Survey of referring veterinarians’ perceptions of and reasons for referring patients to rehabilitation facilities

Leilani X. Alvarez Department of Tina Santi Flaherty Rehabilitation and Fitness, The Animal Medical Center, 510 E 62nd St, New York, NY 10065.

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Philip R. Fox Department of Caspary Research Institute, The Animal Medical Center, 510 E 62nd St, New York, NY 10065.

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Janet B. Van Dyke Canine Rehabilitation Institute, 2701 Twin Oaks Way, Wellington, FL 33414.

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Patrick Grigsby School of Public Health, City University of New York, New York, NY 10035.

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Abstract

OBJECTIVE To identify patterns of referral to US small animal rehabilitation facilities, document referring veterinarians’ perceptions of rehabilitation services, and examine factors that encouraged and impeded referral of veterinary patients to rehabilitation facilities.

DESIGN Cross-sectional survey.

SAMPLE 461 completed surveys.

PROCEDURES Referral lists were obtained from 9 US rehabilitation facilities, and surveys were emailed or mailed to 2, 738 veterinarians whose names appeared on those lists. Data obtained from respondents were used to generate descriptive statistics and perform χ2 tests to determine patterns for referral of patients to rehabilitation facilities.

RESULTS 461 surveys were completed and returned, resulting in a response rate of 16.8%. The margin of error was < 5% for all responses. Most respondents (324/461 [70.3%]) had referred patients for postoperative rehabilitation therapy. Respondents ranked neurologic disorder as the condition they would most likely consider for referral for future rehabilitation therapy. The most frequently cited reason for not referring a patient for rehabilitation therapy was perceived cost (251/461 [54.4%]) followed by distance to a rehabilitation facility (135/461 [29.3%]). Specialists were more likely than general practitioners to refer patients for rehabilitation therapy. The majority (403/461 [87.4%]) of respondents felt that continuing education in the field of veterinary rehabilitation was lacking.

CONCLUSIONS AND CLINICAL RELEVANCE Results indicated a need for continuing education in small animal rehabilitation for veterinarians. Improved knowledge of rehabilitation therapy will enable veterinarians to better understand and more specifically communicate indications and benefits for pets receiving this treatment modality.

Abstract

OBJECTIVE To identify patterns of referral to US small animal rehabilitation facilities, document referring veterinarians’ perceptions of rehabilitation services, and examine factors that encouraged and impeded referral of veterinary patients to rehabilitation facilities.

DESIGN Cross-sectional survey.

SAMPLE 461 completed surveys.

PROCEDURES Referral lists were obtained from 9 US rehabilitation facilities, and surveys were emailed or mailed to 2, 738 veterinarians whose names appeared on those lists. Data obtained from respondents were used to generate descriptive statistics and perform χ2 tests to determine patterns for referral of patients to rehabilitation facilities.

RESULTS 461 surveys were completed and returned, resulting in a response rate of 16.8%. The margin of error was < 5% for all responses. Most respondents (324/461 [70.3%]) had referred patients for postoperative rehabilitation therapy. Respondents ranked neurologic disorder as the condition they would most likely consider for referral for future rehabilitation therapy. The most frequently cited reason for not referring a patient for rehabilitation therapy was perceived cost (251/461 [54.4%]) followed by distance to a rehabilitation facility (135/461 [29.3%]). Specialists were more likely than general practitioners to refer patients for rehabilitation therapy. The majority (403/461 [87.4%]) of respondents felt that continuing education in the field of veterinary rehabilitation was lacking.

CONCLUSIONS AND CLINICAL RELEVANCE Results indicated a need for continuing education in small animal rehabilitation for veterinarians. Improved knowledge of rehabilitation therapy will enable veterinarians to better understand and more specifically communicate indications and benefits for pets receiving this treatment modality.

