Haddington about 15 miles east of Edinburgh. It has three other centres at Musselburgh, North Berwick and Dunbar, and this summer opened a new hospital on the edge of the town.

As with many veterinary premises built on greenfield sites, the £1.7 million hospital development replaces a main street clinic which had become increasingly overcrowded and lacked adequate parking for clients. But what is unusual about the Haddington hospital is that it looks out across a large car park onto the Lothian Canine Rehabilitation Centre, a dedicated unit with a state-of-the-art underwater treadmill and hydrotherapy facilities.

Tom Brown, the partner with responsibility for the rehabilitation centre, has a long-standing interest in using physiotherapy methods to hasten the return to health of orthopaedic and neurological cases, both dogs and horses. Earlier this year, he attended a residential course in canine physiotherapy at the University of Tennessee, arguably the leading centre for this clinical discipline in the world.

But despite a mass of anecdotal evidence and the long list of satisfied clients testifying to the benefits of physiotherapy in veterinary patients, he admits that there is a remarkable paucity of reliable scientific data on its effects.

Part of the problem has been the difficulty in designing properly controlled studies that will satisfy editors of the leading veterinary publications. But he is convinced that these hurdles are surmountable and alongside his routine clinical duties he hopes to conduct research which will aid understanding of the process – and allow objective comparisons of the results achieved with different methods.

Established service

The Links group has been providing a physiotherapy service for more than two years through Maeve Grant, a chartered physiotherapist who gained a further qualification from the Royal Veterinary College in 2006. Maeve divides her time between her own equine and human patients and working for the Links; previously she was seeing canine patients in their own homes but can now use the facilities which she and Tom have chosen for the new centre.

Tom insists that there should be enough work from within the group to keep the unit busy. So it will not be actively seeking external referrals although it will see patients sent from neighbouring practices where appropriate. Indeed, shortly after opening, the LCRC received its first referral from the Edinburgh veterinary school, which does provide rehabilitation care for its own patients but does not have the advanced treadmill and hydrotherapy facilities available at the private centre.

Maeve conducts the initial assessment for all new physiotherapy cases and draws up a treatment schedule which can be carried out by trained colleagues if she is unavailable.

“One of the big advantages of having this facility is we can take hospitalise patients and give them intensive treatment – not just in standard 30 minute sessions but spread out in short five or 10 minute bursts throughout the day.

“In other words, it is more like the sort of gradual physiotherapy programme that we might get in hospital when recovering from a major op,” Tom points out.

Out-patients

Most cases, however, will be seen on an out-patient basis. Dogs recovering from cruciate repair operations have formed a high proportion of the caseload during the first few weeks at the new facility.

“The treatment regimen will always be fairly case specific but we would normally want to see a patient at least once a week for the first six weeks or so then at more extended intervals for a period of up to three months. In between times we will show the owners the sort of exercises that they can do with their animal at home,” Maeve explains.

This sort of controlled exercise programme available at the centre appears to help post-operative and arthritic animals regain function much faster than relying on cage rest and medication.

It also has systemic effects through improving cardiac function and endurance but the key target tissues for this therapy are actually the healthy tissues of the contralateral limb.

“My main aim in carrying out postoperative rehabilitation is preventing reinjury which can easily happen in something likeacruciate repair because of the animal overloading the unaffected side,” she says.

As far as the owners are concerned, the most important benefits are likely to be intangible improvements resulting from changes in the dog’s demeanour. These are certainly noticeable to the owners during what can often be a lengthy, and therefore relatively costly, treatment regimen. Quite a high proportion of the owners of current cases being treated at the centre do not have a pet insurance policy to cover those costs, Maeve notes.

Solid grounding

After spending four years at the Edinburgh school on a Wellcome Trust studentship investigating respiratory diseases in horses, Tom has a solid grounding in research methodology. So he hopes to use this to provide clients with a better understanding of the effects of the rehabilitation process than their own subjective impressions.

With a projected throughput of up to 10,000 cases a year, the Lothian Canine Rehabilitation Centre should produce enough clinical data to make a significant contribution to the science of veterinary physiotherapy.

But these plans cannot be implemented overnight: Tom is aware that his research interests cannot be allowed to interfere with the smooth running of the business, and so they would need to attract enough external funding to at least cover the costs.

Having been on both sides of the fence, Tom believes that the process for awarding grants in the veterinary sphere is heavily biased towards the academic rather than the practising arm of the profession.

There is also the question of equipment costs. University centres can afford the sort of technologies – such as force plate analysis equipment and digital imaging software – that would be beyond the pocket of a private practitioner, as it would make very little contribution to practice turnover.

But Tom thinks there are alternative approaches which can be adopted in a practice setting. He is planning to use digital video cameras and the sort of inexpensive software used to analyse a golfer’s swing in examining a patient’s gait. If the system works, it will not only be useful in diagnosis and treatment planning, it could also be a useful educational tool.

“The equipment should allow us to measure angles, so we should be able to say to the client: this is how far the dog was able to flex its stifle then and this is what it can do now. I think it will be an ideal way to explain to them what we are trying to do.”

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