Clinical audit of dynamic mobilisation exercise prescription and standards of health records in veterinary physiotherapy practice

TL;DR

This study found that veterinary physiotherapists initially failed to meet standards for prescribing exercises and recording health data for horses, but improved significantly after implementing changes.

Contribution

The study introduces a clinical audit framework to assess and improve DME prescription and health record standards in equine veterinary physiotherapy.

Findings

Initial audit showed no cases met the required standards for exercise prescription and documentation.

After education and template implementation, most audit standards were met in a re-audit.

Client ability to perform correct exercise technique remained a challenge, with 62% still failing to meet the standard.

Abstract

Veterinary physiotherapists did not adhere to the standards for the prescription of dynamic mobilisation exercises nor the Physiotherapy Board of New Zealand standards for health recording during the horse’s first appointment, but marked improvement was observed on re-audit.

Background: Dynamic mobilisation exercises (DME) are popular exercises prescribed during equine rehabilitation, however the application of these exercises in clinical practice has not been investigated. Evidence-based practice and accurate health recording are important for quality improvements in practice.

Aims and objectives: The aim of this study was to improve DME prescription quality and ensure documentation meets Physiotherapy Board of New Zealand governing board standards. The objectives were to establish an evidence-based standard of prescription, to audit the prescription dosage, program duration, combination of exercises, the accuracy of the veterinary physiotherapists (VP) clinical notes and the ability of the client to achieve the correct exercise technique.

Methods: Audit criteria were derived from a literature review. Retrospective data was collected from the health records of two VP, from the same practice and recorded on the data collection tool. Improvement was measured via a re-audit comparison.

Results: Initial audit found that none of the 26 cases met criteria standards. Exercises were not prescribed with the correct dosage, program duration, or in conjunction with gym exercises. Health records indicated the exercise parameters but did not record if clients could achieve the correct technique.

Implementation of changes (team discussion & changes made): Intervention included education for VP. Templates of health records and exercises were also implemented.

Re-audit: No changes to the audit criteria or method were made. The correct technique was not achieved by 17/27 (62%) of the clients involved in the re-audit. This did not meet the criterion standard. All remaining audit standards were achieved.

Application: The recommendations that were implemented resulted in more standardised DME prescription between the VP. Both VP became homogeneous with the dosage, program durations, exercise descriptions, and implemented accurate recording of their program parameters. Other practices should consider their own audits, educate practitioners, and implement customised templates.