Evaluation of agreement between numerical rating scales, visual analogue scoring scales, and force plate gait analysis in dogs

Objective— To evaluate the accuracy of numerical rating (NRS) and visual analogue (VAS) scoring scales compared with force plate gait analysis and agreement between observers for each scoring scale.
Study Design— Experimental study.
Animals— Mixed breed dogs (n=21) with a right limb tibial osteotomy repaired with an external fixator.
Methods— Three small-animal veterinarians with orthopedic training scored lameness using NRS and VAS before surgery, and at 4 and 8 weeks after surgery. Peak force and impulse were determined at the same time points using a force plate. Agreement between observers and with force plate data was assessed. Significance was set at P ≤.05.
Results— Agreement was generally low among observers for both NRS and VAS scores. When evaluated at each time point, an acceptable level of agreement was present only at 4 weeks after surgery. Only impulse had a significant relationship with some of the observers' subjective scores. No significant relationships between any observer's scores and force plate data existed if very lame dogs were omitted.
Conclusions— Subjective scoring scales do not replace force plate gait analysis. Agreement is low unless lameness is severe, and each observer uses an individually unique scale. Subjective scoring scales most accurately reflect force plate gait analysis when lameness is severe.
Clinical Relevance— Subjective lameness scoring scales may not accurately reflect lameness and do not replace force plate gait analysis. Observers must stay the same during the duration of a study for accurate analyses.     

Accuracy and optimization of force platform gait analysis in Labradors with cranial cruciate disease evaluated at a walking gait

OBJECTIVE: To determine the combination of ground reaction forces (GRFs) that best discriminates between lame and non-lame dogs. To compare the sensitivity of force platform gait analysis and visual observation at detecting gait abnormalities in Labradors after surgery for rupture of the cranial cruciate ligament (CCL). ANIMALS: All dogs were adult Labrador Retrievers: 17 free of orthopedic and neurologic abnormalities, 100 with unilateral CCL rupture, and 131 studied 6 months after surgery for unilateral CCL injury, 15 with observable lameness. PROCEDURE: Dogs were walked over a force platform with GRF recorded during the stance phase. Analytic properties of force platform gait analysis were calculated for several combinations of forces. The probability of visual observation detecting a gait abnormality was compared with that of force platform gait analysis. RESULTS: We determined that a combination of peak vertical force (PVF) and falling slope were optimal for discriminating sound and lame Labradors. After surgery, many dogs (75%) with no observable lameness failed to achieve GRFs consistent with sound Labradors. CONCLUSION: A force platform is an accurate method of assessing lameness in Labradors with CCL rupture and is more sensitive than visual observation. Assessing lameness with a combination of GRFs is better than using univariate GRFs. CLINICAL RELEVANCE: Therapies for stifle lameness can be accurately and objectively evaluated using 2 vertical ground reaction forces obtained from a force platform.     

Force plate gait analysis at the walk and trot in dogs with low-grade hindlimb lameness.

OBJECTIVE: To evaluate the accuracy of force plate gait analysis at the walk and trot in dogs with low-grade hindlimb lameness. MATERIAL AND METHODS: Nineteen healthy dogs and 41 dogs with low-grade unilateral hindlimb lameness due to stifle or hip joint problems were walked and trotted over a force plate. Peak vertical forces (PVF) were recorded, and a symmetry index (SI) was calculated from the PVF of the hindlimbs. 'Cut-off' values were determined from the SI of the normal dogs. These cut-off values were used to discriminate lame dogs from normal ones. Sensitivity and specificity were evaluated for measurements at walk and trot, and the Cohen's Kappa coefficient (k) was used to determine the agreement between clinical lameness and force plate measurements, and between force plate results at walk and trot. Receiver Operating Characteristics (ROC) curve were plotted for both gaits to evaluate accuracy. RESULTS: The sensitivity of the measurements at walk was 0.63, and specifity was 0.95. The sensitivity of the measurements at trot was 0.90, and specificity was 1.0. Moderate agreement was found between force plate measurements at walk and trot, and between clinical gait assessment and force plate measurements at walk. Good agreement was found between clinical gait assessment and measurements at trot. ROC analyses revealed the trot (94.7% [91.7%; 97.7%]) to be the more accurate test than the walk (85.0% [80.1%; 89.9%]). CONCLUSION: The trotting gait was more sensitive and accurate than the walking gait for the differentiation of dogs with a low-grade hindlimb lameness from normal ones using force plate gait analysis.     

