Assessment of quality of life in equine patients

A Qualitative Exploration of UK Leisure Horse Owners' Perceptions of Equine Wellbeing

Human assessment of equine wellbeing is fundamental to ensuring the optimal care of domestic horses. However, terminology associated with wellbeing is still not fully defined and there are currently no validated quality of life (QoL) assessment tools. Furthermore, little is known about what equine wellbeing or QoL means to horse owners, or how their beliefs impact on the management decisions they make for their horse. This study sought to establish how UK leisure horse owners use wellbeing-related terminology by exploring their accounts within a focus group setting. Four online focus group discussions (FGD) were held and qualitative data were collected. FGDs involved a semi-structured discussion, followed by a group activity to compare seven equine wellbeing-related terms of interest introduced by the facilitator. The collected data were analysed using a constructivist grounded theory approach, and also by content analysis, to examine the frequency and subjective meaning of the terms of interest. The results showed that horse owners did not clearly delineate between different terms, rather, they used the terms in the context of their own assessments of their horse. The meanings assigned to what owners experienced with their horse were individual and subjective, shaped by past experiences, relationships with their animal, and peers or social groups. This individualised construction of equine wellbeing impacted on the meaning conveyed when using wellbeing-related terminology. In this study, we extend the literature on equine wellbeing terminology usage, and highlight differences between the academic literature and the real-world experiences of horse owners.

A Comparison Between Working and Nonworking Donkeys Welfare Issues in Nyala City, South Darfur, Sudan

In impoverished nations, donkeys help people make a living. The welfare of donkeys in Sudan is neglected compared with developed countries. However, there is no information available about donkey welfare in Nyala. This study aimed to assess the welfare of donkeys in Nyala. Donkeys were divided into two groups (n=50), working and nonworking. The donkeys' physical, emotional, and clinial parameters and an owner's interview were assessed. There were significant differences in body condition scores: 37% and 47% of working and nonworking donkeys, respectively, had ideal body condition scores, while 13% of working donkeys were emaciated. Of the working and nonworking 33% and 19% had hoof problems, respectively. Fifteen percent of working donkeys had ocular discharge, and 25% had wounds. In working donkeys, 7% and 5% depressive and aggressive behavioral responses, respectively, were observed. Furthermore, there were significant differences in tools used for hitting donkeys, with 33% and 17% of owners using a stick and whip, respectively, for hitting working donkeys. 82% of owners feed their donkeys one to three times daily (50% working and 32% nonworking donkeys), and free access feeding was only observed in 18% of nonworking donkeys. There were no significant differences (P >0.06) in emotional parameters. We conclude that working donkeys suffer from multiple welfare problems more than nonworking donkeys in Nyala. More awareness, veterinary services, and research are needed to improve donkey care in Nyala.

Quality of Life within Horse Welfare Assessment Tools: Informing Decisions for Chronically Ill and Geriatric Horses

Simple Summary

Equine Quality of Life is an important concern in decision making in veterinary medicine and is especially relevant for chronically ill or aged horses when euthanasia is considered. To our knowledge, there is no assessment tool for chronically ill or aged horses that assesses equine Quality of Life defined as the horse’s evaluation of their life. However, tools exist to assess equine welfare in different contexts. Therefore, this study aimed to analyse how equine welfare, Quality of Life, well-being and happiness assessment tools define and attempt to measure these concepts. We discuss the tools’ suitability to assess equine Quality of Life in the context of end-of-life decisions for chronically ill or aged horses. Fourteen publications were found via a systematic literature search, describing ten equine welfare assessment tools and one approach to assessing equine Quality of Life in veterinary practice. Some of these welfare assessment tools have the potential to inform the development of a Quality-of-Life assessment tool supporting well-considered decision making towards the end of horses’ lives if they are adjusted to focus on the horses’ experiences, to provide an overall grade of Quality of Life and are tailored to chronically ill or geriatric horses.

