Cross-sectional survey of cat handling practices in veterinary clinics throughout Canada and the United States

Carly M. Moody 1Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

Search for other papers by Carly M. Moody in
Current site
Google Scholar
PubMed
Close
 MSc, PhD
,
Cate E. Dewey 1Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

Search for other papers by Cate E. Dewey in
Current site
Google Scholar
PubMed
Close
 DVM, PhD
, and
Lee Niel 1Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

Search for other papers by Lee Niel in
Current site
Google Scholar
PubMed
Close
 PhD

Click on author name to view affiliation information

Abstract

OBJECTIVE

To assess handling techniques commonly used during routine examinations and procedures used for calm, fearful, and aggressive cats by veterinarians and nonveterinarian staff at Canadian and US veterinary practices and to evaluate demographic factors associated with those handling techniques.

SAMPLE

310 veterinarians and 944 nonveterinarians who handle cats at Canadian and US veterinary practices.

PROCEDURES

An online questionnaire was developed to evaluate respondent demographics and use of common cat handling practices and techniques. A snowball sampling method was used to send a link to the questionnaire to members of Canadian and US veterinary-affiliated groups. Descriptive statistics were generated; logistic regression was used to identify demographic factors associated with the use of minimal and full-body restraint with scruffing during routine examination and procedures for fearful and aggressive cats.

RESULTS

Full-body restraint was used to handle cats of all demeanors, although its frequency of use was greatest for fearful and aggressive cats. Veterinarians and nonveterinarians who graduated from veterinary training programs before 2006 were less likely to use full-body restraint for cats of all demeanors, compared with nonveterinarians who did not graduate or graduated between 2006 and 2015. Other factors associated with decreased use of full-body restraint included working at an American Association of Feline Practitioners-certified practice and working at a Canadian practice.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that full-body restraint is commonly used to handle cats. Further research is necessary to determine whether current handling recommendations are effective in decreasing stress for cats during veterinary visits.

Abstract

OBJECTIVE

To assess handling techniques commonly used during routine examinations and procedures used for calm, fearful, and aggressive cats by veterinarians and nonveterinarian staff at Canadian and US veterinary practices and to evaluate demographic factors associated with those handling techniques.

SAMPLE

310 veterinarians and 944 nonveterinarians who handle cats at Canadian and US veterinary practices.

PROCEDURES

An online questionnaire was developed to evaluate respondent demographics and use of common cat handling practices and techniques. A snowball sampling method was used to send a link to the questionnaire to members of Canadian and US veterinary-affiliated groups. Descriptive statistics were generated; logistic regression was used to identify demographic factors associated with the use of minimal and full-body restraint with scruffing during routine examination and procedures for fearful and aggressive cats.

RESULTS

Full-body restraint was used to handle cats of all demeanors, although its frequency of use was greatest for fearful and aggressive cats. Veterinarians and nonveterinarians who graduated from veterinary training programs before 2006 were less likely to use full-body restraint for cats of all demeanors, compared with nonveterinarians who did not graduate or graduated between 2006 and 2015. Other factors associated with decreased use of full-body restraint included working at an American Association of Feline Practitioners-certified practice and working at a Canadian practice.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that full-body restraint is commonly used to handle cats. Further research is necessary to determine whether current handling recommendations are effective in decreasing stress for cats during veterinary visits.

Much attention has been focused on handling and restraint techniques used for cats in veterinary clinics in recent years. For some cats and their owners, visits to veterinary clinics are associated with negative experiences, which often leads to a decreased willingness on the part of the owners to take their cats to veterinarians for routine health visits.1–6 In a survey3 conducted in Italy, 944 of 1,111 (85%) cat owners perceived that their cat's welfare was impaired while it was restrained on an examination table during veterinary visits. Results of that survey3 also suggest that cat owners’ assessment of pet care at a veterinary clinic is based on a veterinarian's ability to handle their cat, with rough or careless handling of a cat leading to a negative impression of the veterinarian. In a survey5 of US veterinarians, respondents reported that pet owners delayed bringing injured and sick pets to a veterinary clinic on the basis of past negative experiences. This is concerning because routine veterinary care helps maintain the health and welfare of a pet over its lifetime.4,6,7 One way to reduce negative associations with veterinary visits is to provide positive experiences and reduce animal stress during routine handling for examinations and procedures.

Cat fear and aggression can result in difficulty in handling and restraint for routine examination and lead to incomplete examinations with the potential for inaccurate diagnoses and treatments.3,8 Appropriate handling and restraint of patients are key for the prevention of animal bites and scratches to veterinarians and veterinary staff members.9 Cat bites and scratches are common animal-related injuries incurred by veterinary staff in small animal clinics,9–13 with hand and arm injuries generally occurring during restraint and treatment of cats in examination and treatment rooms.9,12

Many cat-handling guidelines and low-stress initiatives exist,14–22 such as the AAFP cat-friendly certification programa (AAFP-certified practice) and Dr. Sophia Yin's low-stress handling program.b These programs aim to minimize fear and stress in cats during veterinary visits and thereby reduce the potential for aggressive behavior and encourage positive experiences for the animal, owner, and handler. Handling recommendations provided by these guidelines include the use of passive and minimal restraint techniques when possible. Some guidelines recommend the use of full-body restraint on a case-by-case basis,17,18,22 whereas others suggest that alternative restraint methods should be used altogether.14,16,21 One guideline16 states that manual restraint techniques such as full-body immobilization and scruffing are inappropriate. Most guidelines generally suggest the use of alternatives to manual full-body and scruff restraint techniques such as towel wraps, and the AVMA's policy on physical restraint of animals recommends use of the minimal restraint necessary to safely perform an examination or procedure.23 Other recommendations to help improve a cat's experience at a veterinary clinic include handling the patient where it is most comfortable rather than strictly on an examination table, offering positive reinforcement and distraction (eg, treats) during examinations and procedures, using chemical restraint when necessary, and providing clients with information on methods to reduce stress for their pet during future visits. Implementation of these recommendations is thought to be important for improving the veterinary visit experience for both the cat and owner and enhancing the client-veterinarian relationship. Moreover, low-stress handling should facilitate examination, diagnosis, and treatment of cats and increase cat owners’ willingness to bring their cats back to a veterinary clinic for routine care.

It is unknown whether low-stress cat-handling recommendations are widely implemented in veterinary practices. Therefore, the purpose of the study reported here was to assess current handling techniques commonly used during routine examinations and procedures for cats with 3 types of demeanors (calm, fearful, or aggressive) by veterinarians and nonveterinarian staff at veterinary clinics throughout Canada and the United States and to evaluate demographic factors associated with those handling techniques.