Relationship between objective and subjective assessment of limb function in normal dogs with an experimentally induced lameness

Objective— To evaluate the relationship between previously used subjective and objective measures of limb function in normal dogs that had an induced lameness.
Study Design— Prospective, blinded, and induced animal model trial.
Animals— Normal, adult, and mixed-breed dogs (n=24) weighing 25–35 kg.
Methods— Force platform gait analysis was collected in all dogs before and after induction of lameness. All gait trials were videotaped; 60 video trials were evaluated by 3 surgeons with practice limited to small animal orthopedics and 3 first year veterinary students in an effort to establish the relationship between subjective and objective measures of lameness. Evaluators were unaware of the force platform data.
Results— Concordance coefficients were low for all observers and were similar between students and surgeons. These values were further decreased when normal and non-weight bearing trials were removed. Agreement with the force platform data was low even when observers only had to be within ±10% of the ground reaction forces. When repeat trials were evaluated surgeons had a much higher repeatability compared with students.
Conclusions— Subjective evaluation of the lameness in this study varied greatly between observers and agreed poorly with objective measures of limb function.
Clinical Relevance— Subjective evaluation of gait should be interpreted cautiously as an outcome measure whether performed from a single or from multiple observers.     

Computer-based gait analysis of dogs: Evaluation of kinetic and kinematic parameters after cemented and cementless total hip replacement

To date it is unclear whether cementless total hip replacement (THR) in dogs is of clinical advantage in comparison to cemented THR with regard to lameness improvement. Thus the aim of this study was to compare objectively the development of the gait pattern after cemented and cementless THR in dogs. For this purpose, 18 adult dogs with hip dysplasia underwent computer-based gait analysis on an instrumented treadmill prior to unilateral THR and then again ten days, four weeks and four months after surgery. Analysed kinetic parameters were symmetry indices (SI) of vertical ground reaction forces (GRF), which included peak vertical forces (PFz), mean vertical forces (MFz), vertical impulse (IFz), and vertical ground reaction forces of the arthroplasty limbs only. Analysed kinematic parameters were range-of-motion and the flexion and extension angles of hip, stifle and hock joints. The symmetry indice for PVF, MFz and IFz decreased to a value less than six in both THR groups four months after surgery, which is defined as not lame. Improvement in lameness of the arthroplasty limbs during the examination period of four months was not significantly different between the cemented and cementless groups. The results suggest that within a short-term observation period of four months after surgery, neither cementless nor cemented THR have a greater advantage with regard to lameness improvement. Additional studies with larger pools of subjects and longer time periods for follow-up examinations are necessary to verify these findings.     

The effect of weight loss on lameness in obese dogs with osteoarthritis

This paper describes the effect of weight loss on lameness in obese dogs with osteoarthritis (OA). Fourteen obese client-owned dogs with clinical and radiographic signs of OA participated in an open prospective clinical trial. After a screening visit and a visit for collection of baseline data, the dogs were fed a restricted-calorie diet over a study period of 16 weeks that incorporated six follow-up visits. At each visit, body weight and pelvic circumference were measured and severity of lameness was assessed using a numeric rating scale (NRS), a visual analogue scale (VAS) and kinetic gait analysis. This is the first study to assess both subjectively and objectively, the effect of weight loss alone on lameness in obese dogs with OA. The results indicate that body weight reduction causes a significant decrease in lameness from a weight loss of 6.10% onwards. Kinetic gait analysis supported the results from a body weight reduction of 8.85% onwards. These results confirm that weight loss should be presented as an important treatment modality to owners of obese dogs with OA and that noticeable improvement may be seen after modest weight loss in the region of 6.10 – 8.85% body weight.     

