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- Author or Editor: Richard B. Evans x
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Objective—To document the caregiver placebo effect in owners and veterinarians of dogs with lameness from osteoarthritis.
Design—Prospective, randomized, double-blinded, placebo-controlled, multicenter clinical trial.
Animals—58 dogs with lameness secondary to osteoarthritis.
Procedures—Dogs enrolled in the placebo arm of an FDA-approved study were evaluated to determine the relationship between subjective (caregiver responses) and objective (force platform gait analysis) patient outcome measures.
Results—A caregiver placebo effect for owners evaluating their dog's lameness occurred 39.7% of the time. A caregiver placebo effect occurred 44.8% of the time when veterinarians examined dogs for lameness at a walk, 44.8% of the time when veterinarians examined dogs for lameness at a trot, and 43.1% of the time when veterinarians evaluated dogs for signs of pain on palpation of the joint. This effect was significantly enhanced with time. Mean ground reaction forces (GRFs) remained unchanged for dogs during treatment with the placebo. Individually, of 58 dogs, 5 had GRFs that worsened by ≥ 5% over 42 days, 7 had GRFs that improved by ≥ 5% over 42 days, and 46 had GRFs that remained unchanged.
Conclusions and Clinical Relevance—A caregiver placebo effect was common in the evaluation of patient response to treatment for osteoarthritis by both pet owners and veterinarians. Force platform gait analysis was an unbiased outcome measure for dogs with lameness from osteoarthritis. A caregiver placebo effect should be considered when interpreting owner and veterinary reports of patient response to treatment.
Objective—To determine the spatiotemporal gait characteristics and associated covariates of clinically normal dogs and dogs with spinal cord disease.
Animals—42 clinically normal dogs and 24 dogs with myelopathy at spinal cord segment T3-L3.
Procedures—Gait was analyzed for velocity, stride length, stride time, stance time, and swing time and compared between groups with consideration of covariates, including height, weight, velocity, sex, and age.
Results—By use of multivariate regression, dogs with neurologic signs, compared with clinically normal dogs, had decreased stride time, stance time, and stride length in the forelimbs and increased swing time in the hind limbs.
Conclusions and Clinical Relevance—Use of spatiotemporal gait characteristics appears to have potential for use as an outcome measure for dogs with neurologic disease.
Objective—To evaluate severity of medial patellar luxation (MPL) and frequency of concomitant cranial cruciate ligament rupture (CCLR) in dogs.
Design—Retrospective case series.
Animals—162 dogs (266 stifle joints).
Procedures—Medical records of 162 small-breed dogs with MPL were reviewed. Signalment, body weight, luxation grade, bilateral or unilateral MPL, CCLR, and difference in luxation grades between stifle joints were evaluated. Association between severity of MPL and CCLR was investigated.
Results—58 dogs had unilateral MPL, and 104 dogs had bilateral MPL. Dogs ranged from 8.4 months to 16.7 years of age (mean, 5.7 years), and mean body weight was 5.45 kg (12 lb). Forty-one percent of all dogs had concomitant CCLR. Mean age for dogs with MPL alone was 3.0 years, which differed significantly from mean age of dogs with MPL and concomitant CCLR (7.8 years). Dogs with grade IV MPL were significantly more likely to have concomitant CCLR than were dogs with any other grade of MPL. In dogs with bilateral MPL and unilateral CCLR, there was a significantly higher grade of luxation in the stifle joint with CCLR.
Conclusions and Clinical Relevance—Small-breed dogs with MPL and concomitant CCLR were older than were dogs with only MPL. Dogs with grade IV MPL were more likely to have CCLR than were dogs with other grades of MPL. Most dogs with concomitant CCLR had a higher MPL grade in the affected stifle joint than in the intact joint. These findings should be beneficial in client education and clinical diagnosis.
Objective—To evaluate the effects of perioperative oral administration of tramadol, firocoxib, and a tramadol-firocoxib combination on signs of pain and limb function after tibial plateau leveling osteotomy in dogs.
Design—Randomized, blinded, prospective clinical trial.
Animals—30 adult client-owned dogs with unilateral cranial cruciate ligament disease.
Procedures—Dogs were allocated into 3 treatment groups (tramadol, firocoxib, and a tramadol-firocoxib combination). Signs of pain (short-form Glasgow composite measure pain scale), serum cortisol concentrations, and limb function (pressure platform gait analysis) were recorded at several time points before surgery and through 3 days after surgery. Outcome measures were compared among groups.
