Assessment of chronic pain and evaluation of three complementary therapies (gold implants, green lipped mussel, and a homeopathic combination preparation) for canine osteoarthritis, using randomized, controlled, double-blind study designs

The series of investigations presented in this thesis examined different methods of assessing chronic pain in dogs suffering from osteoarthritis (OA) and compared the effects of three different treatments. Data were obtained from two cohorts; 41 dogs with OA due to canine hip dysplasia (CHD) (I,III) and 61 dogs with OA due to CHD or elbow dysplasia (II,IV,V). Questionnaires, veterinary evaluations, visual analog scales (VAS), plasma hormones, radiographs, and force plate evaluations were assessed as OA treatment outcome measures and/or measurements of chronic pain. The results indicated that the multidimensional pain scale including 11 questions with 5-point scale responses was a valid and reliable tool for evaluating chronic pain. This Helsinki chronic pain index (HCPI) can be applied as an outcome measure in clinical trials where chronic pain is evaluated by owners. Of the evaluated complementary therapies for chronic pain due to OA, all three indicated a positive treatment outcome. In the first trial, gold bead implants resulted in a significant positive treatment outcome for the treatment group. However, the placebo group in this study also improved significantly. A positive effect was seen in 65% of the placebo dogs and this exceptionally high incidence of amelioration suggests that the placebo group may have got an effect of unintentional needle acupuncture. The results of this study are therefore controversial and treatment guidelines based on these findings cannot be given. The second trial tested two ingestible OA remedies, green lipped mussel and a homeopathic low-dose combination preparation. Both treatments resulted in statistically significant positive treatment outcomes compared with placebo, but with the positive control (carprofen) being more effective than either of them. The results suggest that both tested treatments may be beneficial for chronic OA. To establish the true role of all these three treatments in outcome-based animal analgesia, more clinical trials, using larger cohorts, should be conducted. Possible mechanisms of action should also be studied.Koska nykylääketiede usein kritisoi ja kyseenalaistaa esim. akupunktio- ja homeopatiahoitoja, halusimme etsiä mahdollista näyttöä niiden tehosta käyttäen lääketieteen omia tutkimustapoja nimenomaan eläimille, tietäen että niillä lumevaikutus on ihmispotilaita vähäisempi. Väitöskirjassa Assessment of chronic pain and evaluation of three complementary therapies (gold implants, green lipped mussel, and a homeopathic combination preparation) for canine osteoarthritis, using randomized, controlled, double-blind study designs tutkittiin koiria, jotka kärsivät lähinnä lonkkanivelen nivelrikosta ja sen aiheuttamasta kroonisesta kivusta. Kaksi osatyötä käsitteli kroonisen kivun arviointia: niissä tutkittiin, miten mm. eläinlääkärin tekemän arvioinnin, omistajalle suunnatun kyselykaavakkeen, röntgenkuvien sekä verinäytteestä mitattavien muuttujien avulla voitaisiin parhaiten arvioida kivun voimakkuutta ja sen lievittymistä hoitotoimenpiteen seurauksena. Lopuksi kehitettiin kroonisen kivun indeksi, jossa koirien omistajat toimivat kivun arvioijina. Muut kolme osatyötä olivat kliinisiä hoitokokeita, jossa koiran nivelrikosta johtuvaa kipua lievitettiin käyttäen kolmea erilaista, vähemmän tunnettua hoitotapaa. Kaikki työt olivat satunnaistettuja, kaksoissokkouutettuja lumekontrollikokeita. Ensimmäisessä kliinisessä hoitokokeessa koirille asetettiin akupunktiopisteisiin pieniä kultahippuja sairastuneen lonkkanivelen ympärille. Tällä pyrittiin pitkittämään akupunktion kipua poistavaa vaikutusta. Lumeryhmän koirille tehtiin ulkoisesti samalta näyttävä toimenpide ei-akupunktiopisteisiin lonkkanivelen ympärille. Positiivinen hoitotulos näkyi 65% koirista, mutta se oli samaa suuruusluokkaa molemmissa ryhmissä. Koska näin positiivinen hoitotulos lumeryhmässä on epätodennäköinen koiralla, voidaan epäillä, että lumetoimenpiteelläkin on saattanut olla kipua lievittävää vaikutusta. Muut tukijat ovatkin osoittaneet, että akupunktiolumehoito, jossa pistetään koehenkilöä muualle kuin akupunktiopisteeseen, lieventää kipua melkein yhtä tehokkaasti kuin traditionaalisiin