Validity of goniometric joint measurements in cats

Inter-rater reliability in performing stifle goniometry in normal and cranial cruciate ligament disease affected dogs: a prospective randomized controlled study

BACKGROUND

Goniometry can be performed clinically in dogs with cranial cruciate ligament disease (CCLD). The purpose of this study was (1) to compare reliability of stifle goniometry in dogs with CCLD and healthy dogs and (2) to investigate the effect of compliance on measurements. Dogs presented for surgical intervention for CCLD (CCL-Dogs; n = 15) and orthopedically healthy dogs (C-Dogs; n = 11) were enrolled in this prospective randomized controlled trial. In each dog, three observers randomly measured maximum stifle flexion (mSF) and maximum stifle extension (mSE) three times with a standard goniometer with the scale covered, while dog compliance was scored (Scores: C0: excellent - C4: poor). Intraclass correlation coefficient (ICC) was calculated for intra-/interobserver reliability. Effects on measurements were evaluated with mixed-effect models (MEM).

RESULTS

Maximum stifle extension and mSE-compliance were significantly decreased in CCL-Dogs compared to C-Dogs (p ≤ 0.004), but mSF and mSF-compliance did not differ between groups. Intraobserver reliability was excellent for all dogs during mSE (ICC:0.75-0.99) and mSF (ICC:0.89-0.99). Interobserver reliability was excellent for mSF in both groups (ICC: C-Dogs:0.84, CCL-Dogs:0.9) and for mSE in CCL-Dogs (ICC:0.94) but only fair for mSE in C-Dogs (ICC:0.58). Robust MEM showed that the combined average of all mSE measurements of all three observers was affected by compliance in both groups (p < 0.001). This effect was not observed for single mSE-measurements by themselves.

CONCLUSION

The results of this study indicate that compliance may affect goniometric stifle extension measurements in healthy and CCLD dogs. In a clinical setting, intra-/interobserver reliability was excellent for all measurements except for maximum stifle extension in healthy dogs.

Validation of a novel clinical tool for monitoring distal limb stiffness

Objective

To validate a novel technique to measure limb stiffness in a clinical setting.

Animals

Three horses and three ponies owned by the Royal Veterinary College.

Procedures

Limb stiffness indices for both forelimbs were first derived using the gold standard of kinematic analysis. Using the same animals, limb stiffness indices were then calculated using portable floor scales to record weight and an electrogoniometer to record changes in metacarpophalangeal joint angle. The two techniques were then assessed for correlation and repeatability.

Results

The repeatability of limb stiffness measurement using the novel clinical tool was considered to be good based on a small coefficient of variation (5.70%). The correlation of limb stiffness as derived by both methods was high (r = 0.78, p < 0.01). Limb stiffness was positively correlated with the mass of the subject (r = 0.85, p < 0.01), with heavier horses having greater limb stiffness.

Clinical relevance

This study has compared a novel method to measure distal forelimb stiffness non-invasively in a clinical setting to kinematic analysis in six equids. It has demonstrated that limb stiffness increases in a linear fashion with body mass consistent with the role of forelimbs providing energy storage. Because in vivo limb stiffness has been shown previously to alter with injury to the superficial digital flexor tendon, it is hypothesized that this technique will offer a practical technique for the clinician to assess limb stiffness in clinical cases. Further study will be necessary to determine its clinical usefulness in such cases.

Do owner-reported changes in mobility reflect measures of activity, pain and degenerative joint disease in cats?

OBJECTIVES

The aim of this blinded, nested case-control study was to compare cats with and without early owner-reported mobility changes using subjective and objective outcome measures (owner-completed questionnaires, orthopaedic examination).

METHODS

A total of 57 cats with and without early owner-reported signs of impaired mobility were allocated to the case (n = 30) and control (n = 27) groups, respectively. Participating owners completed one inclusion and two pre-visit questionnaires (Feline Musculoskeletal Pain Index, VetMetrica). Cats were then visited in their own homes, where they underwent an orthopaedic examination, an assessment of their body condition score and temperament, and the placement of an accelerometer on their collar for 2 weeks.

RESULTS

There was no significant difference between groups for age category, breed, sex, temperament and body condition score. Case cats scored significantly lower for the Feline Musculoskeletal Pain Index (P = 0.003) and the VetMetrica domain of Comfort (P = 0.002), but not Vitality (P = 0.009) or Emotional Wellbeing (P = 0.018). Total pain (P <0.0001), crepitus (P = 0.002) and thickening (P = 0.003) scores were higher in case cats, as was the presence of bilateral disease (P = 0.005, odds ratio 14) and the number of bilaterally affected joints (P = 0.001).

CONCLUSIONS AND RELEVANCE

Both the Feline Musculoskeletal Pain Index and orthopaedic examination were able to differentiate cats with early owner-reported signs of impaired mobility from healthy cats. VetMetrica Comfort domain scores indicated a compromised quality of life for cats with early owner-reported signs of impaired mobility compared with healthy cats. Being able to recognise signs of mobility impairment earlier would allow interventions aimed at slowing disease progression, thereby improving feline health and welfare.

A new method proposed to explore the feline's paw bones of contributing most to landing pattern recognition when landed under different constraints

Felines are generally acknowledged to have natural athletic ability, especially in jumping and landing. The adage “felines have nine lives” seems applicable when we consider its ability to land safely from heights. Traditional post-processing of finite element analysis (FEA) is usually based on stress distribution trend and maximum stress values, which is often related to the smoothness and morphological characteristics of the finite element model and cannot be used to comprehensively and deeply explore the mechanical mechanism of the bone. Machine learning methods that focus on feature pattern variable analysis have been gradually applied in the field of biomechanics. Therefore, this study investigated the cat forelimb biomechanical characteristics when landing from different heights using FEA and feature engineering techniques for post-processing of FEA. The results suggested that the stress distribution feature of the second, fourth metacarpal, the second, third proximal phalanx are the features that contribute most to landing pattern recognition when cats landed under different constraints. With increments in landing altitude, the variations in landing pattern differences may be a response of the cat's forelimb by adjusting the musculoskeletal structure to reduce the risk of injury with a more optimal landing strategy. The combination of feature engineering techniques can effectively identify the bone's features that contribute most to pattern recognition under different constraints, which is conducive to the grasp of the optimal feature that can reveal intrinsic properties in the field of biomechanics.

