Validation of a structured questionnaire as an instrument to measure chronic pain in dogs on the basis of effects on health-related quality of life

OBJECTIVE: To validate the use of a novel questionnaire as an instrument for measurement of chronic pain in dogs through its impact on health-related quality of life (HRQL). ANIMALS: 108 dogs with chronic degenerative joint disease and 26 healthy dogs. PROCEDURES: Questionnaire responses were subjected to factor analysis (FA) and questionnaire scores to discriminant analysis to evaluate construct validity. Questionnaire scores were used to explore the potential of this instrument for minimizing respondent bias and for evaluative purposes. RESULTS: FA results revealed a sensible factor structure accounting for 65% of the variance in data, with factors identifiable as domains of HRQL in dogs affected by chronic pain. Further evidence for construct validity was provided when questionnaire scores were used to discriminate, on the basis of 218 questionnaires, between dogs with clinician-awarded pain scores of 0 and dogs with pain scores >or= 1 (88% discrimination, with 95% of no-pain group dogs and 87% of some-pain group dogs correctly categorized). Use of the questionnaire provided minimized respondent bias. CONCLUSIONS AND CLINICAL RELEVANCE: Validation of the questionnaire as an instrument for discriminative and evaluative measurements of orthopedic chronic pain through its impact on HRQL in dogs was provided. Use of the questionnaire, with further testing and refinement, may support improved clinical decision making, facilitate development of evidence-based therapeutic options for chronic diseases, and help veterinarians and owners define humane end points in dogs. IMPACT FOR HUMAN MEDICINE: Information gained here may provide improved measurements of clinical change in animal studies that use dogs with naturally occurring chronic pain to evaluate novel human treatment protocols.     

Development and evaluation of a questionnaire for assessing health-related quality of life in dogs with cardiac disease

OBJECTIVE: To develop and evaluate a questionnaire (functional evaluation of cardiac health [FETCH] questionnaire) for assessing health-related quality of life in dogs with cardiac disease. DESIGN: Prospective study. ANIMALS: 360 dogs with cardiac disease PROCEDURE: The questionnaire was developed on the basis of widely accepted clinical signs of cardiac disease in dogs. A FETCH score was calculated by summing responses to questionnaire items; possible scores ranged from 0 to 85. For questionnaire validation, owners of 60 dogs were asked to complete the questionnaire and provide an overall assessment of their dogs' quality of life (16 owners completed the questionnaire twice). Disease severity was assessed with the International Small Animal Cardiac Health Council (ISACHC) classification for cardiac disease. Following validation, the final questionnaire was administered to owners of the remaining 300 dogs. RESULTS: Internal consistency of the questionnaire was good, and the FETCH score was significantly correlated with the owner-reported quality-of-life score and with ISACHC classification. For owners that completed the questionnaire twice, scores were significantly correlated. During the second phase of the study, the FETCH score ranged from 0 to 70 (median, 7) and was significantly correlated with ISACHC classification, but did not vary significantly with underlying disease. For dogs examined twice, the change in FETCH score was significantly greater for dogs in which ISACHC classification improved than for dogs in which ISACHC classification was unchanged. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the FETCH questionnaire is a valid and reliable method for assessing health-related quality of life in dogs with cardiac disease.     

Effects of electrostimulated acupuncture on ground reaction forces and pain scores in dogs with chronic elbow joint arthritis

OBJECTIVE: To determine whether use of electrostimuluated acupuncture (ESA) would result in significant improvements in ground reaction forces and lameness scores in dogs with chronic elbow joint osteoarthritis secondary to elbow joint dysplasia. DESIGN: Randomized, controlled, crossover clinical trial. ANIMALS: 9 dogs with chronic forelimb lameness and radiographic evidence of elbow joint osteoarthritis. PROCEDURES: All dogs had a 3-week control acclimation period during which gait analysis was performed weekly. Dogs then received ESA once weekly for 3 weeks followed by a sham treatment once weekly for 3 weeks or received the sham treatment followed by ESA. Gait analysis was repeated prior to each treatment, and owners were asked to provide pain scores by use of a visual analog scale method. RESULTS: Treatment (control, acupuncture, or sham) did not have a significant effect on ground reaction forces for any limb. Owners of 8 of the 9 dogs were able to correctly guess the time period when ESA was delivered. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that ESA did not have any significant effects on severity of lameness, as determined by measurement of ground reaction forces, or severity of pain, as determined by visual analog scale pain scores, in dogs with chronic elbow joint osteoarthritis secondary to elbow joint dysplasia.     