akupunktiopisteisiin annettu hoito. Toisessa ja kolmannessa kliinisessä hoitokokeessa oli tutkittavien valmisteiden ja lumeryhmien lisäksi positiivinen kontrolli, eli ylimääräinen ryhmä, joka sai yleisesti käytettyä koiran kipulääkettä. Tutkittavat valmisteet olivat vihersimpukkauute (Perna canaliculus) sekä matalapotenssinen homeopaattien yhdistelmävalmiste (Zeel®), jossa aineiden kuiva-aine pitoisuudet (mg) annosta kohden liikkuvat 10-2 ja 10-8 välillä. Kivun lieventymistä lääkinnän jälkeen arvioitiin eläinlääkäritutkimuksen, askel-voimalevy-tutkimuksien sekä omistajan tekemien kivun arviointien perusteella. Molemmat valmisteet lievensivät kipua merkitsevästi enemmän kuin vastaavat lumevalmisteet mutta huonommin kuin tulehduskipulääke. Koska koiraa käytetään yleisesti mallina ihmisen nivelrikon tutkimuksessa tilojen samankaltaisuuden vuoksi, tulokset ovat mielenkiintoisia myös ihmisen nivelrikkoa ajatellen. Toivottavasti tulokset kannustavat tutkijoita jatkamaan myös vähemmän tunnettujen kivunlievitysmenetelmien tehon ja mahdollisten vaikutusmekanismien selvittämistä sekä ihmisillä että eläimillä.Då den vedertagna västerländska medicinen ofta kritiserat tex. akupunktur och homeopati för att vara ovetenskapliga , ville vi pröva dessa behandlingsformer hos hund, då man hos djur lättare kan utföra undersökningar enligt strikta Evidence Based Medicine protokoll och dessutom kan man räkna med en mindre placebo effekt än hos människor. I avhandlingen Assessment of chronic pain and evaluation of three complementary therapies (gold implants, green lipped mussel, and a homeopathic combination preparation) for canine osteoarthritis, using randomized, controlled, double-blind study designs undersöktes hundar som lider av kronisk smärta som en följd av ledgångsinflammation (osteoartros). Denna sjukdom kallas hos hundar ofta för höftleds- eller armbågsdysplasi. Två av artiklarna behandlar utvärderingsmetoder av kronisk smärta: I det första arbetet studerades bl.a. veterinärers smärtevaluering, ett frågeformulär till ägarna, röntgenbildsevaluering samt undersökning av blodvärden. I det påföljande arbetet gjordes psykometrisk statistik på ett index för kronisk smärta som hade utarbetats som en följd av det första arbetet. Indexet baserade sig på ägarnas evaluering av smärtan och konstaterades vara både verklighetsöverensstämmande och pålitligt i kliniska underökningar där ett kriterium som följs upp är lindringen av kronisk smärta. De tre följande arbetena var kliniska studier där tre nya, mindre vanliga behandlingsmetoder för kronisk smärta förorsakad av osteoartros hos hund, testades. Studierna baserade sig på ett slumpmässigt urval, var dubbelblinda samt placebokontrollerade; de två sista studierna hade dessutom en positiv kontrollgrupp, som gavs en väl etablerad smärtmedicin för hund. Objektiva och subjektiva evalueringsmetoder användes. I den första studien jämfördes hundar som fick guldkulor implanterade i akupunkturpunkter runt höftleden med placebogruppens hundar som endast fick nålstick i andra punkter runt den sjuka höftleden. Med denna behandling eftersträvades en förlängning av akupunkturens smärtlindrande effekt. Hos ca. 65% av hundarna kunde en smärtlindrande effekt skönjas, oberoende av behandlingsgrupp. Denna procent är betydligt högre än vad som vanligtvis skulle vara normalt i placebo behandlade hundar med kronisk smärta. Då andra forskare har med hjälp av funktionell MRI-analys av hjärnan kunnat påvisa att all nålbehandling, oberoende av om den tilldelas en riktig akupunkturpunkt eller inte, underlättar kronisk smärta, kan man ifrågasätta vår placebogrupps, och därmed placebo resultatens, giltighet. De två följande kliniska studierna testade smärtlindringseffekten hos ett grönläppsmusselpreparat (Perna canaliculus) samt ett homeopatiskt lågpotent kombinationspreparat, intagna via munnen. Substansmängderna i den intagna homeopatiska dosen låg mellan 10-2 och 10-8. Båda testade behandlingsformer hade ett signifikant bättre behandlingsresultat jämfört med placebogruppen men effekten var dock lite sämre än hos den etablerade smärtmedicinen. Då hunden ofta används som modell för human osteoartros, är resultaten av dessa studier också av intresse för human medicin. Dessa undersökningar kan förhoppningsvis uppmuntra andra forskare till motsvarande behandlingsundersökningar samt till försök att utreda behandlingarnas verkningsmekanismer

