Complementary and Alternative Medicine for The
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DOI: 10.1002/vms3.64 Original Article Complementary and alternative medicine for the management of orthopaedic problems in Swiss Warmblood horses Catharina D. Lange, Shannon Axiak Flammer, Vinzenz Gerber, Ditte Kindt and Christoph Koch Institute of Equine Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland Abstract It appears that complementary and alternative medicine (CAM) is used increasingly often in horses for the assessment and treatment of suspected orthopaedic problems, especially back problems. The aim of this study was to determine the frequency of CAM use for the management of orthopaedic problems in a defined popula- tion of Swiss Warmblood horses. A total of 239 owners and caretakers of horses from a pre-defined database were called by a veterinarian to participate in the survey. A standardized questionnaire was designed to deter- mine, for each orthopaedic case, where the localization of the problem was (limb or back) and if conventional medicine or CAM was used for consultation and treatment. When CAM was employed, the CAM discipline and administrator (veterinarian or alternative therapist) was defined. A total of 222 cases in 170 horses with orthopaedic problems were identified. Sixty-two horses were identified with a back problem, 96 horses with a lameness involving one or more limbs and 12 horses with a combined back problem and lameness. CAM was used commonly in this population (73.9%, 164 of 222) for both diagnostic workup and treatment of suspected orthopaedic problems, but was rarely administered by a veterinarian (12%, 27 of 222). In general, if a back problem was suspected by the owner, CAM was more frequently applied for diagnosis and treatment than in cases where a lameness was suspected; (91.9%, 68 of 74) vs. (64.9%, 96 of 148) (P < 0.001), respectively. Osteopathy was the most frequently applied CAM discipline. CAM was frequently used for diagnostic and therapeutic purposes in Swiss Warmblood horses with suspected orthopaedic problems. CAM practitioners were consulted predominantly if a back problem was suspected, and the majority of CAM practitioners were not veterinarians. Keywords: back problems, complementary and alternative medicine (CAM), horse, lameness, orthopaedic problems. Correspondence: Christoph Koch, Institute of Equine Medicine, Vetsuisse Faculty, University of Bern and ALP-Haras, | downloaded: 2.10.2021 Langgassstrasse€ 124, Postfach 8466, CH-3001 Bern, Switzerland. E-mail: [email protected] Introduction diagnostic, and therapeutic philosophies and prac- tices.’ Common therapies include aroma therapy, A healthy musculoskeletal apparatus is critical for phytotherapy, magnetic field therapy, orthomolecu- success in equestrian sports. Sport horses both at lar therapy, energy therapy, low-energy photon ther- international and amateur levels are known to be apy, acupuncture, homoeopathy, nutraceutical assessed and treated by Complementary and Alter- therapy, Bach flower remedy therapy and manual or native Medicine (CAM) practitioners in order to manipulative therapy (https://www.avma.org/About/ maintain a sound level of fitness or to address sus- Governance/Documents/2014W_2013W_Resolution3 pected problems resulting from athletic activity. _Attch2.pdf [accessed 28 Jan, 2016]). The increasing The American Veterinary Medical Association amount of available training programmes for equine defines Complementary and Alternative Veterinary practitioners in Europe for various CAM modalities Medicine as a ‘heterogeneous group of preventive, (Deletraz et al. 2007) may be indicative of the https://doi.org/10.7892/boris.108378 source: © 2017 The Authors. Veterinary Medicine and Science Published by John Wiley & Sons Ltd. 1 Veterinary Medicine and Science (2017), , pp. – This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. 2 C.D. Lange et al. demand for CAM in veterinary medicine. Studies questionnaire (Tables 1 and Table S1) was devel- have investigated the effectiveness and success of oped. All telephone interviews were conducted by CAM treatment methods in horses (Faber et al. the same veterinarian (D.K.). Prior to contacting the 2003; Gomez Alvarez et al. 2008; Sullivan et al. 2008) owners, the interviewer was trained for consistency but to the authors’ knowledge, the extent of the and the questionnaire was tested in German and demand for CAM investigations and treatments French by performing practice interviews under the remains unknown. supervision of one of the co-authors (V.G.) with The objective of this study was to assess the fre- three other co-workers who had extensive experience quency of the use of CAM assessments