Development of a questionnaire assessing health-related quality-of-life in dogs and cats with cancer

Health-related quality-of-life (HRQoL) has been studied extensively in human medicine. There is currently no standard HRQoL evaluation for veterinary oncology patients. The aim of this study was to assess the practicality, usefulness and robustness, from a pet owner and clinician perspective, of a questionnaire for the assessment of HRQoL in canine and feline cancer patients. A HRQoL assessment entitled 'Cancer Treatment Form' and two questionnaires entitled 'Owner Minitest' and 'Clinician Minitest' were designed. The first and second were completed by owners of patients presenting to a veterinary oncology referral service and the third by attending clinicians. The 'Cancer Treatment Form' was well received by owners and clinicians and provided a valuable assessment of HRQoL with 98% (82/84) of owners reporting an accurate reflection of their pet's quality-of-life. Following this, minor improvements to the form could be suggested prior to regular use in evaluation of clinical oncology patients.     

Development of a scale to evaluate postoperative pain in dogs

OBJECTIVE: To design and evaluate a scale for measurement of postoperative pain in dogs. DESIGN: Randomized, blinded, prospective study, with positive- and negative-control groups. ANIMALS: 36 dogs undergoing general anesthesia for ovariohysterectomy and 12 dogs undergoing general anesthesia without surgery. PROCEDURE: A pain assessment scale was developed for dogs, which incorporated physiologic data (heart and respiratory rates) and behavioral responses (response to palpation, activity, mental status, posture, and vocalization). This pain scale was then applied to a study in which dogs were allocated to 2 groups, depending on the type of medication administered (acepromazine maleate only or acepromazine and butorphanol) before induction of general anesthesia. The 36 dogs that had ovariohysterectomy were allocated to 3 groups, members of which received butorphanol, carprofen, or no analgesic after surgery. Dogs were scored for signs of pain and videotaped at 0, 1, 2, 4, 6, 8, 12, and 18 hours after surgery by an assessor who was blinded to the groups. Results were analyzed for significant differences in pain scores for single categories and total pain scores among groups. Video segments were scrambled and then scored by a second external assessor to test the repeatability of the results, using the pain assessment scale. RESULTS: Mean total pain scores were significantly different between the group of dogs that underwent general anesthesia only and each group of dogs that underwent general anesthesia and surgery. Pain scores for the analgesic-treatment groups reflected the known onset and duration of action of the analgesic used. Agreement between the internal and external assessors was excellent and indicated high precision between the 2 assessors for the population of dogs as a whole. CLINICAL IMPLICATIONS: Behavioral and physiologic measurements can be used reliably to evaluate degree of pain in dogs during the postoperative period and their response to analgesics.     

Development of a behaviour-based scale to measure acute pain in dogs

A composite scale for assessing pain in dogs in a hospital setting has been developed on the basis of observations of their behaviour. Initially, 279 words and expressions suggested by 69 veterinary surgeons were reduced into 47 words and expressions which were allocated into seven behaviour categories: demeanour and response to people, posture, mobility, activity, response to touch, attention to painful area and vocalisation. Three statistical methods, hierarchical agglomerative cluster analysis, Cronbach's alpha coefficient, and analysis of variance with multiple comparisons and empirical cumulative distributions, were used to validate these procedures, and a questionnaire accompanied by a list of definitions was designed around the expressions. The new composite scale is more detailed than previously reported scales for assessing pain in dogs on the basis of their behaviour, and the methods used in its development are based on sound scientific principles.     

Clinical signs of cardiovascular effects secondary to suspected pimobendan toxicosis in five dogs

The purpose of this study was to review the medical records of dogs that were either suspected or known to have ingested large doses of pimobendan and to describe the clinical signs associated with pimobendan toxicosis. The database of Pet Poison Helpline, an animal poison control center located in Minneapolis, MN, was searched for cases involving pimobendan toxicosis from Nov 2004 to Apr 2010. In total, 98 cases were identified. Of those, seven dogs that ingested between 2.6 mg/kg and 21.3 mg/kg were selected for further evaluation. Clinical signs consisted of cardiovascular abnormalities, including severe tachycardia (4/7), hypotension (2/7), and hypertension (2/7). In two dogs, no clinical signs were seen. Despite a wide safety profile, large overdoses of pimobendan may present risks for individual pets. Prompt decontamination, including emesis induction and the administration of activated charcoal, is advised in the asymptomatic patient. Symptomatic and supportive care should include the use of IV fluid therapy to treat hypotension and address hydration requirements and blood pressure and electrocardiogram monitoring with high-dose toxicosis. Practitioners should be aware of the clinical signs associated with high-dose pimobendan toxicosis. Of the dogs reported herein, all were hospitalized, responded to supportive care, and survived to discharge within 24 hr of exposure.     

