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A Survey of Animal Physiotherapy Practice in Britain
285
RESEARCH REPORT
A Survey of Animal Physiotherapy Practice in Britain D Knowles Shylie Mackintosh Key Words Animal physiotherapy. Summary Chartered physiotherapists involved in animal therapy were surveyed regarding the role of physiotherapists in animal therapy and liaison with the veterinary profession. Questionnaires were sent to 44 category A members of the Association of Chartered Physiotherapists in Animal Therapy, and 30 valid responses were received. Respondents treated horses and dogs most frequently but cats, sheep, goats and cattle were also mentioned. Sore backs and necks, as well as tendon and ligament injuries, were the most commonly treated conditions using mainly electrotherapy and manual techniques. Close liaison between the veterinary and physiotherapy professions was considered essential and requires ongoing attention. It was concluded that, as providers of a complementary service, chartered physiotherapists in animal therapy have a role to fill in veterinary medicine.
Introduction Physiotherapy, in its broadest sense, has been used to treat animals for centuries. However, only in the last decade h a s animal physiotherapy earned some recognition. The Association of Chartered Physiotherapists in Animal Therapy (ACPAT) was founded in 1985 as a Specific Interest Group of the Chartered Society of Physiotherapy (CSP). The group developed from concern voiced by members of the Royal College of Veterinary Surgeons (RCVS) and the CSP regarding the practice of unqualified ‘lay people’ in the area of animal therapy and also from CSP members interested in animal therapy. Stringent requirements were laid down by the RCVS for acceptance of chartered physiotherapists working with animals and all must abide by the Veterinary Surgeons Act 1966 which permits treatment of a n animal by a physiotherapist, provided the veterinarian who examines the animal prescribes physiotherapy treatment. ACPAT members are insured only if they have veterinary authority to treat the animal and they and other persons who do not comply with the Act are liable to prosecution. ACPAT consists of three registers. Category A members are chartered physiotherapists with two years’ clinical experience in the human field who have attended three study days which cover basic anatomy, physiology and biomechanics of movement in horses and dogs. They must also have a record of safety and efficiency from two
veterinary surgeons. Category B members are chartered physiotherapists who are entitled to treat animals only under the direct supervision of a category A member or veterinary surgeon. Associate members include other interested allied professionals and student members. There has been little research in the area of animal physiotherapy and, of t.he literature available, much is prescriptive. Heat and cold therapy, massage and exercise regimes have been recommended for use with small animals and horses to treat conditions such as acute swelling, pain and muscle spasm (Hopes, 1970; Jones, 1990; Lawson, 1970; Rogers et al, 1989; Tangner, 1984). Hydrotherapy has long been used to treat animals, horses in particular, as it provides a non-weight-bearing medium with resistance to movement to develop cardiovascular function and improve muscle strength (Bromiley, 1991; Hopes, 1970; Scanlon, 1983;Tangner, 1984; Randell, 1990). Shortwave diathermy, inductothermy, microwave, ultrasound therapy and faradism also have been suggested forms of treatment for animal patients (Hopes, 1970). Studies investigating the efficacy of some of these machines for human patient use have been carried out using animals, eg pulsed shortwave diathermy with rats (Raji, 19841, laser therapy with mice (Dyson and Young, 1986) and pulsed direct current with rabbits (Brown et al, 1988). However, studies of animal-specific therapy are sparse. One study, of questionable design (acknowledged by its author), suggested ultrasound could be useful in the treatment of musculoskeletal conditions in dogs, cats and horses (Lang, 19801, while another demonstrated the beneficial effects of a physiotherapy regime on postfracture rehabilitation in cattle (Sharifi and Sharma, 1990). There is little information available on the practice of chartered physiotherapists in animal therapy. This survey therefore aimed to determine the present role of chartered physiotherapists in animal therapy and ascertain the physiotherapists’ views regarding liaison with veterinary surgeons.
Methodology Four Category A members were given a pilot questionnaire, and their responses which were used to improve its format. The new version-was sent to the remaining 44 category A members of ACPAT in December 1991. The questionnaire was divided into sections: (A) general questions, (B) liaison and referral systems, (C) the work of animal therapists and (D) attitude-probing statements. A combination of filter questions, closed and open-ended response formats and attitude-searching statements using the traditional fivepoint Likert scale was used. The data were analysed using descriptive statistics or reviewed in a qualitative manner.
Physiotherapy, May 1994, vol80, no 5
286
Results
0Humans
121
From the 44 questionnaires mailed, 31 (71%) were returned; one of these was invalid and therefore the results were obtained from 30 questionnaires.
Animals
All respondents were females who had graduated between 1943 and 1988 from 22 different physiotherapy schools throughout the UK. They had initially heard about animal therapy in a variety of ways, most commonly through ACPAT (13%),Physiotherapy Journal (13%), having their own animals treated by a n 'animal therapist' (13%) or using their physiotherapy skills on their own animals (10%). One member became aware of animal therapy through a veterinary surgeon who was using a n unqualified therapist for hisher patients.
11-2@ ' ' 21-30 ' Time (hours)
Animal Physiotherapists' Work The respondents had been involved with human practice between three and 48 years and 29 (97%) were still working in this area. In animal practice, experience ranged from one to 30 years, with 23 (77%) having been involved in animal therapy for ten years or less. Most worked between 0-5 hours per week with both humans and animals (fig 1). Only one physiotherapist treated animals exclusively.