Validating and reliability testing the descriptive data and three different disease diagnoses of the internet-based DOGRISK questionnaire

Background: The DOGRISK questionnaire is an internet-based ongoing study of canine nutrition, living environment, and disease. Here we aim to assess the performance of the questionnaire using data from the first three years in relation to some descriptive and disease variables. We used associated questions, official register records, test-retest repeatability, and email/mail contact with questionnaire respondents. Results: Reliability against an official register of gender, season of birth, breed, and results of hip radiography was tested and Cohen's Kappa was between 0.95-0.99. Internal consistencies of hypothyroidism status and dog's age were calculated using Cronbach's Alpha (alpha = 0.95 and alpha = 0.99, respectively). Test-retest repeatability of ten variables among 224 participants was analyzed. Gender, season of birth, and born in owner family had Cohen's Kappa > 0.86, color of coat, vaccination status as an adult, other dogs in household, and vaccination status as a puppy had Cohen's Kappa between 0.67-0.80, and body condition score under two months of age and tidiness of household, had Cohen's kappa of 0.45 and 0.42, respectively. In addition, time spent outside had Cohen's kappa of 0.37. Of the owners contacted by email/mail to confirm their dog's atopy/allergy (skin symptoms), 8.9 % reported that they had given an incorrect answer (positive predicted value 91 %), but only 69 % of all reaffirmed positive answers had a diagnosis set by a veterinarian. Conclusions: Our study showed that owners were diligent with basic information and with the status of three diseases. Cohen's Kappa in the reliability of the test-retest was in most variables at least 0.67. We propose that the descriptive variables and the disease variables be used as such when we generate hypotheses from the DOGRISK data.Peer reviewe

A randomised, double-blinded, placebocontrolled clinical study on intra-articular hyaluronan treatment in equine lameness originating from the metacarpophalangeal joint

Background: Intra-articular inflammation resulting in lameness is a common health problem in horses. Exogenous intra-articular hyaluronic acid has been shown to provide an analgesic effect and reduce pain in equine and human osteoarthritis. High molecular weight non-animal stabilized hyaluronic acid (NASHA) has gained popularity in the treatment of human arthritic conditions due to its long-acting pain-relieving effects. The aim of this study was to compare the response to treatment of lameness localized in the equine metacarpophalangeal joint injected with non-animal stabilized hyaluronic acid (NASHA) and placebo (saline). Twenty-seven clinically lame horses with a positive response to diagnostic intra-articular anaesthesia of the metacarpophalangeal joint and with no, or at most mild, radiographic changes in this joint were included in the study. Horses in the treatment group (n = 14) received 3 mL of a NASHA product intra-articularly, and those in the placebo group (n = 13) received an equivalent volume of sterile 0.9 % saline solution. Results: The change in the lameness score did not significantly differ between NASHA and placebo groups (P = 0.94). Scores in the flexion test improved more in the NASHA group compared with placebo (P = 0.01). The changes in effusion and pain in flexion were similar (P = 0.94 and P = 0.27, respectively) when NASHA and placebo groups were compared. A telephone interview follow-up of the owners three months post-treatment revealed that 14 of the 21 horses (67 %) were able to perform at their previous level of exercise. Conclusions: In the present study, a single IA NASHA injection was not better than a single saline injection for reducing lameness in horses with synovitis or mild osteoarthritis. However, the results of this study indicate that IA NASHA may have some beneficial effects in modifying mild clinical signs but more research is needed to evaluate whether the positive effect documented ie. reduced response in the flexion test is a true treatment effect.Peer reviewe

