Why and how to set up an Osteoarthritis (OA) clinic

1 May 2024

Osteoarthritis (OA) is a considerable welfare concern in dogs, affecting an estimated 35% of dogs of all ages, rising to 80% of dogs over the age of 8 years old1.

At this year’s BSAVA Congress, Dr Siobhan Menzies, Director of HolisticPet, and Kirsty Cavill, Director of Clinical Services at The Vet Connection and co-founder of PAWS Canine Myotheraphy Care spoke about the benefits of establishing an OA clinic, and shared advice on how to do it.

Why launch an OA clinic?

Siobhan Menzies highlighted the varied benefits to patients, clients and veterinary staff of setting up an OA clinic.

Principally, OA clinics are clinically beneficial. As veterinary professionals, we have a duty of care to our clients and patients. Management of OA is a life-long commitment, and care needs to be individualised, taking into consideration the pet’s condition, comorbidities, age and fitness, and the owner’s willingness to spend money and commit time managing their pet’s condition. To address this, practices need to offer a range of options for managing OA, which there’s rarely enough time to do effectively in a busy GP clinic. Therefore, it’s a much better option for an OA clinic to be taken out of the GP clinic.

Another benefit of an OA clinic is that they make good business sense. Owners will typically need to spend a considerable amount of money managing their pet’s OA over several years, and there’s a potential for lost revenue if the client goes elsewhere for treatment.

Finally, operating an OA clinic is hugely rewarding for the veterinary team. It helps the team to form relationships with clients and patients, and bonds clients to your practice.

How to launch an OA clinic?

As previously mentioned, it’s much more effective to run an OA clinic outside of the busy GP clinic.

You need to have at least one member of dedicated staff to run the clinic. This can be a single nurse, several vets and nurses, hydro-therapists or physiotherapists – consider the whole team.

Consider the space you have available. You don’t need to have a lot of space to run an OA clinic. It can be done from a small consulting room or can be done remotely with a staff member working at home and using video calling. This provides a good opportunity to see the client’s home environment and assess how suitable it is for the patient (e.g. considering flooring and steps). There is also the option to offer mobile home visits, which again offers the opportunity to see a client’s home environment. This can also be beneficial if bringing a patient into practice might cause them to have a flare-up of conditions from being in the car or navigating the practice if it’s not OA-safe (e.g. has slippery floors).

Communications and client education are hugely important in the ongoing management of OA. In particular, educate clients on weight management, supplements (such as Omega), exercise modifications and duration. You can teach clients to use massage, hot and cold packing and therapeutic exercise (e.g. swimming). It’s also important that clients are educated on the best home environment for their pet.

When considering equipment, teaching your staff how to use therapeutic exercise can be really impactful. Consider acupuncture training for vets. However, before spending money on equipment, such as electrophysical agents, get independent advice and education on what will best fit your requirements.

Running nurse-led OA clinics

Nurses are often the vital conduit between the patient, owner, vet and the wider support network. Kirsty Cavill advised the following elements that should be considered when running nurse-led OA clinics.

  • Check the suitability of the practice environment and whether it is OA ready. Can the patient safely navigate the waiting area to the consulting room? This can be made easier by putting down rubber mats or yoga mats, so patients don’t slip on slippery floors.
  • Define the pain assessment protocols you will use, for example, clinical metrology instruments.
  • Agree assessment strategies and define criteria for identifying measurable change in patients.
  • Be prepared and know what questions you are going to ask clients and allow sufficient time for these.
  • Create an evidence-based treatment plan with clear objectives.
  • Be observant for concurrent diseases developing.
  • Have a named vet nurse or team for continuity and support.
  • Develop a nurse-led strategy for effective communication between clinics and physical appointments.
  • Ensure medication reviews are happening to see whether the medication is effective and when breakthrough pain is occurring.
  • Engage with owners early, especially those with medium-large breed dogs. Educate them on appropriate lifestyle, nutrition and weight management, and the benefits of training dogs to use ramps at an early age, not waiting until they are older and painful. These conversations should happen when dogs are young, and can be done at puppy parties and socialisation.
  • Use educational displays in waiting areas to signpost owners to appropriate resources about OA.
  • If cats with OA are coming to the clinic, consider stressor stacking.

Resources

The BSAVA PetSavers Ageing Canine Toolkit was developed to inform pet owners on the common conditions affecting aged dogs, including osteoarthritis: https://www.bsavalibrary.com/content/cilgrouppetsaversact

The BSAVA Manual of Canine and Feline Musculoskeletal Disorders: https://www.bsavalibrary.com/content/book/10.22233/9781910443286#chapters

References

Canine Arthritis Management (2024) Arthritis: the basics. Available at https://caninearthritis.co.uk/what-is-arthritis/arthritis-the-basics