U 0, I
m
Horses and dogs were the most commonly treated animals with 28 (93%) and 25 (83%) of the respondents treating them respectively (figure 2). Other large and small animals seen included cattle, sheep, goats, ferrets and a rabbit.
t-"
Ultrsound and laser were the modalities most frequently used with horses. Of the 28 physiotherapists treating horses, 18 (64%)used these techniques. Tendonitis, sore backs, bursitis and muscular trauma were commonly treated with both ultrasound and laser; the latter was also used for wounds, abscesses and skin conditions. The manual techniques of mobilisation and manipulation were regularly applied to back and neck problems (10 and 11 subjects respectively). Massage was occasionally used for oedema and muscle strains. Eight subjects used ice and/or compression bandages to treat inflammatory conditions, eg tendonitis, capsulitis and bursitis.
Physiotherapy,May 1994, voi80, no 5
'
Horses '.
I
/
L
-
The most common conditions reported in horses were sore backs and necks and 20 of the 28 members who had horses referred to treating these. Tendon and ligament damage was the next most frequently presented disorder (15/28),followed by wounds/abscesses and skin conditions (12/28),muscular problems, eg tears, atrophy, and other soft tissue trauma (9/28). contractures (11/28), Conditions such as sore shins (inflammation of the metacarpal and occasionally metatarsal bones), splints (ossification of the interosseous ligament between the metacarpal and occasionally matatarsal bones - Hayes, 1981),osteo-arthritis, stifle (knee) lameness, capsulitis and bursitis (capped hocks) were also mentioned.
31-40
Fig 1: Hours worked by respondents per week with both human and animal patients
Distances travelled to assess and treat animals ranged from 'limitless' (10%)to 'home-based' (10%)with the most frequent distances travelled between 15-20miles (27%). The number of animals treated in one week varied from less than five to over 40. Five or fewer animals per week (50% of respondents) were most usual.
Horses
n
n
Dogs
L
u)
2
I
Cats
.-
S
m
1
o
Other large animals
Q,
I
Q
Oth& small animals 0
5
10
15
20
25
30
Number of subjects Fig 2: Variety of animals treated by respondents
Interferential, neuromuscular stimulation and faradism were also used for some conditions in horses. Other treatment methods reported included pulsed shortwave diathermy, magnetic field therapy, infra-red heat, advice on rider re-education, saddle alterations, changes in shoeing practice and schooling and exercise regimens.
Dogs Of the 25 physiotherapists who saw dogs, 15 (60%) commonly treated them for back problems. Tendon and ligament trauma was also frequently seen in dogs, especially following cruciate ligament repairs. Ten subjects (40%)had treated other joint problems such as osteo-arthritis and hip dysplasia. Muscular problems, wounds and skin conditions were also commonly seen in dogs. Physiotherapy techniques applied to dogs were similar to those used with horses. Laser therapy ultrasound and manipulations were the most commonly used treatment methods, followed by mobilisations and neuromuscular stimulation. Others included passive exercises, hydrotherapy, magnetic field therapy, pulsed shortwave, acupuncture and active exercise.
287
Other Animals Cats, sheep, goats, cattle and a rabbit were also mentioned in this section. Their conditions included torn stifle ligaments (sheep, cows), back problems (sheep, goats, cats, cows), musculoskeletal problems (cows, calves, sheep, cats), neuropraxia and muscle atrophy (cat), tendonitis (bull) and meningitis (rabbit). The treatment methods used with these animals were the same as those used with horses and dogs.
A variety of methods was used in treatment evaluation for all animal groups, including improvement in performance, return to full function, feedback from ownerdriders, measurements eg swelling, lameness scale, joint range of movement, photographs and videos.
Referral to an Animal Therapist Referrals usually came from veterinary surgeons, owners and trainers. Farriers had also referred patients. Seventeen respondents (56%) thought the ‘right of first referral’ would be beneficial, with 11of these 17 stating that even if the animal was referred directly to a physiotherapist, close liaison with the veterinary surgeon would still be imperative. Nine members (30%) thought ‘right of first referral’ would not be of benefit. They considered referral via a veterinary surgeon acted as protection to the animal from over-enthusiastic treatment; and communication, liaison and professionalism between animal therapists and veterinary surgeons was not considered sound enough to allow safe, independent and accepted animal practice. Four respondents (13%) thought direct referral could be beneficial in some cases such as assessment only (no treatment), saddle-related bruising and non-veterinary problems such as a horse with schooling difficulty. Delays between the time of injury and the referral of the animal to them were experienced by 28 respondents (93%).The most frequent reasons for delay were that the veterinary surgeon and owner tried traditional methods of treatment first, eg anti-inflammatories and rest; veterinary surgeons and owners were unaware of animal therapists; or there was poor communication between owners, veterinary surgeons and animal therapists. The length of the delay varied from four days to one year. The most common time lapses reported were between seven and 14 days and ‘various/can be months’. It was agreed by 21 members (70%)that animal physiotherapy was often used as a last resort, compared with six (20%) who disagreed and three who did not have an opinion either way.
Liaison with Veterinary Surgeons and Other Referral Sources Many commented that veterinary surgeons had given them a mixed reception; some had been negative prior to treatment but positive afterwards, and that as time went on the attitudes of veterinary surgeons were becoming more positive. However, six members (20%) found some veterinary surgeons were extremely negative or refused to acknowledge the existence of the animal therapist. Owners and other referral sources (farriers and saddlers) were positive about animal physiotherapy in all but one case.