Abstract

Equine Quality of Life (QoL) is an important concern in decision making in veterinary medicine and is especially relevant for chronically ill or geriatric horses towards the end of their lives. To our knowledge, there is no currently available QoL assessment tool for chronically ill or geriatric horses that assesses equine QoL defined as the horse’s evaluation of their life. However, tools exist to assess equine welfare in different contexts. Hence, the aims of this study were to analyse how equine welfare, QoL, well-being and happiness assessment tools label, define and operationalise the concepts and to discuss the tools’ suitability to assess equine QoL in the context of end-of-life decisions for chronically ill or geriatric horses. Fourteen articles were found through a systematic literature search, describing ten equine welfare assessment tools and one approach to integrating equine QoL in veterinary practice that suggests QoL assessment parameters. We discuss that some welfare assessment tools have the potential to support the development of a QoL assessment tool informing decisions towards the end of horses’ lives if they are adjusted to focus on the horses’ experiences, to provide an integration into an overall QoL grade and are tailored to chronically ill or geriatric horses.

Scoping review of end-of-life decision-making models used in dogs, cats and equids

BACKGROUND

End-of-life decisions for companion animals can be stressful for veterinarians and owners, and when delayed result in poor animal welfare. Delayed euthanasia has been identified as a particularly prominent issue for horses. This scoping review aimed to identify the available literature on veterinary decision-making models, which can support end-of-life planning.

METHODS

A protocol was preregistered, and a structured literature search was performed on six electronic databases. Publications were reviewed against specifically developed eligibility criteria. Data from original studies and narrative-type reviews were extracted separately, and the components of each model were charted.

RESULTS

A total of 2211 publications were identified, 23 met the inclusion criteria and were included in the final review. Eight were original research studies and 15 were narrative reviews or similar. Publications were not indexed uniformly, increasing the difficulty of discovering relevant sources. The end-of-life decision-making process comprised three stages: (1) making the decision, (2) enacting the decision and (3) aftercare. Twenty key components of decision-making models were identified, although no publication reflected all of these.

CONCLUSIONS

A lack of original research studies and equine-specific publications was identified. Shared decision-making models for euthanasia in veterinary practice should include all three stages and consider species-specific issues.

Development of a Composite Pain Scale in Foals: A Pilot Study

Prompt pain management is crucial in horses; however, tools to assess pain are limited. This study aimed to develop and pilot a composite scale for pain estimation in foals. The “Foal Composite Pain Scale” (FCPS) was developed based on literature and authors’ expertise. The FCPS consisted of 11 facial expressions, 4 behavioural items, and 5 physical items. Thirty-five pain-free foals (Control Group) and 15 foals experiencing pain (Pain Group) were used. Foals were video-recorded at different time points: the Control Group only at inclusion (C), while the Pain Group at inclusion (T1), after an analgesic treatment (T2), and at recovery (T3). Physical items were also recorded at the same time points. Videos were scored twice by five trained observers, blinded to group and time points, to calculate inter- and intra-observer reliability of each scale item. Fleiss’ kappa values ranged from moderate to almost perfect for the majority of the items, while the intraclass correlation coefficient was excellent (ICC = 0.923). The consistency of FCPS was also excellent (Cronbach’s alpha = 0.842). A cut-off ≥ 7 indicated the presence of pain. The Pain Group scores were significantly higher (p < 0.001) than the Control Group and decreased over time (T1, T2 > T3; p = 0.001). Overall, FCPS seems clinically applicable to quantify pain and improve the judgment of the quality of life in foals, but it needs modifications based on these preliminary findings. Consequently, further studies on a larger sample size are needed to test the feasibility and validity of the refined FCPS.

The use of the roter interaction analysis system in assessing veterinary student clinical communication skills during equine wellness examinations in rural Kentucky, USA: A pilot study

BACKGROUND

Effective clinical communication can aid veterinarians in building good client relationships, increase adherence to recommendations and, ultimately, improve patient health and welfare. However, available information on veterinary communication in the equine context is limited. The objective of this study was to describe the communication of veterinary students in the equine environment who had previous communication training. Additionally, we assessed the suitability of the Roter Interaction Analysis System (RIAS) for the analysis of audio-video recordings of equine wellness consultations.

METHODS

Twenty-seven equine wellness consultations performed by second-year Ross University School of Veterinary Medicine students were recorded in rural Kentucky, United States of America. Recordings were submitted to a professional coder who applied the RIAS to the equine context by expanding or adjusting code definitions.

RESULTS

A substantial amount of utterances (i.e. segments of speech) were allocated to core communication skills including building rapport (30%), facilitation and client activation (24%) and education and counselling (23%). There was a large variation in utterances used among consultations of the same veterinary student and students; they did not appear anxious or nervous.

