Abstract Introduction: Physiotherapy in the human intensive care setting is in common use and supported by Level 1 evidence. In the canine intensive care setting, however, physiotherapy is novel, despite many studies published to support aspects of human physiotherapy being conducted on experimental dogs and there being 83 canine intensive care beds in Sydney alone. As veterinary care progresses and people place more importance on their pet’s health care, an opportunity arises to examine the potential for physiotherapy to augment the veterinary care of client-owned dogs in a veterinary referral hospital setting. The first objective of this thesis was therefore to determine which common conditions cause dogs to present recumbent to veterinary referral hospitals, and then to conduct a literature review on these conditions and ways in which physiotherapy has the potential to add to the treatment of them. The next objective was to describe the short-term effects of recumbency on a number of key body systems in clinically unwell dogs, as concern was that recumbency itself may contribute to pathogenesis and/or poorer recovery, however this could not be investigated before preliminary studies like this were performed. The next objective was to conduct clinical trials of the use of two well-proven techniques in human physiotherapy on dogs with conditions commonly reported in the earlier studies of this thesis. The chosen techniques were continuous positive airway pressure (CPAP) to assist in the recovery of dogs with brachycephalic airway obstructive syndrome (BAOS) from general anaesthetic, and the use of manual chest physiotherapy in dogs with aspiration pneumonia following tick (Ixodes holocyclus) poisoning. Design: Retrospective epidemiological study; Literature review; Cross-sectional descriptive study; Randomised controlled trial; Clinical trial. Results: Dogs admitted recumbent represented 3.18% of total admissions, however had a confirmed survival rate of only 43.5%. Sydney canine intensive care units have a combined capacity of 83 beds, so many other dogs experience recumbency as part of their veterinary management, despite being admitted ambulant, and therefore also have the potential to benefit from physiotherapy. Diagnoses were split into categories, with suspected intervertebral disc disease the most common neurological diagnosis, hit by car the most common orthopaedic diagnosis, collapse the most common diagnosis in the ‘otherwise unwell’ category and tick (Ixodes holocyclus) poisoning and poison (e.g. metaldehyde) ingestion the most common toxicology diagnosis, all of which have the potential to be just as amenable to physiotherapy in dogs as they are in people. However, interspecies comparisons revealed that although the dogs studied had broadly comparable diagnoses to humans, they had a higher mortality rate and received much less physiotherapy than humans. Key body systems were therefore measured in recumbent dogs, with the finding that the dogs included under the strict definition of recumbency in this study maintained a fairly consistent clinical state in the short-term of their period of recumbency (median days 3 to 5 of hospitalization). This finding supported the investigation of physiotherapy as a potential to not only reduce the mortality rate but to speed return to function, which has the potential to also lower the economic burden of prolonged hospitalization on owners. Continuous positive airway pressure was therefore investigated for its potential to improve the safety of recovery from general anaesthetic in dogs with BAOS. Tolerance and effect of CPAP were investigated with positive results demonstrated to improve time to recovery, with no additional distress, in dogs with BAOS recovering from a general anaesthetic. An evidence-based protocol of manual chest physiotherapy was then tested on dogs with aspiration pneumonia following tick (Ixodes holocyclus) poisoning. Demeanour, saturation of peripheral oxygen and auscultation all improved following the first manual chest physiotherapy session, demonstrating tolerance and effect. Conclusions: Primary recumbency is an uncommon but serious condition in dogs that warrants attention by physiotherapy researchers, as dogs admitted ambulant but who spend part of their hospitalization recumbent also have the potential to benefit. This thesis determined the common causes of recumbency in dogs and determined that key body systems of recumbent dogs are clinically stable without the assistance of physiotherapy to improve their short-term rate of recovery. Positive short-term results were yielded from the use of CPAP and manual chest physiotherapy that may benefit other clinically unwell dogs with similar respiratory conditions. Further research should be conducted into other ways in which physiotherapy can augment the care of recumbent dogs, as well as lower the mortality rate and speed the return to function in dogs in the intensive care setting, as it is possible that not all positive findings in human research were replicated in these studies due to Type II error resulting from small sample sizes due to abnormal weather patterns that reduced the number of presentations of dogs with BAOS or tick poisoning during the study period.
| Identifer | oai:union.ndltd.org:ADTP/254156 |
| Creators | Helen Nicholson |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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