Materials and Methods

Study population

The study protocol was reviewed and approved by the University of Guelph Research Ethics Board. The target population for the study consisted of licensed veterinarians and nonveterinarian staff who routinely handled cats and worked at veterinary clinics in Canada or the United States.

Questionnaire

A questionnaire was developed for online distribution to veterinarians and nonveterinarians who handled cats and worked at veterinary practices in Canada and the United States. Results of previous veterinary questionnaires indicate that respondent demographic factors influence attitudes and practices related to animal care and welfare. For example, in surveys completed by Canadian veterinarians,24–26 administration of postoperative analgesics was significantly influenced by a respondent's gender and year of graduation and whether the clinic where that person worked employed veterinary technicians. Therefore, for the questionnaire developed for the study reported here, respondent demographics such as current position (practicing veterinarian, veterinary technologist, veterinary assistant, or other), gender, postsecondary training program attended, and year of graduation were included as putative factors that might influence how a respondent handles cats. Specifically, we assessed whether individual or clinic demographics influenced techniques used to restrain cats for examinations and procedures.

The questionnaire was comprised of 4 sections that included respondent demographics (n = 7 questions), general handling methods used for cats (9), frequency of use for 15 handling techniques (6), and location of cat handling in the examination room (1). The term secure restraint and cat mask were used as synonyms for full-body restraint and cat muzzle in the questionnaire; however, full-body restraint and cat muzzle were used here for consistency with current literature.

Demographic questions were designed to glean information regarding a respondent's gender, current position in a veterinary clinic and whether that position required schooling, year of graduation, and province or state where employed. General handling questions were designed to determine whether the clinic where a respondent worked had a cats-only examination room, the mean number of cats examined and treated at the clinic on a daily basis, the standard protocol for approaching and handling cats at the clinic, and how often a preexamination was performed by a nonveterinarian, the respondent handled cats (eg, daily or weekly), treats were provided to cats during handling, chemical restraint was used for fearful or aggressive cats, and information on how to decrease stress for cats at future veterinary visits was provided to cat owners. Additionally, respondents were asked whether the primary clinic where they worked was an AAFP-certified practice because that was the only cat-handling certification program available for veterinary practices at the time the survey was conducted.

The third section of the questionnaire assessed the frequency with which 15 cat-handling techniques were used on calm (patient appears relaxed with no signs of aggression or fear-related behavior), fearful (patient is immobile with signs of fear-related behaviors such as lowered posture, dilated pupils, and flattened ears but does not attempt to bite or scratch the handler), and aggressive (patient exhibits signs of fear or escape-related behaviors while attempting to bite or scratch the handler) cats during routine physical examinations and procedures (eg, nail trimming and blood and urine sample collection; Supplementary Appendix S1, available at: avmajournals.avma.org/doi/suppl/10.2460/javma.256.9.1020). For most of the handling techniques, respondents were provided with a description and photograph depicting use of the technique; photographs were provided by the AAFP as well as anonymous sources. Respondents were asked to subjectively evaluate the frequency with which they used each technique as always, often, sometimes, rarely, or never. The last section of the questionnaire assessed how frequently various locations within an examination room (eg, floor, examination table, scale, chair, or patient carrier) were used for handling calm, fearful, and aggressive cats.

Four veterinarians from Guelph, ON, Canada, pretested the questionnaire to assess its clarity and face validity. Feedback from those veterinarians was used to refine the questions and create the final questionnaire.

The questionnaire was administered by use of an online survey software programc and was available from July 27 to December 29, 2015. Snowball sampling was initiated by use of email invitations that included an advertisement containing a link to the questionnaire along with a request for recipients to distribute the advertisement to associated member lists and websites and social media accounts. Email invitations were sent to all Canadian Veterinary Medical Association and AVMA bodies and all Canadian and US veterinary technologist and technician organizations as well as the American Association of Veterinary Clinicians, Veterinary News Network, Veterinary Hospital Managers Association, Cat Healthy, American Board of Veterinary Practitioners, American Veterinary Society of Animal Behavior, American Animal Hospital Association, AAFP, and Association of Shelter Veterinarians. The advertisement was also posted on the Ontario Veterinary College's social media accounts and distributed to all Canadian and US veterinary school alumni accounts that were discoverable on social media.d Questionnaire participation was anonymous and voluntary, and respondents provided consent online before accessing the questionnaire.

Data analysis

Responses from individuals who were not currently working as a veterinarian or veterinary staff member (n = 15), did not examine or handle cats (23), or did not answer any questions other than the initial demographic questions (27) were excluded from analyses; some respondents met > 1 exclusion category. Information from 1,254 respondents was included in the analysis. Descriptive statistics were generated initially.

For each of the 15 handling techniques for which frequency of use was assessed, responses were consolidated to create a binary outcome (used or not used). Always, often, and sometimes responses were combined in the used category, and rarely and never responses were combined in the not-used category. Consolidating the data for each handling technique into a binary outcome facilitated evaluation of factors that were associated with the use of minimal restraint and full-body restraint with scruffing during examinations and procedures for fearful and aggressive cats. Those 2 restraint methods were chosen because they represented a contrasting degree of restraint.

Methods of restraint used during examinations were evaluated separately from those used during procedures for each type (calm, fearful, and aggressive) of cat. Logistic regression was used to assess demographic factors associated with the use of minimal and full-body restraint with scruffing during examination and procedures for fearful and aggressive cats. Outcomes were modeled as follows: use of minimal restraint during examination for fearful cats, use of minimal restraint during examination for aggressive cats, use of full-body restraint with scruffing during examination for fearful cats, use of full-body restraint with scruffing during examination for aggressive cats, use of minimal restraint during procedures for fearful cats, use of minimal restraint during procedures for aggressive cats, use of full-body restraint with scruffing during procedures for fearful cats, and use of full-body restraint with scruffing during procedures for aggressive cats.

Because all respondents who were veterinarians had received formal postsecondary education, whereas respondents who were not veterinarians may not have received any formal postsecondary education, data for veterinarians were initially analyzed separately from data for nonveterinarians. However, a secondary analysis was subsequently performed that excluded responses regarding formal postsecondary veterinary training. Thus, separate models were created for respondents who were veterinarians, respondents who were nonveterinarians, and all respondents combined.

Explanatory variables assessed in all logistic regression models included gender (female or male [referent]), AAFP-certified practice (yes or no [referent]), mean number of cats handled by respondents on a daily basis (0 to 3, 4 to 6, ≥ 7 [referent]; 0 was included as an option for the mean number of cats handled per day for respondents who indicated that they handled cats but not on a daily basis), country (Canada or United States [referent]), and all possible 2-way interactions among those variables. Additional explanatory variables assessed in models for nonveterinarian respondents included whether they attended postsecondary school (yes or no [referent]) and graduation year (before 2006, 2006 to 2015, or did not graduate [referent]). Graduation year (before 2006, 2006 to 2015, or did not graduate [referent]) was assessed in models for veterinarian respondents, and position at a clinic (veterinarian or nonveterinarian [referent]) was assessed in models that included data from all respondents.

