A guide for clinicians, nurses, animal physical therapists and non-clinical staff

The 5x5x5 system has been designed to help clinicians structure a therapeutic plan by linking osteoarthritis (OA) with five stages of management to five grades of osteoarthritis with five scores of pain.

The overriding aims are to ensure that owners understand:

– What OA means for their dog

– The progression and life-long nature of the disease

– Treatment options available to them

Getting owners working alongside veterinary professionals is key for this condition so by this staging of OA, together they can follow a gold standard protocol for the identification, diagnosis, treatment, and reassessment.

The 5x5x5 is also an effective communication tool for the practice team essential for a seamless continuation of care for the patient and its owner. In conjunction with clinical notes, the proposed workflow ensures all parties (veterinary staff and owners) know where they are in the disease process and the next possible steps.

Canine osteoarthritis is a progressive and debilitating disease that requires continual assessment with appropriate updating and modification to the treatment plan as the disease evolves.

The goals are:

– Recognising the clinical signs as early as possible in the disease process

– Alleviating the dog’s discomfort and avoiding sensory ‘wind up’

– Minimising the occurrence of further degenerative changes

restoring the affected joint/joints to as near a normal and pain free function as possible

Routine monitoring and assessment are critical to achieving these goals. Using the 5x5x5 system actively with the owner helps maintain their understanding and involvement which is key to driving their compliance and essential with any treatment regime.

The OA guide How it works

Grading chart Simple steps to understand and tailor treatment of canine osteoarthritis

Arthritis has a complicated changing pathophysiology which requires different interventions at different phases of the disease process. By grading the condition through clinical examination and diagnostic imaging a targeted approach becomes a reality in preference to “blanket” treatment.

With new interventions in intra-articular medicine, understanding the joint environment is imperative when choosing appropriate approaches.

Staging chart Simple steps to communicate canine osteoarthritis

Arthritis is a progressive disease which relies on owner acceptance to get the best long-term results. Through using a staging system owners know where their pet is within the management plan.

The 5x5x5 not only encourages owners to have a full work up performed prior to initiating treatment, it also provides a guide on treatment options and prepares them for end of life decisions when all treatment options have been exhausted.

The 5x5x5 ensures simple and effective communication between colleagues as to where the owner and their dog have reached in the treatment plan and the options available relative to the grade of the disease and pain scores.

For a complete disease maintenance plan the options here should be combined with other modalities (e.g ABC and E – Analgesia/Body condition score & diet/supportive Care/Exercise) providing a full multimodal approach.

Pain scoring chart Simple steps to prioritise treatment of canine osteoarthritis

The main presenting sign of arthritis is pain. If left untreated this results in chronic maladaptive pain and resultant quality of life issues. Making sure owners fully understand this and the need to address the pain is imperative in ensuring effective treatments are being employed.

By utilising changes in the dog’s behaviour, posture and mobility a suitable pain score can be subjectively calculated. Gaining understanding and involving the owner with this pain scale will aid driving compliance, encourage a multi-modal approach and reduce the likelihood of flare ups and chronic pain states developing.

With a little practice, this simple pain score should allow all members of the clinical team to judge and record the dog’s status similarly. Continuity within a practice is something owners always value.

Staging of canine OA with owner

Screenshot 2018-09-19 10.47.27

The workflow

5x5x5 OA workflow

Grading including intra-articular treatment options for canine OA

5x5x5 Grading

Adequate analgesic management may necessitate the use of additional systemic analgesics as part of a complete plan.

Disclaimer: On occasion, reference may be made to drugs which are not licensed for use in animals. The Editor does not take any responsibility for the safety and efficacy of such products. Any persons using these products do so entirely at their own risk.