Visits to veterinary surgeons and visits combined with ‘other’ (eg word of mouth, telephone calls, personal contact, the ACPAT register and lecturing to interested clubs/societies) were the most usual forms of advertising with seven members (23%) using all these means. Three respondents (10%) used no form of advertising. Communication (8 members, 27%) and education (1 1 members, 37%) were t h e m a i n a r e a s where improvements regarding liaison with veterinary surgeons were thought necessary. Subjects commented that animal therapists need to educate veterinary surgeons about their role in animal therapy, ie what physiotherapy can offer to which cases, its benefits and advantages and that animal therapy is a complement to veterinary treatment rather than a replacement. A team approach to animal care was considered important as 29 members (97%) disagreed with the statement ‘a team approach to animal care is not necessary’. The remaining one member went against the trend by strongly agreeing with the statement. Joint lectures and courses to promote exchange of knowledge and ideas, more researchkase studies to provide evidence of the effects of animal therapy and the two professions working from a joint practice/surgery were also suggested ways of enhancing liaison between the two bodies. There was significant agreement with the statement: ‘The formation of a British Veterinary Association (BVA) sub-group affiliated to ACPAT would be beneficial to both professions.’ Twenty-two mzm beys (73%) strongly agreed while none disagreed. Twentyseven members (90%) supported the suggestion that many problems in providing a n animal therapy service could be alleviated by physiotherapists working from veterinary practices.
Discussion Although there was a 71% return rate of the questionnaires, normally considered a good response, with so few category A members of ACPAT (48) to survey, the resulting number of respondents was small. A higher response rate might have given a clearer picture of animal physiotherapy practice in Britain. Only one member treated animal patients only, suggesting that animal therapy has not yet established itself completely as a viable career - or possibly members preferred a combination of human and animal practice. Horses and dogs were the most commonly treated animals, probably because they are often bred as competition animals which, if injured, require immediate rehabilitation to return them to their peak athletic ability (Lawson, 1970; Hopes, 1970; Lang, 1980; Rogers et al, 1989).Owners are therefore prepared to consult a physiotherapist in the hope of speedier rehabilitation. A few farm animals had been treated suggesting that, if the value of an animal is high, breeders may be inclined to use animal physiotherapy. Twelve respondents had treated cats, indicating, as Randell (19901, Martin (1990), Lang (1980) and Tangner (1984) suggested, that these animals may also benefit from physiotherapy. The high incidence of back and neck problems with horses and dogs could be related to the extremes of athletic ability sometimes demanded of these animals,
Physiotherapy,May 1994, vol80, no 5
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particularly in the case of horses which also have to carry the additional weight of riders. Unfortunately there is very little published research relating to the efficacy of physiotherapy with horses, dogs and cats. A review of the literature revealed only a few research studies in this area. Several support the use of ultrasound in musculoskeletal conditions in these animal groups (Lippiello and Smalley 1991; Lang, 1980; Morcos and Aswad, 1978a, b). Apparently this electrotherapy technique is as useful in animals as for humans. Functional recovery was improved in post-fracture cattle given a massage and exercise regime when compared to a control group of cattle with fractures (Sharifi and Sharma, 1990). No other studies were found investigating massage or exercise. Herrod-Taylor (1967) documented a series of successful case studies of spinal manipulation in horses but no scientifically rigorous data were found in the literature. There are many descriptive and prescriptive reports in the literature relating to animal physiotherapy with no data to support suggestions and claims (Hopes, 1970; Jones, 1990; Rogers et al, 1989; Bromiley, 1991; Randell, 1990).Clearly there is a need for animal-specific and treatment-specific research studies to investigate the use of physiotherapy techniques with animal patients. As yet many of these techniques, eg hydrotherapy, electrotherapy, massage and mobilisation, have not even been thoroughly investigated in human patients either. In 1985Vogel suggested faradism and ultrasound were the ‘main armaments’ of the animal therapist. Although ultrasound was a commonly used modality in this survey, the laser was equally popular, with faradism being used by only a few respondents. The laser has been proposed for use in wound healing which may justify its popularity in this survey as wounds were commonly referred (Dyson and Young, 1986). The widespread use of ultrasound in the surveyed population has been supported by several studies (Lippiello and Smalley 1991; Lang, 1980; Marcos and Aswad, 1978a). Other electrotherapy modalities have been recommended for use in animal physiotherapy including shortwave diathermy (Lawson, 1970; Hopes, 1970; Warman, 1970; Jones, 1990); interferential and other higMow frequency currents (Calder, 1970; Rogers et al, 1989); neuromuscular stimulation (Randell, 1990; Rogers et al, 1989; Jones, 1990); magnetic field therapy (Jones, 1990); and microwave therapy (Hopes, 1970).Interferential currents a n d neuromuscular stimulation were used by physiotherapists in this survey but magnetic field therapy, shortwave diathermy and microwave therapy were used only very occasionally - possibly because the machines are not easily portable or because alternative treatments were found as effective. Mobilisations and manipulations were frequently used in the treatments of both horses and dogs as suggested by Hopes (19701, Warman (1970) and Jones (1990). These techniques are commonly used to treat back and neck problems in human patients and it appears that this is also true for animal patients. In the literature, frequently recommended treatments for use in animal therapy are hot/cold therapy and massage (Lawson, 1970; Hopes, 1970; Calder, 1970; Randell, 1990; Jones, 1990; Tangner, 1984; Rogers et al, 1989).However, few respondents used these regularly, perhaps because the ownerdtrainers can
Physiotherapy, May 1994, vol80, no 5
I
apply these techniques themselves. Hydrotherapy was used regularly by only four of the respondents, refuting recommendations of its application in animal therapy by Scanlon (19831, Tangner (1984),Randell (1990),Roger et al (1989) and Hopes (1970). It is probable that hydrotherapy is a commonly used method of tieatment or exercise by the ownerdtrainers of large, well established horse yards where a pool has been specially constructed. Many therapists would not have easy access to such a pool. In response to the question regarding ‘right of first referral’ only six respondents thought this would be beneficial to the physiotherapist. Right of first referrral may reduce the time between injury and treatment and the owner may benefit financially (it eliminates the need for a visit from the veterinary surgeon). However, animal therapists would not have the same knowledge as veterinary surgeons regarding animal conditions. Therefore even if right of first referral was accepted, close liaison and an effective team approach between the two professions would still be of the highest, importance.