Joint angle, moment and power compensations in dogs with fragmented medial coronoid process

Fragmented medial coronoid process (FMCP) is the most common cause of forelimb lameness in juvenile medium and large breed dogs; however methods of assessing the disruption to their gait remain subjective. The purpose of this study was to objectively quantify the mechanical disruptions to gait in dogs with arthroscopically confirmed unilateral FMCP. Seven dogs underwent full inverse dynamic analysis at the time of diagnosis. Kinematic and force data were collected from both forelimbs at trot. Stance phase joint angles, net joint moments and net joint powers were calculated using custom software. There were gross differences in kinetic and kinematic patterns between FMCP affected and compensating forelimbs. Stance time was 0.24 sec on the lame side and 0.26 sec on the compensating side. The shoulder and the elbow were more flexed at ground contact, and elbow, carpal and MCP joints had smaller ranges of motion on the lame side. Net joint moments were significantly reduced (P < 0.05) in the elbow, carpal and MCP joints of the FMCP affected limb. Net joint powers were likewise significantly smaller (P < 0.05). However, the overall moment and power patterns persisted. Total limb support moment was significantly smaller on the affected side (P < 0.05). Total limb power was significantly reduced on the affected side (P < 0.05) being most affected in its propulsive phase in the second half of stance. Inverse dynamic analysis of this clinical condition is an objective means by which to assess the mechanical disruption to gait.     

Effects of balancing and shoeing of the forelimb feet on kinematic gait analysis in five horses with navicular disease

The effects of balancing the foot and shoeing (B&S) on the kinematics of five Quarter Horses with navicular disease were evaluated using computerized gait analysis. Kinematic measurements of the right forelimb and head were made before and after palmar digital nerve block (PDNB) and before and after B&S of the forelimb feet. Carpal and fetlock joint angle, foot displacement, and temporal gait measurements were made for at least five strides in each horse trotting on a treadmill. Kinematic measurements were compared before and after PDNB and before and after B&S by analysis of variance with an α=0.05. The most significant kinematic changes seen after PDNB were in the vertical head movement parameters studied. Total vertical head excursion and measures of head height asymmetry between right and left forelimb stance phases decreased after PDNB. After B&S mean carpal flexion and maximum hoof height during the swing phase of the stride increased, but none of the head movement parameters significantly changed. Results of this study indicate that the ability of treadmill kinematic gait analysis to evaluate for improvement in lameness by monitoring vertical head movement parameters is not significantly affected in horses with navicular disease three weeks after balancing and shoeing the forelimb feet.     

The use of high-speed treadmills for lameness and hoof balance evaluations in the horse

Examination for lameness remains the most important component of the clinical evaluation for poor performance. Although conventional examinations can be used to diagnose many causes of lameness, treadmill video gait analysis and dynamic hoof balance evaluations have proved to be useful not only for evaluating lameness but also for maintenance of long-term soundness. Treadmill lameness evaluations offer a major advantage compared to conventional evaluations because of the stationary position of the exercising horse relative to the people performing the examination. Lameness is suspected if asymmetric motion is observed or asymmetric sounds of the feet contacting the tread surface are heard during the treadmill evaluation. Localization of lameness to the front or hind legs is the first step in the treadmill gait analysis protocol. In trotting and pacing horses, asymmetric movements associated with foreleg lameness generally are confined to the front end. In contrast to the pacing gait, asymmetric movements associated with hindlimb lameness can involve both the front and rear of the horse at the trot. The evaluation is continued to determine which side of the horse is abnormal. Viewed from the front, horses with primary forelimb lameness appear to have an asymmetric downward rotation of the torso, head, and neck away from the stiffer lame front leg toward the flexed normal leg as it contacts the tread surface. The lame hind leg can appear to be stiff relative to the opposite normal leg. This results in uneven side-to-side oscillations of the pelvis rotating away from the abnormal stiff-appearing hind leg toward the normal, flexed hind leg as it contacts the tread surface. Both front- and hind-leg lamenesses cause dissociation of the normal foot-fall sequence, resulting in the alteration of the normal two beat gait at the trot or the pace to a three-beat gait. The final step of the lameness examination involves the use of diagnostic regional anesthesia to determine the anatomic location of the lameness. Treadmill video gait analysis can be used to evaluate differences in the horse's gait before and after each anesthetic block. Optimal foot balance during exercise is critical for long-term maintenance of musculoskeletal soundness. Combining slow-motion video gait analysis with treadmill exercise provides an excellent method for evaluating hoof balance at a variety of speeds. Optimal hoof balance can be achieved by using the technique of successive trimming and re-evaluation. The principles of hoof balancing include establishing dorsopalmar or dorsoplantar hoof balance.(ABSTRACT TRUNCATED AT 400 WORDS)     