Development of a discriminative questionnaire to assess nonphysical aspects of quality of life of dogs

OBJECTIVE: To develop a preliminary discriminative questionnaire for assessment of nonphysical aspects of the quality of life (QOL) of pet dogs and evaluate the questionnaire's content validity, test-retest reliability, and internal consistency. STUDY POPULATION: Owners of 120 dogs. PROCEDURE: Each QOL question had 4 response options, representing descending levels of QOL that were equally weighted. A maximum of 38 items contributed to the QOL score. The questionnaire was administered by telephone to owners of dogs with appointments at a veterinary teaching hospital before the appointment. After the appointment, each dog was classified as sick or healthy by use of defined criteria; owners of healthy dogs had a second interview 3 to 4 weeks later. Test-retest reliability (kappa), internal consistency (Cronbach alpha), and respondents' comprehension were used as criteria for excluding an item. RESULTS: There were 77 sick and 43 healthy dogs. Twenty-two QOL questions had significant kappa values (0.11 to 0.91). The Cronbach alpha values for 5 domains of QOL ranged from 0.45 to 0.61, indicating that the domains had moderate internal consistency (homogeneity). The initial pool of 38 items was reduced to 27. CONCLUSIONS AND CLINICAL RELEVANCE: The questionnaire was designed to complement veterinary assessment of dogs' physical health. The questionnaire may be a useful tool in making decisions regarding dogs' QOL.     

Evaluation of a questionnaire regarding nonphysical aspects of quality of life in sick and healthy dogs

OBJECTIVE: To evaluate the ability of a questionnaire regarding the nonphysical aspects of quality of life (QOL) to differentiate sick and healthy dogs. ANIMALS: 120 dogs. PROCEDURE: The questionnaire was administered by telephone to owners of 120 dogs with appointments at a veterinary teaching hospital. A QOL score was calculated for each dog on the basis of questions relevant to the dog during the 7 days before the interview. Scores were recorded as bar graphs, and linear regression was used to examine the effect of health status and other variables on QOL score. Certain questions were eliminated post hoc, on the basis of defined criteria, and the analyses were repeated. RESULTS: Scores were similar for sick (range, 670% to 93.8%) and healthy (range, 68.0% to 89.8%) dogs. Environment (suburban vs rural) and duration of ownership were significant explanatory variables and accounted for 10.5% of the variation in the QOL score. Eleven questions were eliminated post hoc. The scores derived from the 2 versions of the questionnaire were highly correlated (r = 0.92). CONCLUSIONS AND CLINICAL RELEVANCE: There was no evidence that the QOL questionnaire could differentiate healthy dogs from sick dogs; environmental and owner factors appeared to be more important.     

Validity of a health-related quality-of-life scale for dogs with signs of pain secondary to cancer

OBJECTIVE: To develop and validate a health-related quality-of-life scale for dogs with pain secondary to cancer. DESIGN: Questionnaire development. ANIMALS: 40 healthy dogs with no history or signs of pain, 20 dogs with dermatologic disease but no signs of pain other than mild pruritus, and 20 dogs with cancer. PROCEDURE: Owners of all dogs completed a questionnaire containing 12 questions with 4 options for each question, and a quality-of-life score ranging from 0 to 36 was calculated. Scores for dogs with cancer were compared with scores for healthy dogs and dogs with dermatologic disease. RESULTS: All owners indicated that the questionnaire was easy to complete. Scores for healthy dogs were significantly different from scores for dogs with cancer and scores for dogs with dermatologic disease. Scores for dogs with dermatologic disease were significantly different from scores for dogs with cancer. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that a simple questionnaire may be useful in assessing health-related quality of life in dogs with pain secondary to cancer, in that dogs with cancer had significantly lower scores than did healthy dogs and dogs with dermatologic disease.     

