December 2023 19 Leading Article forms of acupuncture (Jaeger et al. 2006, Lane & Hill 2016, Chomsiriwat & Ma 2019, Baker-Meuten et al. 2020). Further larger scale randomised controlled trials using acupuncture as a treatment for canine OA in different joints, and comparing acupuncture with and without other therapeutic modalities and pharmacological treatments could improve the evidence base. PHYSIOTHERAPY AND HYDROTHERAPY Physiotherapy in the human field is an accepted treatment modality for patients with OA, and multiple studies show its effectiveness at reducing clinical signs of OA (Roddy et al. 2004, Deyle et al. 2005, McAlindon et al. 2014, Bannuru et al. 2019, Mazzei et al. 2021). In veterinary physiotherapy, published randomised controlled trials investigating the efficacy of physiotherapy in dogs with OA are limited (Mlacnik et al. 2006, Crook et al. 2007, Drum et al. 2021, Barale et al. 2022). The aims of physiotherapy in OA treatment are to improve muscle strength, joint mobility, balance and stability (Millis & Levine 1997, Dycus et al. 2017). Physiotherapy protocols for the treatment of canine OA can take multiple forms. These protocols include landbased therapeutic exercise programmes and manual therapies, hydrotherapy and other physiotherapeutic modalities including the application of different temperatures (e.g. cryotherapy or thermal heat), and different energies such as laser, electric, magnetic or ultrasound (Millis & Levine 1997, Langley-Hobbs 2010, Drum et al. 2021). Recently, the idea of a “physiotherapy pyramid” aimed at considering a systematic approach to canine OA management has been proposed (Mille et al. 2022). This pyramid has four layers and starts at the bottom with environmental modification, followed by an exercise plan, home exercises specifically designed for dogs with OA, and finally by treatment from a trained physiotherapist. This pyramid idea outlines the importance of considering and implementing cost-effective, practical modifications at home, and gaining owner agreement and compliance to follow exercise plans and home exercises (Mille et al. 2022). Published studies investigating the efficacy of different physiotherapeutic modalities in the treatment of canine OA are outlined in Table 4. Table 3. Studies investigating acupuncture as a treatment for canine osteoarthritis Type of acupuncture investigated Author Study type Groups Sample size Study length Outcome measures Conclusions Evidence level (Aragon & Budsberg 2005) Dry needle acupuncture Teixeira et al. (2016) Randomised, blinded controlled clinical trial Acupuncture Carprofen Placebo capsules 54 HD affected dogs 16 healthy dogs 8 weeks Subjective: owner evaluation, VAS CMI: CBPI Objective: kinetics Acupuncture or carprofen groups did not differ significantly from placebo. CBPI and VAS pain intensity assessment decreased in acupuncture group from baseline at week 4 and 6 II Baker-Meuten et al. (2020) Randomised, blinded, controlled clinical trial Placebo Acupuncture 32 dogs 4 weeks Subjective: SOS Objective: GRF, AC CMI: CSOM, CBPI No difference between baseline and acupuncture and placebo for GRF, AC, SOS. Improvement in some CMI scores with baseline versus acupuncture and placebo versus acupuncture II Mixed acupuncture and other physical therapies Lane & Hill (2016) Randomised, blinded, crossover clinical trial Exercise restriction followed by combined acupuncture and manual therapy (CAMT) 47 dogs 42 days Subjective: owner questionnaire VAS No significant improvement with exercise restriction alone. Significant improvement in some measures after CAMT appointments III Silva et al. (2017) Prospective study Acupuncture and other alternative therapies (ALG) Acupuncture and pharmaceutical analgesic (AAG) 145 dogs with neurological disease 36 (n=8 ALG, n=28 AAG) dogs with musculoskeletal disease (including OA) 24 weeks Subjective: VAS CMI: HCPI, QLA VAS and HCPI reduced in both groups over course of trial, but more so in musculoskeletal group III
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