Association between subjective lameness grade and kinetic gait parameters in horses with experimentally induced forelimb lameness

OBJECTIVE: To evaluate the association between subjective lameness grades and kinetic gait parameters and assess the variability in kinetic parameters in horses with experimentally induced forelimb lameness. ANIMALS: 32 horses. PROCEDURES: Forelimb lameness was induced in each horse via injection of lipopolysaccharide into 1 metacarpophalangeal joint (40 experimental trials). Subjective lameness grading and 13 kinetic gait parameters (force plate analysis) were assessed before (baseline) and at 12, 18, and 24 hours after lipopolysaccharide injection. While horses were trotting, kinetic gait analysis was performed for 8 valid repetitions at each time point. Repeated-measures analyses were performed with 8 repetitions for each kinetic parameter as the outcome, and lameness grades, time points after lipopolysaccharide injection, and repetition order as explanatory variables. Sensitivity and specificity of kinetic parameters for classification of horses as sound or lame (in relation to subjective lameness scores) were calculated. Between- and within-horse variabilities of the 13 kinetic parameters were assessed by calculation of coefficients of variation. RESULTS: Subjective lameness grades were significantly associated with most of the kinetic parameters. Vertical force peak and impulse had the lowest between- and within-horse coefficients of variation and the highest correlations with subjective lameness grade. Vertical force peak had the highest sensitivity and specificity for lameness classification. Vertical force peak and impulse were significantly decreased even in horses with mild or unobservable lameness. CONCLUSIONS AND CLINICAL RELEVANCE: Among the kinetic gait parameters, vertical force peak and impulse had the best potential to reflect lameness severity and identify subclinical forelimb gait abnormalities.     

Detection of lameness and determination of the affected forelimb in horses by use of continuous wavelet transformation and neural network classification of kinematic data

OBJECTIVE: To investigate continuous wavelet transformation and neural network classification of gait data for detecting forelimb lameness in horses. ANIMALS: 12 adult horses with mild forelimb lameness. PROCEDURE: Position of the head and right forelimb foot, metacarpophalangeal (ie, fetlock), carpal, and elbow joints was determined by use of kinematic analysis before and after palmar digital nerve blocks. We obtained 8 recordings from horses without lameness, 8 with right forelimb lameness, and 8 with left forelimb lameness. Vertical and horizontal position of the head and vertical position of the foot, fetlock, carpal, and elbow joints were processed by continuous wavelet transformation. Feature vectors were created from the transformed signals and a neural network trained with data from 6 horses, which was then tested on the remaining 2 horses for each category until each horse was used twice for training and testing. Correct classification percentage (CCP) was calculated for each combination of gait signals tested. RESULTS: Wavelet-transformed vertical position of the head and right forelimb foot had greater CCP (85%) than untransformed data (21%). Adding data from the fetlock, carpal, or elbow joints did not improve CCP over that for the head and foot alone. CONCLUSIONS AND CLINICAL RELEVANCE: Wavelet transformation of gait data extracts information that is important for the detection and differentiation of forelimb lameness of horses. All of the necessary information to detect lameness and differentiate the side of lameness can be obtained by observation of vertical head movement in concert with movement of the foot of 1 forelimb.     