For each logistic regression outcome, univariable analyses were performed initially to assess the association between each explanatory variable and that outcome. Explanatory variables with values of P ≤ 0.20 on univariable analysis were eligible for inclusion in a multivariable model. Each multivariable model was created by means of a backward elimination process whereby all eligible explanatory variables were included in the model in addition to all possible 2-way interactions, then variables with the smallest and most nonsignificant (P > 0.05) contribution to the outcome were excluded one by one until only variables with a value of P < 0.05 remained. After the backward elimination process was completed, each removed explanatory variable was added back to the model one by one (ie, in a stepwise process) to confirm that it was not significantly associated with the outcome. Because all the explanatory variables assessed were categorical in nature, model fit was assessed solely on the basis of evaluation of 2-way interaction terms. Results were reported as the OR and accompanying 95% CI. All analyses were performed with statistical software.e

Results

Respondents

Data provided by 1,254 respondents were analyzed; however, the number of valid responses varied among questions. The majority of respondents identified as female (1,174/1,251 [93.8%]), described themselves as veterinary technicians or technologists (760/1,254 [60.6%]), and worked at US veterinary clinics (859/1,214 [70.8%]; Table 1). Most respondents reported that they handled cats on a daily basis (1,138/1,205 [94.4%]) but did not work at an AAFP-certified practice (956/1,199 [79.7%]) or a clinic with a separate examination room for cats only (813/1,205 [67.5%]; Table 2).

Table 1—

Descriptive information for 1,254 veterinarians and nonveterinarians who completed an online questionnaire regarding cat-handling practices in veterinary practices in Canada and the United States.

VariableCategoryNo. (%) of respondents
Position in veterinary clinicVeterinarian310 (24.7)
 Veterinary technician or technologist760 (60.6)
 Veterinary assistant134 (10.7)
 Other50 (4.0)
Received formal postsecondaryYes965 (77.0)
  veterinary training relevant to positionNo288 (23.0)
Graduation year2006-2015538 (58.4)
 1996-2005212 (23.0)
 1986-1995115 (12.5)
 1976-198549 (5.3)
 1965-19756 (0.7)
 Before 19651 (0.1)
GenderFemale1,174 (93.8)
 Male67 (5.4)
 Other4 (0.3)
 Prefer not to answer6 (0.5)
CountryCanada337 (27.8)
 United States859 (70.7)
 Prefer not to answer18 (1.5)

Some respondents did not answer all questions; therefore, the number of respondents varies among variables. Percentages may not sum to 100 because of rounding.

Table 2—

Descriptive information regarding the cat handling practices in veterinary clinics where the respondents to the questionnaire described in Table 1 worked.

VariableCategoryNo. (%) of respondents
AAFP-certified practiceYes243 (20.3)
 No956 (79.7)
Examination rooms for cats onlyYes392 (32.5)
 No813 (67.5)
Frequency with which cats areDaily1,138 (94.4)
handled at the practiceWeekly61 (5.1)
 Monthly6 (0.5)
Mean No. of cats handled per day04 (0.3)
at the practice1-3335 (27.8)
 4-6446 (37.0)
 7-9229 (19.0)
 10-12101 (8.4)
 13-1591 (7.5)
Does the clinic have a protocolYes586 (48.7)
  for approaching and handling aggressive cats?No618 (51.3)
Is the cat handling protocol followedYes517 (88.5)
  by clinic staff?No67 (11.5)

See Table 1 for key.

Cat-handling practices

Approximately half (586/1,204 [48.7%]) of the respondents indicated that the clinic where they worked had an established protocol for approaching and handling aggressive cats (Table 2). The general handling of cats during veterinary visits varied among respondents (Table 3). The majority (793/1,191 [66.6%]) of respondents indicated that they rarely or never used chemical sedation to restrain fearful cats, and only 444 of 1,185 (37.5%) respondents reported that they always (n = 65) or often (379) used chemical sedation to restrain aggressive cats. Most respondents (1,024/1,201 [85.3%]) reported that they always (n = 665) or often (359) recorded relevant details regarding the handling of difficult cats in the patient record. Three hundred eighty of 1,204 (31.6%]) respondents indicated that they always (n = 108) or often (272) offered cats treats during handling. Most respondents indicated that they generally examined cats on an examination table or in the bottom of a cat carrier regardless of patient demeanor and rarely examined cats that were restrained on a person's lap, the examination room floor, or alternative surfaces (Table 4).

Table 3—

Summary statistics regarding general cat handling practices at Canadian and US veterinary clinics as provided by the respondents to the questionnaire described in Table 1.

VariableAlwaysOftenSometimesRarelyNever
Preexamination performed by a nonveterinarian266 (22.1)274 (22.8)241 (20.1)254 (21.1)167 (13.9)
Offer treats during handling108 (9.0)272 (22.6)347 (28.8)314 (26.1)163 (13.5)
Use chemical restraint before handling Fearful cats10 (0.8)58 (4.9)330 (27.7)529 (44.4)264 (22.2)
Aggressive cats65 (5.5)379 (32.0)505 (42.6)203 (17.1)33 (2.8)
When handling a difficult cat, relevant details are recorded in the patient record665 (55.4)359 (29.9)133 (11.1)38 (3.2)6 (0.5)
Information provided to clients about reducing patient stress for future veterinary visits267 (22.5)390 (32.9)358 (30.2)36 (11.5)35 (2.9)

Values represent the number (percentage) of respondents.

See Table 1 for reminder of key.

Table 4—

Summary statistics regarding location in examination room where the respondents to the questionnaire described in Table 1 handle calm, fearful, and aggressive cats.