Rehabilitation is a rapidly growing and emerging field in veterinary medicine. Interest in canine physical rehabilitation began in the 1980s and continued throughout the 1990s as information on the topic became increasingly available via journals, textbooks, and seminars in the veterinary and human physical therapy fields. One of the early continuing education seminars on canine rehabilitation was the International Canine Sports Medicine Symposium (originally The International Racing Greyhound Symposium), which was first held in 1986 in conjunction with the North American Veterinary Conference.1 There has been rapid growth in the number and type of athletic events for dogs, and the demand for veterinary care of canine athletes and owners’ expectations regarding the standard of that care, especially during the recovery phase, have increased concurrently.2,3 As a result, during the last 15 years, programs have emerged to provide veterinarians with training and certification in animal rehabilitation. Currently, there are 2 certification programs in canine rehabilitation available in the United States.a,b Additionally, the AVMA and the American Physical Therapy Association have adopted position statements that endorse collaboration between veterinarians and physical therapists and established guidelines to uphold rehabilitation therapy to the same standards as traditional veterinary medicine.1 The American College of Veterinary Sports Medicine and Rehabilitation was approved by the American Board of Veterinary Specialties in 2010, and at the time of the study reported here had 62 diplomates specializing in canine rehabilitation.4,5 The AARV was formed in 2007 and had 404 members at the time of the study reported here.6 Results of several studies7–12 substantiate the benefits of canine rehabilitation during the postoperative recovery period. As the field of canine rehabilitation gained momentum, so has interest in the referral of canine patients to rehabilitation facilities by veterinarians and pet owners who seek to improve patient outcomes.

Most veterinarians currently in practice received little formal training in physical rehabilitation during their formal veterinary education. Although veterinary schools are beginning to offer rehabilitation programs and courses, a review of the curriculums posted on the websites for the 28 AVMA-accredited veterinary schools in the United States13 by the first author (LXA) of this report revealed that only 11 currently offer coursework related to small animal rehabilitation. Thus, as the field of veterinary rehabilitation continues to expand, it is necessary to inform and educate the veterinary community and public on the applications and potential benefits of those services. Accordingly, it is important to understand the perceptions and opinions of veterinarians regarding indications and contraindications of rehabilitation therapy and the conditions they believe might merit rehabilitation services. The purpose of the survey described here was to identify patterns of referral to small animal rehabilitation facilities across the continental United States, document referring veterinarians’ perceptions of rehabilitation services, and examine factors that encouraged and impeded referral of patients to rehabilitation facilities. We hypothesized that unresolved lameness would be the primary reason for referral and that distance to a rehabilitation facility would be the primary impediment to referral.

Materials and Methods

Data Collection

The study protocol was reviewed and approved by the Animal Medical Center's Institutional Review Board Committee. An initial pilot survey was developed and conducted in the New York City metropolitan area in April 2014, and the results from that survey were used to modify the questionnaire used in the survey reported here. The final questionnaire (Supplemental Appendix S1, available at http://avmajournals.avma.org/doi/suppl/10.2460/javma.249.7.807) consisted of 10 multiple-choice, ranking, and polar (yes-no) questions and was the same as the questionnaire used for the pilot survey, except cost was added as an option for reasons why patients were not referred to a rehabilitation facility and a question regarding geographic region was added in the demographic section. Demographic information collected included respondent's level of work experience (< 2, 2 to 5, > 5 to 10, > 10 to 15, or > 15 years), position in the workplace (associate or practice owner), area of practice (general practice, house-call practice, industry or pharmaceutical, per diem, referral or specialty practice, or research), and geographic region (Northeast, Southeast, Midwest, Southwest, or West). Referral pattern information collected included numbers and types of cases previously referred for rehabilitation therapy, reasons for or against referring a patient for rehabilitation therapy, and likelihood of referring patients with various conditions for rehabilitation therapy in the future (each condition listed was ranked on a 5-point Likert scale [1 = least likely and 5 = most likely]). Respondents were also asked to indicate whether they thought continuing education on veterinary rehabilitation was lacking.

