The development of an instrument to measure chronic pain in dogs

This research applied the psychometric approaches of proxy human chronic pain and HRQL instrument development to the development of an instrument to measure chronic pain in the dog, using the owner to provide a proxy report. The development of the instrument followed established steps designed to ensure an instrument’s validity: the identification of all domains relevant to the measurement of interest; generation of a pool of potential instrument items; selection of instrument items from the item pool, and validation of that selection; design and pre-testing of the prototype instrument; field-testing of the instrument to establish its psychometric properties. Domain identification was carried out through interviews with 47 owners of dogs suffering chronic pain. Potential items (descriptive terms) were generated using questionnaires completed by 165 dog owners. These domains and the items selected were subsequently validated by 12 veterinary practitioners and by 10 owners of dogs suffering chronic pain. The validated list of items was incorporated into a structured questionnaire, and this instrument was pre-tested using 26 dog owners. The finished instrument was then field-tested using the owners of 155 dogs who completed a total of 390 questionnaires prior to and during treatment at the University of Glasgow Small Animal Hospital and at a local Veterinary Practice, a majority of which dogs were suffering from chronic degenerative joint disease (DJD). Factor analysis of the instrument responses for dogs suffering DJD revealed an interpretable 12-factor model, in which factors were interpreted as domains of canine HRQL: ‘vitality’, ‘physical limitation’, ‘lethargy’, ‘anxiety’, ‘aggression’, ‘emotional upset’, ‘appetite’, ‘consistency of behaviour’, ‘mental disturbance’, ‘attention-seeking’, ‘sadness’ and ‘acceptance’. This analysis provided evidence for the construct (factorial) validity of the instrument, since responses to instrument items revealed an underlying structure that reflected the construct upon which the instrument was developed. Scores were calculated for each of the 12 domains of HRQL identified by the factor analysis, and these were able to discriminate between dogs with chronic pain and healthy dogs on >86% of occasions. Profiles of HRQL scores obtained for dogs with chronic pain were compared with those obtained for healthy dogs in a control group, and differences in these profiles were observed. An examination of changes in HRQL domain scores over time for individual dogs revealed that these scores tended to reflect clinical change in those individuals. The process described here offers a novel approach to the development of chronic pain and HRQL instruments for a range of animal species, and may have relevance for human chronic pain and HRQL instrument development

Shortening of an existing generic online health-related quality of life instrument for dogs

Objective: Development, initial validation and reliability testing of a shortened version of a web-based questionnaire instrument to measure generic health-related quality of life in companion dogs, to facilitate smartphone and online use. Materials and Methods: The original 46 items were reduced using expert judgment and factor analysis. Items were removed on the basis of item loadings and communalities on factors identified through factor analysis of responses from owners of healthy and unwell dogs, intrafactor item correlations, readability of items in the UK, USA and Australia and ability of individual items to discriminate between healthy and unwell dogs. Validity was assessed through factor analysis and a field trial using a “known groups” approach. Test–retest reliability was assessed using intraclass correlation coefficients. Results: The new instrument comprises 22 items, each of which was rated by dog owners using a 7-point Likert scale. Factor analysis revealed a structure with four health-related quality of life domains (energetic/enthusiastic, happy/content, active/comfortable, and calm/relaxed) accounting for 72% of the variability in the data compared with 64% for the original instrument. The field test involving 153 healthy and unwell dogs demonstrated good discriminative properties and high intraclass correlation coefficients. Clinical Significance: The 22-item shortened form is superior to the original instrument and can be accessed via a mobile phone app. This is likely to increase the acceptability to dog owners as a routine wellness measure in health care packages and as a therapeutic monitoring tool

Development, initial validation and reliability testing of a web-based, generic feline health-related quality of life instrument