CONCLUSIONS

Students made use of core communication skills, indicating that experiences from pre-clinical training could be transferred to equine practice. Furthermore, this study demonstrated that the RIAS could be considered for consecutive studies aiming to provide observational data on clinical communication in the equine context.

Objective Assessment of Chronic Pain in Horses Using the Horse Chronic Pain Scale (HCPS): A Scale-Construction Study

The objective assessment of chronic pain is of utmost importance for improving welfare and quality of life in horses. Freedom from disease and pain is one of the 'five freedoms' that are necessary for animal welfare. The aim of this study was to develop a pain scale for the assessment of chronic pain in horses (Horse Chronic Pain Scale; HCPS), which is based on behavioural and facial expressions. The scale was used to assess 53 horses (26 horses diagnosed with chronic painful conditions by means of clinical examination and additional diagnostic procedures (consisting of osteoarthritis, chronic laminitis, chronic back and neck problems, chronic dental disorders) and 27 healthy control animals). Animals were assessed once daily for three consecutive days by two observers that were blinded to the condition of the animals and were unaware of any analgesic treatment regimens. The HCPS consists of two parts, the Horse Chronic Pain Composite Pain Scale (HCP CPS, with behavioural parameters) and the EQUUS-FAP (Equine Utrecht University Scale for Facial Assessment of Pain). The HCP CPS had good inter-observer reliability (intraclass correlation coefficient (ICC) = 0.84, p < 0.001), while the EQUUS-FAP component (with facial expression-based parameters) had poor inter-observer reliability (ICC = 0.45, p < 0.05). The inter-observer reliability of the combined HCPS was good (ICC = 0.78, p < 0.001). The HCPS revealed significant differences between horses with chronic painful conditions and control horses on 2 out of 3 days (p < 0.05). In conclusion, we tested a composite pain scale for the assessment of chronic pain in horses based on behavioural and facial expression-based parameters. Further studies are needed to validate this pain scale before it can be used in practice.

Clinical Evaluation and Preventative Care in Donkeys

Clinical evaluation and preventative care in donkeys should follow similar guidelines as for horses. There are species-specific differences due to the desert-adapted physiology of the donkey. Donkeys are mainly used as pack animals, companions and for production of meat or milk - they may be kept well into old age. Diseases often present late or may go unrecognized leading to poor welfare and quality of life. Basic knowledge of nutrition, blood values, pharmacology and common disease recognition will help veterinarians improve the health and welfare of donkeys.

History, clinical findings and outcome of horses with radiographical signs of equine odontoclastic tooth resorption and hypercementosis

The progression of equine odontoclastic tooth resorption and hypercementosis (EOTRH) has not been completely evaluated, and currently, the only effective treatment is extraction of severely affected teeth. We aim to describe how the disease relates to the history and clinical findings and to report on the outcome in individual horses. This case series comprises data collected from 20 horses (age 14–29 years old) with radiographic findings of EOTRH in their incisor and/or canine teeth. Most horses affected with EOTRH in this study were admitted for dental problems, but some for other complaints such as colic. Of the 288 teeth evaluated radiographically, 224 teeth were abnormal. Radiographic findings were most frequently located in the apical aspect and reserve crown of the teeth, and lesions were also commonly found in clinically normal teeth. Histopathology of extracted teeth showed inflammation in the periodontal ligament and revealed that resorption often extended to the dentine. Some owners were unwilling to allow extraction of their horses’ severely affected teeth, even though this treatment has been shown to increase the wellbeing of the horse. As EORTH is a life-long condition, the progression of the disease has to be continuously monitored and the treatments adjusted accordingly.

A standardised equine-based welfare assessment tool used for six years in low and middle income countries

The majority of horses, donkeys and mules (equids) are in low- and middle-income countries, where they remain a key source of labour in the construction, agriculture and tourism industries, as well as supporting households daily through transporting people and staple goods. Globally, approximately 600 million people depend on working equids for their livelihood. Safeguarding the welfare of these animals is essential for them to work, as well as for the intrinsic value of the animal’s quality of life. In order to manage animal welfare, it must be measured. Over the past decade, welfare assessment methodologies have emerged for different species, more recently for equids. We present the Standardised Equine-Based Welfare Assessment Tool (SEBWAT) for working equids. The tool is unique, in that it has been applied in practice by a non-governmental organisation (NGO) for six years across Low-Middle-Income Countries (LMICs). We describe the revision of the tool from an original to a second version, the tool methodology and user training process and how data collection and analysis have been conducted. We describe its application at scale, where it has been used more than 71,000 times in 11 countries. Case study examples are given from the tool being used for a needs assessment in Guatemala and monitoring welfare change in Jordan. We conclude by describing the main benefits and limitations for how the tool could be applied by others on working equids in LMICs and how it may develop in the future.