The protocol used to administer the questionnaire was consistent with that outlined in previously published veterinary surveys.14–16 Briefly, participation in the current survey was advertised in the AARV monthly newsletter. Interested AARV members provided referral lists for their rehabilitation facilities to the principle investigator (LXA). Nine rehabilitation facilities in the continental United States submitted referral lists, which included veterinarians who had and had not referred patients to those facilities. All referral lists remained confidential. In October 2014, the questionnaire was emailed to 1, 978 veterinarians. One hundred forty-six of those emails bounced, or were returned as undeliverable, and were excluded from the tally of potential respondents; thus, 1, 832 questionnaires were delivered electronically. Questionnaires were mailed to an additional 916 veterinarians for whom email addresses were unavailable (this included the 47 veterinarians who participated in the pilot survey). Ten questionnaires were returned as undeliverable and were excluded from the tally of potential respondents. Thus, 906 paper questionnaires were delivered by traditional mail. Collectively, questionnaires were sent to 2, 738 veterinarians in the continental United States.

Although responses from veterinarians who participated in the pilot survey in April 2014 were evaluated with those from veterinarians who participated in the survey in October 2014, veterinarians who participated in the April survey were not eligible to participate in the October survey. Therefore, each respondent was represented only once in the present report. Potential respondents were offered a chance to win 1 of 5 gift cards (funded by The Animal Medical Center) as an incentive for participating in the survey and were given 2 weeks to respond.

Statistical analysis

Descriptive statistics were used to summarize survey results. For some categorical variables, certain categories were combined because of low response frequencies. For example, the Southwest and West categories were combined for geographic region and general practice and house-call practice categories were combined as were per diem, research, and industry-pharmaceutical categories (designated as other) for area of practice. A χ2 test was used to evaluate whether the frequency of responses varied among the categories within each categorical variable. Individual categories within each categorical variable were evaluated with 1-sample t tests to calculate the 95% confidence interval for the frequency percentage. All analyses were performed with commercially available software,c and values of P < 0.05 were considered significant.

Results

Three hundred twenty-five of 1, 832 (17.7%) electronic questionnaires and 136 of 906 (15.0%) paper questionnaires were completed and returned. Thus, the overall response rate for the survey was 16.8% (461/2, 738). Given the sample size for the survey, the margin of error was < 5% for all responses. None of the respondents were trained rehabilitation veterinarians or members of the AARV. Of the 461 respondents, most had been in practice for > 15 years (185 [40.1%]) and were associate veterinarians (298 [64.6%]) in general practice (387 [83.9%]; Table 1). Most of the respondents practiced in the Northeast (222 [48.2%]), followed by the West (97 [21%]), Midwest (66 [14.3%]), Southeast (63 [13.7%]), and Southwest (13 [2.8%]) regions of the continental United States.

Table 1—

Demographic characteristics for 461 US veterinarians who responded to a survey designed to identify patterns of referral to small animal rehabilitation facilities, document referring veterinarians’ perceptions of rehabilitation services, and examine factors that encouraged and impeded referral of veterinary patients to rehabilitation facilities.

VariableNo. (%) of respondents
No. of years in practice
 < 219 (4.1)
 2–575 (16.3)
 > 5–1093 (20.2)
 > 10–1589 (19.3)
 > 15185 (40.1)
Workplace position
 Associate298 (64.6)
 Practice owner163 (35.4)
Area of practice
 General practice387 (83.9)
 House-call practice11 (2.4)
 Industry-pharmaceutical1 (0.2)
 Per diem5 (1.1)
 Referral or specialty practice51 (11.1)
 Research6 (1.3)
US geographic region
 Northeast222 (48.2)
 Southeast63 (13.7)
 Midwest66 (14.3)
 Southwest13 (2.8)
 West97 (21.0)

Nine US veterinary rehabilitation facilities provided investigators with their referral lists, which included the names and email and business addresses of veterinarians who had and had not referred patients to those facilities. A 10-question survey was successfully emailed or mailed to 1, 832 and 906 veterinarians, respectively, within the continental United States in 2014;461 responded, resulting in a response rate of 16.8%.

