Could it be colic? Horse-owner decision making and practices in response to equine colic

UK horse owners and veterinary practitioners' experiences of decision-making for critical cases of colic

BACKGROUND

The survival of horses diagnosed with critical colic (requiring referral or euthanasia) relies on rapid and effective decision-making by the owner and veterinary practitioner.

OBJECTIVES

To explore UK horse owners' and veterinary practitioners' experiences of decision-making for critical cases of equine colic.

STUDY DESIGN

Qualitative study using a phenomenological approach.

METHODS

Individual, semi-structured telephone interviews were conducted with 14 horse owners and 13 veterinary practitioners (vets) who had experienced a critical decision (referral or euthanasia) for a horse with colic. A purposive, convenience sample of participants was recruited. Sessions explored participant's experience of colic, including recognition, help-seeking behaviour, and challenges. Thematic analysis was performed on collected data.

RESULTS

Four over-arching themes were identified; 'head', 'heart', 'practicalities' and 'impact'. Owners acknowledged responsibility for their horse's welfare but had different perspectives than vets on the importance of finance ('head'). Both vets and owners described how the horse-human relationship ('heart') often led to conflict during decision-making. The vet-client relationship was influential on decision-making for both owners and vets; involving other people in decision-making was described both positively and negatively by participants ('heart'). 'Practicalities', such as lack of preparedness, transport issues and adverse weather conditions, were identified by both owners and vets as barriers. Owners described a 'rollercoaster' of emotions after a critical decision, with profound impacts on their mental wellbeing, feelings of guilt, and long-term changes in behaviour ('impact'), and a lack of support to manage these feelings.

MAIN LIMITATIONS

Small sample size.

CONCLUSIONS

This study describes stakeholder decision-making during critical cases of equine colic. Factors that commonly influenced decisions included an owner's previous knowledge and beliefs, social pressures, logistics and the relationship between the owner and vet. The study highlighted long-term impacts on the owner, including their management and decisions for subsequent horses. These factors should be considered in shared decision-making.

"How long is life worth living for the horse?" A focus group study on how Austrian equine stakeholders assess quality of life for chronically ill or old horses

BACKGROUND

Quality of life (QoL) provides a comprehensive concept underpinning veterinary decision-making that encompasses factors beyond physical health. It becomes particularly pertinent when seeking responsible choices for chronically ill or old horses that emphasise their well-being and a good QoL over the extension of life. How different stakeholders use the concept of QoL is highly relevant when considering the complexity of these decisions in real-life situations.

METHODS

Seven focus group discussions (N = 39) were conducted to gain insights into how stakeholders assess and use equine QoL in veterinary care decisions for chronically ill and/or old horses. The discussions included horse owners (n = 17), equine veterinarians (n = 7), veterinary officers (n = 6), farriers (n = 4), and horse caregivers (n = 5). The combination of deductive and inductive qualitative content analysis of the group discussions focused on identifying both similarities and differences in the views of these groups regarding QoL for old and/or chronically ill horses.

RESULTS

Findings show agreement about two issues: the importance of the individuality of the horse for assessing QoL and the relevance of QoL in making decisions about veterinary interventions. We identified differences between the groups with respect to three issues: the time required to assess QoL, stakeholders' contributions to QoL assessments, and challenges resulting from those contributions. While owners and caregivers of horses emphasised their knowledge of a horse and the relevance of the time they spend with their horse, the veterinarians in the study focused on the differences between their own QoL assessments and those of horse owners. In response to challenges regarding QoL assessments and decision-making, stakeholders described different strategies such as drawing comparisons to human experiences.

CONCLUSIONS

Differences between stakeholders regarding equine QoL assessments contribute to challenges when making decisions about the care of chronically ill or old horses. The results of this study suggest that individual and collaborative reflection about a horse's QoL should be encouraged, for example by developing practicable QoL assessment tools that support relevant stakeholders in this process.

Stakeholder perceptions of thoroughbred yearling sales endoscopy in Australia: can we do better?

OBJECTIVE

To identify thoroughbred industry stakeholders' views on the yearling sales endoscopy in Australia.

DESIGN

Semi-structured qualitative group interviews with equine veterinarians, thoroughbred breeders and yearling purchasers.

METHODS

Twenty-nine experienced thoroughbred industry stakeholders participated in online focus groups: (1) equine veterinarians involved in yearling endoscopy; (2) thoroughbred breeders; and (3) yearling buyers. The focus groups were audio and video recorded and digital whiteboards were available. Data was transcribed, live-coded and analysed thematically.

RESULTS

The main themes identified included the uncertainty surrounding the relationship between yearling laryngeal function and future performance, especially the significance of yearlings with grade 3 out of 5 laryngeal function; interobserver variability in the laryngeal function grade assigned by veterinarians to the same endoscopic exam; and the presence of intra-horse variability in laryngeal function over different time points.

DISCUSSION

Stakeholders raised multiple concerns about the current yearling sales endoscopy process in Australia. Recommendations to address these concerns include further investigation into the race performance of yearlings identified with grade 3 laryngeal function; training of veterinarians to reduce inter-observer variability; and the need to determine the most appropriate grading system to use in yearlings. Future research should evaluate the significance of intra-horse variability in a yearling population.

Prospective case study of critical decision making for horses referred for treatment of colic

BACKGROUND

There is limited evidence on factors affecting critical decision making for horses with colic. This study's aim was to describe the assessment and decision making involved in horses referred for management of colic.