Limb-Sparing Surgery in Two Cats Using a Femoral Endoprosthesis with an Integrated Total Knee Replacement Implant

OBJECTIVE

 The aim of this study was to describe a novel limb-sparing technique for the management of feline bone neoplasia using a custom-made femoral endoprosthesis in combination with a total knee replacement (TKR) prosthesis.

METHODS

 Two cats with distal femoral bone tumours underwent pelvic limb salvage procedures with custom-made implants designed from patient-specific computed tomography images to replace the distal femur and the stifle. In case 1, the first-generation implant was a combination of a cemented femoral endoprosthesis with a uniaxial hinged cemented TKR prosthesis. Due to aseptic loosening of the endoprosthesis, revision was performed with a second-generation femoral endoprosthesis modified with a short intramedullary peg and a lateral bone plate for immediate stability. In case 2, a third-generation endoprosthesis with an intramedullary peg and two orthogonal bone plates for immediate stability, combined with a custom-designed rotationally hinged cemented TKR prosthesis, was used. Clinical and radiographic follow-up was recorded.

RESULTS

 After revision surgery in case 1 and with the third-generation implant in case 2, no complications were encountered. Both cats showed minor mechanical restriction of stifle range of motion and good clinical long-term outcome without local tumour recurrence.

CLINICAL SIGNIFICANCE

 The combination of a femoral endoprosthesis and a TKR prosthesis can be a viable alternative for distal femoral limb salvage in cats.

A Systematic Review of Musculoskeletal Mobilization and Manipulation Techniques Used in Veterinary Medicine

Simple Summary

Neck and back pain are common ailments in animals. While there are medical and surgical treatment options available for select patients, conservative care is the most common form of management of pain, stiffness and muscle spasms. Physical therapists, osteopaths and chiropractors use mobilization and manipulation techniques to evaluate and treat muscle and joint problems in both humans and animals, but there seems to be little scientific evidence available to support their use in veterinary medicine. This study reviews the scientific literature with the goal of identifying the clinical indications, dosages, outcome parameters, and efficacy of mobilization and manipulation techniques in dogs and horses. Fourteen articles were included in this review of which 13 were equine and one was a canine study. There was a large variability in the quality of evidence that supports the use of joint mobilization or manipulation in treating pain, stiffness and muscle hypertonicity in horses. Therefore, it was difficult to draw firm conclusions despite all studies reporting positive effects. Future studies need to establish standardized methods to evaluate the optimal dosages of mobilization and manipulation for use in animals.

Abstract

Mobilization and manipulation techniques are often used in small animal and equine practice; however, questions remain concerning indications, dosing and efficacy. A bibliographic search was performed to identify peer-reviewed publications from 1980 to 2020 that evaluated the clinical effects of musculoskeletal mobilization and manipulation techniques in dogs, cats and horses. The search strategy identified 883 papers for review. Inclusion and exclusion criteria were applied. The clinical indications, dosages, outcome parameters, and reported efficacy within each publication were recorded and categorized for comparison with scientific quality assessed according to a standardized grading system. Fourteen articles were included in this systematic review of which 13 were equine and one was a canine study. Seven of these were cohort studies and seven were randomized controlled clinical trials. The canine study involved carpal immobilization-remobilization and all equine studies focused on the effects of passive mobilization (n = 5) or manipulation (n = 8) of the axial skeleton. Study quality was low (n = 4), moderate (n = 7), and high (n = 3) and included a wide array of outcome parameters with varying levels of efficacy and duration of therapeutic effects, which prevented further meta-analysis. Therefore, it was difficult to draw firm conclusions despite all studies reporting positive effects. Optimal technique indications and dosages need to be determined to improve the standardization of these treatment options.

The Effect of Cranial Cruciate Ligament Rupture on Range of Motion in Dogs

Range of motion (ROM) is a measure often reported as an indicator of joint functionality. Both the angle of extension and that of flexion were measured in 234 stifle joints of dogs with cranial cruciate ligament (CCL) rupture. The aims of this study were to investigate the correlation between CCL rupture and alterations in the range of stifle joint motion and to determine whether there was a prevalence modification of one of the two angles. All the extension and flexion angles were obtained from clinical records and were analysed in various combinations. A significant relationship was found between normal angles and abnormal angles; concerning the reduction in the ROM, a significant prevalence in the alteration extension angle was found. Of the 234 stifles, 33 (13.7%) were normal in both angles. These results could offer important insights regarding the influence of CCL rupture on compromising the ROM. This awareness could be a baseline for understanding the ability of surgical treatment to restore one angle rather than another angle, to address the choice of treatment and to help physiotherapists in their rehabilitation program.

Assessment of Orthopedic Versus Neurologic Causes of Gait Change in Dogs and Cats

Diagnosis of forelimb lameness may be challenging, as it not only can be due to multiple common orthopedic diseases but also may occasionally be caused by neurologic disease. A thorough orthopedic and neurologic examination is key to determining which disease category is the likely culprit. Deficits identified on the neurologic examination, such as proprioceptive deficits, changes in reflexes, and presence of spinal hyperesthesia, are key in identifying neurologic causes of forelimb lameness.

Medial pantarsal arthrodesis with Compact UniLock 2.0 locking plate system in a cat

Background:

Pantarsal arthrodesis is a salvage procedure carried out for the treatment of tarsal joint disease, including severe osteoarthritis with intractable pain in the tarsocrural joint, tarsal fractures, shearing injuries, tarsocrural joint instability, and failure of the common calcaneal tendon. Although medial plating is preferable, the high incidence of post-surgery complications is possible. Using thin, pre-contouring or easy contouring, locking plates might reduce the incidence of such complications. However, to date, there are no pre-contouring and dedicated locking plates for pantarsal arthrodesis with medial placement.

Case Description:

The case of an 18-month-old female stray European cat has been referred because of a severe tibiotarsal injury improperly treated with an intramedullary pin. The patient was submitted for medial pantarsal arthrodesis, performed with the Compact UniLock 2.0™ locking plate systema (DePuy Synthes, Oberdorf, Switzerland). The authors hypothesized that this particularly innovative osteosynthesis system could present advantages compared to the systems already in use for medial pantarsal arthrodesis and therefore reduce the risk of complications.

Conclusion:

This innovative titanium locking system, because of its versatile contour function and thinness, allowed the good functional recovery of the limb and showed numerous advantages over traditional systems.

