We’re all familiar with the phrase ‘evidence-based practice’. That is what we are supposed to be doing – practicing our veterinary rehab work in ways that are based on evidence of what works and what does not. But ours is a field that is still shiny new and growing, and the reality is that we have very little evidence to go on. Slowly but surely that is changing, and it’s very exciting – but right now, what do we do when there is just no research to point a clear way forward? How do we become evidence based when there is no evidence?
Review the Available Literature
There is a limited body of literature available that directly relates to veterinary rehab, but it is there, and we should familiarize ourselves with it. We need to know the work that has been done and is currently being done to expand our field. We should be working to support and recognize the people that are actively involved in research in any way we can.
There is also almost unlimited research available on the rehabilitation of the human body which is worthwhile reading and learning from. Some things we will be able to extrapolate to animals and some things we won’t; some findings may lead us to ask questions that might otherwise not have occurred to us. There are instances where research on humans and animals are linked – such as in degenerative myelopathy (DM) in dogs and amyotrophic lateral sclerosis (ALS) in humans (Coates et al., 2017). We discussed this link in a previous blog. In some areas, we can be guided by the direction that research is taking in humans, especially when looking at the recommended surgeries and treatment options for certain conditions, such as IVDD.
Reading research – even when it is not 100% relevant to a clinical situation (which it rarely is to begin with) – will equip us with knowledge and push us to question and grow. It provides a context to our thinking and our work.
Record, Review and Compare
Lately, we’ve emphasized the value of recording our patients’ progress through photos and videos. Keeping records can help us to examine, compare and improve our treatments. Our experience is often the only evidence we have, and can be extremely valuable in starting to assemble retrospective studies. But we need to record accurately and comprehensively. Unless we record what we have done honestly, accurately and systematically through videos, photos and treatment notes, our anecdotal evidence becomes tarnished by memory and opinion, and loses all value and objectivity. Without accurate records and reflection on them, we’ll simply do the same things over and over for the next twenty years, continuing to prove ourselves ‘right’, even though our treatments may not be working optimally.
We need to review our records to benefit from them. Look at the photos, watch the videos, read your notes thoroughly and ask yourself: Did I achieve all I aimed to achieve? Could I have done something differently? Why did I use that modality or exercise at that specific time? How did the patient perform the activity? How could I have guided the patient to perform it better?
Whatever you do and see, question yourself and look for ways you might improve. Show the video to colleagues and discuss it with them; they may see something you have missed. In addition, compare notes between different patients and to other therapists’ notes. This is how we start compiling retrospective studies on the treatment of specific conditions.
As veterinary rehab therapists, we need to see the bigger picture. Ours is a growing field, and we need to actively grow and strengthen it for the benefit of all. By pooling our knowledge and resources, we’re helping to develop a body of research. We all grow and learn, and our profession, as a result, can only strengthen and improve, gaining the recognition it deserves.
Be Open to Criticism and Growth
I love how the Greyfriars team in the UK works – not only are they team orientated, they guide and learn from one another continually. The hydrotherapist speaks to the behaviorist, the behaviorist consults with the physiotherapist and they all involve the veterinarian. It’s a great system, and it shows in their results. We should consult with all members of the healthcare team regularly, gaining and giving as much information as possible. A behaviorist may see something in a video that you miss, suggesting an adaptation to an exercise that will improve your outcome. The same can be said for a veterinarian, a physiotherapist, a trainer, a farrier … If we open ourselves up to the opinions and criticisms of others, our growth, and our successful outcomes, will skyrocket!
I realize that research is rarely perfect – we never have a 100% controlled environment in real life, and this may cause us to question some of our findings. But we do need to engage with the questions being asked and the answers being gained, both our own and those of others. Only by immersing ourselves in the process of sharing and gaining knowledge will we grow this fascinating field, and refine and improve the treatments we’re able to give our patients.