Results of χ2 analyses indicated that the number of patients referred for rehabilitation therapy varied significantly by a respondent's geographic region (P < 0.001) and area of practice (P < 0.001), and the numbers of patients referred for rehabilitation therapy during the 12 months prior to the survey were summarized for each of those variables (Table 2). Practitioners in the Northeast referred patients for rehabilitation therapy less frequently than expected (P < 0.001), whereas practitioners in the West and Southwest referred patients for rehabilitation therapy more frequently than expected (P < 0.001). Veterinarians in specialty or referral practices were significantly (P < 0.001) more likely to refer patients for rehabilitation therapy than were veterinarians in general or house-call practices. The number of patients referred for rehabilitation therapy did not vary significantly for any of the other demographic variables assessed.

Table 2—

Actual (expected) number of respondents to the survey described in Table 1 categorized by the number of patients referred for rehabilitation therapy within the 12 months prior to the survey within each geographic region and area of practice.

 No. of patients referred for rehabilitation therapy during the 12 months prior to the survey 
Variable01–23–56–8> 8Total
Geographic region
 Northeast65 (47.7)*76 (70.8)52 (58.3)17 (21.7)12 (23.6)*222
 Southeast10 (13.5)18 (20.1)23 (16.5)4 (6.2)8 (6.7)63
 Midwest11 (14.2)20 (21.1)15 (17.3)10 (6.4)10 (7.0)66
 West and Southwest13 (23.6)*33 (35.1)31 (28.6)14 (10.7)19 (11.7)*110
 Total991471214549461
Area of practice
 General or house-call practice84 (85.5)131 (126.9)112 (104.5)37 (38.9)34 (42.3)398
 Referral or specialty practice9 (11.1)13 (16.3)6 (13.4)*8 (5.0)15 (5.4)*51
 Other6 (2.6)3 (3.8)3 (3.2)0 (1.2)0 (1.3)12
 Total991471214549461

Results of χ2 analyses indicated that number of patients referred for rehabilitation therapy varied significantly by a respondent's geographic region (P < 0.001) and area of practice (P < 0.001).

Actual value differs significantly (P < 0.05) from the expected value.

Included veterinarians who worked on a per diem basis and those who worked in industry, pharmaceutical, and research fields.

See Table 1 for remainder of key.

Three hundred sixty-two (78.5%) respondents had referred at least 1 patient for rehabilitation therapy within the 12 months prior to the survey, whereas the remaining 99 (21.5%) respondents had never referred a patient for rehabilitation therapy. Patients most commonly referred for rehabilitation therapy were those that required postoperative rehabilitation and those with osteoarthritis and neurologic disorders (Table 3). The most frequently cited reason for referring a patient for rehabilitation therapy was the veterinarian's belief that it would result in a better or faster recovery, followed by a chronic or unresolved lameness or mobility disorder. Of the 461 respondents, 116 (25.2%) reported referring a patient for rehabilitation therapy at the request of the owner. Respondents ranked neurologic disorder as the condition they would most likely consider for referral for future rehabilitation therapy (mean Likert score, 3.62) followed by osteoarthritis (3.31), pain management (3.18), routine postoperative care (3.13), soft tissue injury (3.08), and weight loss and fitness (2.67). The most frequently cited reason for not referring a patient for rehabilitation therapy was cost (251/461 [54.4%]) followed by distance to rehabilitation facility (134/461 [29.1%]). The majority (403/461 [87.4%; 95% confidence interval, 84.4% to 90.4%]) of respondents indicated that continuing education in the area of veterinary rehabilitation was lacking.

Table 3—

Frequency distribution of responses provided by the veterinarians who responded to the survey described in Table 1 regarding the reasons they did or did not refer patients for rehabilitation therapy.