Results—A significantly greater number of dogs in the tramadol group (8/10 dogs) had a pain score > 6 after surgery, compared with the other groups. No significant differences were detected in the pain scores between the firocoxib and the tramadol-firocoxib combination groups. There were no significant differences in serum cortisol concentrations among the 3 groups. Limb function was significantly decreased for dogs in the tramadol group on days 1 and 2 after surgery and in the firocoxib group on day 1 after surgery. Although limb function decreased for dogs in the tramadol-firocoxib combination group, the change was not significant for any day after surgery.
Conclusions and Clinical Relevance—Dogs that received firocoxib orally, alone or in combination with tramadol, had lower pain scores, lower rescue opiate administration, and greater limb function than dogs that received only tramadol. When used alone, oral administration of tramadol may not provide sufficient analgesic efficacy to treat dogs with pain after orthopedic surgical procedures.
Objective—To determine the relationship between serum cortisol concentration and pain severity as measured by force platform gait analysis in dogs with experimentally induced synovitis of the stifle joint.
Animals—10 healthy hound-type dogs.
Procedures—Dogs underwent 2 study phases. In the first phase, serum cortisol concentration, systolic arterial blood pressure, heart rate, and gait data were obtained at 0 (first sample), 2.5, 5, 7.5, and 10 hours. In the second phase, the same data were gathered immediately before (0 hours) and 2.5, 5, 7.5, and 10 hours after induction of acute urate synovitis in the left stifle joint. Data were statistically evaluated to compare changes in variable values over time and to determine the accuracy of serum cortisol measurements for diagnosis of acute orthopedic pain.
Results—Following induction of synovitis, ground reaction forces were significantly decreased relative to preinduction values at 2.5, 5.0, 7.5, and 10.0 hours and serum cortisol concentration was significantly increased at 2.5 hours. A cortisol concentration of ≥ 1.6 μg/dL indicated pain with a 91% sensitivity and 35% specificity.
Conclusions and Clinical Relevance—In this model, cortisol concentration may be useful for diagnosing pain in dogs. Although, with a cutoff of ≥ 1.6 μg/dL, pain would be detected in most dogs with pain, some pain-free dogs would also be identified as having pain. Conversely, dogs with a serum cortisol of < 1.6 μg/dL would be unlikely to have pain. Validation of this diagnostic test in a large, heterogeneous group of clinical patients is necessary.
Objective—To evaluate the effect of focused extracorporeal shock wave therapy (ESWT) and radial pressure wave therapy (RPWT) on immunohistochemical staining for substance P and calcitonin gene-related peptide (CGRP) in the skin and periosteum of sheep.
Procedures—All 4 limbs of 36 sheep were treated with ESWT, RPWT, or a sham treatment. For 14 days after treatment, at least 2 sheep were euthanized daily and tissue was harvested for histologic evaluation of nerves via staining for substance P and CGRP in the skin and periosteum.
Results—No effects of ESWT or RPWT were observed on the number of nerves with stain uptake for substance P or CGRP in the skin or periosteum.
Conclusions and Clinical Relevance—Substance P- and CGRP-containing nerve fibers are not disrupted by EWST or RPWT. Further studies are needed to identify the mechanism of analgesia observed in association with these treatment modalities.
Objective—To document peak vertical force (PVF) and vertical impulse (VI) in the pads of Greyhounds and Labrador Retrievers.
Animals—8 Greyhounds and 8 Labrador Retrievers.
Procedure—Velocity and acceleration were restricted to ranges of 0.9 to 1.1 m/s and –0.1 to 0.1 m/s2, respectively. The PVF and VI measurements were collected from digital pad (DP)-2, -3, -4, and -5 and the metacarpal pad (McP) or metatarsal pad (MtP) of each limb in each dog.
Results—We found no significant differences between the left and right forelimbs or hind limbs for any pad in either breed. Vertical forces in the forelimb were always greater than those in the hind limb. The PVF in the forelimbs of Greyhounds was greatest in DP-3, -4, and -5 and DP-3, DP-4, and the MtP in the hind limbs. The VI in Greyhound forelimbs was greatest in DP-3, -4, and -5 but greatest in DP-4 in the hind limbs. The PVF in the forelimbs of Labrador Retrievers was greatest in the McP, whereas in the hind limbs it was greatest in DP-4. The VI in Labrador Retriever forelimbs was greatest in DP-3, DP-4, and the McP but greatest in DP-3 and -4 in the hind limbs. Significant differences were detected in load distribution between the breeds.