LocationCat demeanorAlwaysOftenSometimesRarelyNever
Examination room floorCalm17 (2.2)65 (8.3)157 (20.1)217 (27.8)325 (41.6)
 Fearful8 (1.0)43 (5.5)163 (21.0)188 (24.2)375 (48.3)
 Aggressive4 (0.5)28 (3.6)91 (11.7)167 (21.5)486 (62.6)
A person's lapCalm18 (2.3)142 (18.2)224 (28.7)144 (18.5)252 (32.3)
 Fearful2 (0.3)34 (4.4)202 (26.1)166 (21.5)370 (47.8)
 Aggressive1 (0.1)3 (0.4)28 (3.61)109 (14.1)634 (81.8)
Bottom of carrierCalm23 (3.0)224 (28.8)316 (40.6)131 (16.8)84 (10.8)
(with or without towel)Fearful50 (6.4)394 (50.6)268 (34.5)34 (4.4)32 (4.1)
 Aggressive52 (6.7)285 (36.7)248 (32.0)104 (13.4)87 (11.2)
Examination tableCalm307 (39.2)415 (53.0)53 (6.8)8 (1.0)0 (0.0)
 Fearful179 (23.0)425 (54.6)158 (20.3)14 (1.8)2 (0.3)
 Aggressive177 (22.80341 (43.9)187 (24.1)54 (7.0)18 (2.3)
ScaleCalm100 (12.8)156 (20.0)199 (25.5)122 (15.6)205 (26.2)
 Fearful58 (7.5)176 (22.6)234 (30.8)116 (14.9)194 (24.9)
 Aggressive31 (4.0)96 (12.4)186 (23.9)182 (23.4)282 (36.3)
Alternative surfacesCalm13 (1.7)74 (9.5)223 (28.6)170 (21.8)301 (38.5)
 Fearful2 (0.3)60 (7.7)202 (26.0)186 (23.9)327 (42.1)
 Aggressive1 (0.1)23 (3.0)110 (14.1)196 (25.2)448 (57.6)

See Table 3 for key.

The reported frequency of respondents using the 15 handling techniques assessed varied depending on whether an examination or procedure was being performed and whether the cat was calm (Figure 1), fearful (Figure 2), or aggressive (Figure 3). Respondents indicated that passive or minimal restraint was generally used for calm cats; however, it was not uncommon for full-body restraint techniques to be used for calm cats, especially while routine veterinary procedures were performed. Fearful cats were often restrained by use of passive and minimal techniques and loose towels as well as scruffing, muzzles, burrito and reverseburrito towel wraps, and full-body restraint techniques. Full-body restraint techniques, towel wraps, gloves, and muzzles were commonly used to handle aggressive cats.

Figure 1—
Figure 1—

Reported frequency of use for 15 handling techniques for calm cats during routine examination (A) and veterinary procedures (eg, nail trimming and blood and urine sample collection; B) as reported by 1,254 veterinarians and nonveterinarians who completed an online questionnaire regarding cat-handling practices at veterinary clinics in Canada and the United States. Calm cats were defined as cats that appeared relaxed with no signs of aggression or fear-related behavior. The number of respondents who assessed each technique varied, and no technique was assessed by all respondents. Therefore, for each handling technique listed, the cumulative number of responses was < 1,254. For the purpose of these charts, frequency of use was coded as always (black bars), often or sometimes (gray bars), and rarely or never (white bars).

Citation: Journal of the American Veterinary Medical Association 256, 9; 10.2460/javma.256.9.1020

Figure 2—
Figure 2—

Reported frequency of use for 15 handling techniques for fearful cats during routine examination (A) and veterinary procedures (B) as reported by the respondents to the questionnaire described in Figure 1. Fearful cats were defined as cats that were generally immobile with signs of fear-related behaviors, such as lowered posture, dilated pupils, and flattened ears, but that did not attempt to bite or scratch the handler. See Figure 1 for remainder of key.

Citation: Journal of the American Veterinary Medical Association 256, 9; 10.2460/javma.256.9.1020

Figure 3—
Figure 3—

Reported frequency of use for 15 handling techniques for aggressive cats during routine examination (A) and veterinary procedures (B) as reported by the respondents to the questionnaire described in Figure 1. Aggressive cats were defined as cats that exhibited signs of fear or escape-related behaviors and that attempted to bite or scratch the handler. See Figure 1 for remainder of key.

Citation: Journal of the American Veterinary Medical Association 256, 9; 10.2460/javma.256.9.1020

Logistic regression results

A total of 24 logistic regression models were created to assess demographic factors associated with minimal or full-body restraint with scruffing during routine veterinary examinations and procedures for veterinarians, nonveterinarians, and both veterinarians and nonveterinarians combined.

Veterinarians—The number of veterinarian respondents who contributed to the dataset was 232 for the model for use of minimal restraint during examination for fearful cats, 207 for the model for use of minimal restraint during procedures for fearful cats, 222 for the model for use of minimal restraint during examination for aggressive cats, 204 for the model for use of minimal restraint during procedures for aggressive cats, 229 for the model for use of full-body with scruff restraint during examination for fearful cats, 207 for the model for use of full-body with scruff restraint during procedures for fearful cats, 223 for the model for use of full-body with scruff restraint during examination for aggressive cats, and 207 for the model for the use of full-body with scruff restraint during procedures for aggressive cats.

Year of graduation from veterinary school was not significantly associated with any of the 8 outcomes of interest (ie, models). Use of minimal restraint during routine examination and procedures for fearful cats was not significantly associated with any of the demographic factors evaluated. Use of minimal restraint during examination and procedures for aggressive cats was not associated with whether a veterinarian did or did not work at an AAFP-certified practice but was associated with country. Veterinarians who worked at Canadian practices were more likely than veterinarians who worked at US practices to use minimal restraint during examination (OR, 1.79; 95% CI, 1.05 to 3.07; P = 0.03) and procedures (OR, 2.11; 95% CI, 1.14 to 3.96; P = 0.02) for aggressive cats.

Use of full-body with scruff restraint during examination and procedures for fearful cats was significantly associated with whether veterinarians worked at an AAFP-certified practice and country. Veterinarians who worked at AAFP-certified practices were less likely than veterinarians who did not work at AAFP-certified practices to use full-body with scruff restraint during examination (OR, 0.20; 95% CI, 0.05 to 0.63; P = 0.01) and procedures (OR, 0.27; 95% CI, 0.13 to 0.55; P < 0.001) for fearful cats. Also, veterinarians who worked at Canadian practices were less likely than veterinarians who worked at US practices to use full-body with scruff restraint during examination (OR, 0.49; 95% CI, 0.24 to 0.98; P = 0.049) and procedures (OR, 0.31; 95% CI, 0.17 to 0.56; P < 0.001) for fearful cats.

Use of full-body with scuff restraint during examination and procedures for aggressive cats was significantly associated with whether veterinarians worked at an AAFP-certified practice. Veterinarians who worked at AAFP-certified practices were less likely than veterinarians who did not work at AAFP-certified practices to use full-body with scruff restraint during examination (OR, 0.42; 95% CI, 0.22 to 0.80; P = 0.007) and procedures (OR, 0.35; 95% CI, 0.17 to 0.73; P = 0.005) for aggressive cats.