VariableNo. (%) of respondents95% confidence interval for percentage
Types of conditions or reasons for which patients might be referred for rehabilitation therapy
 Postoperative rehabilitation324 (70.3)66.1–74.5
 Osteoarthritis274 (59.4)54.9–63.9
 Neurologic disorder240 (52.1)47.5–56.6
 Underwater treadmill210 (45.6)41.0–50.1
 Soft tissue injury180 (39)34.6–43.5
 Unresolved lameness169 (36.7)32.2–41.1
 Laser therapy128 (27.8)23.7–31.9
 Weight management and fitness112 (24.3)20.4–28.2
 Never referred patient for rehabilitation therapy53 (11.5)8.6–14.4
 Shockwave therapy25 (5.4)3.4–7.5
 Other12 (2.6)1.1–4.1
Reasons for referring patients for rehabilitation therapy during the 12 mos prior to the survey
 Better or faster recovery293 (63.6)59.2–68.0
 Chronic or unresolved lameness200 (43.4)38.8–47.9
 Heard of success for other patients181 (39.3)34.8–43.7
 Owner requested referral116 (25.2)21.2–29.1
 Other96 (20.8)17.1–24.5
Reasons for not referring patients for rehabilitation therapy
 Cost251 (54.4)49.9–59.0
 Distance to rehabilitation facility135 (29.3)25.1–33.4
 Other125 (27.1)23.0–31.2
 Unaware of benefits of rehabilitation therapy53 (11.5)8.6–14.4
 Fear of losing business42 (9.1)6.5–11.7
 Unaware of rehabilitation services40 (8.7)6.1–11.3
 Concern for losing patient28 (6.1)3.9–8.3

Respondents could select multiple categories within each variable.

See Table 1 for remainder of key.

Discussion

Results of the present study suggested that perceived cost was the most common reason that respondents did not recommend physical rehabilitation for their patients. The second most frequently cited reason for not referring patients for rehabilitation therapy was the distance to the rehabilitation facility, which we hypothesized would be the primary deterrent to rehabilitation therapy. The perception that the cost of rehabilitation therapy is generally high relative to the benefits observed may be inaccurate, and further research is warranted to assess the actual value placed on a pet's quality of life relative to the cost required to improve that quality of life. Compared with the costs for other veterinary specialty services, the cost associated with rehabilitation therapy might not be as high as many assume. For example, in 2014, the mean cost per visit for the rehabilitation service at a large veterinary teaching hospital was less than that for any other specialty service provided at that hospital.d Similar findings were reported by the other 9 rehabilitation facilities that provided referral lists for the present survey. Additionally, at least 10 pet insurance companies currently cover rehabilitation services to some extent, with most covering 80% to 90% of the costs (depending on plan level), which makes rehabilitation therapy more affordable for pet owners.17 Insurance coverage for rehabilitation therapy is comparable to that for orthopedic and neurosurgery procedures. Results of another study18 indicate that pet owners are likely to pursue treatments recommended by their veterinarians, and the pet owners’ perceptions of the value of those treatments for their pet's quality of life were positively associated with how well the veterinarian explained the need for the treatment under consideration. That study18 involved 2, 000 pet owners, and the authors concluded that, although many owners are price sensitive, cost did not prevent most of them from pursing treatments recommended by the veterinarian. Moreover, pet ownership is beneficial to the health and well-being of humans.19 Companion animals are no longer regarded as luxury items but rather as essential members of the family, and owners expect a higher level of care than they did 10 to 15 years ago. Clearly, more information needs to be collected regarding the safety, efficacy, and cost of rehabilitation therapy for veterinary patients. Also, continuing education programs targeted toward general practitioners could improve awareness of rehabilitation therapy among veterinarians and clients and permit them to make more informed decisions regarding rehabilitation services.