Concurrent Validity of Equine Joint Range of Motion Measurement: A Novel Digital Goniometer versus Universal Goniometer

Simple Summary

With the growth of the field of equine rehabilitation, there is an increased demand on rehabilitation clinicians to utilize simple and reliable objective outcome assessment tools. Goniometry, the measurement of joint angles, traditionally performed with a universal goniometer (UG), is a commonly utilized assessment tool in monitoring problems of the musculoskeletal system, as well as the progression of rehabilitation interventions. Goniometry has been demonstrated to be of value, being both reliable and valid, in humans and other animal species. There are different types of goniometers, each of which has some benefit, but varies in accessibility, cost, and user-friendliness. This study examined the use of a novel digital goniometer (DG) in the measurement of angles of two joints in a horse, and comparing the measurements to those taken with a UG. The study demonstrated significant differences in range of motion for the carpus and fetlock joint, a 2–3° difference comparing measurements on a sedated horse with corresponding radiographs, a “fair” to “excellent” inter-tester reliability and a “fair” to “almost perfect” intra-tester reliability. The novel DG was found to be easier to use than the UG. In conclusion, the novel DG may serve as a simple tool for measuring joint motion in equine rehabilitation patients.

Abstract

Goniometry is the measurement of joint angles with a conventional universal goniometer (UG) or a digital goniometer (DG). The UG is validated for use in dogs and cats. However, it demands both of the user’s hands when measuring. To avoid this, a novel type of DG has been developed, simplifying measurement by offering single-hand usage. The objective of this study is to examine the concurrent validity of the DG. The study consists of measurement with the DG and UG for flexion of the carpus and fetlock on ten horses, and with the DG in flexion and neutral positioning of the fetlock on a sedated horse and corresponding radiographs, intra- and inter-tester reliability and a survey on user-friendliness. The data were analyzed with ANOVA and intraclass correlation coefficient (ICC), with a significance of p < 0.05. The study showed significant differences in range of motion for the carpus and fetlock joint, a 2–3° difference comparing measurements on a sedated horse with corresponding radiographs, a “fair” to “excellent” inter-tester reliability and a “fair” to “almost perfect” intra-tester reliability, and the DG was easier to use than the UG. In conclusion, the novel DG may serve as a simple tool for measuring joint motion in equine rehabilitation patients.

The biomechanical characteristics of a feline distal forelimb: A finite element analysis study

As a typical digitigrade mammal, the uniquely designed small distal limbs of the feline support two to three times of its body weight during daily movements. To understand how force transmission occurs in relation to the distal joint in a feline limb, which transfers bodyweight to the ground, it is necessary to examine the internal stress distribution of the distal joint limb in detail. Therefore, finite element models (FEM) of a healthy feline were established to predict the internal stress distribution of the distal limb. The FEM model included 23 bony components, various cartilaginous ligaments, as well as the encapsulated soft tissue of the paw. The FEM model was validated by comparison of paw pressure distribution, obtained from an experiment for balance standing. The results demonstrated a good agreement between the experimentally measured and numerically predicted pressure distribution in the feline paw. Additionally, higher stress levels were noted in the metacarpal segment, with smaller stresses observed in the phalanges portion including the proximal, middle, and distal segments. The raised metacarpal segment plays an important role in creating a stiff junction between the metacarpophalangeal (MCP) and wrist joint, stabilizing the distal limb. The paw pads help to optimize stress distribution in phalanx region. Findings from this study contribute to our understanding of feline distal forelimb biomechanical behavior. This information can be applied to bionic design of footwear since an optimal stiff junction and pressure distribution can be adapted to enhance injury relief and sports activities. Further developments may include progress, evaluation, and treatment of metatarsophalangeal joint injuries in human populations.

Effect of sedation or general anesthesia on elbow goniometry and thoracic limb circumference measurements in dogs with naturally occurring elbow osteoarthritis

OBJECTIVE

To evaluate the effect of sedation or general anesthesia (GA) on elbow goniometry and thoracic limb circumference (TLC) measurements in dogs with elbow osteoarthritis (OA).

STUDY DESIGN

Prospective study.

ANIMALS

Twenty-four client-owned dogs with radiographically confirmed elbow OA.

METHODS

Elbow goniometry and TLC measurements were made before and after either sedation or GA by using a hand-held goniometer and spring tension measuring tape, respectively. Observers were not allowed to review their pre-sedation or pre-GA measurements at the time of obtaining measurements on dogs under sedation or GA. Mixed analysis of variance models were used to compare elbow goniometry and TLC measurements before and after sedation or GA.

RESULTS

Eleven and thirteen dogs were included in the sedation and GA groups, respectively. Mean elbow flexion decreased by 5° and 3° and mean elbow extension increased by 6° and 2° under sedation and GA, respectively. Total range of motion increased by 11° under sedation and by 5° under GA. Each of these changes was statistically significant (P < .05) except elbow extension under GA (P = .129). Sedation and GA did not influence TLC measurements (P > .05).

CONCLUSION

Sedation or GA led to slight and similar increase in elbow flexion and extension but did not influence TLC measurements in dogs with elbow OA.

CLINICAL SIGNIFICANCE

Sedation or GA can cause slight alterations to goniometric measurements in canine elbows with OA. The protocols used in this study for sedation and GA seem interchangeably acceptable for goniometry and TLC measurements in dogs with elbow OA.

Goniometric Assessment in French Bulldogs

Goniometry is a low-cost, user-friendly and widely available technique used by different veterinary medicine professionals to estimate joint range of motion (ROM). Studies providing breed-specific reference ranges for goniometric measurements are scarce and there is a lack of information regarding joint angles in French Bulldogs. This prospective study set out to determine normal ROM for the carpus, elbow, shoulder, tarsus, stifle and hip joints in healthy, adult French Bulldogs using goniometry. We hypothesized ROM would be similar in this and other dog breeds. Twenty dogs met the inclusion criteria. Sample size was calculated using power analysis based on previous studies. Goniometric measurements were made by a single examiner. Limbs were measured in random order and three measurements made per joint. Dogs were not sedated. Joint angles measured in French Bulldogs in this study were similar to those reported in Labrador Retrievers (shoulder, carpal, and tarsal flexion), Rottweilers (shoulder, carpus, and hip flexion), and Dachshunds (hip, stifle, and tarsal flexion). Similar flexion angles and ROM were detected in right and left limb joints. Findings of this study suggest similar ROM in French Bulldogs and other dog breeds. Lack of radiographic assessment and the fact that goniometric measurements were made by a single examiner were the major limitations of this study.