Nonveterinarians—The number of nonveterinarian respondents who contributed to the data set was 646 for the model for use of minimal restraint during examination for fearful cats, 525 for the model for use of minimal restraint during procedures for fearful cats, 608 for the model for use of minimal restraint during examination for aggressive cats, 515 for the model for use of minimal restraint during procedures for aggressive cats, 631 for the model for use of full-body with scruff restraint during examination for fearful cats, 517 for the model for use of full-body with scruff restraint during procedures for fearful cats, 613 for the model for use of full-body with scruff restraint during examination for aggressive cats, and 521 for the model for use of full-body with scruff restraint during procedures for aggressive cats.

Similar to veterinarian respondents, use of minimal restraint during routine examination and procedures for fearful cats was not significantly associated with any of the demographic factors evaluated. Cat-handling techniques during procedures did not differ significantly between nonveterinarians who did and did not receive formal postsecondary veterinary training. However, those who received formal veterinary training were more likely than those who did not receive such training to use full-body with scruff restraint during examination of fearful cats (OR, 1.6; 95% CI, 1.11 to 2.27; P = 0.012). Use of full-body with scruff restraint for fearful cats was also significantly associated with the country of employment and whether respondents worked at an AAFP-certified practice. Respondents who worked at Canadian practices were less likely than respondents who worked at US practices to use full-body with scruff restraint during examination (OR, 0.54; 95% CI, 0.34 to 0.81; P = 0.002) and procedures (OR, 0.42; 95% CI, 0.27 to 0.64; P < 0.001) for fearful cats. Respondents who worked at AAFP-certified practices were less likely than respondents who did not work at AAFP-certified practices to use full-body with scruff restraint during examination (OR, 0.53; 95% CI, 0.34 to 0.81; P = 0.005) and procedures (OR, 0.55; 95% CI, 0.35 to 0.89; P = 0.01) for fearful cats.

Use of minimal restraint for aggressive cats was not associated with country of employment but was significantly associated with whether the respondent worked at an AAFP-certified practice. Nonveterinarians who worked at an AAFP-certified practice were more likely than those who did not work at an AAFP-certified practice to use minimal restraint during examination (OR, 1.7; 95% CI, 1.11 to 2.58; P = 0.013) only for aggressive cats.

Use of full-body with scruff restraint for aggressive cats was associated with country of employment and whether the respondent worked at an AAFP-certified practice. Respondents who worked at Canadian practices were less likely than respondents who worked at US practices to use full-body with scruff restraint during examination (OR, 0.49; 95% CI, 0.32 to 0.75; P = 0.001) and procedures (OR, 0.44; 95% CI, 0.26 to 0.73; P = 0.002) for aggressive cats. Similarly, respondents who worked at AAFP-certified practices were less likely than respondents who did not work at AAFP-certified practices to use full-body with scruff restraint during examination (OR, 0.60; 95% CI, 0.38 to 0.96; P = 0.03) and procedures (OR, 0.51; 95% CI, 0.30 to 0.90; P = 0.018) for aggressive cats.

For nonveterinarians who received formal postsecondary veterinary training, year of graduation was significantly associated with handling techniques used for calm, fearful, and aggressive cats. Compared with nonveterinarians who graduated before 2006, those who graduated between 2006 and 2015 were more likely to use full-body with scruff restraint during examination (OR, 1.7; 95% CI, 1.10 to 2.73; P = 0.002) and procedures (OR, 1.9; 95% CI, 1.06 to 3.23; P = 0.030) for aggressive cats and less likely to use minimal restraint during examination of aggressive cats (OR, 0.6; 95% CI, 0.39 to 0.89; P = 0.012). Also, respondents who graduated between 2006 and 2015 were more likely to use full-body with scruff restraint during procedures for fearful cats (OR, 1.8; 95% CI, 1.15 to 2.92; P = 0.011), compared with respondents who graduated before 2006.

Compared with nonveterinarian respondents who did not graduate from a formal postsecondary veterinary training program (nongraduates), nonveterinarian respondents who graduated between 2006 and 2015 were less likely to use full-body with scruff restraint (OR, 0.59; 95% CI, 0.41 to 0.89; P = 0.011) during examination of fearful cats. When handling fearful cats, nonveterinarians who graduated before 2006 were less likely to use full-body with scruff restraint during examination (OR, 0.5; 95% CI, 0.34 to 0.83; P = 0.005) and procedures (OR, 0.4; 95% CI, 0.23 to 0.67; P < 0.001), compared with nongraduates. When handling aggressive cats, respondents who graduated before 2006 were more likely to use minimal restraint during examination (OR, 1.85; 95% CI, 1.18 to 2.86; P = 0.008) and procedures (OR, 2.5; 95% CI, 1.41 to 4.55; P = 0.002) and less likely to use full-body with scruff restraint during examination (OR, 0.4; 95% CI, 0.26 to 0.73; P = 0.002) and procedures (OR, 0.4; 95% CI, 0.18 to 0.71; P = 0.004), compared with nongraduates.

Veterinarians and nonveterinarians combined—Respondent position (veterinarian or nonveterinarian) was the only factor evaluated that was significantly associated with the use of minimal restraint for fearful cats. Compared with nonveterinarians, veterinarians were less likely to use minimal restraint during examination (OR, 0.6; 95% CI, 0.36 to 0.96; P = 0.031; n = 892) and more likely to use minimal restraint during procedures (OR, 1.6; 95% CI, 1.05 to 2.42; P = 0.034; 747) for fearful cats. Results for the final multivariable models for the other 6 outcomes of interest were summarized (Table 5).

Table 5—

Final multivariable logistic regression models for factors associated with the use of minimal or full-body restraint with scruff during routine examinations and veterinary procedures (eg, nail trimming and blood and urine sample collection) for fearful and aggressive cats as reported by the respondents of the questionnaire described in Table l.