Liaison with Veterinary Surgeons and Other Referral Sources In general, animal therapists thought they were well received by the veterinary profession as was to be expected (those who do not agree with it do not refer). However, a few veterinary surgeons were reluctant to acknowledge animal therapy. A survey of British veterinary surgeons by McNamara and Mackintosh (1993) also found a generally positive attitude to physiotherapists with a few veterinary surgeons feeling strongly against animal therapy by physiotherapists. While some of the veterinary profession are aware of the benefits of physiotherapy, however, further efforts at public relations are needed to increase the awareness and understanding of those who remain suspicious of animal therapy. Greater understanding and acceptance of animal therapy could be achieved by increasing veterinary surgeons’ knowledge of the physiotherapy services available and provision of evidence of success, ie case studies and more research on techniques. This could result in the two professions working more effectively and efficiently together.
Conclusions Physiotherapists have a role to play in veterinary medicine. Animal therapists can offer treatment to many breeds of animal, but a t present are more involved with horses and dogs. Many conditions can be treated by animal therapists including sportinglathletic injuries, neurological and orthopaedic cases, using a variety of manual and electrical treatment techniques. Positive promotion of animal physiotherapy is needed within the veterinary world to allow recognition and growth of this field of physiotherapy practice. Authors D Knowles BSc(Hons)Physiotherapy was a student and Shylie Mackintosh BAppSc(Physi0) MSc MAPA was a senior lecturer
at the University of East London at the time of the study.
Address for Correspondence
Shylie Mackintosh, 54 Clifton Street, Prospect, South Australia 5082.
289
Contribution D Knowles designed the study and collected and analysed the data and Shylie Mackintosh supervised the project and prepared the manuscript for publication.
References Bromiley, M W (1991).Equine lnjury and Therapy, BSP Professional Books, Oxford. Brown, M, McDonnell, M K and Menton, D M (1988).‘Electrical stimulation effects on cutaneous wound healing in rabbits’, Physical Therapy, 68, 955 - 959. Calder, J
D (1970).‘The dog as a patient’, Physiotherapy, 56,
2,60-61. Dyson, M , and Young, S (1986).‘Effect of laser therapy on wound contraction and cellularity in mice’, Lasers in Medical Science, 1, 125-130.
McNamara, K and Mackintosh, S F H (1993).‘Veterinary surgeons’ perceptions of animal physiotherapy’, Physiotherapy, 79, 6,312-316. Morcos, M B and Aswad, A (1978a).‘Treatment of two clinical conditions in racehorses by ultrasonic therapy’, Equine Veterinary Journal, 10, 4, 128- 129. Morcos, M B and Aswad, A (1978b).‘Histological studies of the effects of ultrasonic therapy on surgically split flexor tendons’, Equine Veterinary Journal. 10, 4,267- 269. Raji, A M (1984).‘An experimental study of the effects of pulsed electromagnetic field on nerve repair’, Journal of Hand Surgery, 9B, 105-111. Randell, L (1990).‘Animal physiotherapy’, ACPAT Newsletter, September. Rogers, P A, Cain, M J, Kent, E and Ogden, E C (1989). ‘Physiotherapy, homoeopathy and acupuncture in the treatment and prevention of lameness and the maintenance of peak fitness in horses (part l)’,lrish Veterinary News, 11, 5,8- 12.
Hayes, M H (1981).Veterinary Notes for Horse Owners, Anchor Press, London. Herrod-Taylor, E (1967).‘A technique for manipulation of the spine in horses’, The Veterinary Record, 81, 17, 432.
Scanlon, E J (183).‘Equine hydrotherapy’, Modern Veterinary Practice, 64, 148- 150.
Hopes, R (1970).‘Physiotherapy in the horse’, Physiotherapy, 56, 2,56-59.
Sharifi, D and Sharma, S N (1990).‘Effect of physiotherapy after tibia1 transfixation in cattle’, lndian Veterinary Journal, 67,
Jones, W
952- 954.
conditions in the horse, dog and cat’, Veterinary Record, 106,
Tangner, G H (1984).‘Physical therapy in small animal patients: Basic principles and applications’, The Compendium of Continuing Education for the Practising Veterinarian, 6, 10.
E (1990).‘Physical therapy’, Equine Sports Medicine, 10,309-310. Lang, D C (1980).‘Ultrasonic treatment of musculoskeletal
427 - 431.
933- 936.
Lawson, D D (1 970).‘Physiotherapy in veterinary medicine’, Physiotherapy, 56, 2, 53 - 55.
Vogel, C (1985).‘The dangers of “alternative treatments” ’, Veterinary Record, November 2,475 - 476.
Lippiello, L and Smalley, L (1991).’Densitometric assessment of equine bone repair following pulsed ultrasound therapy’, Equine Practice, 13, 4, 17-24.
Warman, E M B (1970).‘Dachshund with a slipped disc’, Physiotherapy, 56, 2,65.
Hayfever in the Garden by Tim Rich. Marion Merrell Dow Ltd, Lakeside House, Sfockley Park. Uxbridge, Middlesex U B l l 16E. 1994. 21 pages. Free for SAE.
IIayfever affects 10-124 of t h e population a t some time in their lives. This new publication answers many of the questions relating to the condition what hayfevcr is, who is affected and what the symptoms are. Although i t is not usually a serious medical condition, in severe cases normal daily activities can be inhibited. The booklet offers a simple guide to the pollen snurces t h a t may be causing problems. In spring hayfever tends to be caused by tree pollen; in early summer, May to July, it is likely to be grass pollen; and between August and September it is probably pollen from weeds, fungal spores or herbaceous plants. A description and line drawings of particular garden culprits is included, together with tips on how to avoid hayfever.
