Status of Equine Rehabilitation and Level of Scientific Validation. Legal Aspects. Rehabilitation 11/2/2014

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Arnold Price
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Status of Equine Rehabilitation and Level of Scientific Validation Steve Adair MS, DVM, DACVS, DACVSMR University of Tennessee Veterinary Medical Center Legal Aspects AVMA 1996: recognized veterinary

1 Status of Equine Rehabilitation and Level of Scientific Validation Steve Adair MS, DVM, DACVS, DACVSMR University of Tennessee Veterinary Medical Center Legal Aspects AVMA 1996: recognized veterinary physical therapy as the use of noninvasive techniques, excluding veterinary chiropractic, for the rehabilitation of injuries AVMA emphasized that veterinary physical therapy should be offered in the context of a valid veterinarian-client-patient relationship 2001: the AVMA classified veterinary physical therapy as a method of Complementary and Alternative Veterinary Medicine In most states physical therapy and physical therapist are protected Use physical rehabilitation Each state individually regulates the standards for veterinary medicine and for physical therapy by their practice acts Rehabilitation is to restore or bring to a condition of health or useful and constructive activity Refers to the treatment of injury or disease Rehabilitation 1

Conditioning refers to the maintenance or improvement of current physical capability with the goal to prevent injury Conditioning KESMARC KY Equine Rehab Facilities Numerous facilities across US Most

2 Conditioning refers to the maintenance or improvement of current physical capability with the goal to prevent injury Conditioning KESMARC KY Equine Rehab Facilities Numerous facilities across US Most are unregulated Most do not have veterinarian on staff Protocols often prescribed by nonprofessional staff Experienced but not trained or paraprofessional Patients veterinarian usually does not formulate therapeutic plan Equine Rehab Facilities Onsite Services Swimming Underwater Treadmill Eurociser Balneotherapy Cryotherapy Whole Body Vibration Low-level laser Pulsed electromagnetic therapy Therapeutic ultrasound HBOT Estim Facilitated Services Massage Chiropractic Accupuncture Nutrition consultation Orthotics Other 2

3 Equine Rehab Facilities Personnel Experience Most are avid horse people Most are trainers Most have years of horse experience Most are self taught or are a paraprofessional Exceptions Some are PT s or veterinary technicians Modalities With few exceptions anyone can purchase equipment Minimal regulation Numerous companies that compete All it takes is money Science Behind the Art 3

4 Those who claim to know in the absence of evidence are, at best, proclaiming their faith, not their knowledge Rothstein JM (1997) Effect vs. Efficacy An effect on tissue does not necessarily mean a treatment is efficacious Something that is not proven does not mean that it is proven not Most equine studies deal with effect and not efficacy Prolonged or repeated ice water cooling is the most effective cooling limbs. External heat is effective primarily in superficial tissues. Randomized clinical trials are needed for efficacy. Thermal Therapies 4

Only one case series study indicates efficacy of hydrotherapy on lower leg injuries Salt Water HydroTherapy All

evidence in man Experimental studies indicate positive effects of exercise on cartilage or tendon healing Controlled

Dr. Rebecca Paulekas Studies on equine electrotherapy are lacking Standardized and established methods in man and

5 Only one case series study indicates efficacy of hydrotherapy on lower leg injuries Salt Water HydroTherapy All other papers deal with effects Hydrotherapy Therapeutic Exercise Therapeutic exercise is based on good clinical evidence in man Experimental studies indicate positive effects of exercise on cartilage or tendon healing Controlled clinical studies about the effects of various exercise rehabilitation programs on healing are required Courtesy of Dr. Rebecca Paulekas Studies on equine electrotherapy are lacking Standardized and established methods in man and dogs, such as TENS or NMES, have a potential for use in horses Should be evaluated in controlled clinical studies Electrotherapy 5

Electromagnetic Therapy Despite encouraging first experiences with PEMF therapy, no conclusive evidence for its efficacy in horses is available

Laser Therapy Studies on low power laser treatment in horses have failed to establish positive results Laser effects using standard (human)

testing in horses Therapeutic Ultrasound Experimental studies on horses provide evidence of effect from ultrasound therapy Increase heat within

6 Electromagnetic Therapy Despite encouraging first experiences with PEMF therapy, no conclusive evidence for its efficacy in horses is available Long term, daily use shows improved bone healing in human Controlled clinical studies, based on adequate numbers of horses, are needed Low-Level Laser Therapy Studies on low power laser treatment in horses have failed to establish positive results Laser effects using standard (human) treatment have not been shown efficacious Applications of LLLT with good evidence of therapeutic efficacy in man require controlled clinical testing in horses Therapeutic Ultrasound Experimental studies on horses provide evidence of effect from ultrasound therapy Increase heat within tendons Equine case reports do not match the results of large meta-analyses in man Need controlled clinical studies with a sufficient number of horses to document efficacy 6

7 Lack of Positive Equine Studies? 1) No adequate studies performed at all, possibly due to lack of interest, lack of a sufficient specific case load or lack of money 2) Ideal technical parameters for a particular modality are not well established in horse or other species 3) The assessment of the effects of PT modalities are not based on adequate parameters 4) Treatment may not work Conclusions 1) Basic studies are needed dealing with dose dependent effects at the tissue level 2) Clinical studies have to be based on clearly defined patient populations and treatment specifications 3) The effect of the therapy has to be evaluated based upon objectively measurable parameters 4) A sufficient number of treated horses and control horses are needed to obtain a sufficient statistical power Future Organizations American College of Veterinary Sports Medicine and Rehabilitation American Association of Rehabilitation Veterinarians International Association of Veterinary Rehabilitation and Physical Therapy Certification Two certification courses in US that are opened to Veterinarians, Veterinary Technicians, Physical Therapist, Physical Therapy Assistants 7

8 Databases Cochrane - PEDro (Physiotherapy Evidence Database) - 8

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