Model outcomeNo. of respondents who contributed to model datasetVariableCategoryOR (95% CI)P value
Use of minimal restraint845AAFP-certified practiceYes1.5 (1.06-2.12)0.023
during examination for  NoReferent
aggressive cats CountryCanada1.4 (1.02-1.90)0.036
   United StatesReferent
  Respondent positionVeterinarian1.6 (1.13-2.12)0.007
   NonveterinarianReferent
Use of full-body restraint874AAFP-certified practiceYes0.5 (0.31-0.68)< 0.00l
with scruffing during  NoReferent
examination for fearful cats No. of cats handled/day0-3 vs 4-61.6 (1.11-2.32)0.013
   4-6 vs ≥ 70.6 (0.40-0.81)0.002
  CountryCanada0.5 (0.35-0.70)< 0.001
   United StatesReferent
  Respondent positionVeterinarian0.3 (0.26-0.55)< 0.001
   NonveterinarianReferent
Use of full-body restraint with85lAAFP-certified practiceYes0.6 (0.38-0.79)0.001
scruffing during examination  NoReferent
for aggressive cats CountryCanada0.6 (0.38-0.79)< 0.001
   United StatesReferent
  Respondent postionVeterinarian0.5 (0.34-0.66)< 0.001
   NonveterinarianReferent
Use of minimal restraint during732CountryCanada1.6 (1.11-2.72)0.011
procedures for aggressive cats  United StatesReferent
Use of full-body restraint with738AAFP-certified practiceYes0.4 (0.29-0.63)< 0.001
scruffing during procedures  NoReferent
for fearful cats CountryCanada0.4 (0.26-0.50)< 0.001
   United StatesReferent
Use of full-body restraint with742AAFP-certified practiceYes0.5 (0.30-0.70)< 0.001
scruffing during procedures  NoReferent
for aggressive cats CountryCanada0.4 (0.26-0.57)< 0.00l
   United StatesReferent

Only variables with values of P < 0.05 were included in the final multivariable model for each outcome.

— = Not applicable.

Discussion

Results of the survey reported here suggested that the handling techniques used for cats in Canadian and US veterinary practices were dependent on the cat's demeanor and reason for handling or restraint. Most respondents indicated that they used passive and minimal restraint techniques when handling calm cats for examinations and procedures and used passive, minimal, or loose towel techniques when handling fearful cats for examinations. However, some respondents indicated that they used full-body immobilization (ie, full-body restraint) techniques including scruffing when handling calm and fearful cats, with a fairly high proportion of respondents reporting that they used those types of techniques always or often for procedures. For many animal species, full-body restraint generally elicits an unconditioned fear response and induces stress.27–30 For example, full-body restraint causes sympathoadrenal activation31 and avoidance behavior such as struggling,32–34 which can result in incomplete examinations and the potential for inaccurate diagnoses and treatments.3,8 Inaccurate diagnosis and treatment are a concern for the health and welfare of cats as well as other species of veterinary interest.

It has been suggested that, historically, use of higher, or extensive, levels of restraint for animals was condoned in veterinary medicine in the interest of preventing injuries to personnel.21 However, given that full-body restraint causes fear in cats, the use of such techniques may potentiate aggressive behavior in cats, thereby increasing the risk of injury for both the cats and handlers.16 Indeed, current cat-handling guidelines recommend the use of passive and minimal restraint techniques to help minimize arousal and fear and keep cats calm during veterinary examinations and procedures, which in turn should reduce the risk of aggression and subsequent injury to the patient or veterinary personnel.16,20,21

Unfortunately, not all cats can be adequately restrained with passive or mini mal handling techniques, and additional handling tools may be necessary for an examination or procedure to be performed. Loose towels and towel wraps are recommended handling alternatives for cats in most cat-handling guidelines, with the theory being that wrapping a towel around a cat may help to keep it calm,16,19,20,22 although scientific data to support that theory are lacking. Respondents of the present survey reported that towels and towel wraps were commonly used to restrain calm cats during procedures and restrain fearful and aggressive cats during both examinations and procedures. Gloves and muzzles were also commonly used when handling aggressive cats. Although gloves likely help handlers feel safer when handling aggressive cats and may protect handlers from injury, their use is not recommended in some cat-handling guidelines.19,22 Those guidelines suggest that the use of gloves does not reduce cat behaviors indicative of fear such as struggling,22 but data to support that claim are lacking. Tools that reduce visual stimulation, such as cat muzzles, may help calm animals.17,19,22 However, Anseeuw et al14 warn that muzzles may cause cats to become immobile (ie, freeze), which is an established fear response in animals.31 In the present survey, results indicated that cat bags and scruffing tools were infrequently used to restrain cats. Further research is necessary to better understand veterinarian and nonveterinarian staff perceptions regarding common cat-handling techniques and to identify motivations for selection of specific cat-handling tools and methods.

The use of treats during handling of cats varied substantially among the respondents of the present survey. Some respondents might be wary about providing treats to patients, especially obese cats and cats with signs of gastrointestinal disease or that are scheduled to undergo sedation or anesthesia.35 Furthermore, cats that are stressed have decreased food intake,36,37 and cats in a negative affective state while in a veterinary examination room are unlikely to consume treats.3 However, many cats will consume treats while in an examination room, and it has been argued that with common sense, owner consent, and individualized patient assessment, the use of palatable food may help create a more positive experience for a cat when used for distraction, redirection, reward, and counterconditioning during handling.14,16,17,19,20,22,35

The AAFP certification program for cat-friendly handling was introduced to provide cats with a more positive experience and reduce stress during veterinary visits. Results of another study38 suggest that veterinary personnel who work at AAFP-certified practices use scruffing for restraint of cats less frequently than do personnel who work at non–AAFP-certified practices. That finding was consistent with the results of the present survey, which indicated that respondents who worked at AAFP-certified practices were less likely to use full-body restraint with scruffing than were respondents who worked at non–AAFP-certified practices. Results of the present survey also indicated that minimal restraint techniques for cats were more commonly used in AAFP-certified practices than in non–AAFP-certified practices. Collectively, those findings suggested that the AAFP certification program is effecting positive changes in cat-handling methods implemented in Canadian and US veterinary practices. It is possible that alternative initiatives and cat-handling certification programs, which were not available at the time this survey was conducted, might be similarly effective. It would be beneficial to repeat the present survey to evaluate changes associated with cat-handling initiatives and programs introduced after this questionnaire was administered.

Results of the present survey suggested that veterinarians and nonveterinarians who worked at Canadian practices were less likely than those who worked at US practices to use full-body restraint with scruffing on fearful and aggressive cats. This finding may be attributable to differences in education regarding animal behavior, welfare, and ethics between Canadian and US veterinary training programs. Although differences in animal-handling education have not been compared between Canadian and US veterinary training programs, results of other studies39,40 indicate that not all veterinary training programs offer courses dedicated to animal behavior, ethics, and welfare, and those that do, provide differing content. Further research is necessary to determine how differences in veterinary curricula affect recent graduates’ handling of cats and their ability to identify and mitigate behavioral signs of fear and stress in cats.

In the present survey, veterinarians were more likely to use minimal restraint on aggressive cats and were less likely to use full-body with scruff restraint on fearful and aggressive cats during examinations than were nonveterinarians; however, a similar trend was not observed for the performance of routine veterinary procedures. Discrepancies in cat-handling practices between veterinarians and nonveterinarians might be attributable to differences in awareness of alternative handling tools and the benefits of minimal restraint techniques between the 2 groups.