Part I of Finnish Agility Dog Survey: Training and Management of Competition-Level Agility Dogs

Knowledge regarding training, competition, and management routines of agility dogs is lacking. Through a retrospective online questionnaire, Finnish owners and handlers of 745 competition-level agility dogs provided information on training routines and management of these dogs during one year free of agility-related injuries. Competition routines were collected from the national competition results database. Most dogs trained agility 1–2 times a week, with a median active training time of 18 min a week. Dogs competed in a median of 2.1 runs per month at a speed of 4.3 m/s. Common field surfaces were different types of artificial turfs and dirt surface. Warm-up and cool-down were established routines, and 62% of dogs received regular musculoskeletal care. Moreover, 77% of dogs underwent conditioning exercises, but their frequency was often low. Additionally, dogs were walked for a median of 1.5 h daily. Pearson’s chi-squared and Kruskal–Wallis tests were used to evaluate the association between a dog’s competition level and training and competition variables. A dog’s competition level was associated with competition (p < 0.001) and training frequency (p < 0.001); dogs at higher levels compete more but train less than dogs at lower levels. This study provides information on training, competition, and management routines of competing agility dogs

Part II of Finnish Agility Dog Survey: Agility-Related Injuries and Risk Factors for Injury in Competition-Level Agility Dogs

Dog agility is associated with a risk for sport-related injuries, but few risk factors for injury are known. A retrospective online questionnaire was used to collect data on 864 Finnish competition-level agility dogs&mdash;including 119 dogs (14%) with agility-related injury during 2019. Data included injury details, health background, experience in agility, and sport and management routines prior to the injury. Risk factors for injury were evaluated with multivariate logistic regression. The rate of competition-related injuries was 1.44 injuries/1000 competition runs. The front limb was injured in 61% of dogs. In 65% of dogs, the injury presented as lameness. The main risk factors for agility-related injury during 2019 were multiple previous agility-related injuries (OR 11.36; 95% CI 6.10&ndash;21.13), older age when starting course-like training (OR 2.04 per one year increase; 95% CI 1.36&ndash;3.05), high training frequency, diagnosis of lumbosacral transitional vertebra, and physiotherapy every two to three months compared with never. The most important protective factors were moderate competition frequency and A-frame performance technique. These associations do not confirm causality. We identified new risk factors for injury in agility. This information can be used to improve the welfare of agility dogs

Part II of Finnish Agility Dog Survey : Agility-Related Injuries and Risk Factors for Injury in Competition-Level Agility Dogs

Dog agility is associated with a risk for sport-related injuries, but few risk factors for injury are known. A retrospective online questionnaire was used to collect data on 864 Finnish competition-level agility dogs&mdash;including 119 dogs (14%) with agility-related injury during 2019. Data included injury details, health background, experience in agility, and sport and management routines prior to the injury. Risk factors for injury were evaluated with multivariate logistic regression. The rate of competition-related injuries was 1.44 injuries/1000 competition runs. The front limb was injured in 61% of dogs. In 65% of dogs, the injury presented as lameness. The main risk factors for agility-related injury during 2019 were multiple previous agility-related injuries (OR 11.36; 95% CI 6.10&ndash;21.13), older age when starting course-like training (OR 2.04 per one year increase; 95% CI 1.36&ndash;3.05), high training frequency, diagnosis of lumbosacral transitional vertebra, and physiotherapy every two to three months compared with never. The most important protective factors were moderate competition frequency and A-frame performance technique. These associations do not confirm causality. We identified new risk factors for injury in agility. This information can be used to improve the welfare of agility dogs