Information to Support Health of the Nation NHS Executive. HSG(94) 19. BAPS. Health Publications Unit, DSS Distribution Centre, Heywood Stores, Manchesfer Road, Heywood, Lancs OL 10 2PZ. 32 pages.
This document from the NIIS Executive sets out the intiatives currently under way to monitor the progress of the Health of the Nation targets, both within and
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Wide variations in the performance of community and hospital services in England and Wales have been found by t h e Audit Commission, with clinical productivity varying by a s much as 50% between similar providers. In this report t h e Commission acknowledges t h a t providers a r e trying to find ways to improve quality and efficiency, with snme doing well. Others, however, the report
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Physiotherapy, May 1994, vol80, no 5
RESEARCH REPORT
A Survey of Animal Physiotherapy Practice in Britain D Knowles Shylie Mackintosh Key Words Animal physiotherapy. Summary Chartered physiotherapists involved in animal therapy were surveyed regarding the role of physiotherapists in animal therapy and liaison with the veterinary profession. Questionnaires were sent to 44 category A members of the Association of Chartered Physiotherapists in Animal Therapy, and 30 valid responses were received. Respondents treated horses and dogs most frequently but cats, sheep, goats and cattle were also mentioned. Sore backs and necks, as well as tendon and ligament injuries, were the most commonly treated conditions using mainly electrotherapy and manual techniques. Close liaison between the veterinary and physiotherapy professions was considered essential and requires ongoing attention. It was concluded that, as providers of a complementary service, chartered physiotherapists in animal therapy have a role to fill in veterinary medicine.
Introduction Physiotherapy, in its broadest sense, has been used to treat animals for centuries. However, only in the last decade h a s animal physiotherapy earned some recognition. The Association of Chartered Physiotherapists in Animal Therapy (ACPAT) was founded in 1985 as a Specific Interest Group of the Chartered Society of Physiotherapy (CSP). The group developed from concern voiced by members of the Royal College of Veterinary Surgeons (RCVS) and the CSP regarding the practice of unqualified ‘lay people’ in the area of animal therapy and also from CSP members interested in animal therapy. Stringent requirements were laid down by the RCVS for acceptance of chartered physiotherapists working with animals and all must abide by the Veterinary Surgeons Act 1966 which permits treatment of a n animal by a physiotherapist, provided the veterinarian who examines the animal prescribes physiotherapy treatment. ACPAT members are insured only if they have veterinary authority to treat the animal and they and other persons who do not comply with the Act are liable to prosecution. ACPAT consists of three registers. Category A members are chartered physiotherapists with two years’ clinical experience in the human field who have attended three study days which cover basic anatomy, physiology and biomechanics of movement in horses and dogs. They must also have a record of safety and efficiency from two
veterinary surgeons. Category B members are chartered physiotherapists who are entitled to treat animals only under the direct supervision of a category A member or veterinary surgeon. Associate members include other interested allied professionals and student members. There has been little research in the area of animal physiotherapy and, of t.he literature available, much is prescriptive. Heat and cold therapy, massage and exercise regimes have been recommended for use with small animals and horses to treat conditions such as acute swelling, pain and muscle spasm (Hopes, 1970; Jones, 1990; Lawson, 1970; Rogers et al, 1989; Tangner, 1984). Hydrotherapy has long been used to treat animals, horses in particular, as it provides a non-weight-bearing medium with resistance to movement to develop cardiovascular function and improve muscle strength (Bromiley, 1991; Hopes, 1970; Scanlon, 1983;Tangner, 1984; Randell, 1990). Shortwave diathermy, inductothermy, microwave, ultrasound therapy and faradism also have been suggested forms of treatment for animal patients (Hopes, 1970). Studies investigating the efficacy of some of these machines for human patient use have been carried out using animals, eg pulsed shortwave diathermy with rats (Raji, 19841, laser therapy with mice (Dyson and Young, 1986) and pulsed direct current with rabbits (Brown et al, 1988). However, studies of animal-specific therapy are sparse. One study, of questionable design (acknowledged by its author), suggested ultrasound could be useful in the treatment of musculoskeletal conditions in dogs, cats and horses (Lang, 19801, while another demonstrated the beneficial effects of a physiotherapy regime on postfracture rehabilitation in cattle (Sharifi and Sharma, 1990). There is little information available on the practice of chartered physiotherapists in animal therapy. This survey therefore aimed to determine the present role of chartered physiotherapists in animal therapy and ascertain the physiotherapists’ views regarding liaison with veterinary surgeons.
Methodology Four Category A members were given a pilot questionnaire, and their responses which were used to improve its format. The new version-was sent to the remaining 44 category A members of ACPAT in December 1991. The questionnaire was divided into sections: (A) general questions, (B) liaison and referral systems, (C) the work of animal therapists and (D) attitude-probing statements. A combination of filter questions, closed and open-ended response formats and attitude-searching statements using the traditional fivepoint Likert scale was used. The data were analysed using descriptive statistics or reviewed in a qualitative manner.
Physiotherapy, May 1994, vol80, no 5
286
Results
0Humans
121
From the 44 questionnaires mailed, 31 (71%) were returned; one of these was invalid and therefore the results were obtained from 30 questionnaires.
Animals
All respondents were females who had graduated between 1943 and 1988 from 22 different physiotherapy schools throughout the UK. They had initially heard about animal therapy in a variety of ways, most commonly through ACPAT (13%),Physiotherapy Journal (13%), having their own animals treated by a n 'animal therapist' (13%) or using their physiotherapy skills on their own animals (10%). One member became aware of animal therapy through a veterinary surgeon who was using a n unqualified therapist for hisher patients.