Moving beyond the "Five Freedoms" by Updating the "Five Provisions" and Introducing Aligned "Animal Welfare Aims"

Simple Summary

A Five Provisions/Welfare Aims paradigm has been formulated as a coherent alternative to the Five Freedoms. It retains the memorable simplicity of the original paradigm and is linked to it, but avoids the acknowledged complications that arise by using the term “freedoms”. Also, it accommodates current scientific understanding of animal welfare, is easily understood and provides guidance on beneficial objectives for animal welfare management. It is an evocative and engaging paradigm anticipated to be of particular interest to non-specialist members of the lay public who are concerned about animal welfare.

Abstract

Although the Five Freedoms paradigm has been very influential in shaping animal welfare thinking for the last two decades, it has two key disadvantages. First, the focus on “freedom” from a range of negative experiences and states has been misunderstood in a number of quarters to mean that complete freedom from these experiences and states is possible, when in fact the best that can be achieved is for them to be minimised. Second, the major focus of the Freedoms on negative experiences and states is now seen to be a disadvantage in view of current understanding that animal welfare management should also include the promotion of positive experiences and states. The challenge therefore was to formulate a paradigm that overcame these two main problems and yet was straightforward enough to be accessible to non-specialists, including members of the lay public who are interested in animal welfare. This was achieved by highlighting the Five Provisions, originally aligned with the Five Freedoms, but now updated to direct welfare management towards activities that both minimise negative experiences or states and promote positive experiences or states as specified by particular Animal Welfare Aims assigned to each Provision. Aspects of the four welfare principles from the European Welfare Quality assessment system (WQ^®) and elements of all domains of the Five Domains Model for animal welfare assessment have been incorporated into the new Five Provisions/Welfare Aims paradigm. Thus, the paradigm is easily understood and provides clear guidance on beneficial objectives for animal welfare management. It is anticipated that the paradigm will have application to many species found in a wide range of circumstances.

Using physical and emotional parameters to assess donkey welfare in Botswana

INTRODUCTION

Working donkeys in Maun, Botswana contribute to people's livelihoods substantially through the provision of transport, ploughing and income generating activities. However, working donkeys suffer from various welfare issues that were investigated in this study to provide preliminary insights on their health and well-being.

MATERIALS AND METHODS

An assessment protocol involving direct observations of the donkeys was developed and operationalised to assess physical and emotional welfare. Physical welfare parameters such as body condition score, abnormal limbs, impeded gait, eye abnormalities, sore and scar locations, hoof and coat condition were recorded. Emotional welfare parameters such as eyes, tail movement, ear position, neck position, posture and vocalisation were recorded. In addition, donkey-owner interactions were recorded and scored, as well as the donkey's response to environmental factors. A total cross-section of 100 donkeys sub-stratified by roles of riding, cart pulling and resting were randomly selected in eight villages and three urban wards and assessed during the period of May to August 2012.

RESULTS

The findings reveals that the 100 adult working donkeys assessed were physically afflicted by poor BCSs of two (66 per cent), long and cracked hooves (50 per cent), sores on at least two locations on their body (53 per cent), scars on at least two locations on their body (86 per cent), and poor coat conditions (58 per cent). Emotionally, donkeys displayed unresponsiveness (35 per cent), avoidance (31 per cent), disinterest in hand sniffing (59 per cent), dull facial expression (33 per cent), tail stillness (89 per cent), neck stiffness and/or raised head (13 per cent) or head hanging low (32 per cent visibly withdrawn), and tense ears pointing back or to the side (69 per cent). By contrast, the remaining donkeys (31 per cent) exhibited a happy demeanour of curiosity, interest, alert facial expression, tail swishing, relaxed ears pointed to the side or forward and neck relaxed and/or level.

CONCLUSIONS

This study offers preliminary findings from an investigation into the welfare of working donkeys in Greater Maun, Botswana, and provides baseline research to inform future research and strategies to enhance donkey well-being.