METHODS

An in-depth case analysis was used to document case presentation, decision making and outcomes for horses referred for colic to two UK equine veterinary practices over a 12-month period. The data recorded included previous history, presenting signs, response to treatment, case outcome and factors affecting decisions for further treatment or euthanasia.

RESULTS

Data were available for 60 cases: 55 were hospitalised for medical or surgical treatment and five horses were euthanased following initial assessment. The main factors affecting treatment decisions were severity of clinical signs (80%, 47/59), financial concerns (10%, 6/59) and ongoing health issues or previous history of colic (5%, 3/59). Factors associated with euthanasia decisions were postoperative complications (5/18), poor prognosis (4/18), deteriorating clinical signs (3/18) and financial concerns (3/18).

LIMITATION

The limited study population may affect the extent to which the findings can be generalised.

CONCLUSION

The severity of clinical signs was the key factor in treatment decision making. The main factors affecting euthanasia decisions were clinical deterioration, poor prognosis and financial constraints. These findings should be incorporated into clinical case recording to capture the multifactorial nature of decision making.

Becoming a matter of veterinary concern

Horses in Great Britain are living into increasingly older age and are often regarded as friends or family members by their owner. The horse is reliant on their owner to meet their needs and this paper discusses how horse owners frame an issue that becomes a matter of veterinary concern within the context of the older horse. Qualitative methods were used to explore the experiences of owners and veterinarians. Data were collected and analysed using a grounded theory approach during the period 2019-2022. Analysis identified that owners undertook an ongoing and iterative process of assessment, monitoring and decision making in relation to the animal and any changes they observed. Matters that became a veterinary concern required the owner to formulate the issue as something that fell within the knowledge domain of the veterinarian. Veterinarians had a medicalised view of older horse health and their perspectives on socially acceptable care were shaped by their understanding of species-specific needs, and whether owners were providing appropriately for those needs. The formulation of a matter of veterinary concern was itself shaped by an owner's experiential knowledge of both veterinary matters and their horse. The extent to which owners felt like they and their individual horse mattered during interactions with veterinarians affected whether they adopted veterinary advice and the nature of future veterinary employment. Findings demonstrate how matters of health, disease, and the role of professionalised forms of medical knowledge, are not static but constantly changing and interacting over time. An issue that became a matter of veterinary concern was contextual, and rooted in individual relationships. The significance of veterinarian-owner interactions in shaping future consumption of veterinary health care may be underestimated.

Use of human behaviour change models to investigate horse owner intention to adopt emergency colic recommendations

BACKGROUND

Behavioural models are widely used within human medicine to understand beliefs and intention associated with major health interventions.

OBJECTIVES

To investigate horse-owner beliefs and practices associated with emergency colic planning.

STUDY DESIGN

Cross-sectional study.

METHODS

An online survey incorporating the Trans-Theoretical Model of behaviour change and the Theory of Planned Behaviour was developed to assess owner intention to adopt three areas of emergency colic planning: (1) prevention/recognition, (2) involvement of others and (3) personal preparation. Participants were recruited using a snowball sampling strategy; multivariable logistic regression of data was performed.

RESULTS

There were 701 horse-owners who completed the survey. Respondents fell into one of two categories: no intention to adopt or already implementing emergency planning recommendations. Most agreed that emergency colic plans would improve their horse's welfare (68%) and aid in decision making (78%). Most disagreed that colic was inevitable (66%) and that treatment options were not within their control (69%). Multivariable analysis showed that those who believed emergency plans were worth creating were more likely to adopt preventive (OR: 2.33, 95% CI: 1.27-4.30, p = 0.007) and personal preparation (OR: 1.61, 95% CI: 1.31-1.97, p < 0.001) recommendations. Preventive recommendations were also associated with 'REACT' campaign awareness (OR 2.36, 95% CI: 1.40-3.97, p = 0.001). Favourable behavioural beliefs, such as the acknowledgement of welfare and decision-making benefits, were linked to the involvement of others in planning (OR: 2.93, 95% CI: 1.78-4.81, p < 0.001).

MAIN LIMITATIONS

Potential response bias and small sample size.

CONCLUSIONS

The majority of owners were either unwilling to adopt suggested recommendations or believed that their approach was currently sufficient. Most owners perceived veterinary professionals as most influential on their decision to plan for a colic emergency, highlighting their importance in any educational campaign.

Long-term outcome after colic surgery: retrospective study of 106 horses in the USA (2014-2021)

Objective

To determine long-term survival rate, defined as survival to 1 year after discharge from the hospital, and rate of return to prior athletic, breeding, or other function in horses undergoing colic surgery at the first presentation at one referral hospital in the Pacific northwest region of the United States.

Procedures

Records were reviewed for all horses that underwent colic surgery between October 2014 and October 2021. Owners of horses that survived to discharge were contacted to obtain follow-up information via internet-based questionnaire or telephone interview. The percentage of horses that survived to 1 year after discharge, rates of return to function, and complications occurring after hospital discharge were determined. The possible association of patient signalment, lesion type, and surgical procedures with long-term survival was examined with Chi-square and Fisher's exact tests. Overall satisfaction was indicated on a scale of 1 (unsatisfied) to 5 (very satisfied).