Part I of Finnish Agility Dog Survey: Training and Management of Competition-Level Agility Dogs

Knowledge regarding training, competition, and management routines of agility dogs is lacking. Through a retrospective online questionnaire, Finnish owners and handlers of 745 competition-level agility dogs provided information on training routines and management of these dogs during one year free of agility-related injuries. Competition routines were collected from the national competition results database. Most dogs trained agility 1–2 times a week, with a median active training time of 18 min a week. Dogs competed in a median of 2.1 runs per month at a speed of 4.3 m/s. Common field surfaces were different types of artificial turfs and dirt surface. Warm-up and cool-down were established routines, and 62% of dogs received regular musculoskeletal care. Moreover, 77% of dogs underwent conditioning exercises, but their frequency was often low. Additionally, dogs were walked for a median of 1.5 h daily. Pearson’s chi-squared and Kruskal–Wallis tests were used to evaluate the association between a dog’s competition level and training and competition variables. A dog’s competition level was associated with competition (p < 0.001) and training frequency (p < 0.001); dogs at higher levels compete more but train less than dogs at lower levels. This study provides information on training, competition, and management routines of competing agility dogs

Development of the Finnish neurological function testing battery for dogs and its intra- and inter-rater reliability

Background: The Finnish neurological function testing battery for dogs (FINFUN) was developed to meet the increasing demand for objective outcome measures in veterinary physiotherapy. The testing battery should provide consistent, reproducible results and have established face and content validity. Internal consistency and intra-and inter-rater reliability of the FINFUN were also investigated. Results: The FINFUN comprised 11 tasks: lying, standing up from lying, sitting, standing up from sitting, standing, proprioceptive positioning, starting to walk, walking, trotting, walking turns and walking stairs. A score from 0 to 4, (0: unable to perform task, 4: performing task with normal motor function) was given for each task, the maximum score being 44. Twenty-six dogs were filmed when performing the FINFUN. Seven observers scored the performances from the video recordings. The FINFUN was considered to have appropriate face and content validity based on a pilot study, clinical experience and critical reflection of the development process. Its internal consistency was excellent, with no Cronbach's alpha values below 0.922. The intra-rater reliability for total score of experienced observers was almost perfect: 0.999 (observer 1) and 0.994 (observer 2). The inter-rater reliability for both experienced and novice observers' total scores was also almost perfect (0.919-0.993). Analysis of each individual task showed substantial intra-rater and inter-rater agreement for the tasks "lying" and "sitting". Conclusions: The FINFUN is an objective, valid and reliable tool with standardized scoring criteria for evaluation of motor function in dogs recovering from spinal cord injury.Peer reviewe

Structural characteristics and predicted functional capacities of epaxial muscles in chondrodystrophic and non-chondrodystrophic dogs with and without suspected intervertebral disc herniation- a preliminary study

Epaxial muscle atrophy is related to spinal diseases in dogs. However, the influence of intervertebral disc herniation (IVDH) on the functional capacity of epaxial muscles has not been investigated. We aimed to estimate force and power-generating capacity of epaxial muscles in chondrodystrophic Dachshunds and non-chondrodystrophic Border terriers bred for similar purposes. Further we aimed to compare these features in Dachshunds with and without IVDH. Cadavers of Dachshunds (n = 16) and Border terriers (n = 7) were investigated with MRI. In the absence of clinical information, MRI findings were used to categorize the Dachshunds into affected (n = 8) and non-affected (n = 8). Epaxial muscle mass, muscle belly length, fascicle length, architectural index and physiological cross-sectional area (PCSA) were obtained through dissections, pain and exercise history through questionnaires. Difference between groups and effect of covariates were assessed with ANCOVA models. Dachshunds had greater muscle mass in M. splenius, M. longissimus capitis and M. iliocostalis thoracis (all PPeer reviewe