Validity and repeatability of goniometry in normal horses

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.

Visually Assessing Equine Quality of Movement: A Survey to Identify Key Movements and Patient-Specific Measures

Outcome measures are essential for monitoring treatment efficacy. The lack of measures for quality of movement in equine physiotherapy and rehabilitation impairs evidence-based practice. To develop a new field-based outcome measure, it is necessary to determine movements most frequently observed during assessment of rehabilitation and performance management cases. An online survey of 81 equine sports medicine veterinarians and equine allied-health clinicians was conducted. The key movements identified included walk and trot on both firm and soft surfaces in a straight line and on a small circle, plus step back, hind leg cross-over, transitions and lunging at walk, trot and canter. The main barriers to observing some movements are access to suitable surfaces and the training level of the horse and handler. Subjective visual assessment of live or videoed horses was the most common method used to track progress of complex movements. The majority (82%) of survey participants agreed or strongly agreed that a modified Patient-Specific Functional Scale would be useful for measuring complex movements. Comments from all professions show a desire to have outcome measures relevant to their needs. This survey identified 24 in-hand movements, which can be used to form the foundation of a simple field-based outcome measure for quality of movement.

Effects of horse housing on musculoskeletal system post-exercise recovery

This study examined the effects of two housing systems (control housing and loose housing) on musculoskeletal condition during recovery from race-like exercise in Standardbred horses. The hypothesis was that a loose housing system provides better conditions for musculoskeletal recovery than the control housing. Eight adult geldings (mean age 11 years) were used in a study with a cross-over design, with the control housing (CH) and loose housing (LH) treatments each run for 21 days. The horses had ad libitum access to forage and performed two similar race-like exercise tests (ET), on day 7 and day 14 in each treatment. Blood samples were collected before ET, at finish line, and at 7, 22, and 44 h of recovery and analysed for the muscle enzyme activities of creatine kinase and amino transferase. Before and three days after ET, hind leg fetlock joint region circumference and diameter, joint range of motion in right hock and carpus, mechanical nociceptive threshold in back muscle, and movement asymmetry were recorded. Overall circumference and overall diameter of hind fetlock joint region were lower in LH horses than CH horses (P=0.045 and P=0.017, respectively), but no other differences were observed. In conclusion, a loose housing system did not alter the recovery of musculoskeletal condition other than preventing a post exercise enlargement of the circumference and diameter of the hind fetlock joint region.

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.

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 Effect of a Physiotherapy Intervention on Thoracolumbar Posture in Horses

Dynamic mobilisation exercises (DME) are often used as part of a physiotherapy rehabilitation programme. Whilst immediate kinematic effects have been measured, the change in posture is anecdotally reported to have a longer duration. This study aimed to test the reliability of a simple objective measurement method, suitable for use in clinical practice, and to objectively measure equine thoracolumbar posture, before and after DME. A single investigator took triplicate measurements of the sagittal thoracolumbar shape using a flexicurve ruler (FCR) then triplicate measurements of the thoracolumbar shape using an adapted FCR (aFCR) in 37 horses. Subsequently, the thoracolumbar shape of 12 horses was measured using the aFCR before random allocation into two groups. Six horses acted as a control group and six horses underwent a series of DME, which included cervical flexion and lateral flexion baited stretches. Measurements were repeated prior to DME, at thirty minutes, one hour and at twenty-four hours after DME to assess thoracolumbar posture. The aFCR ruler had excellent intra-rater reliability compared to a standard FCR (aFCR: p = 0.146; intraclass correlation coefficient (ICC) 0.971; FCR: p = 0.0001; ICC 0.979). Significant increases in flexion occurred in the thoracolumbar region at 30 min (p = 0.027) and one hour (p = 0.046) after DME, but not at 24 h (p > 0.05) with no significant differences in the control group (p > 0.05) between baseline and subsequent times. The results suggest DME create a short-term postural change, determined by using an aFCR, which supports their use as part of a veterinary physiotherapy rehabilitation programme.