Results

Of 185 horses that underwent surgical intervention for colic and met the inclusion criteria, 134 horses recovered from anesthesia, with 106 of these recovered horses (79.1%) surviving to discharge. Of the 71 horses for which follow-up information was obtained, 61 horses survived to 1 year after discharge (long-term survival rate of 85.9%). There were no demographic, lesion type, or surgical procedure variables significantly associated with long-term survival. Prior to surgery, 59/71 horses (83.1%) were engaged in some type of athletic activity. After surgery, 44/61 horses (72.1%) were reported to be athletically active. Only one horse was reported to be retired from athletic activity as a direct result of a complication from surgery. Overall satisfaction with the decision to proceed with colic surgery was rated by all respondents as 4 or 5.

Conclusions and clinical relevance

The long-term survival for this sample of horses was similar to previously published reports of long-term survival after colic surgery. Horses that survived to hospital discharge were highly likely to remain alive and be athletically active 1 year later. There were no factors related to the signalment of the horse, the specific cause of colic, or the surgical procedures performed that were significantly associated with likelihood of survival.

Effect of Sugar Beet Pulp on the Composition and Predicted Function of Equine Fecal Microbiota

The purpose of this study is to determine the effect of the partial replacement of dietary hay with sugar beet pulp (SBP) on the composition and predicted function of the fecal microbiota of healthy adult horses. Fecal samples were collected daily for 12 days from six adult horses after removal from pasture, including a five-day acclimation period, and a seven-day period following the introduction of SBP into their diet, and compared to six untreated horses over a comparable period. Fecal DNA was subjected to 16S rRNA amplicon sequencing and a longitudinal analysis was performed comparing the composition and predicted function. While no significant treatment-associated changes in the richness, alpha diversity, or beta diversity were detected, random forest regression identified several high-importance taxonomic features associated with change over time in horses receiving SBP. A similar analysis of the predicted functional pathways identified several high-importance pathways, including those involved in the production of L-methionine and butyrate. These data suggest that feeding SBP to healthy adult horses acutely increases the relative abundance of several Gram-positive taxa, including Cellulosilyticum sp., Moryella sp., and Weissella sp., and mitigates the predicted functional changes associated with removal from pasture. Large-scale studies are needed to assess the protective effect of SBP on the incidence of the gastrointestinal conditions of horses.

Epidemiology of Colic: Current Knowledge and Future Directions

Epidemiologic studies are essential for the generation of evidence-based, preventive health care strategies. This includes ways to minimize colic risk and assist informed decision making concerning diagnosis, treatment, and likely outcomes. It is important to consider that colic is not a simple "disease" but is a syndrome of abdominal pain that encompasses multiple different disease processes, and which is multifactorial in nature. This review focuses on prevention and diagnosis of colic, including specific forms of colic, communications with owners/carers concerning colic risk and management, and areas of future research.

Survey of the knowledge and perceptions of horse owners in Ireland of common clinical conditions and their impact

BACKGROUND

As the primary decision-maker for their horse's health and welfare, owners' knowledge of clinical conditions may impact their horse's health. Anecdotal evidence suggests that the emotional impact of equine illness on the owner can be severe but research is lacking.

OBJECTIVES

To evaluate horse owners' self-declared knowledge of eight common equine health conditions and perceptions of the quality of information available; to ascertain respondents' perceptions of the severity of impact on their horse of the conditions and potential emotional impact on themselves and to establish the factors of greatest concern to owners when their horse has a health condition and influential factors on end-of-life decisions.

STUDY DESIGN

Online survey of horse owners.

METHODS

An online survey comprising three sections was created: respondent demographics; vignettes of clinical conditions; concerns and decision-making regarding illness and euthanasia. Vignettes focused on arthritis; Pars Pituitary Intermedia Dysfunction; Equine Metabolic Syndrome (EMS); gastric ulcers; high intestinal worm burden; dermatophilosis ('mud rash'); quidding and head tossing; and equine asthma. Respondents were self-selecting. The survey was circulated for completion by horse owners residing in Ireland and Northern Ireland obtaining 491 valid responses.

RESULTS

Respondents declared that they had the highest knowledge of mud rash, with 84.1% rating their knowledge as very good compared to 42% of respondents for EMS. There was positive correlation between the perceived impact on their horse and emotional impact on the owner for all conditions ranging from weak (arthritis 0.36, P < 0.001) to strong (EMS 0.62, P < 0.001). Pain, discomfort, and quality of life were reported as the most common concerns when their horse has a medical condition or when considering euthanasia.

MAIN LIMITATIONS

Potential bias among respondents towards computer literate owners, with good literacy and interest in equine health conditions.

CONCLUSIONS

Knowledge of equine health conditions, perceived impact of conditions on the horse and emotional impact on their owners varied significantly between conditions.

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.

Retrospective Study on Risk Factors and Short-Term Outcome of Horses Referred for Colic from 2016 to 2022

Simple Summary

Colic syndrome is the most common out-of-hours call for equine practitioners. In most cases, medical treatment at home is effective for the resolution of the disorders. In 20% of cases, hospital intensive care is required. Several factors have been addressed as predisposing to the disorder. Cardiovascular and hemodynamic variables are the most reliable indicators of the severity of the condition and, thus, are important prognostic factors. The aim of the study was to highlight the predisposing factors and best prognostic clinical signs for discharge in a cohort of horses referred for colic syndrome. Medical records from 2016 to 2022 were examined. One hundred and fifty-seven horses were included in the study. Month and time of admission were the main predisposing factors. Cardiovascular variables (heart rate on admission and after 3–6 h, packed cell volume, capillary refill time, and mucosal membranes) and the presence of gastric reflux were negatively associated with discharge as well as time to standing after surgery. The results from this retrospective study may help the clinician in evaluating prognosis, deciding on the best treatment, and adequately informing the owner of the rates of success.