Conclusions and Clinical Relevance—This study confirms that DP-3 and DP-4 are major weight-bearing pads in dogs. However, loads were fairly evenly distributed, and DP-5 and the McP or MtP bear a substantial amount of load in both breeds. (Am J Vet Res 2004;65:1497–1501)
Objective—To identify the duration and potential mechanisms of analgesia following extracorporeal shock wave therapy (ESWT) and radial pressure wave therapy (RPWT) in limbs of horses and sheep.
Animals—6 horses and 30 sheep.
Procedure—An electrical stimulus was used to identify the nociceptive threshold for each horse daily for 3 days before treatment (baseline) with ESWT or RPWT, 8 hours after treatment, and at 24-hour intervals for 7 days after treatment. Testing was conducted for the treatment field (midmetacarpus or midmetatarsus) and nerve field (medial and lateral forelimb heel bulbs) distal to a treatment site that included the nerve on the abaxial surface of the proximal sesamoid bone. All 4 limbs of 30 sheep were treated with ESWT, RPWT, or a sham treatment. Two sheep were euthanatized daily and tissue harvested for histologic evaluation of nerves, and concentrations of substance P and calcitonin gene-related peptide were measured in the skin and periosteum.
Results—Values did not differ significantly between baseline and after treatment for the treatment field or nerve field sensation. There was a large difference in the slope when data for horses were plotted for the first 3 days after treatment, compared with the slope for days 4 to 7 after treatment. No differences were found in neuropeptide concentrations after treatment of the sheep, but there was an inflammatory response in the treated nerves.
Conclusions and Clinical Relevance—A small cutaneous analgesic effect may exist at the treatment site for approximately 3 days after ESWT or RPWT in horses. (Am J Vet Res 2005;66:1702–1708)
Objective—To measure alterations in lameness severity that occur following use of extracorporeal shock wave therapy (ESWT) in horses with naturally occurring unilateral forelimb lameness.
Design—Nonrandomized clinical trial.
Animals—9 horses with unilateral forelimb lameness.
Procedures—Force platform gait analysis was performed prior to administration of any treatments (baseline) and after use of local anesthesia to eliminate the lameness. Extracorporeal shock wave therapy was then administered, and gait analysis was repeated 8 hours later and then daily for 7 days.
Results—Compared with the baseline value, peak vertical force was significantly increased 8 hours and 2 days after ESWT, and peak vertical force on day 2 was not significantly different from force measured after use of local anesthesia to eliminate the lameness. Similarly, vertical impulse was significantly increased, compared with the baseline value, 8 hours and 2 days after ESWT, but at all times, it was significantly lower than vertical impulse measured after use of local anesthesia.
Conclusions and Clinical Relevance—Results suggest that in horses with naturally occurring lameness, use of ESWT results in a period of acute improvement in lameness severity that typically persists for 2 days. Thus, in horses undergoing ESWT, exercise should be controlled for a minimum of 2 days after treatment to prevent further injury.
OBJECTIVE To compare the effects of 3 walkway cover types on temporospatial and ground reaction force measurements of dogs during gait analysis with a pressure-sensitive walkway (PSW).
ANIMALS 35 client- and staff-owned dogs (25 nonlame and 10 lame).
PROCEDURES In a crossover study design, all dogs were evaluated at a comfortable walk on a PSW to which 3 cover types (a 0.32-cm-thick corrugated vinyl mat or a 0.32- or 0.64-cm-thick polyvinyl chloride yoga mat) were applied in random order. Temporospatial and ground reaction force measurements were obtained and compared among cover types within the nonlame and lame dog groups.
RESULTS Several variables, including maximum peak pressure, maximum force (absolute and normalized as a percentage of body weight), and vertical impulse (absolute and normalized) differed significantly in most comparisons among cover types for both nonlame and lame dogs. There was no significant difference in maximum force values between the 0.32-cm-thick corrugated vinyl and 0.64-cm-thick polyvinyl chloride cover types for both nonlame and lame dogs.
CONCLUSIONS AND CLINICAL RELEVANCE To the authors’ knowledge, the cover type used during data collection with a PSW is rarely provided in published reports on this topic. The findings in this study suggested that to ensure that PSW data for dogs are collected in a standardized manner, the same cover type should be used during follow-up visits to evaluate clinical outcomes, for the duration of research studies, and at all locations for multi-institutional studies. The cover type should be specified in future PSW studies to allow direct comparisons of findings between studies.