The use of outcome measures in equine rehabilitation

Abstract

Background: The ideal goal of equine rehabilitation following injury or surgery is to return the horse to a level of function that either meets or exceeds the previous performance level, and monitoring progress is important within rehabilitation. Outcome measures (OM) are used extensively in human practice and research, especially patient reported outcomes (PRO). PROs generally consist of a series of questions and observation of functional tasks, use of which may be challenging in equine practice. Aim: The aim of this study was to evaluate the use of OMs by physiotherapists in equine musculoskeletal rehabilitation. Methods: A questionnaire was used to investigate how those involved with the treatment and training of horses measure progress and outcomes during rehabilitation. Results: 71 physiotherapists responded, comprising 51 chartered physiotherapists and 20 physiotherapists without prior human training, with an average of 9.25 years in equine practice; 82.2% reported OM use. When asked to define an OM, 72.5% of chartered physiotherapists and 40% of physiotherapists without prior human training, matched a pre-set definition correctly. The benefits of OM use were reported consistently as a method of objectively monitoring progress and used to adapt treatment plans. The barriers to OM use were lack of OM validation and reliability and time constraints. However, OMs were mainly subjective, such as visual assessment of lameness, palpation and muscle symmetry. Conclusion: In conclusion, confusion exists regarding what an OM is, and OM use is reported but often refers to subjective assessment method. A validated equine musculoskeletal rehabilitation score is required to support clinical practice.

Four Weeks of Incline Water Treadmill Exercise Increases Epaxial Muscle Profile in Horses

“…5 It is important to understand that the extent of thoracolumbar flexion is very much dependent on conformation and range of motion (ROM) of the spinal joints, 3 but previous studies have shown a linear increase in muscular electromyographic activity of both the m. longissimus dorsi and m. rectus abdominis alongside angle of incline of surface. [6][7][8] It is therefore postulated that recruitment of the stabilisation muscles during walking on an inclined WT should show an increase in facilitation and development of muscle across the thoracolumbar back profile in excess of that achieved on the flat. The aim of this study was therefore to assess the effect of recurring inclined WT sessions on equine epaxial muscles development.…”

Generation of Domains for the Equine Musculoskeletal Rehabilitation Outcome Score: Development by Expert Consensus

“…However, the degree of detail regarding the specific physiotherapy interventions, such as for treatments including manual therapy [3], electrotherapy [1] or exercise therapy [4,5], either individually or in combination, varies between publications ranging from trials, often with low subject numbers to clinical review papers. As a result, equine physiotherapists use this information in combination with their experience and clinical reasoning to select treatment interventions they consider effective [6]. For example, in rehabilitation plans for overriding dorsal spinous processes, exercises to encourage ventral flexion to separate the spinous processes [7] are used in combination with exercises to strengthen the deeper 'core' stability muscle multifidus [8].…”

“…To achieve comparable professional practice standards in equine physiotherapy, OMs must be incorporated into practice [6]. To date, a few equine specific OMs that measure a single factor in clinical practice (referred to as objective markers (OBJM)) have been subject to reliability testing but there are no composite equine OMs.…”

“…OBJMs include the use of pressure algometry [26,27], manual palpation scoring [28,29], posture/muscle size measurement from photographs [30], muscle dimension measurement using a flexicurve ruler [31], range of joint motion using a universal goniometer [32,33] and evaluation of pain-related behaviour [34]. Despite these studies, the use of OBJM in clinical practice is sparse and clinicians report this being due to the lack of available, validated and reliable OBJMs [6], suggesting a lack of awareness to the available evidence. In a recent survey, equine physiotherapists stressed that OBJMs and OMs need to be simple to use, inexpensive and relevant to the cases they see [6].…”

“…Despite these studies, the use of OBJM in clinical practice is sparse and clinicians report this being due to the lack of available, validated and reliable OBJMs [6], suggesting a lack of awareness to the available evidence. In a recent survey, equine physiotherapists stressed that OBJMs and OMs need to be simple to use, inexpensive and relevant to the cases they see [6]. It is unknown which domains clinicians working in the equine rehabilitation industry would consider valuable to measure and how these could be combined to generate a composite outcome score specific and relevant for the cases practitioners work with.…”