Abstract

(1) Background: colic syndrome is a multifactorial life-threatening condition in equids. Awareness of predisposing and prognostic indicators is useful to adequately inform the owner of the outcome and plan the best treatment. The aim of the study was to identify the variables associated with short-term survival in a cohort of horses referred for colic to a veterinary teaching hospital; (2) Methods: medical records of horses referred for colic from 2016 to 2022 were retrospectively reviewed. Univariate and multivariate regression models were built to assess the odds ratios of discharge from the hospital, both on the whole sample and in those patients undergoing surgery; (3) Conclusions: Month, time of admission, cardiovascular variables (heart rate on admission and after 3–6 h, packed cell volume, capillary refill time, and mucosal membranes), and presence of gastric reflux were significantly associated with discharge in the univariate regression in all horses and in those surgically treated. In the multivariate regression model, heart rate, packed cell volume, and capillary refill time showed significant association with the outcome in the whole sample. Although comparison between this study and previous studies is difficult due to the number and type of variables included, cardiovascular variables and markers of hypovolemia were also shown to be associated with outcome.

Multi-Institutional Retrospective Case-Control Study Evaluating Clinical Outcomes of Foals with Small Intestinal Strangulating Obstruction: 2000–2020

Simple Summary

Lower survival rates have been reported in foals than adults with severe colic lesions obstructing blood flow to the small intestine, but this has not been compared directly. These survival rates are important to horse owners making medical decisions surrounding colic, for both the foal’s wellbeing and the owner’s finances. In this retrospective case-control study, hospital records of surgical colic cases were collected from five US academic referral hospitals to directly compare foal and adult survival following surgery for specific colic lesions. It was hypothesized that foals would exhibit lower survival than case-matched adults. This study was limited by incomplete medical and surgical records, relatively small sample size, and lack of long-term follow-up. Short-term survival in foals was not significantly different than in adults with comparable colic lesions and may have been partly driven by decision-making on the farm prior to referral. More optimism toward surgical treatment of foals with suspected SISO may be warranted.

Abstract

Lower survival has been reported in foals than adults with small intestinal strangulating obstruction (SISO), but age-dependent outcomes have not been examined directly. Hospital records were collected from five US academic referral hospitals. It was hypothesized that foals would exhibit lower survival than case-matched adults. Foal cases 6-months-of-age or younger, and adult cases between 2- and 20-years-of-age were collected. Data revealed 24 of 25 (96.0%) foals and 66 of 75 (88.0%) adults that were recovered from surgery for SISO survived to hospital discharge. Sixteen of the total 41 (39.0%) foals studied were euthanized intraoperatively, whereas 30 of 105 (28.6%) adults were euthanized intraoperatively. Common lesions in foals that were recovered from surgery were volvulus (n = 13) and intussusception (n = 5), whereas common lesions in adults were volvulus (n = 25) and strangulating lipoma (n = 23). This study was limited by incomplete medical records, relatively small sample size, and lack of long-term follow-up. Unexpectedly, short-term survival tended to be higher in foals than adults and may have been partly driven by case selection prior to referral or surgery or decision-making intraoperatively. More optimism toward surgical treatment of foals with SISO may be warranted.

Factors Associated with Owner-Reported Euthanasia in Equids in France

There is limited evidence regarding the proportion of dead equids in France that were euthanized and the factors influencing the decision-making of euthanasia. The better understanding of which could facilitate research on improvement of welfare, especially on end of life issues. The aim of this study was to estimate the proportion of euthanasia and identify associated factors in equids in France. A web-based survey was created and distributed by the French horse and riding institute to owners who reported an equine death between April 2017 and April 2018 (n = 5 158). Factors associated with euthanasia were identified using a multivariable logistic regression model. The percentage of responses was 10.6% (n = 548/5 158; 95% CI 9.8% to 11.5%). The proportion of euthanasia was 71.0% (n = 389/548; 95% CI 67.2% to 74.8%). The factors "age category", "cause of natural death or reason for euthanasia" and "the length of time during which the animal was reported to be ill by the owner" were significantly associated with euthanasia (P <0.001). The results highlighted that a large majority of owners faced euthanasia decisions and our findings could support veterinarians and owners to better prepare for such an eventuality.

Surveillance of strangles in UK horses between 2015 and 2019 based on laboratory detection of Streptococcus equi

BACKGROUND

Previously national surveillance data for monitoring strangles (Streptococcus equi infection) in UK horses was limited. Improved awareness and knowledge of positive diagnoses would permit the optimisation of biosecurity protocols, decreasing the prevalence of strangles.

METHODS

Seven UK laboratories reported positive strangles diagnoses between 1 January 2015 and 31 December 2019 based on identifying Streptococcus equi via agent detection assays from field-based practitioner-submitted samples. Associated clinical history and animal signalment were collected where provided, and descriptive analysis undertaken.

RESULTS

Within the study period, 1617 laboratory-confirmed diagnoses occurred from samples submitted by 315 veterinary practices. Of these, 51.6% were swabs and 44.0% guttural pouch lavages. Diagnoses were primarily based on qPCR alone (59.6%), qPCR and culture (35.8%), or culture alone (4.6%). A total of 1791 clinical signs were reported for 713 diagnoses, where nasal discharge (31.3%) and pyrexia (20.5%) were most frequently reported. Regions with the highest number of diagnoses included North Yorkshire (n = 75, 4.6%), Staffordshire (n = 71, 4.4%) and West Sussex (North East) (n = 63, 3.9%).