Radiographic assessment of the equine carpal joint under incremental loads and during flexion

Non-physiologic loading of the carpal bones is believed to result in osteochondral fractures, ligament rupture and axial instability in the equine forelimb; however, the mechanism of carpal damage due to non-physiologic loading of the carpus is largely unknown. To investigate carpal stability (alignment and direction of carpal bones’ movement) under load and during flexion, some previously described carpal parameters were measured on radiographs obtained from 24 equine cadaver limbs (aged 10.71±4.15 years). The limbs were transected at the antebrachial midshaft, axially loaded in a commercial press and serially radiographed under a range of incremental loads (extension) and 2 flexion positions. The extensions were measured by a 10° decrease in the dorsal fetlock angle (DFA) from 160° to 110° (DFA160 to DFA110) using the jacking system of the press; and flexions at palmar carpal angle of 45° and 90° (PCA45 and PCA90). As loading increased from DFA160 to DFA110 there was a progressive significant increase in Third Carpal bone Palmar Facet Angle (C3PalFCA: 86.46±2.54° to 88.60±2.51°) but a decrease in Dorsal Carpal Angle (DCA: 173.03±3.47° to 159.65±4.09°); Medial Carpal Angle (MCA: 186.31±1.90° to 184.61±2.26°); and Groove width of the Cr-Ci intercarpal ligament (GW.Cr-Ci ICL: 9.35±1.20° to 8.83±1.13°) while no significant differences were observed for Distal Radial Slope Carpal Angle (DRSCA) and Intermediate carpal bone Proximal Tuberosity-Radial Angle (CiPxTRA). A generalised medio-distal directional displacement in the carpal bones’ movement were observed. In conclusion, increased load on the forelimb (carpus) produced carpal hyperextension with measurable radiographic changes in the position and alignment of the carpal bones. The non-stretching (strain) or shortening of the Cr-Ci ICL during loading, indicated by the decrease in GW.Cr-Ci ICL, suggests a relaxed intercarpal ligament within a confined space which appears to absorb compressional load transferred from carpal bones and redistribution of concussion forces within the carpal joint during loading thereby providing a useful mechanism to minimise carpal damage.

Unique Differences of Minimally Invasive Fracture Repair in the Feline

As the saying goes, "cats are not small dogs." Throughout veterinary medicine history, most of the literature focus has been on the canine. Feline patients, however, now constitute a larger proportion of the pet population and are unique in many aspects. They differ anatomically and biomechanically from canines and have specific recovery needs and different pain-related behaviors. It is important that veterinary surgeons understand these differences and improve their knowledge base in the treatment of cats. This article highlights the differences in cats relevant to minimally invasive fracture repair and how they affect a surgeon's approach to fractures in cats.

Evaluation of Goniometry and Electrogoniometry of Carpus and Elbow Joints in the Barred Owl (Strix varia)

The motion of wing joints is a critical factor for successful flight in avian patients, but little information is available about goniometry in birds. Elbow and carpus joints in flexed and extended positions from 10 orthopedically normal wings of 6 adult wild barred owls (Strix varia) were evaluated with the animals under general anesthesia using a modified universal plastic goniometer and an electrogoniometer. These measurements were compared to those obtained using radiographic assessment. Intra- and interobserver reliability was calculated. Measurements in live animals were compared to those obtained from frozen-thawed carcasses. Results showed that the modified universal plastic goniometer can be used to obtain accurate results for elbow flexion and extension and for carpal flexion with good to excellent reliability compared to measurements collected from radiographic assessment. Measurements obtained using an electrogoniometer were less accurate and less reliable than those obtained with a plastic goniometer, possibly because of the size and configuration of the model used. Comparison of measurements from live animals and carcasses revealed no significant differences between mean measurements and suggested that further evaluation of carcasses as a model for study of goniometry measurements in avian wing joints should be considered.

Feline shoulder luxation: a cadaveric study of injury and repair using ligament prostheses

OBJECTIVES

To describe the range of motion and clinical stability of the feline shoulder following experimental injury and repair using a prosthetic suture technique.

MATERIALS AND METHODS

Eighteen feline cadaveric thoracic limbs were randomly allocated into three groups: medial injury, lateral injury or bilateral injury. Joint range of motion and clinical stability in all directions was recorded before and after specific anatomic structures were sectioned and following surgical repair using a prosthetic suture technique. Results were compared between intact, injured and repaired limbs for each injury type.

RESULTS

There was a significant difference in joint range of motion in specific limb directions between intact and injured joints and between injured and repaired joints. There was no difference in joint range of motion between intact and repaired joints. Four of six medially injured joints were deemed clinically stable and five of six laterally injured joints were deemed clinically stable. All bilaterally injured joints were deemed unstable.

CLINICAL SIGNIFICANCE

The relative contributions of shoulder stabilisers to joint range of motion and clinical stability provide a reference for clinical cases with suspected shoulder instability. The prosthetic suture repair technique described was effective at returning the shoulder joint to a normal range of motion in this ex vivo model.

A three dimensional multiplane kinematic model for bilateral hind limb gait analysis in cats

Background

Kinematic gait analysis is an important noninvasive technique used for quantitative evaluation and description of locomotion and other movements in healthy and injured populations. Three dimensional (3D) kinematic analysis offers additional outcome measures including internal-external rotation not characterized using sagittal plane (2D) analysis techniques.

Methods

The objectives of this study were to 1) develop and evaluate a 3D hind limb multiplane kinematic model for gait analysis in cats using joint coordinate systems, 2) implement and compare two 3D stifle (knee) prediction techniques, and 3) compare flexion-extension determined using the multiplane model to a sagittal plane model. Walking gait was recorded in 3 female adult cats (age = 2.9 years, weight = 3.5 ± 0.2 kg). Kinematic outcomes included flexion-extension, internal-external rotation, and abduction-adduction of the hip, stifle, and tarsal (ankle) joints.

Results

Each multiplane stifle prediction technique yielded similar findings. Joint angles determined using markers placed on skin above bony landmarks in vivo were similar to joint angles determined using a feline hind limb skeleton in which markers were placed directly on landmarks ex vivo. Differences in hip, stifle, and tarsal joint flexion-extension were demonstrated when comparing the multiplane model to the sagittal plane model.

Conclusions

This multiplane cat kinematic model can predict joint rotational kinematics as a tool that can quantify frontal, transverse, and sagittal plane motion. This model has multiple advantages given its ability to characterize joint internal-external rotation and abduction-adduction. A further, important benefit is greater accuracy in representing joint flexion-extension movements.