Investigators of multiple studies7–12,20,21 report beneficial effects of rehabilitation therapy on the outcome for veterinary patients with various disorders. Current American Animal Hospital Association guidelines advocate the use of physical rehabilitation as part of multimodal pain management programs.22 Physical rehabilitation can facilitate recovery from surgery, improve functional status, and result in a better quality of life. It involves a unique approach to medicine in which the therapist recognizes that a particular pathophysiologic diagnosis can manifest differently among patients, and this may affect the functional status of individual patients.23 Rehabilitation therapists assess each patient to determine their functional impairments and ability to perform daily tasks that are essential to quality of life, such as being able to rise independently or posture to defecate and urinate, and then offer treatments that can improve the patient's ability to function independently. In 1 study24 that involved dogs with hip dysplasia, increased duration of exercise was associated with a decrease in lameness score. In another study,25 dogs that underwent rehabilitation therapy after lateral fabellar suture stabilization surgery were not further benefitted by administration of NSAIDs.

Human patients commonly undergo physical therapy following neuromuscular and skeletal injuries, and results of multiple studies26–31 indicate that physical therapy is beneficial for injury prevention, facilitates recovery from surgery and overuse injuries, and improves the outcomes for musculoskeletal disorders. In veterinary medicine, most practices currently do not have rehabilitation facilities, and pet owners may not be offered referral for or education regarding rehabilitation therapy. Although continuing education programs in veterinary rehabilitation therapy are available, most practicing veterinarians were not exposed to that topic during their primary veterinary education, which might decrease the likelihood that they will seek out those programs. More lectures on the benefits of rehabilitation therapy should be offered at national and regional veterinary conferences to better educate the veterinary community, specifically general practitioners.

Results of the present study indicated that respondents in the West and Southwest referred patients for rehabilitation therapy more frequently than expected, whereas respondents in the Northeast referred patients for rehabilitation therapy less frequently than expected. Those results may be a reflection, or artifact, of the method used to distribute the survey. The geographic span of the referral lists provided by rehabilitation practices located in the Northeast was much broader than that for the referral lists provided by rehabilitation practices located in the West and Southwest. Thus, the driving distance for owners of patients referred to the practices in the Northeast tended to be greater than that for owners of patients referred to practices in the West and Southwest. Consequently, respondents in the Northeast might not truly be less likely to refer a patient for rehabilitation therapy. Interestingly, according to AARV member data, there are fewer veterinary rehabilitation facilities located in the Northeast than in the Midwest and Southeast.6 Additionally, we were not surprised that respondents who worked at referral or specialty practices were more likely than respondents in other areas of practice to refer patients for rehabilitation therapy, because they are likely to have greater familiarity with and perhaps closer access to rehabilitation facilities than other types of practitioners.

A limitation of the present survey was that it was not possible to determine whether the respondents were representative of the general population of veterinarians in the United States. The survey was sent only to veterinarians whose names appeared on referral lists provided by participating rehabilitation facilities. The veterinarians on those lists might have been more knowledgeable about or had more exposure to rehabilitation therapy than the general population of veterinarians and represented a biased population. However, the referral lists included veterinarians who never or seldom referred patients for rehabilitation therapy as evidenced by the fact that, of the 461 respondents, 53 (11%) had never referred a patient for rehabilitation therapy, and 99 (21%) stated that they had not referred a patient for rehabilitation therapy in the 12 months prior to the survey. Additionally, the proportion of respondents (51/461 [11.1%]) who were diplomates of AVMA American Board of Veterinary Specialties-recognized organizations was similar to that (11, 417/99, 720 [11.4%]) for the general population of US veterinarians as reported by the AVMA Market Statistics of 2013.32,33

In an ideal situation, we would have evaluated the responses from veterinarians who worked in house-call practices separately because those practitioners are more likely to care for patients with substantial functional impairments that might benefit from or necessitate rehabilitation therapy than are practitioners in other areas of practice. Unfortunately, the proportion of survey respondents who worked in house-call practice (11/461 [2.4%]) was too small to significantly affect the statistical analyses.

Findings of the present survey suggested there is a need for continuing education programs in small animal rehabilitation for veterinarians. Improved knowledge about the indications for and expected outcomes of rehabilitation therapy will enable veterinarians to better communicate with owners the value and benefit of that treatment modality for their pets regardless of the therapy cost or distance to a rehabilitation facility.

Acknowledgments

Supported by The Animal Medical Center.

