Evaluation of mild lameness in horses trotting on a treadmill by clinicians and interns or residents and correlation of their assessments with kinematic gait analysis

Kevin G. Keegan From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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David A. Wilson From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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Daniel J. Wilson From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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Bryan Smith From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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Earl M. Gaughan From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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R. Scott Pleasant From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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James D. Lillich From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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Joanne Kramer From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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Rick D. Howard From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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Christy Bacon-Miller From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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Elizabeth G. Davis From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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Kimberly A. May From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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Hoyt S. Cheramie From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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William L. Valentino From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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Phillip D. van Harreveld From the Department of Veterinary Medicine and Surgery, College of Veterinary Medicine (Keegan, Wilson DA, Kramer, Bacon-Miller), and the Department of Physical Medicine and Rehabilitation, Rusk Rehabilitation Center (Wilson DJ, Smith), University of Missouri, Columbia, MO 65211; the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506 (Gaughan, Lillich, Davis, Valentino, van Harreveld); and the Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061 (Pleasant, Howard, May, Cheramie).

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Abstract

Objective

To estimate sensitivity and accuracy of subjective evaluation of mild lameness in horses during treadmill locomotion and to correlate subjective evaluation with kinematic analysis.

Animals

19 lame and 5 clinically normal horses.

Procedure

Lameness was evaluated by subjective score and kinematic analysis before and after palmar digital nerve block (PDNB). Evaluations were made by 6 clinicians and 7 interns or residents. Within- and between-observer agreement analyses (κ values) were calculated and compared, using a Student’s t-test. Pearson’s product-moment correlation coefficients were calculated between clinician’s change in score and the change in kinematic variables after PDNB.

Results

Within-observer agreement was within the range expected for conditions of moderate diagnostic difficulty. Within-observer agreement was higher for clinicians than for interns or residents. Between-observer agreement was acceptable for scores within 1 value of each other. Between-observer agreement of change in lameness score after PDNB was poor. When kinematic variables were ranked with each clinician’s subjective change in score, only 2 were among the top 3 for the majority of clinicians. Asymmetry of vertical head movement between contralateral forelimb stance phases and the point of maximum hoof height during swing decreased as lameness subjectively improved.

Conclusion

Mild lameness may be difficult to evaluate during treadmill locomotion. Although clinicians were more repeatable in their subjective evaluation of lameness than interns or residents, they were not more reliable at detecting the true state of lameness.

Clinical Relevance

Lack of agreement between clinician scoring of mild lameness emphasizes the need to use more objective measures for quantifying lameness. (Am J Vet Res 1998;59:1370–1377)

Abstract

Objective

To estimate sensitivity and accuracy of subjective evaluation of mild lameness in horses during treadmill locomotion and to correlate subjective evaluation with kinematic analysis.

Animals

19 lame and 5 clinically normal horses.

Procedure

Lameness was evaluated by subjective score and kinematic analysis before and after palmar digital nerve block (PDNB). Evaluations were made by 6 clinicians and 7 interns or residents. Within- and between-observer agreement analyses (κ values) were calculated and compared, using a Student’s t-test. Pearson’s product-moment correlation coefficients were calculated between clinician’s change in score and the change in kinematic variables after PDNB.

Results

Within-observer agreement was within the range expected for conditions of moderate diagnostic difficulty. Within-observer agreement was higher for clinicians than for interns or residents. Between-observer agreement was acceptable for scores within 1 value of each other. Between-observer agreement of change in lameness score after PDNB was poor. When kinematic variables were ranked with each clinician’s subjective change in score, only 2 were among the top 3 for the majority of clinicians. Asymmetry of vertical head movement between contralateral forelimb stance phases and the point of maximum hoof height during swing decreased as lameness subjectively improved.

Conclusion

Mild lameness may be difficult to evaluate during treadmill locomotion. Although clinicians were more repeatable in their subjective evaluation of lameness than interns or residents, they were not more reliable at detecting the true state of lameness.

Clinical Relevance

Lack of agreement between clinician scoring of mild lameness emphasizes the need to use more objective measures for quantifying lameness. (Am J Vet Res 1998;59:1370–1377)

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