Preliminary evaluation of a quality-of-life screening programme for pet dogs

OBJECTIVES: To evaluate a potential screening programme that would raise awareness of welfare consideration of pet dogs visiting a veterinary practice. METHODS: The questionnaire asked owners to provide biographical information about their dog, assess the resources they provided their dog (comfort, exercise, diet, mental stimulation and companionship) from the perspective of their dog's wellbeing and choice, score a range of behavioural and medical signs on visual analogue scale, rate how willing they would be to take on the life of their dog on a visual analogue scale and suggest changes that would improve the quality of life of their dog. RESULTS: Twenty-seven owners completed the questionnaire on consecutive days. There was good correlation for all the parameters between the two days (P<0.05). Of the 16 expected correlations to test internal consistency, nine were significant (P<0.05). Twenty-six per cent of owners scored in the top 10 mm of the visual analogue scale for being willing to "take on the life their dog was living". More exercise was the most commonly suggested change to improve quality of life (14 owners). CLINICAL SIGNIFICANCE: The questionnaire was found to be repeatable, feasible and to have good internal consistency and validity, making it suitable for use in veterinary practice to assess welfare.     

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.     

Relationship between physiological factors and clinical pain in dogs scored using a numerical rating scale

A study was designed to investigate the association between heart rate, respiratory rate and pupil dilation and a subjective pain score allocated using a numerical rating scale (NRS). Four groups of dogs (n = 17 to 20 per group) were included: orthopaedic surgery cases, soft tissue surgery cases, dogs with medical conditions and healthy dogs. Each dog was examined by five veterinary surgeons within a four-hour period. When examining each dog, the observers recorded heart rate, respiratory rate, pupil dilation (present or absent) and a pain score using a NRS (range 0 to 10). For surgical cases, all study assessments were carried out between 21 and 27 hours following the end of surgery. The correlation coefficients between physiological parameters and NRS score were small but, depending on the analysis, were significant for heart rate and NRS score (P < 0·05). However, the size of the coefficient, 0·168, indicated that the relationship was not biologically significant. There was no association between respiratory rate and NRS score. Analysis of the relationship between NRS score and pupil dilation indicated that there was an association between this factor and pain, depending on the analysis. This was significant for the surgical groups (P < 0·05) but not for the other groups.
These findings indicate that heart rate and respiratory rate are not useful indicators of pain in hospitalised dogs. It is also unlikely that pupil dilation will be a useful tool in the assessment of pain.     

Assessing repeatability and validity of a visual analogue scale questionnaire for use in assessing pain and lameness in dogs

OBJECTIVE: To develop a visual analogue scale (VAS) questionnaire that is repeatable and valid for use in assessing pain and lameness in dogs. SAMPLE POPULATION: 48 client-owned dogs with mild to moderate lameness. PROCEDURE: The dogs were from 3 studies conducted during a 3-year period. Of the 48 dogs, 19 were used in repeatability assessment, 48 were used in principal component analysis, and 44 were used in model selection procedures and validity testing. A test-retest measure of repeatability was conducted on dogs with a change of < 10% in vertical peak force. A force platform was used as the criterion-referenced standard for detecting lameness. Principal component analysis was used to describe dimensionality of the data. Repeatable questions were used as explanatory variables in multiple regression models to predict force plate measurements. Peak vertical, craniocaudal, and associated impulses were the forces used to quantify lameness. The regression models were used to test the criterion validity of the questionnaire. RESULTS: 19 of 39 questions were found to be repeatable on the basis of a Spearman rank-correlation cut point of > 0.6. Model selection procedures resulted in 3 overlapping subsets of questions that were considered valid representations of the forces measured (vertical peak, vertical impulse, and propulsion peak). Each reduced model fit the data as well as the full model. CONCLUSIONS AND CLINICAL RELEVANCE: The VAS questionnaire was repeatable and valid for use in assessing the degree of mild to moderate lameness in dogs.     