For the nonveterinarian respondents of the present survey, cat-handling practices were significantly associated with year of graduation from a formal postsecondary veterinary training program. Respondents who graduated between 2006 and 2015 were more likely to use full-body with scruff restraint during examination and procedures for aggressive cats and during procedures for fearful cats than were respondents who graduated before 2006. Compared with respondents who did not graduate from a formal postsecondary veterinary training program (nongraduates), respondents who graduated between 2006 and 2015 were less likely to use full-body with scruff restraint during examination of fearful cats, and those who graduated before 2006 were less likely to use full-body with scruff restraint and more likely to use minimal restraint for aggressive cats. The findings in regard to nonveterinarian respondents who did and did not graduate from a veterinary training program were not surprising. An essential component of effective animal handling is the ability to identify signs of fear or stress in patients and adapt restraint techniques to prevent escalation of arousal.16–21 This skill generally improves with education and experience and likely translates into the use of less aggressive restraint methods by trained and experienced nonveterinarians. It is recommended that additional effort be made to educate veterinary practice staff about the use and benefits of minimal restraint techniques for cats, particularly nonveterinarians who have not or only recently graduated from veterinary training programs.

The survey reported here was not without limitations. The questionnaire was disseminated by email and social media, and the snowball sampling method used likely limited survey respondents to those with an active email account or social media presence and those comfortable with online survey platforms. Only a small number of veterinarian and nonveterinarian respondents indicated that they graduated from a veterinary training program before 1995, which might be a reflection of the proportion of older respondents who were comfortable with the online dissemination method and survey platform used. Results of previous research suggest that web-based surveys tend to have younger respondents than paper-based surveys,41–43 although results of a 2015 study44 indicate that older people are increasingly likely to use the internet.

The majority (1,174/1,251 [93.8%]) of respondents to the present survey identified as female, which was expected given that over half of Canadian and US veterinarians are females45,46 and a large proportion of recent graduates from veterinary training programs47 and veterinary technicians48 are females. Nonveterinarian respondents, such as veterinary technicians and assistants, outnumbered veterinarian respondents in the present survey. Nonveterinarians have an important role in animal handling for various veterinary procedures49 and thus were an important segment of our target population. Most survey respondents indicated that they routinely handled between 1 and 6 cats on a daily basis, which was important because the purpose of this study was to evaluate cat-handling practices. However, it is possible there was sampling bias in that persons with a particular interest in cat-handling practices might have been over-represented in the survey.

Findings of the present survey indicated that passive and minimal restraint techniques are commonly used to handle calm cats at Canadian and US veterinary practices; however, there is still widespread use of full-body restraint techniques including scruffing during veterinary visits for cats of all demeanors. Several methods of restraint were reported for handling of fearful cats including passive, minimal, and full-body restraint, scruffing, and towels, whereas full-body restraint, scruffing, towel wraps, gloves, and muzzles were commonly used to handle aggressive cats. Veterinarians and nonveterinarians who graduated before 2006 were less likely to use full-body restraint with scruffing for cats of all demeanors, compared with nonveterinarians who graduated between 2006 and 2015 and nongraduates. Other factors associated with decreased use of full-body restraint with scruffing included working at an AAFP-certified practice and working in a Canadian practice. Continued progress in reducing stress for cats during veterinary visits is important for ensuring the health and welfare of those animals as well as ensuring that cat owners are willing to bring their pets to veterinarians for routine health care. Unfortunately, scientifically sound evidence supporting current cat-handling recommendations is lacking, and further research is necessary to determine whether those recommendations are effective in decreasing stress for cats during veterinary visits.

Acknowledgments

Supported by grants awarded to Dr. Niel from the Natural Sciences and Engineering Research Council.

The authors declare that there were no conflicts of interest. The authors thank the AAFP for feedback during questionnaire development and for providing photographs depicting various cat-handling procedures for inclusion in the questionnaire.

ABBREVIATIONS

AAFP

American Association of Feline Practitioners

CI

Confidence interval

Footnotes

a.

Cat Friendly Practice, AAFP, Hillsborough, NJ.

b.

Low Stress Handling University, Davis, Calif.

c.

Qualtrics Software Company, Provo, Utah.

d.

Facebook Inc, Menlo Park, Calif.

e.

SAS Studio, version 3.7, SAS Institute, Cary, NC.

References

  • 1. Hewson C. Evidence-based approaches to reducing in-patient stress—part 1: why animals' sensory capacities make hospitalization stressful to them. Vet Nurs J 2014;29:130132.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2. Hewson C. Evidence-based approaches to reducing in-patient stress—part 3: how to reduce in-patient stress. Vet Nurs J 2014;29:234236.

  • 3. Mariti C, Bowen JE, Campa S, et al. Guardians' perceptions of cats' welfare and behavior regarding visiting veterinary clinics. J Appl Anim Welf Sci 2016;19:375384.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4. Volk JO, Felsted KE, Thomas JG, et al. Executive summary of the Bayer veterinary care usage study. J Am Vet Med Assoc 2011;238:12751282.

  • 5. Volk JO, Felsted KE, Thomas JG, et al. Executive summary of phase 2 of the Bayer veterinary care usage study. J Am Vet Med Assoc 2011;239:13111316.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6. Volk JO, Thomas JG, Colleran EJ, et al. Executive summary of phase 3 of the Bayer veterinary care usage study. J Am Vet Med Assoc 2014;244:799802.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7. Osborne D. Companion animal client numbers continue to fall in most provinces. Can Vet J 2011;52:11431145.

  • 8. Glardon OJ, Hartnack S, Horisberger L. Analyse du comportement des chiens et des chats pendant l'examen physique en cabinet veterinaire. Schweiz Arch Tierheilkd 2010;152:6975.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9. Gribbins JD, MacMahon K. Workplace safety and health for the veterinary health care team. Vet Clin North Am Small Anim Pract 2015;45:409426.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10. Fowler H, Adams D, Bonauto D, et al. Work-related injuries to animal care workers, Washington 2007–2011. Am J Ind Med 2016;59:236244.

  • 11. Jeyaretnam J, Jones H. Physical, chemical and biological hazards in veterinary practice. Aust Vet J 2000;78:751758.

  • 12. Nordgren LD, Gerberich SG, Alexander BH, et al. Evaluation of factors associated with work-related injuries to veterinary technicians certified in Minnesota. J Am Vet Med Assoc 2014;245:425433.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13. Nienhaus A, Skudlik C, Seidler A. Work-related accidents and occupational diseases. Int Arch Occup Environ Health 2005;78:230238.

  • 14. Anseeuw E, Apker C, Ayscue C, et al. Handling cats humanely in the veterinary hospital. J Vet Behav 2006;1:8488.

