International Survey Regarding the Use of Rehabilitation Modalities in Horses

Abstract

To define which biologic, electrophysical and other modalities are used in horses for injury or performance issues, a questionnaire regarding 38 modalities was distributed to eight veterinary groups. A total of 305 complete or partial responses were obtained from over 10 geographic regions; 75.4% from private equine practice or regional private equine referral hospitals, 14.1% from university teaching hospitals or satellite clinics, 8.2% from private mixed animal practice, and 2.3% from veterinary rehabilitation centers. The majority of respondents were located in the USA (60%), Europe (25.6%), and Canada (5.6%). Respondents reported working with athletic horses primarily in the disciplines of hunter-jumper (26.9%), dressage (16.0%), and pleasure riding (14.7%), followed by Western riding, track racing, and eventing. Warmbloods (39.7%) were the predominant breed presenting to respondents, followed by Thoroughbreds (20.3%) and Quarter Horses (17.3%) ahead of other breeds. All 38 modalities were used by respondents. The 10 most prominently utilized were controlled hand walking (97.3%), therapeutic shoeing (96.1%), ice (95.2%), compression bandaging (89.5%), platelet rich plasma (PRP; 86.5%), therapeutic exercises (84.3%), interleukin-1 receptor antagonist protein therapy (IRAP; 81.4%), stretching (83.3%), and cold water hydrotherapy (82.9%). Heat (77.6%), massage (69.0%), and acupuncture (68.3%) were also commonly utilized. The least prominently used modalities were hyperbaric oxygen therapy (9.4%), cytowave (8.3%), and radiofrequency (6.4%). Injectable modalities (IRAP, PRP, mesotherapy, stem cells) were almost solely administered by veterinarians; other modalities were variably applied by veterinarians, technicians, veterinary assistants, farriers, physical therapists, trainers, and other entities. A total of 33% of respondents reported working collaboratively with physical therapists on equine patients. Findings indicate that a broad range of invasive and non-invasive modalities are used in equine patients to address a variety of rehabilitation and performance needs, and that personnel with varying levels of expertise are involved in their administration. This suggests that further investigation to better define the delivery, efficacy and any negative effects of many of these modalities is important.

A Survey of Clinical Usage of Non-steroidal Intra-Articular Therapeutics by Equine Practitioners

“…In another survey of equine practitioners in 2018, PRP and ACS were considered two of the top 10 rehabilitation modalities for musculoskeletal injuries (12). PRP was used in 98.9% of cases to treat tendon or ligament injuries, while ACS was more frequently used in the joint postoperatively (55.3%) or to maintain performance (32.3%) (12). Similarly, in our survey, PRP and cellular therapies were more frequently used to treat soft tissue injuries (tendons or ligaments), while products such as ACS and APS were used to treat joint disease.…”

“…Equine practitioners have used NSIATs for years (12), and currently, there are many options available on the market. In the literature, there is limited information regarding the clinical experience of practitioners with these products, such as their product preference and treatment protocol (4,12). This survey was not a hypothesis-driven study.…”

Equine Rehabilitation: A Scoping Review of the Literature

“…At 6 and 12 months follow up, the foal did not have any deficits. In a survey of rehabilitation modalities used in horse treatments, massage was used by 69% of the respondents [ 49 ].…”

“…Guedes described manual therapy and movement as elective techniques in painful conditions but did not present any parameters of usage [ 37 ]. A survey published in 2018 indicated that range of motion therapies were reportedly used in 71.9% of the responses [ 49 ].…”

The development of safe and effective rehabilitation protocols for horses

“…There has been a recent proliferation of rehabilitation approaches and modalities with claims of effectiveness for treating musculoskeletal and neurological disorders in horses (Kaneps 2016; Schlachter and Lewis 2016; Wilson et al 2018b). There is also a growing body of evidence that some of these modalities do have a level of safety and efficacy in specific applications (Nankervis et al 2016; Haussler 2018; Holcombe et al 2019).…”