Use of single-dose oral gabapentin to attenuate fear responses in cage-trap confined community cats: a double-blind, placebo-controlled field trial

Objectives This double-blind, placebo-controlled study evaluated the safety and efficacy of single-dose oral gabapentin administered for the attenuation of fear responses in cage-trap confined community cats. Methods Community cats presented in cage traps for trap-neuter-return (TNR) were recruited and screened for inclusion. Each enrolled cat was randomly assigned and administered one of three equal-volume, single-dose treatments: placebo, low-dose gabapentin (50 mg) or high-dose gabapentin (100 mg). At baseline, 1, 2, 3 and 12 h post-administration, a single, blinded observer scored each cat for signs of fear and sedation using published paradigms, calculated the respiratory rate and documented any observable facial injuries. Results Fifty-three cats met the inclusion criteria and completed the study. Cat stress score (a measure of fear) was lower in cats that received gabapentin (50 or 100 mg) than in cats that received placebo (50 mg: P = 0.027; 100 mg: P = 0.029), with the greatest reduction at 2 h post-treatment ( P = 0.0007). Respiratory rates did not differ between treatment groups. There was no difference in sedation scores between the groups ( P = 0.86) at any time point ( P = 0.09). Cat facial injuries did not vary by treatment group or over time. No adverse effects were detected specific to gabapentin administration. At 1 h, hypersalivation was observed in four cats across all treatment groups. All cats recovered from surgery and anesthesia uneventfully. Conclusions and relevance This study supports the hypothesis that 50 mg or 100 mg gabapentin (9.2-47.6 mg/kg per cat) reduces fear responses in confined community cats without measurable sedation over 3 h post-administration vs placebo. Gabapentin treatment was well tolerated in this population of cats. Further studies are recommended to investigate the use of oral gabapentin earlier in the TNR process, such as immediately after trapping or prior to transport for the prevention of confinement-related injuries.

Feline talocrural luxation: A cadaveric study of repair using ligament prostheses

Currently recommended surgical techniques to treat severe biaxial feline talocrural soft-tissue injuries commonly lead to unsatisfactory outcome. Data relating to canine talocrural stabilisation may not be useful in cats due to major differences in tarsal anatomy between the species. This experimental biomechanical cadaveric study used specimens (n = 10) prepared from the distal pelvic limbs of five adult cats. The aim was to design a technique for treating talocrural luxation using suture prostheses and bone tunnels, and to investigate its suitability for use in clinical cases. Four prosthetic ligaments were placed through a series of five 1.5 mm bone tunnels. Two prostheses, the caudoproximal pair, were taut in talocrural flexion and two prostheses, the craniodistal pair, were taut in extension. The intact specimens had their range-of-motion (ROM) and stability tested, after which they were transected at the talocrural joint (simulated luxation) and repaired using the technique described. The ROM and stability of the repaired specimens were tested and compared to the intact specimens. The repaired specimens had comparable stability to the intact specimens, although the ROM was different (p <0.05) in six of 16 positions (p <0.003125). These corresponded to the positions where the lateral prostheses were taut. The repair technique described may be useful in the treatment of talocrural luxation, as it is lowprofile in an area of limited soft-tissue cover, allows anatomic reduction, restores normal talocrural joint stability and near-normal tarsal ROM.

Measurements of normal joint angles by goniometry in calves

The aim of this study was to establish normal reference values of the forelimb and hindlimb joint angles in normal Holstein calves.

Thirty clinically normal Holstein calves that were free of any detectable musculoskeletal abnormalities were included in the study. A standard transparent plastic goniometer was used to measure maximum flexion, maximum extension, and range-of-motion of the shoulder, elbow, carpal, hip, stifle, and tarsal joints. The goniometric measurements were done on awake calves that were positioned in lateral recumbency. The goniometric values were measured and recorded by two independent investigators.

As a result of the study it was concluded that goniometric values obtained from awake calves in lateral recumbency were found to be highly consistent and accurate between investigators (p <0.05).

The data of this study acquired objective and useful information on the normal forelimb and hindlimb joint angles in normal Holstein calves. Further studies can be done to predict detailed goniometric values from different diseases and compare them.

Investigating canine elbow joint stabilisation through mechanical constraints of the deep fascia and other soft tissues

The objective of this research was to investigate how the range of flexion and extension of the canine elbow joint is constrained by the mechanical connections and attachments of soft tissue structures. The skin, a section of deep fascia and several muscles from both forelimbs from six adult greyhounds and seven other breeds were sequentially transected or removed, over 13 steps. During each step, repeated measurements of elbow flexion and extension were recorded using a goniometer. Only marginally significant changes to the range of flexion occurred in any of the 13 steps or overall for the greyhounds. Clearly significant changes to extension occurred in several dissection steps. Removing the skin resulted in a significant increase in elbow extension of 1.7° ± 0.3 (P < 0.001) in the greyhounds and 1.6° ± 0.3 (P < 0.001) in the other breeds. Severing the deep fascia from the humerus and its connections across the elbow joint resulted in the largest significant change in elbow extension of 9.9° ± 0.3 (P < 0.001) in the greyhounds and 6.9° ± 0.7 (P < 0.001) in the other breeds. Transecting the biceps brachii m. close to the elbow resulted in an increase of 2.8° ± 0.3 (P < 0.001) in the greyhounds but a non-significant change in the other breeds. Transecting the extensor carpi radialis m. from its origin resulted in an increase of 5.5° ± 0.4 (P < 0.001) in the greyhounds and 3.9° ± 0.7 (P < 0.001) in the other breeds. These results suggest that the collagenous framework and attachments of the skin, deep fascia, and extensor carpi radialis m., play a significant role in the function of the canine elbow by restricting it from overextension and hence stabilising it during periods of loading, in a variety of different canine breeds, and that these structures are functionally integrated into the way the forelimb supports the bodyweight separately from any involvement of muscle tone or muscle movements. Observations on the anatomical connections of the deep fascia between the cranial distal humerus and the antebrachial fascia highlighted its probable importance in relating movements between the shoulder and the carpus.

Evaluating aging in cats: How to determine what is healthy and what is disease

PRACTICAL RELEVANCE

Many of the changes that occur with aging are not considered pathologic and do not negatively affect overall wellness or quality of life. Ruling out disease is essential, however, when attempting to determine whether an aged cat can be considered 'healthy'. A clear understanding of the normal and abnormal changes that are associated with aging in cats can help practitioners make decisions regarding medical management, feeding interventions and additional testing procedures for their aged patients.