CONCLUSION

This study presents important insights into the diagnosis and clinical features of strangles in UK horses, even though limited and/or missing clinical history and signalment on laboratory submission forms restricts the completeness of the data.

Caring for the Older Horse: A Conceptual Model of Owner Decision Making

The number of aged horses in the UK has been growing over recent years, with many horses remaining active and being cared for into old age. However, increasing age is paralleled with a heightened risk of morbidity and mortality; therefore, owners of older horses must manage changes in their horse, making decisions about management and health care provision. In this paper, we discuss data collected from an open-access online discussion forum, where forum users sought advice arising from concerns about their older horse. Qualitative data analysis was performed using grounded theory methods. A conceptual model was developed to demonstrate the multifaceted ways in which ageing affects the human-horse relationship and impacts upon outcomes for the horse. The model reflects the dynamic nature of caring for an older horse to accommodate change over time-outcomes for the horse shift as the context of day-to-day life changes. The model provides novel insight into how decisions around older horse care are made.

Qualitative study of the influence of horse-owner relationship during some key events within a horse's lifetime

BACKGROUND

There is a lack of research exploring how the horse-human relationship influences horse owners' decision-making. The aim of this study was to investigate how an owner's relationship with their horse affects decisions around key events during their horse's lifetime.

METHODS

An online survey and semi-structured telephone interviews were conducted with horse-owners. The online survey asked horse owners about their experiences of decision-making and their relationship with their horse and identified interview participants. Two semi-structured interviews were conducted with 11 horse owners on their experience of purchasing and euthanasia of horses. Interviews were recorded and transcribed, and thematic analysis was performed.

RESULTS

There were 938 responses to the online survey. The majority of owners considered their horse to be a member of the family (92.9%, 808/870). The mean amount spent annually on their horse was £9215 (range £324-14,240). Seven themes were identified in the interviews including mismatching of horse and rider; financial, time, welfare and personal obligations involved in horse ownership; shared-decision making; the horse's quality of life; guilt and responsibility grief surrounding euthanasia decisions.

CONCLUSION

This study highlighted the strong owner-horse relationship, the significant obligations involved in horse ownership and the emotional impact of euthanasia decisions.

Could it be osteoarthritis? How dog owners and veterinary surgeons describe identifying canine osteoarthritis in a general practice setting

•

Owners describe a range of early behavioural indicators of canine osteoarthritis.

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Their beliefs and prior knowledge may impact when and how they seek advice.

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Vets in general practice describe a common “typical osteoarthritis” presentation.

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History, examination and trial treatment are used to diagnose osteoarthritis.

•

Vets and owners may find osteoarthritis consultations frustrating and unrewarding.

Canine osteoarthritis is a common, painful condition that is typically managed in a general practice setting. Osteoarthritis may have significant negative impacts on the welfare of both dogs and their owners. Anticipated early clinical signs of canine osteoarthritis and the preferred route to its diagnosis are well described by veterinary subject experts in published literature. However, little is known about changes owners first recognise in a dog ultimately diagnosed with osteoarthritis, how they make decisions about when to present that dog to a general practitioner, or whether the described diagnostic pathways are followed by general practitioners. The aim of this research was to investigate how dog owners and veterinary surgeons describe identifying and diagnosing canine osteoarthritis.

Owners of osteoarthritic dogs were recruited for semi-structured interview, and veterinary surgeons working in general practice were invited to take part in practice-based focus groups. Transcripts from both datasets were thematically analysed using a contextualist epistemology with an ontology based on critical realism to construct convergent themes from latent and semantic codes. Thirty-two interviews were completed with 40 owners from 32 households who discussed 35 dogs with osteoarthritis, and 26 veterinary surgeons engaged in four practice-based focus groups.

Owners described identifying a wide range of acute and chronic, typically subtle and intermittent, behavioural and demeanour changes prior to their dogs’ osteoarthritis diagnosis. Few attributed these changes to canine osteoarthritis, and some waited many months before presenting their dog to a veterinary practice. Veterinary surgeons described a consistent ‘typical osteoarthritis’ presentation that they recognised through history taking and clinical examination. Their diagnostic work-up rarely followed that advocated by subject experts for reasons including lack of time and perceptions that it would not change the outcome. Many veterinary surgeons described frustration that some owners did not accept their recommendations to provide analgesia for affected dogs. Short consultation lengths, poor awareness of owner knowledge levels, and lack of recognition of the importance of owners’ prior knowledge, beliefs and assumptions may contribute to these consultations being perceived as challenging by some veterinary surgeons and owners.

This research demonstrates that veterinary surgeons and owners want dogs with clinical signs of osteoarthritis to be happy and comfortable, but that ineffective communication and lack of trust in the consulting room may be a barrier. Our data identifies many new avenues for future research and improved communication strategies that could facilitate earlier identification and treatment of canine osteoarthritis in general practice.

Exploring horse owners' understanding of obese body condition and weight management in UK leisure horses

BACKGROUND

Equine obesity is considered one of the most serious welfare concerns in UK leisure horses, yet little is known about how horse owners conceptualise their horse's weight as part of its health, or how they plan and carry out weight management.