Antebrachial metacarpal arthrodesis for fusion of deranged carpal joints in two dogs

Congenital malformation of the carpal joint in a young dog resulted in a progressive lameness. Traumatic disruption of the carpus in another dog resulted in carpal bone necrosis, infection, and chronic instability. Radial metacarpal arthrodesis was performed in both dogs. The diseased carpal bones were excised, sparing the accessory carpal bone in both dogs. Radial metacarpal arthrodeses were then performed, using bone plate fixation. In the dog with the malformed limb, the gait had improved, but intermittent lameness was still present 8 months later because of an associated malarticulation of the cubital joint. The dog with the traumatized carpus had little or no lameness associated with normal activity for 32 months.     

Evaluation of a canine total-elbow arthroplasty system: a preliminary study in normal dogs

OBJECTIVE: Short-term, in vivo evaluation of a total-elbow arthroplasty (TEA) system in normal dogs. STUDY DESIGN: Prospective evaluation comparing pre- and postoperative findings. ANIMALS: Six normal, skeletally mature, large-breed dogs. METHODS: Physical, radiographic, and force-plate gait examinations were performed on all dogs before surgery. TEA was performed in the dogs using a canine TEA system. Examinations were repeated every 8 weeks for 24 weeks, with an additional examination at 52 weeks. Pre- and postoperative findings were compared. RESULTS: The TEA led to an excellent outcome in 3 of 6 dogs. Force-plate gait examination found that the dogs continued to improve over time and had a peak vertical force (PVF) in the surgical limb that was 99.6% of normal (range, 95.8% to 106.4%) 52 weeks after surgery. Major problems encountered during the postoperative time period were non-weight-bearing lameness (1 dog), osteomyelitis (1 dog), and fracture of the ulna (1 dog). CONCLUSIONS: TEA can be successfully performed in dogs. CLINICAL RELEVANCE: Based on 1-year data, TEA can be successfully performed in dogs and could be considered as a treatment alternative for adult dogs with severe osteoarthritis and lameness of the elbow joint.     

Pre- and postoperative force plate analysis of dogs with experimentally transected cranial cruciate ligaments treated using tibial plateau leveling osteotomy

Objective— Quantitative and objective assessment of hindlimb kinetics after cranial cruciate ligament (CrCL) transection and subsequent stifle stabilization using the tibial plateau leveling osteotomy (TPLO) in normal dogs.
Study Design— In vivo experimental biomechanical evaluation.
Animals— Six healthy adult foxhounds.
Methods— Dogs were screened by orthopedic and radiographic examination before study entry. Force plate analysis of gait was measured before extirpation of the right CrCL and TPLO and again at 8 and 18 weeks after surgery.
Results— There was a significant decrease in peak vertical forces (PVFs) and vertical impulse (VI) of the treated hindlimb at 8 weeks when compared with preoperative and 18-week measurements. When compared with preoperative values, there was no significant difference in 18 week PVF and VI in dogs that had TPLO.
Conclusion— TPLO can restore kinetic measures of limb function at 18-weeks after surgery when compared with preoperative values after experimental transection of the CrCL in dogs.
Clinical Relevance— TPLO induces lameness that returns to near normal at 18 weeks. The severity and duration of lameness was similar to that reported for other experimental models of stifle instability repaired by different techniques.     

What can we learn from visual and objective assessment of non-lame and lame horses in straight lines,on the lunge and ridden?

Traditionally and when using objective gait analysis, horses with and without lameness are most frequently assessed trotting in straight lines in hand. Valuable information can be gained from assessment on the lunge and ridden in walk, trot and canter. No studies have quantified lameness during all aforementioned conditions and gaits at once, despite the rapid recent development in equine gait analysis methods. Objective methodologies, previously confined to gait laboratories, are currently being expanded to field technologies using accelerometers and inertial measurement units (IMUs). This publication aims to describe normal gait and the spectrum of pain-related gait abnormalities and other musculoskeletal adaptations to pain that can be observed in walk, trot and canter during in hand and ridden assessment in straight lines and on a circle on hard and soft surfaces. In addition, it aims to describe briefly how IMUs have been used and areas for further research in the light of what we know from subjective lameness examinations and what is possible with IMUs.     