Evaluation of a questionnaire for obtaining owner-perceived, weighted quality-of-life assessments for dogs with spinal cord injuries

OBJECTIVE: To evaluate a questionnaire for obtaining owner-perceived, weighted quality-oflife assessments for dogs with spinal cord injuries. DESIGN: Evaluation study. Animals-100 dogs with spinal cord injuries and 48 healthy control dogs. PROCEDURES: The questionnaire was adapted from a questionnaire (the schedule for the evaluation of individual quality of life-direct weighting) used for human patients. Specifically, owners were asked to identify 5 areas or activities they believed had the most influence on their dogs' quality of life, assess their dogs' current status in each of those areas, and provide a weighting for the importance of each area. Results were used to construct a weighted quality-of-life score ranging from 0 to 100 for each dog. Owners were also asked to provide a quality-of-life score with a visual analog scale (VAS). RESULTS: A good correlation was found between weighted and VAS quality-of-life scores. Dogs with spinal cord injuries had weighted quality-of-life scores that were significantly lower than scores for control dogs. Quality-of-life areas and activities provided by owners of dogs with spinal cord injuries were similar to areas and activities provided by owners of healthy control dogs and could mostly be encompassed by 5 broader domains: mobility, play or mental stimulation, health, companionship, and other. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that the questionnaire could be used to obtain owner-perceived, weighted quality-of-life assessments for dogs with spinal cord injuries. Obtaining owner-perceived quality-of-life assessments for individual dogs should allow veterinarians to better address quality-of-life concerns and expectations of owners.     

Comparison of Force Plate Gait Analysis and Owner Assessment of Pain Using the Canine Brief Pain Inventory in Dogs with Osteoarthritis

Background

Lameness assessment using force plate gait analysis (FPGA) and owner assessment of chronic pain using the Canine Brief Pain Inventory (CBPI) are valid and reliable methods of evaluating canine osteoarthritis. There are no studies comparing these 2 outcome measures.

Objective

Evaluate the relationship between CBPI pain severity (PS) and interference (PI) scores with the vertical forces of FPGA as efficacy measures in canine osteoarthritis.

Animals

Sixty‐eight client‐owned dogs with osteoarthritis (50 hind limb and 18 forelimb).

Methods

Double‐blind, randomized. Owners completed the CBPI, and dogs underwent FPGA on days 0 and 14. Dogs received carprofen or placebo on days 1 through 14. The change in PS and PI scores from day 0 to 14 were compared to the change in peak vertical force (PVF) and vertical impulse (VI).

Results

PS and PI scores significantly decreased in carprofen‐ compared with placebo‐treated dogs (P = .002 and P = .03, respectively). PVF and VI significantly increased in carprofen‐ compared with placebo‐treated dogs (P = .006 and P = .02, respectively). There was no correlation or concordance between the PS or PI score changes and change in PVF or VI.

Conclusions and Clinical Importance

In these dogs with hind limb or forelimb osteoarthritis, owner assessment of chronic pain using the CBPI and assessment of lameness using FPGA detected significant improvement in dogs treated with carprofen. The lack of correlation or concordance between the change in owner scores and vertical forces suggests that owners were focused on behaviors other than lameness when making efficacy evaluations in their dogs.     

Development and validation of a questionnaire for measuring behavior and temperament traits in pet dogs

OBJECTIVE: To develop and validate a questionnaire to assess behavior and temperament traits of pet dogs. DESIGN: Cross-sectional survey of dog owners. Animals-1,851 dogs belonging to clients of a veterinary teaching hospital or members of national breed clubs and 203 dogs examined by canine behavior practitioners because of behavior problems. PROCEDURE: Owners were asked to complete a questionnaire consisting of 152 items eliciting information on how dogs responded to specific events and situations in their usual environment. Data from completed questionnaires were subjected to factor analysis, and the resulting factors were tested for reliability and validity. RESULTS: Factor analysis yielded 11 factors from 68 of the original questionnaire items that together accounted for 57% of the common variance in questionnaire item scores. Reliability was acceptable for all but 1 of these factors. Behavior problems in 200 of the 203 dogs with behavior problems could be assigned to 7 diagnostic categories that matched 7 of the factors identified during factor analysis of questionnaire responses. Dogs assigned to particular diagnostic categories had significantly higher scores for corresponding questionnaire factors than did those assigned to unrelated diagnostic categories, indicating that the factors were valid. Validity of the remaining 4 factors could not be examined because of a lack of information on dogs with behavior problems related to these factors. CONCLUSIONS AND CLINICAL RELEVANCE: Findings suggest that the resulting 68-item questionnaire is a reliable and valid method of assessing behavior and temperament traits in dogs. The questionnaire may be useful in screening dogs for behavior problems and in evaluating the clinical effects of various treatments for behavior problems.     