and treat- in questionnaire-based research from a previous ments for equine orthopaedic problems in a defined study involving more than 400 horses (Ramseyer Swiss Warmblood population and to identify factors, et al. 2007). which may influence the owners’ decision to utilize In the context of this study, a categorization was these methods. Additionally, an overview of who made to differentiate ‘lameness’ and ‘back problem’. administers the CAM (veterinarian vs. non-veteri- The term ‘lameness’ referred to any gait abnormality narian) was desired. The authors hypothesized that caused by pathologies localized in one or more horse owners would prefer conventional veterinary extremity, whereas ‘back problems’ included consultation and management for musculoskeletal pathologies located at the cervical, thoracolumbar conditions in the limbs, whereas CAM would be pre- and sacroiliac regions. The questionnaire had two ferred over conventional medicine for treatment of different sections: one for lameness and one for back suspected neck or back problems. problems which were utilized depending on whether the owners’ declared the horse has a lameness prob- lem, a back problem, or both. The questionnaire was Materials and Methods designed to obtain the owners’ interpretations of the clinical signs and the frequency and localization of Horses the musculoskeletal problems. Further questions The study group was originally defined for an investi- aimed to distinguish who was consulted for the clini- gation that used a standardized questionnaire cal evaluation and therapy, which diagnostic tools designed to collect data regarding the potential were used and which types of therapies were imple- hereditary components of recurrent airway obstruc- mented. tion in Swiss Warmblood horses (Gerber et al. 2009). The 761 horses for this original study were all Swiss Statistical analysis Warmblood horses aged 5 years and older, bred and housed in Switzerland, and registered with the Swiss Statistical analyses were performed using a dedi- Equestrian Federation. Two influential stallions with cated program.1 A two-sided P value < 0.05 was confirmed history of recurrent airway obstruction, considered statistically significant. Continuous data and a large number of their descendants and off- are expressed as mean Æ standard deviation. Chi- spring, were chosen for investigation (Ramseyer Square tests and analyses of variance were used to et al. 2007). Of these 761 interviewed owners, 357 compare proportions and continuous variables for horses were selected because the owners stated an differences in gender, colour, age and language and orthopaedic problem in the recurrent airway obstruc- for, different methods of CAM, as appropriate. For tion-questionnaire. multivariate analysis of the use of CAM and CAM as the first choice in consultation, logistic regression Questionnaire 1The R Project for Statistical Computing (R-statistical soft- Based on previously collected data (Ramseyer et al. ware V user! 2014, University of California, CA, USA) www. 2007; Gerber et al. 2009), a standardized r-project.org [accessed 29 Jan, 2015). © 2017 The Authors. Veterinary Medicine and Science Published by John Wiley & Sons Ltd. Veterinary Medicine and Science (2017), , pp. – CAM for management of orthopaedic problems 3 Table 1. Owner survey, translated into English, used to interview owners regarding the use of Complementary and Alternative medicine (CAM) to address orthopaedic problems in their Swiss Warmblood horses Lameness Appearance and progression of lameness How often has your horse been lame □ Once □ Several times or had a back problem? Same reason? □ Yes □ No When did the lameness/problem appear? How long has your horse been lame? Where did the lameness appear? □ Left Front □ Right Front □ Left Hind □ Right Hind □ Ataxia □ All 4 legs □ Back □ Neck □ Sacroiliac joint What was the reason? □ Trauma □ Shoeing □ Others Do you know which structure was injured? □ Superficial □ Suspensory □ Check ligament □ Joint Flexor Tendon ligament □ Muscle □ Others Would you describe the lameness □ Severe □ Moderate □ Mild □ very mild as severe or mild? Consultation/Diagnosis/Treatment Who was your first choice for consultation? □ Veterinarian □ Others Has your horse been examined by □ Yes □ No a veterinarian? Has your horse been examined by a □ Yes □ No non-veterinarian? Has your horse been treated with CAM? □ Yes □ No Which diagnostic tools have been used by the veterinarian? Which diagnostic imaging tools have been □ Yes □ Yes used by the veterinarian? Ultrasound Radiography □ Yes □ Yes CT □ Yes MRI Scintigraphy Has diagnostic local anaesthesia been used? □ Yes □ No Has the horse been treated with medication? □ Yes □ No If yes,