11-2@ ' ' 21-30 ' Time (hours)
Animal Physiotherapists' Work The respondents had been involved with human practice between three and 48 years and 29 (97%) were still working in this area. In animal practice, experience ranged from one to 30 years, with 23 (77%) having been involved in animal therapy for ten years or less. Most worked between 0-5 hours per week with both humans and animals (fig 1). Only one physiotherapist treated animals exclusively.
U 0, I
m
Horses and dogs were the most commonly treated animals with 28 (93%) and 25 (83%) of the respondents treating them respectively (figure 2). Other large and small animals seen included cattle, sheep, goats, ferrets and a rabbit.
t-"
Ultrsound and laser were the modalities most frequently used with horses. Of the 28 physiotherapists treating horses, 18 (64%)used these techniques. Tendonitis, sore backs, bursitis and muscular trauma were commonly treated with both ultrasound and laser; the latter was also used for wounds, abscesses and skin conditions. The manual techniques of mobilisation and manipulation were regularly applied to back and neck problems (10 and 11 subjects respectively). Massage was occasionally used for oedema and muscle strains. Eight subjects used ice and/or compression bandages to treat inflammatory conditions, eg tendonitis, capsulitis and bursitis.
Physiotherapy,May 1994, voi80, no 5
'
Horses '.
I
/
L
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The most common conditions reported in horses were sore backs and necks and 20 of the 28 members who had horses referred to treating these. Tendon and ligament damage was the next most frequently presented disorder (15/28),followed by wounds/abscesses and skin conditions (12/28),muscular problems, eg tears, atrophy, and other soft tissue trauma (9/28). contractures (11/28), Conditions such as sore shins (inflammation of the metacarpal and occasionally metatarsal bones), splints (ossification of the interosseous ligament between the metacarpal and occasionally matatarsal bones - Hayes, 1981),osteo-arthritis, stifle (knee) lameness, capsulitis and bursitis (capped hocks) were also mentioned.
31-40
Fig 1: Hours worked by respondents per week with both human and animal patients
Distances travelled to assess and treat animals ranged from 'limitless' (10%)to 'home-based' (10%)with the most frequent distances travelled between 15-20miles (27%). The number of animals treated in one week varied from less than five to over 40. Five or fewer animals per week (50% of respondents) were most usual.
Horses
n
n
Dogs
L
u)
2
I
Cats
.-
S
m
1
o
Other large animals
Q,
I
Q
Oth& small animals 0
5
10
15
20
25
30
Number of subjects Fig 2: Variety of animals treated by respondents
Interferential, neuromuscular stimulation and faradism were also used for some conditions in horses. Other treatment methods reported included pulsed shortwave diathermy, magnetic field therapy, infra-red heat, advice on rider re-education, saddle alterations, changes in shoeing practice and schooling and exercise regimens.
Dogs Of the 25 physiotherapists who saw dogs, 15 (60%) commonly treated them for back problems. Tendon and ligament trauma was also frequently seen in dogs, especially following cruciate ligament repairs. Ten subjects (40%)had treated other joint problems such as osteo-arthritis and hip dysplasia. Muscular problems, wounds and skin conditions were also commonly seen in dogs. Physiotherapy techniques applied to dogs were similar to those used with horses. Laser therapy ultrasound and manipulations were the most commonly used treatment methods, followed by mobilisations and neuromuscular stimulation. Others included passive exercises, hydrotherapy, magnetic field therapy, pulsed shortwave, acupuncture and active exercise.
287
Other Animals Cats, sheep, goats, cattle and a rabbit were also mentioned in this section. Their conditions included torn stifle ligaments (sheep, cows), back problems (sheep, goats, cats, cows), musculoskeletal problems (cows, calves, sheep, cats), neuropraxia and muscle atrophy (cat), tendonitis (bull) and meningitis (rabbit). The treatment methods used with these animals were the same as those used with horses and dogs.
A variety of methods was used in treatment evaluation for all animal groups, including improvement in performance, return to full function, feedback from ownerdriders, measurements eg swelling, lameness scale, joint range of movement, photographs and videos.
Referral to an Animal Therapist Referrals usually came from veterinary surgeons, owners and trainers. Farriers had also referred patients. Seventeen respondents (56%) thought the ‘right of first referral’ would be beneficial, with 11of these 17 stating that even if the animal was referred directly to a physiotherapist, close liaison with the veterinary surgeon would still be imperative. Nine members (30%) thought ‘right of first referral’ would not be of benefit. They considered referral via a veterinary surgeon acted as protection to the animal from over-enthusiastic treatment; and communication, liaison and professionalism between animal therapists and veterinary surgeons was not considered sound enough to allow safe, independent and accepted animal practice. Four respondents (13%) thought direct referral could be beneficial in some cases such as assessment only (no treatment), saddle-related bruising and non-veterinary problems such as a horse with schooling difficulty. Delays between the time of injury and the referral of the animal to them were experienced by 28 respondents (93%).The most frequent reasons for delay were that the veterinary surgeon and owner tried traditional methods of treatment first, eg anti-inflammatories and rest; veterinary surgeons and owners were unaware of animal therapists; or there was poor communication between owners, veterinary surgeons and animal therapists. The length of the delay varied from four days to one year. The most common time lapses reported were between seven and 14 days and ‘various/can be months’. It was agreed by 21 members (70%)that animal physiotherapy was often used as a last resort, compared with six (20%) who disagreed and three who did not have an opinion either way.
Liaison with Veterinary Surgeons and Other Referral Sources Many commented that veterinary surgeons had given them a mixed reception; some had been negative prior to treatment but positive afterwards, and that as time went on the attitudes of veterinary surgeons were becoming more positive. However, six members (20%) found some veterinary surgeons were extremely negative or refused to acknowledge the existence of the animal therapist. Owners and other referral sources (farriers and saddlers) were positive about animal physiotherapy in all but one case.
