Ten Steps to the Perfect Rehab Evaluation

When we have a repeatable and reliable system to evaluate and treat our patients, we know that we can consistently perform the best evaluations without missing any important information. It also allows us to approach more complicated or challenging cases with confidence.

 

There are 10 steps to the perfect rehabilitation evaluation:

1. Get the medical history
2. Get the diagnostic imaging and reports from the referring vet
3. Read the client questionnaire
4. Observe the patient
5. Evaluate movement
6. Physically examine the patient
7. Create a treatment plan
8. Set goals and expectations
9. Send the client home with the information they need
10. Write a vet report

 

Everyone works out their own way of doing a rehab evaluation, but I would like to share my preferred approach. It’s a system – and I love systems because they make daily life more orderly and more enjoyable. My ideal evaluation affords me time to gather information, think, and work cooperatively with my client and the referring vet.

You might find some aspects of my system helpful:

 

1.  Get the medical history

We must know the patient’s medical history – get this from the referring vet. History is important because medical conditions such as cardiovascular disease, skin conditions, and even cancer can affect our treatment choices.

 

 2. Get the radiograph or MRI report

I always like to look at the radiographs before I read the history. It gives me valuable information – and I like to see what I can discover for myself before I am told!

 

 3. Read the client questionnaire

The client can give you the broadest and most detailed information about their pet. I ask them to fill in a questionnaire prior to the first appointment. The questionnaire asks the following questions:

• What do they wish to achieve from the consultation? This allows me to manage expectations – which are sometimes unrealistic.
• What is their pet’s quality of life, out of 5, currently?
• What motivates their pet?
• What does the pet most enjoy doing?
• Does the pet’s condition prevent them from doing what they most enjoy?
• What supplements and medications are they taking?

You can create your own questionnaire with the information that is important to you, or you can use an already validated client questionnaire such as the CBPI or CODI. Asking the client to fill in the questionnaire at regular intervals will allow you to monitor the progress of the patient from their perspective.

 

4. Observe

The first thing I do during the consult is to observe the pet while talking to the owner. I watch their posture, how they move, how they get up, and how they lie down. This gives me a general idea of the pet’s sense of well-being, state of mind, and areas of discomfort.

 

 5. Evaluate movement

I then walk and trot the dog in a quiet area where I can do a movement evaluation. I like them to walk in a straight line back and forth, while I watch them walk directly away from me and towards me, as well from both sides. I then ask them to walk in a circle to the right and a circle to the left. This is a helpful diagnostic exercise, as some soft tissue injuries are exacerbated when the patient is on a circle.

I then test a series of functional movements, which is slightly different for orthopedic patients vs neurological patients.

For Ortho patients, I want to look at the quality of:

• Sit,
• Down,
• Transitions between stand, sit and down,
• Any specialized movements that the dog needs to perform in their work.

For a neuro patient, I will evaluate all of these movements as well as

• Tail movement,
• Conscious proprioception,
• Hopping test,
• Wheelbarrow test,
• Hemi walking,
• Tactile placing.

The more specialized movement tests for neurological dogs are often easier to perform later during the physical evaluation when the patient is comfortable with my hands on them.

 

6. Physically examine the patient

I then do a thorough physical examination, while the dog stands on a non-slip surface in a quiet area with no distractions. I do a full orthopedic examination and a neurological examination. Some neuro cases can present similarly to orthopedic cases, and vice versa. I take goniometric measurements of the affected joints and the contralateral joints. I always take muscle mass measurements at the first consult, unless the pet is anxious and overwhelmed.

Having a thorough evaluation sheet to fill in can make the physical exam simpler, ensuring that you can follow a step-by-step process as you palpate, score, test, and measure each area of the patient. We have created some evaluation form templates that you can access in the Onlinepethealth Members portals if you need a place to get started.

Download the equine evaluation form template here 

Download the canine ortho evaluation form template here 

Download the canine neuro evaluation form template here 

 

 7. Create a treatment plan

At this point, I have a good idea of where the main problem areas are and how I want to treat them. I will discuss the treatment plan and goals with the owner, and invite their feedback in creating a treatment plan that works for them.  The owner must take an active part in creating a treatment plan. This way the client feels part of the process and is more likely to appreciate the improvements we see in the coming weeks.

I always explain that the plan is not set in stone; it may change, depending on the response from the patient. If at any stage we don’t see the expected improvements, we will re-evaluate and change the plan, or, if we suspect a complication, we will refer back to the vet. Once a client knows this, they are far more likely to accept any changes I introduce later on.

 

 8. Set goals and expectations

I like to give my clients hope, but one needs to be careful not to create unrealistic expectations. For example, if the dog has been paralyzed for four months, it’s unlikely the dog will start walking within one month of treatment. Most clients will accept this if you explain it clearly. Having goals that matter to the patient and the client will also help them to stay motivated throughout rehabilitation. A good client questionnaire will help you determine what the best goals will be for a specific patient-client combo. Good goals will be personal, will speak to the motivators of the dog and the owner, and will consider the quality of life of the patient.

For one patient it might be a return to competition, while for another it might be one last season of duck hunting. One patient might aim to be able to go hiking, while another might aim to be able to get onto the furniture for owner cuddles.

 

9. Send the client home with the information they need

We want to send the owner home with a few important things:

1. A simple summary of our evaluation findings and the treatment plan
2. A clear and easy-to-follow home exercise program
3. Information on the condition their pet is suffering from (if we have this available as information sheets)
4. Information on any additional recommendations we have made (diet changes, supplements, etc)

Clients are often overwhelmed with information overload during a consult, and cannot remember everything I tell them. An information sheet gives them something to ponder and to share with others in the family so that all are clear on the condition and its treatment. There are many programs and applications at the moment that allow us to easily share this information with owners in a professional, clear structure. Some of my favorites include GoGo Charlie, EQ Active, and Equicantis.

 

 10. Write and send the vet report

I always write a report for the referring vet, in which I discuss the findings and the plan, and inform him or her of when to expect further feedback.

If you need help writing a vet report, you can download our free download on how to write a vet report here.

 

Bringing it all together

It’s great to have a system and to progress through these steps methodically. I find that the critical aspect of my system is clear communication; this is so often overlooked in our pressure to get things done.

My questionnaire is crystal clear; I hear expectations and correct them where they’re unrealistic right at the outset; and I try to explain the treatment plan and its nuances on day one, emphasizing that it may change as we progress through the treatment plan. When both the client and I understand one another perfectly – and when the referring vet is kept in the loop – the chances are high that my client will trust me and be satisfied with my services.