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 (r(P)=0.43, P=0.02) and percentage body fat loss (r(P)=0.39, P=0.03). These results indicate demonstrable improvement in HRQOL for obese dogs that successfully lose weight.     

Prevalence and characteristics of pain in dogs and cats examined as outpatients at a veterinary teaching hospital

OBJECTIVE: To determine prevalence of pain among dogs and cats examined as outpatients at a veterinary teaching hospital and characteristics of pain in dogs and cats with evidence of pain. DESIGN: Cross-sectional study. ANIMALS: 1,153 dogs and 652 cats examined as outpatients at The Ohio State University during 2002. PROCEDURE: A questionnaire was administered to owners of all dogs and cats. For dogs and cats with evidence of pain, the cause, signs, anatomic location, type (superficial somatic, deep somatic, or visceral), duration, and severity of the pain and the principle mechanism (inflammatory, neuropathic, both, or unknown) responsible for the pain were determined on the basis of questionnaire responses and results of physical examination. The presence of primary hyperalgesia, secondary hyperalgesia, allodynia, and hyposensitivity was recorded. RESULTS: 231 (20%) dogs and 92 (14%) cats had evidence of pain. Dogs with evidence of pain were significantly older and heavier than dogs without. Cats with evidence of pain were significantly older than cats without. In most dogs and cats with evidence of pain, the pain was determined to be of short duration (< 7 days), of mild or moderate severity, somatic, associated with primary hyperalgesia, and inflammatory. Analgesic drugs were frequently administered to dogs with chronic pain, but were not always considered effective. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that mild or moderate pain associated with inflammation may be seen in dogs and cats examined as outpatients. Older, heavier dogs and older cats were more likely to have evidence of pain.     

Development of a questionnaire to assess the impact of atopic dermatitis on health-related quality of life of affected dogs and their owners

Atopic dermatitis (AD) is a chronic or chronically relapsing human and canine skin disease that is known to affect the quality of life (QoL) of affected individuals. Several studies have been conducted to develop disease-specific questionnaires and assess QoL in parents of children with AD and in the children themselves. The severity of canine AD is however currently evaluated using only clinical and pruritus scores. Measurement of the QoL of affected dogs and their owners could therefore provide a new tool for assessing disease severity and treatment efficacy. Ninety-eight owners of AD-affected dogs were asked to complete two questionnaires aiming to evaluate the QoL of affected dogs and their owners on one hand and the relationship between them and their dog on the other hand. Statistical analyses were carried out in order to assess the validity of the questionnaires and to select relevant questions for future studies. These analyses resulted in the selection of 13 questions that could be used in further studies aiming at determining the QoL of affected animals and their owners.     

A prospective,randomized, blinded,placebo-controlled multisite clinical study of bedinvetmab,a canine monoclonal antibody targeting nerve growth factor,in dogs with osteoarthritis

ObjectiveBedinvetmab is a canine monoclonal antibody targeting nerve growth factor. This study evaluated the efficacy and safety of bedinvetmab for alleviation of pain associated with osteoarthritis in dogs.Study designDouble-blind, randomized, multicentre, placebo-controlled study.AnimalsClient-owned dogs (n = 287) with osteoarthritis.MethodsDogs were randomized (1:1) to subcutaneous injection with placebo (saline, n = 146) or bedinvetmab (0.5–1.0 mg kg^–1, n = 141) administered monthly. After 3 months, 89 bedinvetmab-treated dogs that responded positively based on owner and veterinarian assessments were administered up to six additional doses of bedinvetmab in a single-armed open-label continuation phase. The primary efficacy end point was treatment success based on the owner-assessed canine brief pain inventory (CBPI) on day 28. Treatment success was defined as ≥ 1 reduction in pain severity score (0–10) and ≥ 2 in pain interference score (0–10).ResultsPercentage treatment success was significantly greater in the bedinvetmab group than in the placebo group from day 7 through all assessed time points (p ≤ 0.0025). On day 28, 43.5% of dogs achieved treatment success with bedinvetmab compared with placebo (16.9%) (p = 0.0017). Treatment success continued through days 56 (50.8%) and 84 (48.2%) in the bedinvetmab group and was < 25% in the placebo group at all time points. Sustained efficacy was demonstrated in the continuation phase. Adverse health events occurred at similar frequencies in both groups. They were considered typical for a population of dogs with osteoarthritis and not related to study treatment. Treatment with bedinvetmab demonstrated a significant effect on all three components of CBPI—pain interference, pain severity, quality of life.Conclusions and clinical relevanceThis study demonstrated the effectiveness and safety of bedinvetmab administered monthly for up to 9 months at 0.5–1.0 mg kg^–1 for alleviation of pain associated with canine osteoarthritis.     

