Multimodal management involves recognising different domains that impact the clinical and pathological manifestation of osteoarthritis and in recognising these attempting to address them in a management plan. This is a global appraisal and response to the disease. Different ranges of  domains  have been described2 but a useful guide is as follows ( Fig 5)

1.Pain Management

2. Joint Pathology
3. Physical Rehabilitation
4. Nutritional Management
5. Active Lifestyle
6. Owner Education and Participation

Fig 5    A Six Domain Multimodal Plan

This provides a comprehensive approach to managing all stages and forms of the disease.  It can take planning time and effort to implement an effective multimodal management plan but the approach to management set out in this module using targeted assessment via the Tri-Sector approach greatly assists this as it targets three of the listed domains , Pain; Joint Pathology and Physical Rehabilitation  ( Table 5) and combined with the CCM Toolbox (Table 6) provides treatment options for each of these management domains. Combining this approach with Nutritional/Obesity management and Active Lifestyle promoted by the M stage of the CCM system enables a systematic approach to a personalised multimodal solution for an individual case.

The final domain, Owner Education and Participation is extremely important in ensuring that the plan is practical and achievable for the owners and fits with their own preferences and expectations. This contextualises any plan.  Compliance and sustainability depend on full owner participation.