Objectives: The objective of this study was to develop a valid, reliable web-based, generic feline health-related quality-of-life (HRQoL) questionnaire instrument to measure the affective impact of chronic disease. Methods: A large initial item pool, obtained through interviews with cat owners, was reduced using predetermined criteria, survey scores for relevance and clarity, and the ability of individual items to discriminate between healthy and sick cats when owners completed a prototype questionnaire. Using these data, factor analysis was used to derive a scoring algorithm and provide evidence for factorial validity. Validity was demonstrated further in a field trial using a ‘known groups’ approach (sick vs healthy cats will have a different HRQoL profile, and the HRQoL profile of cats will deteriorate as comorbidities increase). Test–retest reliability was assessed using intra-class correlation coefficients (ICC). Results: In total, 165 items were reduced to 20 and, on the basis of a factor analysis that explained 72.3% of the variation in scores input by 71 owners of 30 healthy and 41 sick cats using the prototype, these were allocated to three domains (vitality, comfort and emotional wellbeing [EWB]) with a scoring algorithm derived using item loadings. Subsequently, the owners of 36 healthy and 58 sick cats completed one or two (n = 48) assessments. Median scores (healthy vs sick) for all domains were significantly different (P <0.001), 78% of cats were correctly classified as healthy or sick and for comorbidities the correlation coefficients were moderate (vitality 0.64; comfort 0.63; EWB 0.50). Test–retest reliability was good (ICC vitality 0.635; comfort 0.716; EWB 0.853). Conclusions and relevance: This study provides initial evidence for the validity and reliability of a novel HRQoL instrument to aid the assessment and management of chronic diseases of cats

Optimising outputs from a validated online instrument to measure health-related quality of life (HRQL) in dogs

Measurement of health-related quality of life (HRQL) is becoming increasingly valuable within veterinary preventative health care and chronic disease management, as well as in outcomes research. Initial reliability and validation of a 22 item shortened version of VetMetrica (VM), structured questionnaire instrument to measure HRQL in dogs via a mobile application was reported previously. Meaningful interpretation and presentation of the 4 domain scores comprising the HRQL profile generated by VM is key to its successful use in clinical practice and research. Study one describes transformation of domain scores from 0–6 to 0–100 and normalisation of these based on the healthy canine population in two age ranges, such that a score of 50 on a 0–100 scale represents the score for the age-related average healthy dog, and establishment of a threshold to assess domain-specific health status for individual dogs. This provides the clinician with a simple method of ascertaining the health status of an individual dog relative to the average healthy population in the same age group (norm-based scoring). Study two determines the minimum important difference (MID) in domain scores which represents the smallest improvement in score that is meaningful to the dog owner, thus providing the clinician with a means of recognising what is likely to be a significant improvement in scores for an individual dog over time. Visual representation of these guidelines for the purpose of interpreting VM profile scores is presented using case studies

Pre-trilostane and 3-hour post-trilostane cortisol to monitor trilostane therapy in dogs

It is recommended that trilostane therapy of canine hyperadrenocorticism is monitored using an ACTH stimulation test, however this has never been validated. Three cortisol concentrations (pre-trilostane, 3-hour posttrilostane and 1-hour post-ACTH stimulation) were compared to a clinical score obtained from an owner questionnaire. There were 110 sets of 3 cortisol measurements and questionnaires obtained from 67 trilostane treated dogs. Questionnaire results were used to classify each dog as well or unwell. Well dogs were then categorised as having excellent, moderate or poor hyperadrenocorticism control, using thresholds produced by 14 independent veterinarians. Correlation co-efficients were used to compare the three cortisol concentrations to the owner score and the Kruskal Wallis and Mann-Whitney U tests were used to compare the three cortisol concentrations between categories of control. Cortisol cut-off values between significantly different categories were determined using ROC curves. Pre-trilostane and 3-hour post-trilostane cortisol were better correlated to the owner score and had cut-offs to differentiate between categories of control that had superior sensitivity and specificity results, than the post-ACTH cortisol. Iatrogenic hypoadrenocorticism was not detected in any unwell dog. This study shows that the pre-trilostane and 3-hour post-trilostane cortisol are potentially better monitoring methods than the ACTH stimulation test

Evaluating Complementary Therapies for Canine Osteoarthritis—Part II: A Homeopathic Combination Preparation (Zeel®)