Visits to veterinary surgeons and visits combined with ‘other’ (eg word of mouth, telephone calls, personal contact, the ACPAT register and lecturing to interested clubs/societies) were the most usual forms of advertising with seven members (23%) using all these means. Three respondents (10%) used no form of advertising. Communication (8 members, 27%) and education (1 1 members, 37%) were t h e m a i n a r e a s where improvements regarding liaison with veterinary surgeons were thought necessary. Subjects commented that animal therapists need to educate veterinary surgeons about their role in animal therapy, ie what physiotherapy can offer to which cases, its benefits and advantages and that animal therapy is a complement to veterinary treatment rather than a replacement. A team approach to animal care was considered important as 29 members (97%) disagreed with the statement ‘a team approach to animal care is not necessary’. The remaining one member went against the trend by strongly agreeing with the statement. Joint lectures and courses to promote exchange of knowledge and ideas, more researchkase studies to provide evidence of the effects of animal therapy and the two professions working from a joint practice/surgery were also suggested ways of enhancing liaison between the two bodies. There was significant agreement with the statement: ‘The formation of a British Veterinary Association (BVA) sub-group affiliated to ACPAT would be beneficial to both professions.’ Twenty-two mzm beys (73%) strongly agreed while none disagreed. Twentyseven members (90%) supported the suggestion that many problems in providing a n animal therapy service could be alleviated by physiotherapists working from veterinary practices.
Discussion Although there was a 71% return rate of the questionnaires, normally considered a good response, with so few category A members of ACPAT (48) to survey, the resulting number of respondents was small. A higher response rate might have given a clearer picture of animal physiotherapy practice in Britain. Only one member treated animal patients only, suggesting that animal therapy has not yet established itself completely as a viable career - or possibly members preferred a combination of human and animal practice. Horses and dogs were the most commonly treated animals, probably because they are often bred as competition animals which, if injured, require immediate rehabilitation to return them to their peak athletic ability (Lawson, 1970; Hopes, 1970; Lang, 1980; Rogers et al, 1989).Owners are therefore prepared to consult a physiotherapist in the hope of speedier rehabilitation. A few farm animals had been treated suggesting that, if the value of an animal is high, breeders may be inclined to use animal physiotherapy. Twelve respondents had treated cats, indicating, as Randell (19901, Martin (1990), Lang (1980) and Tangner (1984) suggested, that these animals may also benefit from physiotherapy. The high incidence of back and neck problems with horses and dogs could be related to the extremes of athletic ability sometimes demanded of these animals,
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particularly in the case of horses which also have to carry the additional weight of riders. Unfortunately there is very little published research relating to the efficacy of physiotherapy with horses, dogs and cats. A review of the literature revealed only a few research studies in this area. Several support the use of ultrasound in musculoskeletal conditions in these animal groups (Lippiello and Smalley 1991; Lang, 1980; Morcos and Aswad, 1978a, b). Apparently this electrotherapy technique is as useful in animals as for humans. Functional recovery was improved in post-fracture cattle given a massage and exercise regime when compared to a control group of cattle with fractures (Sharifi and Sharma, 1990). No other studies were found investigating massage or exercise. Herrod-Taylor (1967) documented a series of successful case studies of spinal manipulation in horses but no scientifically rigorous data were found in the literature. There are many descriptive and prescriptive reports in the literature relating to animal physiotherapy with no data to support suggestions and claims (Hopes, 1970; Jones, 1990; Rogers et al, 1989; Bromiley, 1991; Randell, 1990).Clearly there is a need for animal-specific and treatment-specific research studies to investigate the use of physiotherapy techniques with animal patients. As yet many of these techniques, eg hydrotherapy, electrotherapy, massage and mobilisation, have not even been thoroughly investigated in human patients either. In 1985Vogel suggested faradism and ultrasound were the ‘main armaments’ of the animal therapist. Although ultrasound was a commonly used modality in this survey, the laser was equally popular, with faradism being used by only a few respondents. The laser has been proposed for use in wound healing which may justify its popularity in this survey as wounds were commonly referred (Dyson and Young, 1986). The widespread use of ultrasound in the surveyed population has been supported by several studies (Lippiello and Smalley 1991; Lang, 1980; Marcos and Aswad, 1978a). Other electrotherapy modalities have been recommended for use in animal physiotherapy including shortwave diathermy (Lawson, 1970; Hopes, 1970; Warman, 1970; Jones, 1990); interferential and other higMow frequency currents (Calder, 1970; Rogers et al, 1989); neuromuscular stimulation (Randell, 1990; Rogers et al, 1989; Jones, 1990); magnetic field therapy (Jones, 1990); and microwave therapy (Hopes, 1970).Interferential currents a n d neuromuscular stimulation were used by physiotherapists in this survey but magnetic field therapy, shortwave diathermy and microwave therapy were used only very occasionally - possibly because the machines are not easily portable or because alternative treatments were found as effective. Mobilisations and manipulations were frequently used in the treatments of both horses and dogs as suggested by Hopes (19701, Warman (1970) and Jones (1990). These techniques are commonly used to treat back and neck problems in human patients and it appears that this is also true for animal patients. In the literature, frequently recommended treatments for use in animal therapy are hot/cold therapy and massage (Lawson, 1970; Hopes, 1970; Calder, 1970; Randell, 1990; Jones, 1990; Tangner, 1984; Rogers et al, 1989).However, few respondents used these regularly, perhaps because the ownerdtrainers can
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apply these techniques themselves. Hydrotherapy was used regularly by only four of the respondents, refuting recommendations of its application in animal therapy by Scanlon (19831, Tangner (1984),Randell (1990),Roger et al (1989) and Hopes (1970). It is probable that hydrotherapy is a commonly used method of tieatment or exercise by the ownerdtrainers of large, well established horse yards where a pool has been specially constructed. Many therapists would not have easy access to such a pool. In response to the question regarding ‘right of first referral’ only six respondents thought this would be beneficial to the physiotherapist. Right of first referrral may reduce the time between injury and treatment and the owner may benefit financially (it eliminates the need for a visit from the veterinary surgeon). However, animal therapists would not have the same knowledge as veterinary surgeons regarding animal conditions. Therefore even if right of first referral was accepted, close liaison and an effective team approach between the two professions would still be of the highest, importance.