OBJECTIVES

This study aimed to further our understanding of leisure horse owners' perceptions of equine health and awareness of excess fat in order to clarify our understanding of successful strategies for managing equine weight.

STUDY DESIGN

This study used a qualitative research methodology.

METHODS

Data comprised 16 threads from online UK equine discussion fora, 28 individual interviews with leisure horse owners, 19 interviews with equine professionals such as vets and nutritionists, and two focus groups with a further 21 horse owners. Data were anonymised and analysed using a grounded theory approach.

RESULTS

Awareness of excess fat was a complex issue, with owners finding it difficult to differentiate equine obesity from the shape they thought the horse was "meant to be", particularly if the horse was a heavier breed such as a native pony or cob. Owners were not necessarily "aware" or "unaware" of fat, but instead equine body fat was constructed as an integral part of the equine body. For example, owners might say that they thought their horse was an ideal weight yet describe their horse's overall body shape as "like a Thelwell". When owners became aware of fat as a changeable part of the horse's body, and/or a threat to health, the presence of fat was articulated as a strong-willed adversary, and weight management was considered a "battle" or "war". Owners found weight management difficult because they perceived that it had immediate negative welfare implications for the horse, and this therefore interfered with their preferred ownership practices and the horse-human relationship.

MAIN LIMITATIONS

Interview data are self-reported, and people may not always do what they say they do.

CONCLUSIONS

This study has provided valuable insight into how owners conceptualise weight and weight management, yielding important information about communicating with owners about weight, tailoring weight management strategies, and promoting positive welfare.

Mixed methods investigation of the use of telephone triage within UK veterinary practices for horses with abdominal pain: A Participatory action research study

BACKGROUND

Telephone triage is an integral part of modern patient care systems in human medicine, and a key component of veterinary practice care systems. There is currently no published research on telephone triage within the veterinary profession.

OBJECTIVE

To investigate current approaches to telephone triage of horses with abdominal pain (colic) in veterinary practice and develop new resources to support decision-making.

STUDY DESIGN

Participatory action research using mixed-methods approach.

METHODS

An online survey assessed current approaches to telephone triage of horses with colic in UK veterinary practices. Structured group and individual interviews were conducted with four equine client care (reception) teams on their experiences around telephone triage of colic. Evidence-based resources, including an information pack, decision flow chart and recording form, were developed and implemented within the practices. Participant feedback was obtained through interviews six months after implementation of the resources.

RESULTS

There were 116 participants in the online survey. Management and client care staff (53/116) felt less confident giving owner advice (p<0.01) and recognising critical indicators (p = 0.03) compared to veterinary surgeons and nurses (63/116). Thirteen themes were identified in the survey relating to owner advice; exercise and owner safety were most frequently mentioned, but conflicting guidance was often given. Fourteen client care staff were interviewed. They were confident recognising colic during a telephone conversation with an owner and identified the most common signs of critical cases as sweating and recumbency. The new resources received positive feedback; the decision flow chart and information on critical indicators were identified as most useful. After resource implementation, there was an increase in confidence in recognising critical cases and giving owners advice.

MAIN LIMITATIONS

Limited sample population.

CONCLUSIONS

This study described existing approaches to telephone triage, identified variations in advice given, and worked with client care teams to develop new resources to aid decision-making.

An exploration of clinical reasoning and practices used by physiotherapists in the rehabilitation of horses following interspinous ligament desmotomy surgery

INTRODUCTION

Clinical reasoning has not been studied in veterinary physiotherapy and so the methods used and factors involved are unknown. Similarly, the practices of veterinary physiotherapists within a certain rehabilitation programme have not been documented. The aim of this study was to explore the clinical reasoning and practices of veterinary physiotherapists during rehabilitation of horses following interspinous ligament desmotomy surgery.

METHODOLOGY

A qualitative approach was taken and six members of the Association of Chartered Physiotherapists in Animal Therapy were interviewed using a semi-structured approach. The data were transcribed and analysed using Thematic Analysis.

RESULTS

Five themes were identified as relevant to the participants clinical reasoning. These related to structure of the assessment, modalities and reasoning of treatment, involvement of owner and veterinarian and the impact of comorbidities. The data highlight several different factors that influence clinical reasoning and decision making throughout the rehabilitation. An insight into practices involved is also documented.

CONCLUSION

The process of clinical reasoning and decision making described appears complex. The input of both owner and veterinarian are evidently important and require the physiotherapists consideration. Decisions regarding assessment and treatment are influenced by many factors. A mixture of clinical experience and research evidence were used as support.

Indicators of 'critical' outcomes in 941 horses seen 'out-of-hours' for colic

BACKGROUND

This study aimed to describe the presentation and outcomes of horses with signs of colic (abdominal pain) seen 'out-of-hours' in equine practice.

METHODS

This was a retrospective study of horses seen 'out-of-hours' with colic by two equine veterinary practices between 2011 and 2013. Case outcomes were categorised as 'critical' or 'not critical'. A critical outcome was defined as requiring medical or surgical hospital treatment, or resulting in euthanasia or death. A non-critical outcome was defined as resolving with simple medical treatment. A hierarchical generalised linear model was used to identify 'red flag' parameters (aspects of signalment, history and presenting clinical signs) associated with critical outcomes.

RESULTS

Data were retrieved from 941 cases that presented with colic; 23.9 per cent (n=225/941) were critical. Variables significantly associated with the likelihood of a critical outcome in the final multivariable model were increased heart rate (P<0.001), age of the horse (P=0.013) and abnormal mucous membrane colour (P<0.001). Overall 18 per cent (n=168/941) of cases were euthanased.