CLINICAL CHALLENGES

It can be difficult to determine if a cat is displaying changes that are appropriate for age. For example, healthy aged cats may have hematologic or serum biochemistry changes that differ from those of the general feline population. Assessment of behavioral health and cognitive changes, as well as auditory, olfactory and visual changes, can also be challenging in the aged patient.

GOALS

This is the second of two review articles in a Special Issue devoted to feline healthy aging. The goals of the project culminating in these publications included developing a working definition for healthy aging in feline patients and identifying clinical methods that can be used to accurately classify healthy aged cats. This second review proposes criteria for assessing 'healthy aged cats'.

EVIDENCE BASE

There is a paucity of research in feline aging. The authors draw on expert opinion and available data in both the cat and other species.

Goniometry and Limb Girth in Miniature Dachshunds

Purpose. To report the mean and median pelvic limb joint angles and girth measurements in miniature Dachshunds presenting with varying degrees of pelvic limb weakness secondary to thoracolumbar intervertebral disc extrusion. Methods. 15 miniature Dachshunds who presented to WSU-VTH for thoracolumbar disc extrusion. Dachshunds varied in neurologic status from ambulatory paraparetic to paraplegic at the time of measurements. Results. There were no significant differences in joint angles or girth among the three groups (ambulatory paraparetic, nonambulatory paraparetic, or paraplegic) (P > 0.05). When group was disregarded and values for extension, flexion, and girth combined, no differences existed. Conclusions. Goniometry and limb girth measurements can successfully be made in the miniature Dachshund; however, the shape of the Dachshund leg makes obtaining these values challenging. There were no differences in joint angle or girth measurements between dogs with varying neurologic dysfunction at the time of measurement.

Validity and repeatability of goniometry in normal horses

PURPOSE

To assess validity and inter- and intra-tester reliability of equine goniometry and to establish values for carpal, metacarpophalangeal, tarsal, and metatarsophalangeal flexion and extension in horses.

SUBJECTS

Seventeen healthy equine subjects of varied breeds were used.

METHODS

Three investigators blindly and independently measured in triplicate the extension and flexion of carpal, metacarpophalangeal, tarsal, and metatarsophalangeal joints of 17 horses after sedation. Radiographs of these joints in flexion and extension were acquired while under sedation. Goniometric and radiographic measurements were compared statistically and were correlated. A Bland-Altman plot was constructed. Inter- and intra-tester repeatability of goniometry were evaluated by calculating intraclass correlation coefficients (ICC). Mean flexion and extension of carpal, metacarpophalangeal, tarsal, and metatarsophalangeal joints were calculated.

RESULTS

Goniometric and radiographic measurements did not differ statistically and were significantly correlated (correlation coefficients ranged from 0.59 - 0.89). The mean difference between goniometric and radiographic measurements was 0.4°. Triplicate measurements collected by the three raters did not differ significantly within raters (ICC ranging from 0.950 - 0.995) and between raters (ICC ranging from 0.942 - 0.989).

CONCLUSION

Goniometry is a valid and repeatable tool for evaluation of the range of motion of carpal, metacarpophalangeal, tarsal, and metatarsophalangeal joints in standing, sedated healthy horses.

Feline hip dysplasia: A challenge to recognise and treat

PRACTICAL RELEVANCE

The reported incidence of hip dysplasia (HD) in cats varies dramatically between studies, but the condition is likely more common than we realise. There is little doubt that cats with HD and associated osteoarthritis (OA) suffer pain, and this warrants appropriate therapy.

DIAGNOSTIC CHALLENGES

Clinical signs of HD in cats are often gradual in onset, making them difficult to appreciate, but may include inactivity, pelvic limb lameness, difficulty jumping and climbing stairs, and reluctance to squat to defecate. Often lameness is bilateral, and can be particularly difficult to recognise. The most common radiographic finding is an abnormally shallow acetabulum. Subluxation, however, is not consistently associated with OA in cats and therefore the role that joint laxity plays in disease progression remains uncertain. Degenerative changes of the femoral head and neck seem to develop later than in the dog, and are less marked.

THERAPEUTIC CHALLENGES

The majority of cats respond to non-surgical management with environmental modulation, physical therapy, dietary modulation, weight loss, nutraceuticals and drug therapy. Should non-surgical management not provide sufficient relief, two salvage surgical options are available: femoral head and neck excision (FHNE) and total hip replacement (THR). While there is a risk of complications with micro-THR, the positive outcomes that have been reported indicate that it should be considered in the treatment of coxofemoral pathology in cats in the same way that THR is considered for larger dogs, especially given the inconsistent results associated with FHNE. Monitoring the effect of treatment is challenging as the assessment of pain in cats is complex and there is no validated scoring system or owner-completed questionnaire yet available for cats.

EVIDENCE BASE

There is a paucity of clinical reports focusing solely on HD in cats. The author draws on a combination of published studies, in cats, dogs and humans, as well as personal clinical experience.

Contralateral bone widening and transfer for limb sparing in a cat

OBJECTIVE

To report on a novel surgical procedure to treat a long segmental tibial defect in a five-year-old 5 kg spayed female Main Coon cat using transverse distraction osteogenesis in the contralateral tibia to create a free autograft.

METHODS

A long free bone segment was created from the cranial half of the normal tibia. A circular external fixator was constructed to give the segment 7 mm of cranial distraction. After 42 days the widened section of tibial bone was removed and transferred to the defect in the contralateral tibia. Locking plates were used to stabilize the graft and to protect the donor tibial sites.

RESULTS

By 27 months, both tibias were healed, all implants had been removed, function was excellent, and the overall limb length was 90% of the normal side.

CLINICAL RELEVANCE

Compared with longitudinal distraction osteogenesis in long bone defects, transverse distraction of a normal bone requires a significantly shorter distraction distance to produce a similar amount of bone. Thus, distraction time is reduced, with less likelihood of significant soft tissue damage. New bone may be more reliably regenerated in a normal limb due to better tissue health, and native bone may be more readily incorporated than allografts in compromised sites. Disadvantages include the increased morbidity, as well as the risk and expense associated with involvement of a normal limb.

Feline rehabilitation

Cats have orthopedic problems, including osteoarthritis, fractures, and luxations that are positively impacted by physical rehabilitation. Most cats have an independent behavior that requires using a tactful approach to rehabilitation. Cats often do well with manual therapy and electrophysical modalities. Feline rehabilitation sessions may be shorter than canine rehabilitation sessions. Cats do best with therapeutic exercises when these exercises are linked to hunting, playing, or feeding.

