Liverpool Osteoarthritis in Dogs (LOAD) Survey

Liverpool Osteoarthritis in Dogs (LOAD) Survey - Initial Visit

Owner Questionnaire for dogs with mobility problems.
This questionnaire was created by the University of Liverpool in conjunction with Elanco. Any answers given below are stored by Surrey Veterinary Physio only and no data is shared with any other party unless permission is given.
Name

First NameLast Name
Your Pet

NameBreed
AgeSex
Email*
example@example.com
Today's Date

MonthDayYear
Date
Background
How Long has your pet been suffering with his/her mobility problem?

Up to 6 months6-12 months12-24 months24-36 monthsMore than 36 months
Has your dog been diagnosed as suffering from any other problems in addition to his/her orthopaedic disease?

YesNo
If yes, please list below
Please list any medications that your pet is currently receiving
Mobility

Generally
1. How is your dog's mobility in general?*

Very GoodGoodFairPoorVery Poor
2. How disabled is your dog by his/her lameness?*

Not at allSlightyModeratelySeverelyExtremely
3. How active is your dog?*

ExtremelyVeryModeratelySlightlyNot at all
4.What is the effect of cold, damp weather on your dog's lameness?*

No effect at allMild effectModerate effectSevere effectExtreme effect
5. To what degree does your dog show stiffness in the affected leg after a 'lie down'?*

No StiffnessMild StiffnessModerate StiffnessSevere StiffnessExtreme Stiffness
Mobility

At Exercise
6. At exercise, how active is your dog?*

Extremely ActiveVery ActiveFairly ActiveNot Very ActiveNot At All Active
7. How keen is your dog in exercising?*

Extremely keenVery keenFairly keenNot very keenNot at all keen
8. How would you rate your dog's ability to exercise?*

Very GoodGoodFairPoorVery Poor
9. What overall effect does exercise have on your dog's lameness?*

No effectMild effectModerate effectSevere effectExtreme effect
10. How often does your dog rest (stop/sit down) during exercise?*

NeverHardly everOccasionallyFrequentlyVery Frequently
11. What is the effect of cold, damp weather on your pet's ability to exercise?*

No effectMild effectModerate effectSevere effectExtreme effect
12. To what degree does your dog show stiffness in the affected leg after a 'lie down' following exercise?*

No stiffnessMild stiffnessModerate stiffnessSevere stiffnessExtreme stiffness
13. What is the effect of your dog's lameness on his/her ability to exercise?*

No effectMild effectModerate effectSevere effectExtreme effect
Thank you - This information is used to track arthritis changes in your dog.

Surrey Veterinary Physio will send a form every 3 months to help you track and monitor these changes - if we do not get a reply, the emails will stop. We advise adding info@surreyvetphysio.co.uk to your contacts to prevent any emails going into spam.
In submitting this survey you are agreeing to Surrey Veterinary Physio storing your email address and contacting you with regards to the survey results and other communications.

You can opt-out at any time. Your email will NOT be shared with any other party.
Should be Empty:

Liverpool Osteoarthritis in Dogs (LOAD) Survey - Initial Visit

Background

Mobility

Mobility

Thank you - This information is used to track arthritis changes in your dog.