Liaison with Veterinary Surgeons and Other Referral Sources In general, animal therapists thought they were well received by the veterinary profession as was to be expected (those who do not agree with it do not refer). However, a few veterinary surgeons were reluctant to acknowledge animal therapy. A survey of British veterinary surgeons by McNamara and Mackintosh (1993) also found a generally positive attitude to physiotherapists with a few veterinary surgeons feeling strongly against animal therapy by physiotherapists. While some of the veterinary profession are aware of the benefits of physiotherapy, however, further efforts at public relations are needed to increase the awareness and understanding of those who remain suspicious of animal therapy. Greater understanding and acceptance of animal therapy could be achieved by increasing veterinary surgeons’ knowledge of the physiotherapy services available and provision of evidence of success, ie case studies and more research on techniques. This could result in the two professions working more effectively and efficiently together.
Conclusions Physiotherapists have a role to play in veterinary medicine. Animal therapists can offer treatment to many breeds of animal, but a t present are more involved with horses and dogs. Many conditions can be treated by animal therapists including sportinglathletic injuries, neurological and orthopaedic cases, using a variety of manual and electrical treatment techniques. Positive promotion of animal physiotherapy is needed within the veterinary world to allow recognition and growth of this field of physiotherapy practice. Authors D Knowles BSc(Hons)Physiotherapy was a student and Shylie Mackintosh BAppSc(Physi0) MSc MAPA was a senior lecturer
at the University of East London at the time of the study.
Address for Correspondence
Shylie Mackintosh, 54 Clifton Street, Prospect, South Australia 5082.
289
Contribution D Knowles designed the study and collected and analysed the data and Shylie Mackintosh supervised the project and prepared the manuscript for publication.
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2,60-61. Dyson, M , and Young, S (1986).‘Effect of laser therapy on wound contraction and cellularity in mice’, Lasers in Medical Science, 1, 125-130.
McNamara, K and Mackintosh, S F H (1993).‘Veterinary surgeons’ perceptions of animal physiotherapy’, Physiotherapy, 79, 6,312-316. Morcos, M B and Aswad, A (1978a).‘Treatment of two clinical conditions in racehorses by ultrasonic therapy’, Equine Veterinary Journal, 10, 4, 128- 129. Morcos, M B and Aswad, A (1978b).‘Histological studies of the effects of ultrasonic therapy on surgically split flexor tendons’, Equine Veterinary Journal. 10, 4,267- 269. Raji, A M (1984).‘An experimental study of the effects of pulsed electromagnetic field on nerve repair’, Journal of Hand Surgery, 9B, 105-111. Randell, L (1990).‘Animal physiotherapy’, ACPAT Newsletter, September. Rogers, P A, Cain, M J, Kent, E and Ogden, E C (1989). ‘Physiotherapy, homoeopathy and acupuncture in the treatment and prevention of lameness and the maintenance of peak fitness in horses (part l)’,lrish Veterinary News, 11, 5,8- 12.
Hayes, M H (1981).Veterinary Notes for Horse Owners, Anchor Press, London. Herrod-Taylor, E (1967).‘A technique for manipulation of the spine in horses’, The Veterinary Record, 81, 17, 432.
Scanlon, E J (183).‘Equine hydrotherapy’, Modern Veterinary Practice, 64, 148- 150.
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Lippiello, L and Smalley, L (1991).’Densitometric assessment of equine bone repair following pulsed ultrasound therapy’, Equine Practice, 13, 4, 17-24.
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Hayfever in the Garden by Tim Rich. Marion Merrell Dow Ltd, Lakeside House, Sfockley Park. Uxbridge, Middlesex U B l l 16E. 1994. 21 pages. Free for SAE.
IIayfever affects 10-124 of t h e population a t some time in their lives. This new publication answers many of the questions relating to the condition what hayfevcr is, who is affected and what the symptoms are. Although i t is not usually a serious medical condition, in severe cases normal daily activities can be inhibited. The booklet offers a simple guide to the pollen snurces t h a t may be causing problems. In spring hayfever tends to be caused by tree pollen; in early summer, May to July, it is likely to be grass pollen; and between August and September it is probably pollen from weeds, fungal spores or herbaceous plants. A description and line drawings of particular garden culprits is included, together with tips on how to avoid hayfever.
Information to Support Health of the Nation NHS Executive. HSG(94) 19. BAPS. Health Publications Unit, DSS Distribution Centre, Heywood Stores, Manchesfer Road, Heywood, Lancs OL 10 2PZ. 32 pages.
This document from the NIIS Executive sets out the intiatives currently under way to monitor the progress of the Health of the Nation targets, both within and
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Trusting in the Future Towards an Audit Agenda for NHS providers Audit Commission. HMSO Publications Centre, PO Box 276, London SW8 5DT. 1994 (ISBN 0 11 886104 2). 37 pages. €8.50.
Wide variations in the performance of community and hospital services in England and Wales have been found by t h e Audit Commission, with clinical productivity varying by a s much as 50% between similar providers. In this report t h e Commission acknowledges t h a t providers a r e trying to find ways to improve quality and efficiency, with snme doing well. Others, however, the report
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