Thursday, December 3, 2015

The Pet PT Pit Stop: Is the Treatment Necessary? Is It Working?

by Susan E. Davis, PT “pull in for a helpful refuel!”  

It’s all about guiding and empowering you to help your dog avoid injury, provide practical solutions and achieve rapid restoration of health and function!   

About 2 months ago I was evaluating a new patient named Molly, a chocolate Lab, in the client’s home. While taking a history the client mentioned that Molly had prior cold laser treatments in the veterinarian’s office. “We bought a package of twelve treatments”, she explained. “Did they help her?” I asked.  “Actually, no” replied the client.


A package of 12 laser treatments, really? 

What thoughts go through your head as you read this? How about “wouldn’t there be a smaller package with, say, 3-6 treatments”? Wouldn’t you know after a few, if they were helping or not? I asked how the effectiveness of laser treatments was assessed during the process and was told ‘it wasn’t but I wondered about that’. The client explained that a vet tech did each treatment and when the 12 were completed, the veterinarian examined Molly and said there wasn’t any improvement, so no further laser treatment packages were recommended. Duh (forgive me).

In human medicine, the concept of ‘medical necessity’ and proper utilization in care is critical to reimbursement by third party payers. In veterinary medicine, pet insurance is beginning to play a greater role of influence in providing care, but the majority of service is privately paid. Some providers (including physical therapists and rehab practitioners) rely on your willingness to spend without thinking and do “whatever my pet needs’.  An ethical provider will always make decisions based on the medical need of your pet and not on monetary gain. 


Medical evaluation should be performed any time a pet has declined in function, has a significant change in their status, experiences quality of life issues such as with malignancy or major illness, needs prevention care such as with overuse syndrome after amputation (involving the intact remaining limbs),  or has new rehabilitative potential, such as with post-op CCL tear. Treatment services may be recommended based on the results of these evaluations. A re-evaluation should be performed at regular intervals during treatment to see if the care being rendered is effective.

There are several ways to determine is a service is medically necessary. 

First, it should be non-routine a need a skilled trained provider to reach maximum level of care.  This service should be beyond your ability as a pet owner to do on your own and require specialized skills. In general the treatment should be at a mid to high level of medical complexity.  A therapist or rehab practitioner has an ethical obligation to show you as much as you are willing and able to do safely and practically with your dog. For example, it is reasonable to expect an owner to learn simple range of motion exercises and how to coach their dog to perform functional exercises. However, techniques such as spinal manual traction, deep tissue massage or manual joint mobilization require professional level skill.

Secondly, the pet should be responding well to treatment and improving. 

Realistic short and long term goals should be set, with the patient achieving them in a timely manner. Back to my client: 12 sessions of laser without any improvement is an excessive, unreasonable time frame.  If there is no improvement within 3-6 visits max, treatment should be discontinued with the veterinarian or therapist evaluating the patient regularly.

There can be justifiable medical necessity if a patient is not improving, but without skilled treatment intervention they would decline in function. These types of treatment may be considered as maintenance or supportive, but are justifiable in terms of medical necessity.

Maintenance care is treatment that does not yield improvement but prevents future decline. 

An example of this could be with severe hip dysplasia or spondylosis of the spine. When a medical condition is progressive and results in a steady decline, treatment interventions are termed as supportive. Treatment can play a role by providing temporary relief or pain, reducing complications and side effects, giving comfort and maximizing the pet’s quality of life. Examples of this can be therapy for degenerative myelopathy, metabolic disorders, or metastatic cancers in late stages.

Finally, medical necessity may be justified for simpler, lower-level care if co-morbidities exist (a dog with Cushing’s Disease has a secondary open wound) or complexities such as having multiple body areas affected with arthritis, where such treatment may be impractical for the pet owner to provide yet it will improve recovery rates with less number of visits.       
 
***

Susan E. Davis (Sue) is a licensed Physical Therapist with over 30 years of practice in the human field, who transitioned into the animal world after taking courses at the UT Canine Rehabilitation program.  She is located in Red Bank, New Jersey.

She has been providing PT services to dogs and other animals through her entity Joycare Onsite, LLC in pet’s homes and in vet clinics since 2008.

She also provides pro bono services at the Monmouth County SPCA in Eatontown, NJ.  Sue is the proud “dog mommy” to Penelope, a miniature Dachshund with “attitude”.  For more information see her website www.joycareonsite.com , or follow on Twitter @animalPTsue.


Sue is also the author of a fantastic book on physical therapy, Physical Therapy And Rehabilitation For Animals: A Guide For The Consumer.  

Physical therapy can do so many great things for your dog. Understanding all the possibilities physical therapy can offer will change your dog's life. This book definitely belongs on the shelf of every dog lover.



Articles by Susan E. Davis:
Functional Strengthening Exercises: the What, Why and How
One Thing Leads To Another: Why The Second ACL Often Goes Too
Compensation: An Attempt To Restore Harmony
Paring Down to the Canine Core
Canine Massage: Every Dog ‘Kneads’ It”
Photon Power: Can Laser Therapy Help Your Dog?  
Physical Therapy in the Veterinary World  
Reiki: Is it real? 
Dog Lessons: Cooper  
The Essentials Of Canine Injury Prevention: 7 Tips For Keeping Your Dog Safer 
It's Not Just Walking, It's Therapy! 
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part I)
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part II Physical Therapy)
Range Of Motion: It’s A Matter Of Degree…
The Weight Of Water And How It Helps Dogs 
By Land or By Sea? A Comparison of Canine Treadmills 
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part I)
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part II) 
Scar Tissue: Is it Too Much of a Good Thing? 
Physical Therapy Tip Of The Month: Ramps! 
Physical Therapy Tip Of The Month: Indoor Duo Dog Exercises!
Physical Therapy Tip Of The Month: Best Practices After Your Dog’s Surgery 
Physical Therapy Tip Of The Month: Ideas to Chew on - Can Physical Therapy Help with my Dog’s Digestive Problems?
Wrap It Up: Using Soft Supports For Your Dog
When Do I Use Heat versus Cold? : A Tale (or Tail) Of Two Temps! (Part I) 
When Do I Use Heat versus Cold? : A Tale (or Tail) Of Two Temps! (Part II) 
Physical Therapy Tip Of The Month: Safe Summer Boating Tips for your Dog 
Physical Therapy Tip Of The Month: Hip Dysplasia - What’s a Dawg Mama to Do?
PT Pit Stop: Wheeled Carts Keep Them Doggies Rollin' (Part I)
PT Pit Stop: Wheeled Carts Keep Them Doggies Rollin' (Part II)
Staying in the Loop with Targeted Pulsed Electromagnetic Field Therapy
Addressing Frailty Syndrome in Geriatric Dogs 
The Pet PT Pit Stop: "Where's The Evidence?"
Physical Therapy is Great, Except When It Isn’t 
Top Dogs and their Toplines at the Westminster Kennel Club Dog Show (Part I)
Top Dogs and their Toplines at the Westminster Kennel Club Dog Show (Part II) 
What's in a Dog's Gait? 
A Practical Method to manage your Dog’s Care Plan 
Wound Care 101 (Part I The Basics) 
Wound Care 101 (Part II Wound Management)
Prevention and Management of Hip Dysplasia in Puppies: Attention all Breeders!
Support and Braces
Vaccinosis - A Vexing Conundrum 
The Pet PT Pit Stop: Blame it on the Weather, Really!
Relief for Laryngeal Paralysis using Physical Therapy

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