Veterinary rehabilitation is an incredibly rewarding field, but it can also be pretty frustrating. Sometimes our patients just don’t seem to improve, or they get worse, and we cannot figure out why. It helps to have a “route map” that can pinpoint the common weaknesses in what we do.
Lowri Davies presented a webinar entitled The Pitfalls of Rehabilitation, sharing a few areas where our approach may be letting us down, hindering our best attempts to help patients. I’ve summarized them into 8 key points below, in the hope that they will help you achieve better outcomes with your patients.
1. INCORRECT DIAGNOSIS
A diagnosis made through imaging can be incomplete, showing changes in structure that may not be the primary reason for the clinical presentation in front of you. Instead, they may be a secondary effect of a chronic pathology. The diagnosis made with imaging needs to be compared with the clinical presentation. After a full clinical assessment, can you make the same pathoanatomical diagnosis as the one made through imaging alone, or do you find other areas of concern? Imaging can only show changes in structure, not in function. Treating the correct diagnosis is essential to a positive clinical outcome.
2. COMPLEX NATURE OF LAMENESS
Lameness is much more complex than just a pathology. A primary pathology leads to secondary changes in movement, which can lead to changes in structure. All of these areas need to be addressed and corrected to achieve a favorable outcome and to prevent a worsening of the lameness. If you treat only one symptom, the lameness will keep recurring. If you treat only the cause and not the secondary movement dysfunctions and compensations, the patient will develop incorrect movement patterns that will cause changes in structure, leading to new causes of lameness. Always treat holistically – both the cause and the symptoms of lameness.
3. SURGICAL COMPLICATIONS
No amount of therapy can compensate for surgical complications. We can aid in preventing some, but not all, of these; to a great extent, surgical complications are out of our control. We need to know the risk factors for each surgical procedure that we treat postoperatively, so that we can recognize the signs of a complication and refer the patient back for medical intervention as early as possible.
4. INAPPROPRIATE REHABILITATION
Bad rehab is worse than no rehab. Our tools and modalities are not inherently good or bad; it is how we use them that determines their value. When tools are used incorrectly or exercises are badly performed, they can cause harm, delay healing and lead to an increase in pain and discomfort.
Never work prescriptively or according to a set protocol; treat each patient individually and according to how they are on the day, and how they responded to previous treatment. Appropriate rehabilitation should lead to a faster return to function and an improved overall outcome.
5. INADEQUATE PAIN MANAGEMENT
Pain significantly delays healing, and obviously leads to a loss in quality of life. If we do not give pain management first priority in any treatment plan or program, we are likely to fail.
Pain management should address peripheral and central sensitization, and should be as broad as needed. Pharmacological agents should be used when appropriate, and our modalities for managing pain should always be at the very top of our toolbox – the first things we reach for when even the slightest signs of pain occur.
6. POOR COMMUNICATION
Rehabilitation is a team effort. Without proper communication channels between the veterinarian, the therapist and the owner, a return to function may be delayed, signs of regression or complications may be missed, and inappropriate treatment protocols may be implemented.
7. LACK OF COMPLIANCE
Owner compliance is essential. You need to gauge how much the owner is able and willing to do, and ensure that basic principles of rest and exercise restriction/control are implemented. Owner compliance is closely linked to communication – the better an owner understands the animal’s condition, and the more you involve them in treatment sessions, the more compliant they are likely to be.
After an injury or surgery, higher levels of protein in the diet will aid healing and recovery. Geriatric dogs need a higher protein level in their diet to remain strong and active. Weight control is essential; it is easy for a dog recovering from injury or surgery to gain weight due to increased levels of inactivity. This can be prevented with an appropriate adjustment to the diet. Anti-inflammatory diets should be encouraged, with high levels of omega 3, EPA and DHA.
We easily become disheartened when our treatments seem to have little effect. Hopefully, you might spot something in these eight points that holds a clue to the solution next time you’re puzzling over a slow response.
We’re always learning, but we don’t have to ‘learn from our mistakes’. We can learn from someone else’s mistakes! My ‘accident prone’ brother says his mistakes have taught him, but I always counter that with, ‘There are plenty of mistakes others have made that can teach you, too.’ Why go through the pain and suffering, if we can just observe, digest and learn from the experiences of others?
Thanks, Lowri Davies, for sharing your experience with us so that far more people can benefit – and so that more animals may avoid months of discomfort caused by incomplete treatment plans.
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