knee OA and found that a combination of exercise and self-massage therapy yielded better results after 12 weeks compared with exercise alone. However, this randomised study did not see any difference in either group in ROM when assessed using a universal goniometer, whereas a pain questionnaire revealed improvements in the self-massage group [ 8 ].
This correlates with the findings of the canine massage studies, as they all focus on the effects of massage in reducing pain in OA, including reduced muscle spasms, improved flexibility, ROM, performance, pain relief, stress reduction, anxiety relief and enhanced QoL [ 1, 3, 8 ]. This is validated by similar physiological responses to pain and muscle treatment observed in both humans and dogs. Lane and Hill ' s [ 7 ] study of acupuncture and manual therapy in dogs also advocated for a multimodal approach to treating OA in canine patients, highlighting the similarities in physiology and anatomy between dogs and humans. This study examined the combined effects of acupuncture and manual therapy in alleviating musculoskeletal pain in dogs. Manual therapy is defined in the study as‘ hands-on’ therapeutic techniques, including massage, that move the joints and stretch the muscles. The study used a rigorous experimental design and ensured that the owners were unaware of the treatment being administered to their pets. Lane and Hill ' s [ 7 ] study demonstrated that acupuncture and manual therapy significantly improved canine comfort, mobility and lameness. This was evidenced by a significant change in scores for activities such as walking and jumping, managing stairs and rising from a lying position. The results were tested with repeated measures used before and after the treatments. However, this study was unable to establish a direct cause-and-effect relationship between the changes and manual therapy alone.
Comparison of pain measurement systems with the subjective experiences of dog owners
Robust evaluation of pain assessment methodologies is essential when determining the efficacy of canine massage in alleviating pain associated with OA in dogs. Gait analysis and owner-reported outcome measures, such as the Canine Brief Pain Inventory( CBPI), have been used to quantify pain levels and functional change. The development and adoption of standardised outcome measures for assessing the effectiveness of canine massage therapy remain key priorities for advancing evidence-based practice.
A study by Brown et al. [ 2 ] compared force plate gait analysis and the CBPI for pain assessment in dogs with OA and found a moderate correlation between the two assessment methods, suggesting that both methods can provide valuable insights into the pain experienced by dogs. The CBPI, an owner assessment method, provides valuable information on the subjective experience of pain and its effects on the dog ' s activities. Gait analysis is an objective measure that assesses the dog ' s weight distribution and gait abnormalities, indicating the extent of pain-induced mobility issues, and offers a quantitative assessment of pain-related changes in movement patterns. The use of force plate gait analysis and the CBPI would be of benefit in future studies focusing on canine massage and showing statistically significant results for pain reduction.
Riley et al. [ 1 ] conducted a large-scale study on the effect of receiving massage treatments on pain and QoL in dogs. Two studies in this field [ 1, 3 ] lack longitudinal data and rely on subjective assessments made by owners as well as the clinicians performing the treatment, which can introduce bias. Future studies should incorporate objective measures such as gait analysis to supplement owner assessments and should include control groups. Additionally, details on the reliability and validity of scales to assess pain and QoL should be included to strengthen study credibility.
A cross-sectional design, such as that used by Riley et al. [ 1 ], does not demonstrate a cause-and-effect relationship between massage therapy and pain reduction. The absence of a randomised controlled trial design limits the internal validity of this study, as other factors apart from massage therapy could have influenced the results. The study of Lane and Hill [ 7 ], looking at the effectiveness of a combination of acupuncture and manual therapy, relative to no treatment, for musculoskeletal pain in dogs used a double-blinded crossover design but had a small sample size. It used visual analogue scales for pain assessment by the owners; this approach provided significant results, but owner assessments can be a source of bias. Overall, owner perspectives should be considered through qualitative interviews or surveys to enhance understanding of the effectiveness and benefits of canine massage for managing OA-related pain. This information would contribute to a more comprehensive understanding of how canine massage affects pain reduction from the perspective of owners, and would enhance the knowledge of veterinary professionals about its effectiveness as a complementary treatment for managing OA pain.
Comparing the effectiveness of canine massage with other osteoarthritis treatments
Various other treatments have shown promising results in managing pain and improving mobility in dogs with OA. Physiotherapeutic strategies, such as acupuncture in combination with manual therapy, hydrotherapy and therapeutic exercises, have been studied and reported as being effective [ 1, 4, 7 ]. Self-massage has been shown to reduce pain in humans with knee OA [ 8 ]. It would
50 Veterinary Nursing Journal