Step 1: Case Identification and Triage

• Proactively seek eligible patients: those with recurrent lameness, older pets, breeds at higher risk, or with documented OA. Agree a monitoring protocol for at-risk pets and proactively use it on every visit – Wright et al 2021 screening questionnaire or Gen-Pup-M app can be used by clients outside the consulting room
• Reception staff can flag cases, or practices can run audits for at-risk patients from clinical records.
• Integrate OA screening queries into routine wellness exams.

When starting out, it’s important to be aware that there is likely to need to be ongoing refinement of processes, and the success of the first few patients enrolled will impact how the wider practice team views the clinics. Therefore, enrolment of extremely severe or complex pain cases, or those with owners who may be less likely to comply with recommendations, could stall the clinic success and prevent development of robust protocols. Try to enrol patients that are likely to succeed so the clinic can be developed to offer more meaningful support to more complex patients in future, rather than risk losing momentum by enrolling the most ambitious cases while the team is still learning.

Step 2: Case management

Intake and assessment 

• A thorough history is taken, focusing on mobility changes, pain signals, home environment, and previous interventions. 
• Physical exam includes gait analysis, palpation, joint range-of-motion, muscle mass assessment, and pain scoring. 
• Owner-completed questionnaires (e.g., LOAD, Helsinki chronic pain index) supplement the clinical findings. 
• Tri-sector assessment ensures no key area (joint health, pain aetiology, mobility/disablement) is missed. 

Case management

• Apply frameworks such as the CCM system (“Control-Consolidate-Maintain”) to stratify patients and set immediate objectives. 
• Design multimodal plans tailored to the patient—incorporating pharmacological, nutritional, physical therapy, and environmental strategies. 
• Offer written summaries and “mobility passports” so owners understand current status, action plans, and follow-up timelines. 
• Educate the owner about OA, expected disease progression, pain recognition, and lifestyle adjustments. 
• Demonstrate home exercises, review weight control strategies, and explain medication plans. 

Follow-up, Review, and Re-Assessment

• At each follow-up, repeat the tri-sector assessment to identify improvements, new concerns, or disease progression.
• Adjust the care plan based on response, stepping down as pain/mobility improve, stepping up/intensifying if regression or breakthrough pain occurs.
• Integrate feedback from the whole care team including owners, nurses, vets and, if appropriate, physiotherapists.

Clinical Metrology Instruments (CMIs), also called Client-Reported Outcome Measures (CROMs), are validated questionnaires designed to translate an owner’s subjective observations into a semi-quantitative score. They are essential for monitoring chronic, fluctuating conditions like osteoarthritis (OA) because they provide a structured way to measure pain and function, establish a baseline to track progress or decline over time and empower the client and give them a specific task in monitoring their pet’s health. They also capture the pet’s behaviour in its home environment, where it is most natural. The manifestation of OA pain is different in dogs and cats, so the most relevant CMIs are species-specific.

Clinical Metrology Instruments for Dogs

Canine OA often presents as a recognisable lameness, stiffness, or reluctance to perform certain actions. The tools for dogs are well-established and widely used in clinical trials and practice.

1. Canine Brief Pain Inventory (CBPI): canine-bpi.pdf
   • What it Measures: This is one of the most common tools. It has two components: a “Pain Severity Score” (owner rates the dog’s pain on average, at its worst, etc.) and a “Pain Interference Score” (owner rates how much pain interferes with general activities like walking, running, and enjoyment of life).
   • How it Works: The owner scores 11 questions on a 0-10 scale. It’s relatively quick to complete.
2. Helsinki Chronic Pain Index (HCPI): Helsinki Chronic Pain Index – HCPI
   • What it Measures: This index focuses more on behavioural signs of pain, such as mood, willingness to play, and ease of movement. It asks questions like “Is your dog more restless or withdrawn than normal?”
   • How it Works: It’s a series of questions where the owner chooses the most applicable description on a scale.
3. Liverpool Osteoarthritis in Dogs (LOAD): LOAD – Liverpool OsteoArthritis in Dogs
   • What it Measures: This is a comprehensive CMI developed specifically for canine OA. It covers a wide range of factors including stiffness after rest, effect of exercise, and performance of specific activities (e.g., climbing stairs, jumping into the car).
   • How it Works: A 13-item questionnaire where the owner rates the frequency or severity of a problem.

Clinical Metrology Instruments for Cats

Feline OA is notoriously difficult to assess. Cats rarely show obvious lameness. Instead, they exhibit changes in lifestyle and behaviour. They stop doing things they used to do. The CROMs for cats are designed to detect these specific changes.

1. Feline Musculoskeletal Pain Index (FMPI): Feline Musculoskeletal Pain Index | College of Veterinary Medicine
   • What it Measures: This is the gold standard for feline OA. It focuses on changes in mobility and behaviour that are highly indicative of feline joint pain. It asks the owner to rate their cat’s ability to perform actions like jumping up, jumping down, and running.
   • How it Works: The owner answers a series of questions about their cat’s abilities and behaviours, often using a visual analogue scale.
2. Client-Specific Outcome Measures (CSOMs):
   • What it Measures: This is a different, highly individualised approach. Instead of a standardised questionnaire, the veterinarian works with the owner to identify 2-3 specific, important activities that their cat is struggling with.
   • How it Works: The owner might identify “Jumping onto the bed” and “Chasing the laser pointer” as key activities. They then rate the cat’s ability to perform only these specific tasks on a scale (e.g., 1-10) over time.
3. General Quality of Life (QoL) Questionnaires: VETMETRICA
   • What they Measure: While not specific to mobility, general QoL scales (like the VetMetrica HRQL) can be very useful. Chronic pain from OA will negatively impact a cat’s overall quality of life.
   • How they Work: These tools ask broader questions about a cat’s demeanour, happiness, and interaction with the family.

Some pet owners may prefer to monitor their pet’s mobility at home. Gen-Pup-M is a CMI developed specifically to monitor mobility in healthy pets with focus on proactive monitoring and early detection of potential mobility issues. It is available as an app in the UK (Search ‘DogMA App’ in the app store) and can be set to remind clients to regularly complete the questionnaire. Therefore, it is useful for patients in a ‘maintain’ phase to flag any changes between touch points. 

Communication and Referral Pathways

• Maintain clear lines of communication within the team: regular case rounds or handovers facilitate consistent care.
• Set up escalation criteria (e.g., severe pain not responding to standard therapy, sudden decline in function, or concerns about owner compliance).
• Refer to orthopaedic specialists, neurologists, or advanced rehabilitation practitioners when indicated.