Principles and application of range of motion and stretching in companion animals

Optimal function after injury, surgery, or in patients with chronic conditions requires adequate motion in joints, muscles, tendon, fascia, and skin. Range of motion and stretching exercises are commonly used in companion animal rehabilitation programs to maintain or improve motion of musculoskeletal tissues. Range of motion exercises and stretching prevent adhesions from forming, help scar tissue remodeling, may improve muscle tone, and prevent future injury from occurring. Stretching is used to avoid loss of motion or to regain lost joint motion. Stretching is done manually, using external coaptation, or using therapeutic exercises. Careful documentation of range of motion is necessary.

Goniometric evaluation of both forelimbs and hind limbs in two species of Neotropical monkeys

BACKGROUND

The aim of this study was to evaluate the goniometric measurements of the forelimb and hind limb joints in two species of Neotropical primates maintained in captivity.

METHODS

Eighteen intact monkeys organized into two groups were studied: Group 1-9 brown howlers (Alouatta fusca), and Group 2-9 tufted capuchins (Sapajus apella).

RESULTS

Significant differences were observed in the maximum flexion of the shoulder, elbow, carpus, stifle, and tarsus (G1>G2); maximum extension and abduction of the shoulder (G1<G2); maximum extension (G1>G2) and adduction (G1<G2) of the carpus; and maximum extension, abduction and adduction of the hip (G1>G2). The ROM was significantly different in all joints: shoulder (G1<G2), elbow (G1<G2), carpus (G1>G2), hip (G1>G2), stifle (G1<G2), and tarsus (G1<G2).

CONCLUSIONS

A. fusca and S. apella maintained in captivity have significant differences in the goniometric measurements of both forelimb and hind limb joints, primarily in maximum flexion and ROM.

Goniometria dos membros torácicos e pélvicos de ovinos em duas faixas etárias

O trabalho teve por objetivo comparar os valores goniométricos das articulações dos membros torácicos e pélvicos em ovinos da raça Santa Inês em duas faixas etárias (jovens e adultos). Foram utilizados 30 ovinos hígidos, fêmeas, divididos em dois grupos: Grupo 1 com 15 animais jovens (idade entre 6 e 12 meses), Grupo 2 com 15 animais adultos (entre 3 e 6 anos). Foram aferidas a máxima flexão, a máxima extensão e calculou-se a amplitude de movimento das articulações, direita e esquerda, dos membros torácicos (ombro, cotovelo e carpo) e pélvicos (coxofemoral, joelho e tarso), com o emprego de um goniômetro universal de plástico. Cada articulação foi aferida em triplicata por dois avaliadores com o animal em estação. Não foram detectadas diferenças estatísticas entre as médias em ambos os lados, entre os avaliadores ou entre os grupos. Foi possível assim concluir que, em ovinos hígidos, os valores goniométricos não foram influenciados pela idade.

Relationship of orthopedic examination, goniometric measurements, and radiographic signs of degenerative joint disease in cats

Background

Available information suggests a mismatch between radiographic and orthopedic examination findings in cats with DJD. However, the extent of the discrepancy between clinical and radiographic signs of OA in companion animals has not been described in detail. This study aimed to evaluate the relationship between orthopedic examination findings, joint goniometry, and radiographic signs of DJD in 100 cats, in a prospective observational design. Cat temperament, pain response to palpation, joint crepitus, effusion and thickening were graded. Radiographs of appendicular joints and the axial skeleton were made under sedation. Joint motion was measured by use of a plastic goniometer before and after sedation. Associations between radiographic degenerative joint disease (DJD) and examination findings were assessed to determine sensitivity, specificity and likelihood estimations.

Results

Pain response to palpation was elicited in 0-67% of the joints with DJD, with a specificity ranging from 62-99%; crepitus was detected in 0-56% of the joints and its specificity varied between 87 and 99%; for effusion, values ranged between 6 and 38% (specificity, 82-100%), and thickening, 0-59% (specificity, 74-99%). Joints with DJD tended to have a decreased range of motion. The presence of pain increased the odds of having DJD in the elbow (right: 5.5; left: 4.5); the presence of pain in the lower back increased the odds of spinal DJD being present (2.97 for lumbar; 4.67 for lumbo-sacral).

Conclusions

Radiographic DJD cannot be diagnosed with certainty using palpation or goniometry. However, negative findings tend to predict radiographically normal joints. Palpation and goniometry may be used as a tool to help to screen cats, mostly to rule out DJD.

Dose range finding study for the efficacy of meloxicam administered prior to sodium urate-induced synovitis in cats

OBJECTIVE

To determine the lowest efficacious dose of oral meloxicam for relieving pain in cats with a sodium urate (SU)-induced acute inflammatory synovitis.

STUDY DESIGN

Randomized, blinded, controlled, and four-way crossover study.

ANIMALS

Eight surgically neutered cats (four males, four females) paired according to sex.

METHODS

Each pair of cats was treated with 0 (placebo), 0.025, 0.05, or 0.075 mg kg(-1) oral meloxicam once daily for 4 days prior to injection, into alternating stifles, of 1 mL of 20 mg mL(-1) SU crystals, beginning with the right stifle. Each cat received each of the four treatments, separated by at least 21 days. Analgesic efficacy was evaluated based on objective (e.g., pressure mat data total force, contact pressure, and contact area) and subjective (e.g., scores for Analgesia Scale [AS], Lameness Scale [LS], and Visual Analog Scale [VAS]) outcome measures for pain assessment. All outcome measures were recorded before and during 30 hours after SU injection. The pre-defined primary outcome measure was the area under the response-time curve (AUC(0-30) hours) of the total force of the injected limb. Data were analyzed by analysis of variance. A sequential test procedure was applied and the test sequence stopped in case of a nonsignificant result.

RESULTS

Meloxicam at doses of 0.05 and 0.075 mg kg(-1) day(-1) PO was significantly different from placebo for the pre-defined primary outcome measure (i.e., AUC(0-30) hours of total force). All tested meloxicam doses were lower than placebo for the subjective outcome measures (i.e., AUC(0-30) hours of AS, LS, and VAS).

CONCLUSIONS AND CLINICAL RELEVANCE

The lowest efficacious dose of meloxicam for relieving pain in cats with an SU-induced synovitis was 0.05 mg kg(-1) day(-1) PO according to the pre-defined primary outcome measure. However, lower doses may also be effective as seen in the subjective outcome measures.