Objective measurement in equine physiotherapy

Objective measurement should be incorporated into all areas of physiotherapy including within the assessment and treatment of horses, as there is a need to evaluate the effectiveness of treatment intervention objectively. Whilst objective measures are available in a research laboratory setting it appears that in clinical practice mostly subjective methods of recording assessment and reassessment data are used. This article reviews the objective measures currently available to equine physiotherapists for use in clinical practice, beyond those available in a research laboratory setting. Within the literature there are studies reporting the reliability and validity of objective measures for the assessment of pain, gait, posture, range of motion, palpation and muscle size in horses. Whilst these validated objective measurement tools are available, they are not presently used consistently in clinical practice. In addition, the non-verbal nature of the equine patients precludes the use of self-reporting, meaning that there are no reported functional outcome scores possible similar to use with human patients. However, the combined use of pain responses, behavioural changes and objective measures collected during clinical assessment, both pre and post treatment, could be useful in practice. Equine physiotherapists should integrate more objective methods of recording data from assessments of horses.

Generation of Domains for the Equine Musculoskeletal Rehabilitation Outcome Score: Development by Expert Consensus

Simple Summary

Within rehabilitation, measurements taken before, during and after treatments are used to judge patient progress and the effectiveness of prescribed treatments. To know which measurements to use for a given health condition, practitioners must have knowledge of what should be measured, which measurement tools are available and accurate, alongside what they intend to measure. Composite outcome measures (OMs) are tools which use grouped measurement tests to monitor patient progress; they have been tested for a variety of human and canine conditions but none have been designed or tested for use in physical rehabilitation in horses. This study asked leading equine veterinarians, physiotherapists and researchers which measures should be included in an OM for use in the rehabilitation of horses. Using a process to evaluate agreement, ten areas of measurement were included in the final model: lameness, pain at rest, pain during exercise, behaviour during exercise, muscular symmetry, performance/functional capacity, behaviour at rest, palpation, balance and proprioception. Existing reliable tests used to measure these areas were evaluated and potential new measures discussed and now should be taken forward to testing as a composite outcome score to see if they are effective in measuring effectiveness of treatment.

Abstract

Outcome measures (OMs) are a requirement of professional practice standards in human and canine physiotherapy practice for measurement of health status. Measures such as pain and functional capacity of specific regions are used to track treatment impact and can be used to develop optimal management strategies. To achieve comparable patient care in equine physiotherapy, OMs must be incorporated into practice; however, no reliable and valid OMs exist for equine rehabilitation. This study utilised the experience and opinion of a panel of experts working in the equine rehabilitation sphere to gain consensus on the core areas (domains) to be included in a model, to lead to an OM scale for horses undergoing rehabilitation. The Delphi method and content validity ratio testing was used to determine agreement with domains reaching the critical value required for inclusion. The expert panel agreed on ten domains to be included in the OM scale: lameness, pain at rest, pain during exercise, behaviour during exercise, muscular symmetry, performance/functional capacity, behaviour at rest, palpation, balance and proprioception. An OM with these domains would provide a holistic objective assessment tool which could be used by equine rehabilitation professionals in clinical practice.

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.

The Use of the Water Treadmill for the Rehabilitation of Musculoskeletal Injuries in the Sport Horse

In recent years, exercise on a water treadmill has come to have great relevance in rehabilitation and training centres for sport horses. Its use exploits certain physical properties of water, related to the fundamental principles of hydrodynamics, such as buoyancy, viscosity, hydrostatic pressure, and water temperature. These properties together with deliberate specification of the depth of the water and the velocity of the treadmill provide a combination of parameters that can be varied according to the purpose of the rehabilitation or training programme, the disease to rehabilitate, or the healing phase. In the current article, kinematic adaptations to exercise on a water treadmill and the direct application of such exercise to the rehabilitation of superficial and deep digital flexor tendon and accessory ligament injuries and back and joint diseases are described.