The aim of Zero Pain Reflect is to provide vet professionals with an easy-to-read digest on three items of research in pain management which focus on one common subject area.
This research roundup provides a single point of reference for the reader.
Osteoarthritis detection in dogs
Title of the paper
Identification of canine osteoarthritis using an owner-reported questionnaire and treatment monitoring using functional mobility tests. Link to paper.
Aim of the paper
To investigate the diagnostic value of an owner-completed canine osteoarthritis screening checklist to help identify previously undiagnosed osteoarthritis cases, and assess their response to carprofen treatment by monitoring pain and functional mobility.
This study had both primary and secondary objectives. The primary objective was to investigate the diagnostic utility of the screening checklist. The secondary objective was to determine whether functional tests of activity improved with daily NSAID treatment and whether giving those NSAIDs over a longer period demonstrated an additional benefit. The NSAID used in this study was carprofen.
Review of methodology
500 dogs with previously undiagnosed OA were screened with an owner completed checklist. Of these,133 dogs were evaluated for pain and video mobility analysis using the Helsinki Chronic Pain Index (pain score) and Visual Analogue Scale (mobility score) which was then repeated following carprofen treatment for after 30 or 120 days.
The OA screening checklist was used to recruit dogs to the study. The checklist comprised of 9 yes/no questions. If owners answered yes to any questions, the dog was examined by a vet. Presence or absence of OA was confirmed based on history and physical exam. Some, but not all dogs, underwent radiography to confirm diagnosis. If OA was deemed severe enough to warrant treatment, owners were given the choice to participate or not.
Videos of the dogs were recorded to undertake the functional mobility element. These were 5 daily activities as follows;
· Walking on a flat surface (front, side, rear views)
· Jogging on a flat surface (front, side, rear views)
· Rising from a sitting/lying position (side view)
· Ascending stairs (front and rear views) and descending stairs (front and rear views)
All video analysis was performed by a blinded expert who used a VAS to rate each activity – with a score of 100 being the most severe mobility score.
Carprofen was prescribed at 4.4mg/kg BID. The intended duration of treatment was 30 days with some dogs in a 120-day treatment group.
Osteoarthritis (OA) was diagnosed in 38% (188/500) of dogs in this study – based on the use of the OA checklist, verified by vet examination during the consultation. The age range of dogs was 1-20 years with a mean age of 7.6 years. Average weight was 23.7kg (range 2.1-90.7kg). Therapy was recommended in 188 dogs.
Sensitivity and specificity was examined for questions in the checklist. Based on this, three questions with low sensitivity were removed, resulting in a sensitivity and specificity of 88 and 71% respectively.
Most dogs displayed mobility impairment for each behaviour at enrolment, which improved by day 30. Of significant note were improvements seen for jogging and ability to climb stairs. By day 120 improvements in all areas of mobility were seen, except stair climbing.
HCPI scores at baseline were a mean of 18.7 in this population (range 1-34). A decrease in pain scores to 12.5 was seen by day 30 with carprofen treatment. Treatment effect was sustained from day 0-120.
Key points to aid reflection
OA is underdiagnosed. Owners may not associate early indicators of OA with pain. Identifying the subtle early changes is key. The checklist assisted in identifying previously undiagnosed OA.
The screening checklist was useful to identify OA. 38% is higher than previously cited OA prevalence of 20% in dogs – however some advise this number is closer to 40%, a view that is supported by this work.
Less than half of these dogs presented for stiffness or lameness – traditional clinical signs associated with OA.
Duration of treatment had a positive effect on all functional tests – supporting our guidance on pain treatment: it takes time for pain processes to be wound down.
Helsinki Chronic Pain Index (HCPI) and functional mobility (walking, jogging, sitting/lying, walking up and down stairs) improved over time after carprofen treatment.
Consider the individual dog. Some daily activities may improve/deteriorate at different rates – demanding tasks such as rising from lying down may take longer to improve than walking in a straight line.
Conclusion of the paper
The study indicates the potential value of this screening checklist to help identify cases that could otherwise remain undiagnosed.
Our assessment of the paper
Our view is that this is well conducted piece of work. Limitations and bias is fairly addressed in the discussion. The study was sponsored by Zoetis and this does not appear to have influenced the findings reported.
In this section you will find our ‘everyone should read this’ recommendation and a review that we have chosen to support your next steps in integrating this with your clinical practice.
Everyone should read this
Prevalence of radiographic osteoarthritis and associated clinical signs in young dogs
Recommended review article
Pye et al (2022) Advances in the pharmaceutical treatment options for canine osteoarthritis
Where do we see the value in this work?
· Reviews the pharmaceutical treatment options
· Explains the term ‘non-inferiority’ in comparative analgesic studies
· Clearly guides the reader to an evidence-informed prescribing choice
Reflections from this research roundup
What are the discussion points for the practice team from this research?
How has this changed your understanding of OA management?
Should you take a more standardised approach to OA management in your practice?
What are the unanswered questions that you need further help with? Please contact us with these questions.