Effects of meloxicam on severity of lameness and other clinical signs of osteoarthritis in dogs

OBJECTIVE: To evaluate effects of meloxicam on severity of lameness and other clinical signs in dogs with osteoarthritis (OA). DESIGN: Randomized, controlled, multicenter clinical trial. ANIMALS: 217 client-owned dogs with clinical and radiographic signs of OA. PROCEDURE: Dogs were randomly assigned to be treated with meloxicam (n = 105; 0.2 mg/kg [0.09 mg/lb], SC, once on day 1, then 0.1 mg/kg [0.045 mg/lb], PO, q 24 h, for 13 days) or a placebo (n = 112). A general clinical score was assigned by investigators on days 1 (ie, prior to initiation of treatment), 8, and 15 on the basis of severity of lameness, extent of weight bearing, and severity of signs during palpation of the affected joint. Owners and investigators provided overall evaluations on days 8 and 15. RESULTS: Dogs treated with meloxicam had significantly greater improvements in general clinical scores, compared with baseline scores, on days 8 and 15 than did dogs treated with placebo. On days 8 and 15, percentages of dogs treated with meloxicam in which owners and investigators considered treatment to be successful were significantly higher than percentages of control dogs in which treatment was considered to be successful. No abnormalities in hematologic and serum biochemical test results were detected. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that compared with administration of a placebo, administration of meloxicam for 14 days significantly improved the clinical condition of dogs with OA without causing adverse effects.     

Further validation of a pruritus severity scale for use in dogs

A scale to assess the severity of pruritus in dogs was further validated. Comparison of the scale with one containing visible numerical markings demonstrated that owners were heavily influenced by the presence of numbers, resulting in a loss of the scale's ability to generate continuous data. The presence of a traditional visual analogue scale was therefore essential. The scale was tested on 713 owners who presented their dogs for veterinary attention. Pruritus scores in 408 dogs with skin disease covered the full range of possible values (0 to 10). In 305 dogs with no skin disease, 90 owners gave a score greater than zero. Comparison of the scores seen in pruritic dogs, and dogs with no evidence of skin disease, allowed a 'normal range' of 0–1.9 to be established. The scale was able to discriminate between conditions typically regarded as pruritic or non-pruritic. When the scale was assessed for its ability to detect changes in pruritus score following treatment, a median reduction of 4.4 points was observed. The scale was also used to determine what magnitude of response owners would expect following treatment of their pruritic dogs. Only 12% would have been satisfied with a 50% reduction, a figure that is typically quoted as a satisfactory response in clinical trials of anti-pruritic drugs. As a result, alternative methods of assessing clinical trials are proposed. This study has shown the scale to be a valuable tool for clinical assessment of patients, and for monitoring treatment responses in clinical trials.     

The possible role of the tibial plateau angle for the severity of osteoarthritis in dogs with cranial cruciate ligament rupture

The purpose of this study was to determine factors correlated with the severity of radiographic osteoarthritis (OA) scoring in dogs with cranial cruciate ligament rupture (CrCLR). Three radiographs of stifle joints (craniocaudal, mediolateral, and mediolateral radiograph with 90 degree flexion of the stifle and tarsal joints) were obtained from 36 dogs with CrCLR (Clinical group) and from 22 dogs without stifle joint disease (Control group). Information about these dogs was collected from the owners and from medical records. Radiographic OA scores in each dog in the clinical group were determined from radiographs using a numeric grading system previously reported. The tibial plateau angle (TPA) in each dog in both groups was measured on mediolateral radiographs with 90 degree flexion of the stifle and tarsal joints. The Mann-Whitney's U test was used for comparing variables between the clinical group and the control group, and Spearman's rank correlation test was used for evaluating correlations between radiographic OA scores and variables in the clinical group. No significant differences were detected between the clinical group and the control group for any of the variables. There were two positive correlations; one between the radiographic OA score and TPA (r=0.395, p=0.014); and the other between body weight and OA score (r=0.399, p=0.013) in the clinical group. Our results indicate that body weight and TPA could affect the severity of the radiographic OA score in dogs with CrCLR.