Rater Agreement on Gait Assessment during Neurologic Examination of Horses

Background Reproducible and accurate recognition of presence and severity of ataxia in horses with neurologic disease is important when establishing a diagnosis, assessing response to treatment, and making recommendations that might influence rider safety or a decision for euthanasia. Objectives To...

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Published in:	Journal of veterinary internal medicine Vol. 28; no. 2; pp. 630 - 638
Main Authors:	Olsen, E., Dunkel, B., Barker, W.H.J., Finding, E.J.T., Perkins, J.D., Witte, T.H., Yates, L.J., Andersen, P.H., Baiker, K., Piercy, R.J.
Format:	Journal Article
Language:	English
Published:	United States Blackwell Publishing Ltd 01-03-2014 John Wiley & Sons, Inc John Wiley and Sons Inc
Subjects:	Agreement Agreements Animals Ataxia Ataxia - diagnosis Ataxia - veterinary Clinical Science Clinical trials Data analysis Female Gait Horse Diseases - diagnosis Horses Klinisk vetenskap Male Nervous System Diseases - diagnosis Nervous System Diseases - veterinary Neurology Observer Variation Original Physical examination Physical Examination - methods Physical Examination - standards Physical Examination - veterinary Reliability Reproducibility of Results Spinal cord Veterinary medicine Agreement Ataxia Reliability Physical examination
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Summary:	Background Reproducible and accurate recognition of presence and severity of ataxia in horses with neurologic disease is important when establishing a diagnosis, assessing response to treatment, and making recommendations that might influence rider safety or a decision for euthanasia. Objectives To determine the reproducibility and validity of the gait assessment component in the neurologic examination of horses. Animals Twenty‐five horses referred to the Royal Veterinary College Equine Referral Hospital for neurological assessment (n = 15), purchased (without a history of gait abnormalities) for an unrelated study (n = 5), or donated because of perceived ataxia (n = 5). Methods Utilizing a prospective study design; a group of board‐certified medicine (n = 2) and surgery (n = 2) clinicians and residents (n = 2) assessed components of the equine neurologic examination (live and video recorded) and assigned individual and overall neurologic gait deficit grades (0–4). Inter‐rater agreement and assessment‐reassessment reliability were quantified using intraclass correlation coefficients (ICC). Results The ICCs of the selected components of the neurologic examination ranged from 0 to 0.69. “Backing up” and “recognition of mistakes over obstacle” were the only components with an ICC > 0.6. Assessment‐reassessment agreement was poor to fair. The agreement on gait grading was good overall (ICC = 0.74), but poor for grades ≤ 1 (ICC = 0.08) and fair for ataxia grades ≥ 2 (ICC = 0.43). Clinicians with prior knowledge of a possible gait abnormality were more likely to assign a grade higher than the median grade. Conclusion and Clinical Importance Clinicians should be aware of poor agreement even between skilled observers of equine gait abnormalities, especially when the clinical signs are subtle.
Bibliography:	The RCVS Trust Research School KLINIK ArticleID:JVIM12320 Department of Large Animal Sciences Hesteafgiftsfonden Kustos of 1881 University of Copenhagen ark:/67375/WNG-3G7T3F9F-G Danish Agency for Science, Technology and Innovation Oticon istex:E480F203FAF653733062DA50AAEC0A2F0C0B5215 Data S1. Materials and Methods.Data S2. Rater Questionnaire.Table S1. Reliability results in the form of intraclass correlation coefficient for the dichotomous and categorical questions for gait assessment during the equine neurological examination assessed by four to six expert raters. See questionnaire (Data S2) for full details on the questions. Table S2. Reliability results as intraclass correlation coefficient (ICC) for the questions with answers on an ordinal scale. The ICCs are calculated from the gait assessment in the equine neurological examination assessed by four to six expert raters during live sessions only. See questionnaire (Data S2) for full details of the questions. Table S3. Overview of the horses and their median ataxia grade, median lameness grade and conclusions from the spinal cord histopathology. Table S4. Level of clinical significance of the intraclass correlation coefficient ranges for agreement, after Cicchetti. Table S5. Reliability results as intraclass correlation coefficient for the dichotomous and categorical questions in gait assessment in the equine neurological examination assessed by four to six expert raters during live sessions. See (Data S2) for full details of the questions. Table S6. Reliability results as intraclass correlation coefficient (ICC) for the questions with answers on an ordinal scale. The ICCs are calculated from the assessment of gait in the equine neurological examination assessed by four to six expert raters. See questionnaire (Data S2) for full details of the questions. This work has been presented (c) BEVA spring clinical workshop, U.K., April 2013. (e) PhD defence, Taastrup, Denmark, 19 June 2013 (d) Abildgaard symposium, Taastrup, Denmark, March 2013. (a) Abstract and poster at the conference of the European College of Equine Internal Medicine (ECEIM), Le Touquet, France, 2013. (b) Abstract and oral presentation at the 2013 American College of Veterinary Internal Medicine Forum, Seattle, WA. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0891-6640 1939-1676 1939-1676
DOI:	10.1111/jvim.12320