A Quantitative Review of the Equinalysis System for Equine Locomotion Analysis

Movement analysis techniques allow objective and quantitative assessment of kinematic gait analysis. Consistent repeatability of the kinematic data is essential for such assessments. This study investigated whether the repeatability of a standardized Equinalysis Elite gait analysis system is sufficient to allow its use in clinical evaluation of equine lameness with reliable documentation of individual locomotion patterns. The extent to which examinations on different days affected the results when a standardized protocol was used was investigated. The repeatability of distal limb kinematics in nine sound horses over three successive days at one location was investigated. Measurements were performed at the examination area, for three motion cycles at the walk and trot, in each direction per day. Skin markers were placed on the lateral aspect of the coffin joint, forelimb fetlock joint, hindlimb fetlock joint, carpus, tarsus, elbow, and stifle, at clipped sites marked with a permanent marker. The inter-day repeatability of angular measurements of the carpus, tarsus, forelimb fetlock, and hindlimb fetlock joints was determined. A low degree of inter-day repeatability was found with statistically significant (P ≤ .05) differences between findings on different days, observed in the time-angle diagrams of left and right carpus, tarsus, forelimb fetlock, and hindlimb fetlock joints of all horses, at both walk and trot. The standardized Equinalysis Elite system for gait analysis of distal limb kinematics in the horse did not provide highly repeatable data in this setting.     

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.     

Kinematic analysis of the gait of 10 labrador retrievers during treadmill locomotion

The trotting gait of 10 sound, adult labrador retrievers was analysed using kinematic gait analysis on a purpose-built treadmill using video-based motion analysis software. The maximal angular displacement, minimal angular displacement, average angular displacement, and the maximal positive and negative angular velocities of the right elbow and right stifle were measured over five gait cycles at defined time points during each of five two-minute sessions. The dogs' trotting gait was not repeatable, either for individual dogs during the first session or between sessions, or between dogs at the same time points during a session.     

Additional kinematic variables to describe differences in the trot between clinically normal dogs and dogs with hip dysplasia

OBJECTIVE: To describe the abnormal gait of dogs with hip dysplasia by use of kinematic gait analysis. ANIMALS: 19 large-breed dogs with moderate to severe clinical and radiographic evidence of hip dysplasia and 10 clinically normal dogs (controls). PROCEDURE: Kinematic and force plate data were collected, and degree of coxofemoral joint abduction-adduction, mediolateral foot movement, distance between hind feet, maximum hind foot elevation, mediolateral pelvic movement, and coxofemoral joint angular acceleration were calculated. Essential Fourier coefficients were determined and used to reconstruct mean angular acceleration curves. Fourier coefficients and foot and pelvic movement data were compared between groups. RESULTS: Dogs with hip dysplasia had a greater degree of coxofemoral joint adduction and range of abduction-adduction and greater lateral pelvic movement, compared with controls. Foot movement variables did not differ significantly between groups. Coxofemoral joint angular acceleration was greater in the middle to end of the stance phase, whereas deceleration was greater in the late stance to early swing phase and middle to end of the swing phase in dogs with hip dysplasia, compared with controls. CONCLUSIONS AND CLINICAL RELEVANCE: Differences in degree of coxofemoral joint abduction-adduction, amount of mediolateral pelvic movement, and coxofemoral joint angular acceleration between clinically normal dogs and dogs with hip dysplasia may indicate a compensation in gait of affected dogs as a result of discomfort or biomechanical effects attributable to hip dysplasia and degenerative joint disease. Information gained from kinematic and kinetic gait analyses may be useful in evaluating treatments for hip dysplasia in dogs.     

Single ultrasound-guided platelet-rich plasma injection for treatment of supraspinatus tendinopathy in dogs

The effect of a single platelet-rich plasma injection for supraspinatus tendinopathy was assessed in 10 dogs. Subjective (owner-assessed) improvement in lameness and function were seen in 40% of dogs with improved tendon heterogeneity and echogenicity in 60%. There were no significant changes in gait reaction forces 6 wk after treatment.