Laurie's Blogs.

 

26
Feb 2022

Progressing Exercise Sessions – Part 3 - Measuring Outcomes

Laurie Edge-Hughes, BScPT, MAnimSt, CAFCI, CCRT

If you are just tuning in now, this is part 3 about Progressing Exercise Sessions.  If you want to get caught up on Part 1 and Part 2, here are the links to those blogs:

https://www.fourleg.com/Blog?b=553  

https://www.fourleg.com/Blog?b=554  

 

Okay… so perhaps I have convinced you to put more thought into exercise progressions and that you need to push your patients a little bit harder during their exercise sessions.  Now, you want to know if your strategies are working…  what do you monitor and measure to know that you have pushed your patient hard enough (and/or not too hard)?  

 

Here we go down this path of discussion!

 

What outcomes do we traditionally measures in rehab, and which ones are relevant when it comes to exercise prescription?

 

1.  Goniometry.  This tells us about range of motion, but how does range of motion relate to function or strength.  Sadly it doesn’t.  So, I’m not going to go much further into discussing goniometry here.

 

2.  Pressure Algometry.  Well, this could be useful for telling us if we have flared up a joint, but so can a good physical exam.  So, I wouldn’t bother with this tool either.

 

3.  Weight bearing.  This one is functionally relevant.  If a joint feels better, a leg feels stronger, a soft tissue lesion feels less painful, or the animal more comfortable using a limb, then weight bearing should improve.  So, you can add this to your outcome measures list.

 

4.  Thigh circumference.  Unfortunately, this hasn’t been studied extensively in dogs, but it makes sense that if a limb is getting bigger secondary to adding in an exercise program, it makes sense that the animal is using that limb.  As such, this is a quick and easy outcome measure to take into account.

 

5.  Lameness scores.  Here, the evidence is very poor when it comes to validating lameness scores, but if a dog goes from significant lameness to sound, then that is a very important outcome.

 

6.  Functional scoring.  Scoring tests exists for chronic pain (i.e. Helsinki Chronic Pain Index) is well validated.  We can also use the Cincinnati Orthopedic Disability Index.  The great thing about this one is that the rehab therapist and owner can come up with what tasks or skills are important.  

 

7.  Ultrasound imaging.  This would make sense for a tendon lesion.  In physiotherapy practices we will often use ‘real-time ultrasound’.  It’s the same ultrasound, just not calling it ‘diagnostic’ but instead informative in regards to healing of a tendon and whether therapy strategies are working or not.  This is an underutilized tool in rehab practice.

 

8.  Tenderness.  Is the muscle or tendon (if that is the lesion for which the dog is in rehab) less tender on palpation.  While we don’t know how that tendon ‘looks’ without ultrasound or ‘fancier imaging’, palpation can be one factor in an evaluation of rehab success or not.

 

9.  Much like the functional scoring, simply charting about the capabilities of the animal IS an objective outcome.  Exercise tolerance, walking distance, ability to go upstairs, get onto the couch or in the vehicle, how an animal performs the given exercise or time to fatigue (when testing an exercise) are outcome measures – even if they have an element of subjectivity.  These are things that MATTER to the owner.

 

 

This is a shorter blog.. but hopefully ‘practical’ to give you the tools to monitor your exercise progressions.

 

I hope you have found these blogs useful and have a little bit more information in regards to exercise progression!

 

On that note, have a healthy week ahead!

 

Cheers,  Laurie

 



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