A homeopathic combination preparation (HCP) for canine osteoarthritic pain was evaluated in a randomized, double-controlled and double-blinded clinical trial. Forty-four dogs with osteoarthritis (OA) that were randomly allocated into one of three groups completed the study. All dogs were fed test products or placebo for 8 weeks. The dogs were evaluated at the clinic four times, with 4-week intervals. Six different variables were assessed: veterinary-assessed mobility, two force plate variables, an owner-evaluated chronic pain index and pain and locomotion visual analogue scales (VASs). Intake of extra non-steroidal anti-inflammatory drugs was also evaluated. A Chi-squared test and a Mann–Whitney test were used to determine significant improvement between groups. When changed into dichotomous responses of ‘improved’ or ‘not improved’ three out of the six variables showed a significant difference (P = 0.016, P = 0.008, P = 0.039) in improved dogs per group, between the HCP group and the placebo group. The odds ratios were over one for the same variables. As extent of improvement in the variables from start to end of treatment, the HCP product was significantly more improved in four (P = 0.015, P = 0.028, P = 0.049, P = 0.020) of the six variables, compared with the placebo. Our results indicated that the HCP Zeel® was beneficial in alleviating chronic orthopedic pain in dogs although it was not as effective as carprofen

The attitudes of owners and veterinary professionals in the United Kingdom to the risk of adverse events associated with using non- steroidal anti-inflammatory drugs (NSAIDs) to treat dogs with osteoarthritis

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed by veterinary surgeons for the treatment of canine osteoarthritis, and affected dogs may receive these drugs for long periods of time. Whilst short term administration of NSAIDs to dogs is linked to adverse events such as gastrointestinal haemorrhage and renal injury, reports of adverse events associated with their long-term administration are limited in the veterinary literature. This study aimed to investigate the attitudes towards the long term use of NSAIDs for canine osteoarthritis held by three groups who manage osteoarthritic dogs in the United Kingdom: dog owners, veterinary surgeons and veterinary nurses. A qualitative methodology was adopted, using semi-structured interviews and focus groups. Thematic analysis of these data identified three themes: awareness of potential risks; recognition of adverse events; and influence of risk perception on the use of NSAIDs. Awareness of, and concern about, the risk of adverse events associated with NSAID administration to dogs with osteoarthritis was high in all groups, with veterinary surgeons being one of a variety of information sources used by owners to acquire this knowledge. Veterinary surgeons described difficulty in recognising, managing and avoiding adverse events associated with NSAIDs. When adverse events occurred, a wide range of management approaches were adopted ranging from a brief drug respite to permanent cessation of administration of any NSAIDs to that dog. Commonly employed approaches to minimise risk included dose reduction and screening blood tests. This study describes a high level of concern about the risks associated with long term NSAID administration to dogs with osteoarthritis and highlights a diverse range of strategies employed to minimise these risks. The evidence base for these strategies is poor, and this may present a risk to animal welfare if the affected dogs are not receiving adequate analgesia. In order to address this, more accurate and comprehensive data must be supplied to both veterinary professionals and owners on the true frequency of adverse events associated with long term administration of veterinary NSAIDs and how best to avoid them

Quality of life is reduced in obese dogs but improves after successful weight loss

Obesity is thought to affect quality of life, but limited objective data exist to support this supposition. The current study aim was to use a questionnaire to determine health-related quality of life (HRQOL) both before and after weight loss, in obese client-owned dogs. Fifty obese dogs were included, and represented a variety of breeds and genders. Prior to weight loss, owners were asked to complete a validated standardised questionnaire to determine HRQOL. Thirty of the dogs successfully completed their weight loss programme and reached target, and owners then completed a follow-up questionnaire. The completed questionnaire responses were transformed to scores corresponding to each of four factors (vitality, emotional disturbance, anxiety and pain), and scored on a scale of 0–6. Changes in the scores were used to explore the sensitivity of the questionnaire, and scores were correlated with responses to direct questions about quality of life and pain, as well as weight loss.Dogs that failed to complete their weight loss programme had lower vitality and higher emotional disturbance scores than those successfully losing weight (P = 0.03 for both). In the 30 dogs that completed, weight loss led to an increased vitality score (P < 0.001), and decreased scores for both emotional disturbance (P < 0.001) and pain (P < 0.001). However, there was no change in anxiety (P = 0.09). The change in vitality score was positively associated with percentage weight loss (rP = 0.43, P = 0.02) and percentage body fat loss (rP = 0.39, P = 0.03). These results indicate demonstrable improvement in HRQOL for obese dogs that successfully lose weigh