Dr. Van Dyke is the chief executive officer of a company that provides certification courses and seminars in canine rehabilitation.

Presented in abstract form at the 2016 North American Veterinary Conference, Orlando, Fla.

ABBREVIATIONS

AARV

American Association of Rehabilitation Veterinarians

Footnotes

a.

Northeast Seminars, East Hampstead, NH.

b.

Canine Rehabilitation Institute, Wellington, Fla.

c.

IBM SPSS, version 22, IBM Corp, Armonk, NY.

d.

Greene P, The Animal Medical Center, New York, NY: Personal communication, 2015.

References

  • 1. McGonagle L, Blythe L, Levine D. History of canine physical rehabilitation. In: Millis DL, Levine D, eds. Canine rehabilitation and physical therapy. 2nd ed. Philadelphia: Elsevier Saunders, 2014;17.

    • Search Google Scholar
    • Export Citation
  • 2. Cullen KL, Dickey JP, Bent LR, et al. Survey-based analysis of risk factors for injury among dogs participating in agility training and competition events. J Am Vet Med Assoc 2013; 243: 10191024.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3. Zink MC. What is a canine athlete? In: Zink MC, Van Dyke JB, eds. Canine sports medicine and rehabilitation. Ames, Iowa: Wiley-Blackwell, 2013;118.

    • Search Google Scholar
    • Export Citation
  • 4. JAVMA News. Veterinary sports medicine, rehabilitation diplomates announced. J Am Vet Med Assoc 2012; 241: 300.

  • 5. American College of Veterinary Sports Medicine and Rehabilitation. Board certified diplomates. Available at: vsmr.org/diplomates.lasso. Accessed May 27, 2015.

    • Search Google Scholar
    • Export Citation
  • 6. AARV. Find a rehabilitation professional. Available at: rehabvets.org./Referrals.lasso. Accessed Jun 1, 2015.

  • 7. Marsolais GS, Dvorak G, Conzemius MG. Effects of postoperative rehabilitation on limb function after cranial cruciate ligament repair in dogs. J Am Vet Med Assoc 2002; 220: 13251330.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8. Monk ML, Preston CA, McGowan CM. Effects of early intensive postoperative physiotherapy on limb function after tibial plateau leveling osteotomy in dogs with deficiency of the cranial cruciate ligament. Am J Vet Res 2006; 67: 529536.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9. Au KK, Gordon-Evans WJ, Dunning D, et al. Comparison of short- and long-term function and radiographic osteoarthrosis in dogs after postoperative physical rehabilitation and tibial plateau leveling osteotomy or lateral fabellar suture stabilization. Vet Surg 2010; 39: 173180.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10. Drygas KA, McClure SR, Goring RL, et al. Effect of cold compression therapy on postoperative pain, swelling, range of motion, and lameness after tibial plateau leveling osteotomy in dogs. J Am Vet Med Assoc 2011; 238: 12841291.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11. Rexing J, Dunning D, Siegel AM, et al. Effects of cold compression, bandaging, and microcurrent electrical therapy after cranial cruciate ligament repair in dogs. Vet Surg 2010; 39: 5458.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12. Wucherer KL, Conzemius MG, Evans R, et al. Short-term and long-term outcomes for overweight dogs with cranial cruciate ligament rupture treated surgically or nonsurgically. J Am Vet Med Assoc 2013; 242: 13641372.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13. AVMA. Accredited colleges of veterinary medicine. Available at: www.avma.org/ProfessionalDevelopment/Education/Accreditation/Colleges/DocuDocum/colleges_accredited.pdf. Accessed Jul 6, 2015.