  • 15. Carney HC, Little S, Brownlee-Tomasso D, et al. AAFP and ISFM feline-friendly nursing care guidelines. J Feline Med Surg 2012;14:337349.

  • 16. Hammerle M, Horst C, Levine E, et al. 2015 AAHA canine and feline behavior management guidelines. J Am Anim Hosp Assoc 2015;51:205221.

  • 17. Herron ME, Shreyer T. The pet-friendly practice: a guide for practitioners. Vet Clin North Am Small Anim Pract 2014;44:451481.

  • 18. Lloyd JK. Minimising hospital stress for patients in the veterinary hospital: why it is important and what can be done about it. Vet Sci 2017;4:2E2.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19. Moffat K. Addressing canine and feline aggression in the veterinary clinic. Vet Clin North Am Small Anim Pract 2008;38:9831003.

  • 20. Rodan I, Sundahl E, Carney H, et al. AAFP and ISFM feline-friendly handling guidelines. J Feline Med Surg 2011;13:364375.

  • 21. Rodan I. Understanding feline behavior and application for appropriate handling and management. Top Companion Anim Med 2010;25:178188.

  • 22. Yin S. Low-stress restraint techniques. In: Low-stress handling, restraint and behavior modification of dogs and cats. Davis, Calif: CattleDog Publishing, 2009;189404.

    • Search Google Scholar
    • Export Citation
  • 23. AVMA. Policy on physical restraint of animals. Available at: www.avma.org/KB/Policies/Pages/Physical-Restraint-of-Animals.aspx. Accessed Jun 24, 2018.

    • Search Google Scholar
    • Export Citation
  • 24. Dohoo SE, Doohoo IR. Factors influencing the postoperative use of analgesics in dogs and cats by Canadian veterinarians. Can Vet J 1996;37:552556.

    • Search Google Scholar
    • Export Citation
  • 25. Williams VM, Lascelles BD, Robson MC. Current attitudes to, and use of, peri-operative analgesia in dogs and cats by veterinarians in New Zealand. N Z Vet J 2005;53:193202.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26. Hewson CJ, Doohoo IR, Lemke KA. Factors affection the use of postincisional analgesics in dogs and cats by Canadian veterinarians in 2001. Can Vet J 2006;47:453459.

    • Search Google Scholar
    • Export Citation
  • 27. Buynitsky T, Mostofsky DI. Restraint stress in biobehavioral research: recent developments. Neurosci Biobehav Rev 2009;33:10891098.

  • 28. Abercrombie ED, Jacobs BL. Systemic naloxone administration potentiates locus coeruleus noradrenergic neuronal activity under stressful but not non-stressful conditions. Brain Res 1988;441:362366.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29. Wilkinson LO, Jacobs BL. Lack of response of serotonergic neurons in the dorsal raphe nueclues of freely moving cats to stressful stimuli. Exp Neurol 1988;101:445457.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30. Willemse T, Vroom MW, Mol JA, et al. Changes in plasma cortisol, corticotropin, and α-melanocyte–stimulating hormone in cats before and after physical restraint and intradermal testing. Am J Vet Res 1993;54:6972.

    • Search Google Scholar
    • Export Citation
  • 31. Abercrombie ED, Jacobs BL. Single-unit response of noradrenergic neurons in the locus coeruleus of freely moving cats. I. Acutely presented stressful and nonstressful stimuli. J Neurosci 1987;7:28372843.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32. Adolphs R. The biology of fear. Curr Biol 2013;23:R79R93.

  • 33. Archer J. Behavioural aspects of fear, In: Sluckin W, ed. Fear in animals and man. New York: Van Nostrand Reinhold, 1979;5685.

  • 34. Moody CM, Picketts VA, Mason GJ, et al. Can you handle it? Validating negative responses to restraint in cats. Appl Anim Behav Sci 2018;204:94100.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35. Westlund K. To feed or not to feed: counterconditioning in the veterinary clinic. J Vet Behav 2015;10:433437.

  • 36. Stella J, Croney C, Buffington T. Effects of stressors on the behavior and physiology of domestic cats. Appl Anim Behav Sci 2013;143:157163.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37. Tanaka A, Wagner DC, Kass PH, et al. Associations among weight loss, stress, and upper respiratory tract infections in shelter cats. J Am Vet Med Assoc 2012;240:570576.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38. Dawson LC, Dewey CE, Stone EA, et al. Evaluation of a canine and feline behavioural welfare assessment tool for use in companion animal veterinary practice. Appl Anim Behav Sci 2018;201:6776.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39. Shivley CB, Garry FB, Kogan LR, et al. Survey of animal welfare, animal behavior, and animal ethics courses in the curricula of AVMA Council on Education–accredited veterinary colleges and schools. J Am Vet Med Assoc 2016;248:11651170.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40. Main DC. Evolution of animal-welfare education for veterinary students. J Vet Med Educ 2010;37:3035.

  • 41. Callas PW, Solomon LJ, Hughes JR, et al. The influence of response mode on study results: offering cigarette smokers a choice of postal or online completion of a survey. J Med Internet Res 2010;12:e46.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42. Hirsch O, Hauschild F, Schmidt MH, et al. Comparison of web-based and paper-based administration of ADHD questionnaires for adults. J Med Internet Res 2013;15:e47.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43. Zuidgeest M, Hendriks M, Koopman L, et al. A comparison of a postal survey and mixed-mode survey using a questionnaire on patients' experiences with breast care. J Med Internet Res 2011;13:e68.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44. Horevoorts NJ, Vissers PA, Mols F, et al. Response rates for patient-reported outcomes using web-based versus paper questionnaires: comparison of two invitational methods in older colorectal cancer patients. J Med Internet Res 2015;17:e111.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45. AVMA. Market research statistics: U.S. veterinarians. Available at: www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-veterinarians-2015.aspx. Accessed Jan 15, 2018.

    • Search Google Scholar
    • Export Citation
  • 46. Canadian Veterinary Medical Association. Media centre statistics: veterinary demographics (2017). Available at: www.canadianveterinarians.net/about/statistics. Accessed Jan 18, 2018.

    • Search Google Scholar
    • Export Citation
  • 47. Lofstedt J. Gender and veterinary medicine. Can Vet J 2003;44:533535.

  • 48. Norkus CL, Liss DJ, Leighton LS. Characteristics of the labor market for veterinary technician specialists in 2013. J Am Vet Med Assoc 2016;248:105109.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49. Sanders CR. Working out back: the veterinary technician and “dirty work.” J Contemp Ethnogr 2010;30:243272.

Supplementary Materials

All Time Past Year Past 30 Days
Abstract Views 556 0 0
Full Text Views 1143 833 354
PDF Downloads 638 337 35
Advertisement