CONCLUSIONS

This study highlights the mortality associated with colic. The 'red flag' parameters identified should be considered an essential component of the primary assessment of horses with colic.

Aging Equines: Understanding the Experience of Caring for a Geriatric Horse with a Chronic Condition

This study evaluated the experience of 1,448 people in the United States who currently care for or had previously cared for a geriatric horse and how that experience was qualified by the presence or absence of a chronic condition in the horse. An anonymous, online questionnaire was distributed to a cross-country sample to investigate the burden of caregivers from the perspective of owners of geriatric horses. Traumatic events and veterinary care decisions were also explored. Findings from the study supported the hypothesis that owners of geriatric horses with a chronic condition experienced higher levels of physical and emotional care burden, regardless of the age of the geriatric horse. Attachment levels reported by participants were high, regardless of the health status of the horse. This exploratory study provides the equine practitioner a greater understanding of the care burden experienced by owners of geriatric horses, particularly of owners of geriatric horses with a chronic condition, who rely on their veterinarian to guide their management and health care decisions. Veterinarians can help prepare and support clients as they navigate the complexities of caring for an older horse with a chronic condition.

Horse owners' knowledge, and opinions on recognising colic in the horse

BACKGROUND

Colic is the most common emergency problem in the horse. An owner's ability to recognise colic and seek assistance is a critical first step in determining case outcome.

OBJECTIVES

The aim of this study was to assess horse owners' knowledge and opinions on recognising colic.

STUDY DESIGN

Cross-sectional study.

METHODS

An online questionnaire was distributed to horse owners with open and closed questions on their knowledge of normal clinical parameters in the horse, confidence and approach to recognising colic (including assessment through case scenarios), and their demographics. Descriptive and chi squared statistical analyses were performed.

RESULTS

There were 1564 participants. Many respondents either did not know or provided incorrect estimates for their horse's normal clinical parameters: only 45% (n = 693/1540) gave correct normal values for heart rate, 45% (n = 694/1541) for respiratory rate and 67% (n = 1028/1534) for rectal temperature. Knowledge of normal values was statistically associated with participants' educational qualifications (P<0.01). Owners said if they suspected their horse had colic they would assess faecal output (76%; n = 1131/1486), gastrointestinal sounds (75%; n = 1113/1486), respiratory rate (65%; n = 967/1486) and heart rate (54%; n = 797/1486). There was a lack of consensus on whether to call a vet for behavioural signs of colic, unless the signs were severe or persistent. The majority of participants (61%) were confident that they could recognise most types of colic. In the case scenarios, 49% were confident deciding that a surgical case had colic, but 9% were confident deciding an impaction case had colic.

MAIN LIMITATIONS

Most respondents were UK based; risk of self-selection bias for owners with previous experience of colic.

CONCLUSIONS

There was marked variation in horse owners' recognition and responses to colic, and significant gaps in knowledge. This highlights the need for the development of accessible educational resources to support owners' decision-making.

Factors associated with euthanasia in horses and ponies enrolled in a laminitis cohort study in Great Britain

Euthanasia is a complex topic, with animal owners using multiple factors to shape their decision-making process. Previous epidemiological studies have described causes of equine mortality in specific populations, but there is limited evidence regarding factors contributing specifically to equine euthanasia in Great Britain (GB). This observational study used a prospective cohort design: the objectives were to describe owner-reported reasons for euthanasia, estimate the rate of euthanasia and identify associated factors in horses/ponies enrolled in a web-based epidemiological study of laminitis in GB. Self-selected horse/pony owners submitted regular management and health data over 29 months and reported dates and reasons for euthanasia during this period. The overall incidence of euthanasia was estimated and associated factors were identified using multivariable Cox regression modelling, adjusted for age, with variables retained in the final model if P ≤ 0.05. Data were available for 1070 horses/ponies contributing 1093 horse-years at risk (HYAR), with 80 owner-reported euthanasias. The incidence of euthanasia was 7.3 euthanasias per 100 HYAR (95 % confidence interval [CI] 5.9, 9.1). The most frequently reported health reasons contributing to euthanasia were laminitis-related consequences (25.0 % ; CI 16.8, 35.5 %), colic (21.3 % ; CI 13.7, 31.4 %), non-laminitic lameness (20.0 % ; CI 12.7, 30.1 %) and age-related deterioration, including owner-perceived compromised quality of life (20.0 % ; CI 12.7, 30.1 %). Health-related factors associated with significantly higher rates of euthanasia were colic (hazard ratio [HR] 26.4; CI 12.5, 55.8), pituitary pars intermedia dysfunction (HR 3.0; CI 1.7, 5.4) and lameness due to navicular syndrome (HR 5.9; CI 1.8, 20.0), soft tissue injury (HR 6.5; CI 2.7, 15.6) or laminitis (HR 2.7; CI 1.3, 5.7). Further factors included being pure bred (HR 1.7; CI 1.0, 2.8), female (HR 1.7; CI 1.0, 2.9), having poor owner-perceived hoof quality (HR 2.4; CI 1.1, 5.2), being entirely stabled (HR 5.0; HR 2.1, 12.0), being on loan or under temporary care of the study participant (HR 2.3; CI 1.2, 4.4) and participating in affiliated or professional competitions (HR 5.9; CI 2.4, 14.8). Euthanasia rates were significantly higher in the first two study years compared to the third (P < 0.001). Animals whose owners used the study's custom-designed weight tracker tool had significantly lower rates of euthanasia (HR 0.6; CI 0.3, 0.95). This study has identified a number of, arguably preventable, health-related factors associated with higher rates of euthanasia. Data on owners' decision-making process regarding euthanasia, including emotive and financial impacts, were not recorded but are important contributors to euthanasia that require better understanding.