Orthopedic examination in the cat: clinical tips for ruling in/out common musculoskeletal disease

PATIENT GROUP

The majority of cats will develop radiographic evidence of degenerative joint disease by the time they are 12 years of age, and many will suffer from a decline in quality of life associated with undiagnosed and untreated orthopedic disease.

PRACTICAL RELEVANCE

A focused, efficient orthopedic examination, including gait observation and palpation (awake and under sedation), supplemented with appropriate history, is key in ruling in, or out, clinically important musculoskeletal disease. Identifying problems assists in both developing a diagnostic plan and monitoring response to treatment.

CLINICAL CHALLENGES

Many clinicians feel uncomfortable in their ability to reliably perform an orthopedic examination in the cat, and diagnosis and evaluation of response to treatment in cats with orthopedic disease can be challenging. Hands-on training in feline orthopedic examination is limited in many veterinary curricula. Additional constraints may include failure to obtain important information in the history that indicates feline orthopedic disease, lack of appropriate facilities in which to conduct a complete orthopedic examination, and inability to obtain the most important information during the time available to conduct the examination. These problems can create gaps in the practitioner's ability to provide excellent care for a large proportion of the feline population.

GOALS

The above challenges can mostly be overcome with advanced planning and with consideration of the unique behavioral aspects related to feline handling. As discussed in this review, the aim of the initial orthopedic examination is to localize the problem to a specific limb, ideally to a region or joint of the limb, which can further direct diagnostics such as radiography or arthrocentesis. This should provide a basis for follow-up and assessment of whether treatment strategies are effective.

Hips, elbows and stifles: common joint diseases in the cat

PRACTICAL RELEVANCE

Cats commonly present with joint disease and trauma. A methodical approach to diagnostics and treatment can aid the clinician in the management of these cases.

CLINICAL CHALLENGES

Cats with joint disease may present with a vague history owing to their independent nature, and gait assessment is often challenging when compared with the dog. Knowledge of feline-specific anatomy is important to avoid over- or misinterpretation of physical examination or imaging findings.

AUDIENCE

This review of feline joint disease focuses on the more common, non-traumatic conditions of the hip, stifle and elbow. It aims to provide first opinion clinicians with a guide to decision making that will assist them in achieving a diagnosis and formulating a management strategy.

EVIDENCE BASE

There is an extensive body of original articles and textbooks in the published literature relating to aspects of feline joint disease. This article combines information from key companion animal and feline-specific references together with the author's clinical experience to provide a practical overview of joint disease, and highlight important differences between cats and dogs in terms of presentation and treatment.

Validity of goniometric elbow measurements: comparative study with a radiographic method

BACKGROUND

A universal goniometer is commonly used to measure the elbow's ROM and carrying angle; however, some authors question its poor intertester reliability.

QUESTIONS/PURPOSES

We (1) assessed the validity of goniometric measurements as compared with radiographic measurements in the evaluation of ROM of the elbow and (2) determined the reliability of both.

METHODS

The ROM and carrying angle of 51 healthy subjects (102 elbows) were measured using two methods: with a universal goniometer by one observer three times and on radiographs by two independent examiners. Paired t-test and Pearson's correlation were used to compare and detect the relationship between mean ROM. The maximal error was calculated according to the Bland and Altman method.

RESULTS

The intraclass correlation coefficients (ICC) ranged from 0.945 to 0.973 for the goniometric measurements and from 0.980 to 0.991 for the radiographic measurements. The two methods correlated when measuring the total ROM in flexion and extension. The maximal errors of the goniometric measurement were 10.3° for extension, 7.0° for flexion, and 6.5° for carrying angle 95% of the time. We observed differences for maximum flexion, maximal extension, and carrying angle between the methods.

CONCLUSION

Both measurement methods differ but they correlate. When measured with a goniometer, the elbow ROM shows a maximal error of approximately 10°.

CLINICAL RELEVANCE

The goniometer is a reasonable and simple clinical tool, but for research protocols, we suggest using the radiographic method because of the higher level of precision required.

DJD-associated pain in cats: what can we do to promote patient comfort?

PRACTICAL RELEVANCE

Degenerative joint disease (DJD) has a high prevalence in domestic cats and can be associated with pain. This pain should be addressed wherever possible.

AUDIENCE

All practitioners are faced with cats that are mobility impaired due to DJD-associated pain.

PATIENT GROUP

Cats of all ages and breeds, and either sex, can experience DJD-associated discomfort.

CLINICAL CHALLENGES

Recognizing DJD and assessing DJD-associated pain in cats is a challenge. Owner observations of activity and behavior, careful observation and a logical and thorough orthopedic evaluation are key. Current understanding of the etiology of feline DJD and the mechanisms of DJD-associated pain is incomplete, making the rational choice of treatments a further challenge.

EVIDENCE BASE

Evidence is emerging on the prevalence of feline DJD, and on how to assess the associated pain and mobility impairment. There is a lack of information on the etiology of feline DJD and a relative lack of data on the efficacy of putative treatments.

The canine shoulder: selected disorders and their management with physical therapy

The shoulder joint is the most mobile of all main limb joints. While its primary motion is in a sagittal plane, the shoulder has a significant amount of abduction and adduction, and internal and external rotation. Its stability is ensured by the joint capsule, by its specialized bands (medial and lateral glenohumeral ligaments), and by large tendons located inside (eg, tendon of origin of the biceps brachii muscle) or immediately outside the joint (eg, supraspinatus, infraspinatus, teres minor, and subscapularis). Sprains or strains of all supporting structures of the canine shoulder have now been reported and the shoulder pathology resembles the pathology of the human shoulder that includes strains and tears of the rotator cuff muscles, adhesive capsulitis, and calcific tendonitis.

Techniques for objective outcome assessment

Companion animal rehabilitation, a collaborative practice of physical therapy and veterinary medicine, can only demonstrate the effectiveness of its theories, techniques, interventions, and modalities through evidence-based practice, utilizing standardized, reliable, and valid outcome measures, correlated with objective diagnostic data. This essay examines existing and potential objective outcome measures utilized in companion animal rehabilitation and physical therapy regarding pain, vital signs, body condition and composition, range of motion, muscle strength, inflammation, functional mobility, and gait. Discussion is included of the traditional disablement model and the evolution of the physical therapy diagnosis, prognosis, and plan of care.