    • Search Google Scholar
    • Export Citation
  • 14. Towell TL, Hampe S, Wayner CJ. Referring veterinarians’ opinions and veterinary teaching hospital veterinarians’ perceptions of those opinions regarding communication and nutritional product recommendations. J Am Vet Med Assoc 2010; 237: 513518.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Villaroel A, McDonald SR, Walker WL, et al. A survey of reasons why veterinarians enter rural veterinary practice in the United States. J Am Vet Med Assoc 2010; 236: 849857.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16. Pultorak EL, Breitschwerdt EB. Survey of veterinarians’ perceptions of borreliosis in North Carolina. J Am Vet Med Assoc 2014; 244: 592596.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17. AARV. AARV pet insurance summary. Available at: rehabvets.org/_docs/AARV_Pet_Insurance_Summary_2014-06-13.pdf. Accessed Mar 10, 2015.

    • Search Google Scholar
    • Export Citation
  • 18. Lue TW, Patenburg DP, Crawford PM. Impact of the owner-pet and client-veterinarian bond on the care that pets receive. J Am Vet Med Assoc 2008; 232: 531540.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19. Mills D, Hall S. Animal-assisted interventions: making better use of the human-animal bond. Vet Rec 2014; 174: 269273.

  • 20. Mlacnik E, Bockstahler BA, Müller M, et al. Effects of caloric restriction and moderate or intense physiotherapy program for treatment of lameness in overweight dogs with osteoarthritis. J Am Vet Med Assoc 2006; 229: 17561760.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21. Chauvet A, Laclair J, Elliott DA, et al. Incorporation of exercise, using an underwater treadmill, and active client education into a weight management program for obese dogs. Can Vet J 2011; 52: 491496.

    • Search Google Scholar
    • Export Citation
  • 22. Epstein M, Rodan I, Griffenhagen G, et al. 2015 AAHA/AAFP pain management guidelines for dogs and cats. J Am Anim Hosp Assoc 2015; 51: 6784.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23. Sprague S. Introduction to canine rehabilitation. In: Zink MC, Van Dyke JB, eds. Canine sports medicine and rehabilitation. Ames, Iowa: Wiley-Blackwell, 2013;8299.

    • Search Google Scholar
    • Export Citation
  • 24. Greene LM, Marcellin-Little DJ, Lascelles BD. Associations among exercise duration, lameness severity, and hip joint range of motion in Labrador Retrievers with hip dysplasia. J Am Vet Med Assoc 2013; 242: 15281533.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25. Gordon-Evans WJ, Dunning D, Johnson AL, et al. Effect of the use of carprofen in dogs undergoing intense rehabilitation after lateral fabellar suture stabilization. J Am Vet Med Assoc 2011; 239: 7580.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26. Pappas E, Nightingale EJ, Simic M, et al. Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis. Br J Sports Med 2015; 49: 673680.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27. Health Quality Ontario. Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis. Ont Health Technol Assess Ser 2005; 5: 191.

    • Search Google Scholar
    • Export Citation
  • 28. Hölmich P, Nyvold P, Larsen K. Continued significant effect of physical training as treatment for overuse injury: 8–12-year outcome of a randomized clinical trial. Am J Sports Med 2011; 39: 24472451.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29. Sussmilch-Leitch SP, Collins NJ, Bialocerkowski AE, et al. Physical therapies for Achilles tendinopathy: systematic review and meta-analysis. J Foot Ankle Res 2012; 5: 15.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30. Devries G. Surgical and nonsurgical treatment of achilles tendon rupture: the favorable effect of early functional rehabilitation. Clin J Sport Med 2014; 24: 159160.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31. Hoogvliet P, Randsdorp MS, Dingemanse R, et al. Does effectiveness of exercise therapy and mobilization techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Br J Sports Med 2013; 47: 11121119.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32. AVMA. Market Research Statistics: U. S. veterinarians 2013. Available at: www.avma.org/KB/Resources/Statistics/Pages/Market-Research-Statistics-U.S.-Veterinarians-2013.aspx. Accessed Jan 15, 2015.

    • Search Google Scholar
    • Export Citation
  • 33. AVMA. AVMA Market Research Statistics: veterinary specialists 2013. Available at: www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-Veterinary-specialists-2013.aspx. Accessed Jan 15, 2015.

    • Search Google Scholar
    • Export Citation

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