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.     

Prevalence of obese dogs in a population of dogs with cancer

OBJECTIVE: To determine the body condition score (BCS) distribution for dogs examined at a teaching hospital and examine whether the BCS distribution for dogs with cancer differed significantly from the distribution for dogs without cancer. SAMPLE POPULATION: 1,777 dogs with cancer and 12,893 dogs without cancer. PROCEDURES: A retrospective prevalence case-control study was conducted that used medical records from 1999 to 2004. Information was collected on BCS (9-point system), age, breed, sex, neuter status, diagnosis, and corticosteroid administration. Body condition score at the time of examination for cancer (dogs with cancer) or first chronologic visit (dogs without cancer) was recorded. Logistic regression was used to compare BCS prevalence distributions between groups. RESULTS: The overall prevalence of obese dogs (BCS >or= 7/9) was 14.8% (2,169/14,670), and the overall prevalence of overweight dogs (BCS >or= 6/9 to < 7/9) was 21.6% (3,174/14,670). There was a significant difference in the BCS distribution between dogs with and without cancer, with a slightly lower prevalence of being overweight and obese in dogs with cancer. The prevalence of obese and overweight dogs varied with specific cancer types when compared with the prevalence for dogs without cancer. CONCLUSIONS AND CLINICAL RELEVANCE: Differences in obesity prevalence among cancer types is suggestive of an incongruous effect of this variable on cancer expression or a differential effect of specific cancer types on weight status. Systematic use of BCSs will help elucidate the association between obesity and cancer development.     

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.     

Hypoprothrombinemia secondary to administration of sulfaquinoxaline to dogs in a kennel setting.

Sulfaquinoxaline, a coccidiostat readily available to the public, was mixed in the drinking water for this purpose by the owner. Secondary to its use, a bleeding disorder attributable to hypoprothrombinemia developed in several dogs. Clinical signs of bleeding ceased 24 hours after institution of vitamin K1 and discontinuation of sulfaquinoxaline in the drinking water. This report should remind veterinarians that drugs and medications readily available to the public may have adverse effects in animals, and such problems should be investigated whenever multiple dogs in a common setting are affected with the same clinical problem.     

Pregabalin alleviates clinical signs of syringomyelia-related central neuropathic pain in Cavalier King Charles Spaniel dogs: a randomized controlled trial

ObjectiveWe aimed to assess the efficacy and benefit-risk profile of pregabalin (PGN) to reduce the clinical signs of central neuropathic pain (CNeP) as reflected by scratching episodes in dogs with symptomatic syringomyelia (SM).Study designRandomized, double-blind, placebo-controlled crossover study.AnimalsA total of 12 client-owned Cavalier King Charles Spaniels (age, 1.1–7.4 years, bodyweight, 8.2–10.8 kg) with magnetic resonance imaging-confirmed SM and clinical signs of CNeP.MethodsDogs were randomized to either PGN 150 mg or placebo for 25 days, followed by 48 hour washout period before crossover to the alternate phase of 25 days. The primary outcome was defined as number of scratching events during 10 minutes of video-recorded physical activity. Treatment effect was estimated using a generalized estimation equation model. Benefit-risk and quality of life assessments were obtained through owner interviews focusing on potential adverse events.ResultsThe treatment effect estimate was an 84% (95% confidence interval = 75–89%) reduction in mean number of scratching events relative to baseline compared with placebo (p < 0.0001). Owner-assessed satisfactory quality of life was status quo and rated as ‘good’ or ‘could not be better’ in six/11 dogs and improved in four/11 dogs. The most prevalent adverse events were increased appetite in nine/12 dogs and transient ataxia in nine/12 dogs. There was one dog withdrawn by the owner 7 days after crossover to PGN owing to persistent ataxia. No dogs needed rescue analgesia during the trial.Conclusions and clinical relevancePGN is superior to placebo in the reduction of clinical signs of SM-related CNeP in dogs. At a dose range of 13–19 mg kg^–1 orally twice daily, the encountered adverse events were acceptable to all but one owner.