Validity and Responsiveness of the Generic Health-Related Quality of Life Instrument (VetMetrica™) in Cats With Osteoarthritis. Comparison of Vet and Owner Impressions of Quality of Life Impact

Validity is not an inherent property of a measurement scale and so evidence for validity relating to its use for particular purposes, with defined populations and in specified contexts must be accumulated. We have published the development of a web-based, generic health-related quality of life instrument (VetMetrica™) to measure the affective impact of chronic disease in cats and provided evidence for its validity in a mixed population of cats, some of which, according to veterinary judgement, were healthy and others of which were suffering from chronic conditions likely to affect their quality of life, often with multiple co-morbidities present. The first aim of the current study was to demonstrate the construct validity of the VetMetrica™ generic instrument when used with cats suffering from osteoarthritis, by testing the hypothesis that the health-related quality of life profile of cats with different severities of osteoarthritis would differ and by demonstrating convergent validity between the health-related quality of life profile scores and independently quantified vet-assessed pain and quality of life impact scores. The latter involved simple correlation analysis and investigation of the relationship between health-related quality of life domain scores and vet-assessed scores, when adjusted for other potential explanatory variables including number of comorbidities and age. Responsiveness—the ability to detect clinically relevant change—is an essential quality for an evaluative instrument and it also provides evidence for “longitudinal validity”. Therefore, a second aim of this study was to demonstrate that changes in health-related quality of life domain scores concurred with the clinician's impression of change over time in the health status of cats with osteoarthritis, thus providing evidence for the instrument's responsiveness. Previously, we have reported disagreement between owner and vet impression as to health status in cats in general, but not in relation to any specific disease. Accordingly, the third study aim was to investigate the extent of agreement or disagreement between owner impression of the impact of osteoarthritis on their cats' quality of life and vet impression of such impact. Fifty one percentage of cat owners believed their cats to be perfectly healthy despite a clinician diagnosis of osteoarthritis

Camau i'r Dyfodol: Curriculum for Wales: evolving understandings of progression in learning

This project is a collaboration between the University of Wales Trinity Saint David (UWTSD) and the University of Glasgow (UofG), funded by the Welsh Government, and working with education professionals in Wales to further support curriculum reform. The Phase 1 report explores understandings of progression and co-construction in the system and reviews published evidence to develop future phases of the project. Various research methods involving education professionals in Wales were used, providing key findings and insights about where education professionals are in the change process, and the challenges and opportunities associated with realisation of the new Curriculum for Wales. The report develops the project’s approach to co-construction and reviews evidence about the relationships between curriculum, assessment, pedagogy, and progression. The key findings of the Phase 1 report include a desire among educational partners for a shared understanding of progression in learning, challenges to co-construction activities, and questions about how to change towards a learner-focused assessment culture. Additionally, the report suggests that progression in Curriculum for Wales is a broader concept than the learning progressions found in most of the research literature, and that it is unclear whether there is consistency in understandings of the new curriculum across the system. The report’s findings, including understandings developed from the literature and the challenges, approaches, and implications identified, were integral to establishing co-construction activity in Phase 2 of the project. Key findings and considerations were also made for the wider system. As the Camau i’r Dyfodol project moves forward, it is committed to ongoing co-construction with educational partners to support the development of practical understanding of progression in learning as part of Wales’ ambitious curricular reform. This collaborative approach will help to ensure that the curriculum is continuously evolving and improving, in response to the changing needs and demands of learners