Owners and Veterinary Surgeons in the United Kingdom Disagree about What Should Happen during a Small Animal Vaccination Consultation

Dog and cat vaccination consultations are a common part of small animal practice in the United Kingdom. Few data are available describing what happens during those consultations or what participants think about their content. The aim of this novel study was to investigate the attitudes of dog and cat owners and veterinary surgeons towards the content of small animal vaccination consultations. Telephone interviews with veterinary surgeons and pet owners captured rich qualitative data. Thematic analysis was performed to identify key themes. This study reports the theme describing attitudes towards the content of the consultation. Diverse preferences exist for what should be prioritised during vaccination consultations, and mismatched expectations may lead to negative experiences. Vaccination consultations for puppies and kittens were described to have a relatively standardised structure with an educational and preventative healthcare focus. In contrast, adult pet vaccination consultations were described to focus on current physical health problems with only limited discussion of preventative healthcare topics. This first qualitative exploration of UK vaccination consultation expectations suggests that the content and consistency of adult pet vaccination consultations may not meet the needs or expectations of all participants. Redefining preventative healthcare to include all preventable conditions may benefit owners, pets and veterinary surgeons, and may help to provide a clearer structure for adult pet vaccination consultations. This study represents a significant advance our understanding of this consultation type.

A Pilot Qualitative Investigation of Stakeholders' Experiences and Opinions of Equine Insect Bite Hypersensitivity in England

Equine insect bite hypersensitivity (IBH), commonly known as sweet itch or summer eczema, is a frustrating recurrent skin disease in the equine industry involving an immune reaction to the bites of Culicoides spp. midges. To investigate the impact of IBH in the field, an exploratory pilot study was conducted with equine stakeholders in one region of central England. Nine semi-structured, face-to-face interviews were conducted with horse owners and an equine veterinarian. The aim was to gain an understanding of experiences with IBH, and to gauge opinions on the value of the various management strategies horse owners use to control IBH. Awareness of IBH was generally high, particularly in those individuals who had previous experience with the condition. Those with previous experience of IBH commented on the significant effect on daily routines, and the associated cost implications. Most participants supported an integrated approach to hypersensitivity management, and this most commonly involved a combination of physical barriers and chemical repellents, but sometimes included feed supplementation. Overall, attitudes towards IBH suggested that the condition is a notable welfare and economic concern for stakeholders, but veterinary involvement tended to only be in more severe cases. Further research is required in the future to improve understanding, management and potential treatment of this condition.

Occurrence, treatment protocols, and outcomes of colic in horses within Nairobi County, Kenya

Aim:

The aim of this study was to determine the treatments and their outcomes in horses with colic in Nairobi County, Kenya.

Materials and Methods:

This is a retrospective study to determine the occurrence, treatments, pain management, and outcomes of colic in horses in Nairobi County. Association between pain management protocols and the outcomes of colic with regard to recovery or death was also determined. Data collected from four equine practitioners were organized manually and given numerical codes as appropriate to facilitate entry into the computer. The coded data were entered into Microsoft Excel 2010 and exported to StatPlus pro 5.9.8 statistical package for analysis. Simple association tests were done between various factors and occurrence of colic.

Results:

The incidence of colic for the 11 years was 3.1%, which constituted 68.0% spasmodic colic, 27.8% impaction colic, and 4.2% displacement colic. Flunixin meglumine as a nonsteroidal anti-inflammatory drug (NSAID) was used as the only pain management treatment in 85.3% of the cases, flunixin meglumine and butorphanol as NSAID-OPIOD combination in 6.4% of the cases, while buscopan as an antispasmodic was recorded in 5.9% of the cases mainly in spasmodic colic. Univariate analysis revealed simple association between various factors and the type of colic a horse was having. There was an association between the type of colic and the decision-making on the pain management protocol to use, whether single analgesic protocol (χ²=22.5, p<0.001) or use of analgesic combinations (χ²=18.3, p<0.001). The type of colic strongly influenced the decision for performing nasogastric intubation (χ²=265, p<0.001), but performing nasogastric intubation was weakly (χ²=4.9, p=0.03) associated with horse recovery from colic. Type of colic also strongly influenced the need for the use of metabolic stimulants, particularly vitamin B-complex (χ²=99.3, p<0.001). Recovery or death of the horse from colic was strongly associated with the type of colic (χ²=250, p<0.001). The possibility of recurrence of colic was weakly (χ²=4.6, p=0.04) determined by the type of colic, a horse had. Multivariate logistic regression revealed that the main cause of death was intestinal displacement and the majority of the horses with intestinal displacement died (β-estimate 2.7, odds ratio=0.07, p=0.007) compared to horses that had impaction colic.

Conclusion:

The incidence of colic is 3.1%, and the most common type of colic is spasmodic followed by impaction. The most common pain management protocol for colic is NSAIDs, mainly flunixin meglumine, followed by flunixin-butorphanol combination. Surgery for horses with colic in Nairobi County is not commonly done due to impeding poor prognoses. The horse owners tend to prefer euthanasia for such cases.