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Randomized Controlled Trial
. 2012 Sep 10:8:162.
doi: 10.1186/1746-6148-8-162.

Clinical validity of outcome pain measures in naturally occurring canine osteoarthritis

Affiliations
Randomized Controlled Trial

Clinical validity of outcome pain measures in naturally occurring canine osteoarthritis

Pascale Rialland et al. BMC Vet Res. .

Abstract

Background: The conceptual validity of kinetic gait analysis and disability outcome assessment methods has guided their use in the assessment of pain caused by osteoarthritis (OA). No consensus on the best clinical methods for pain evaluation in canine OA exists, particularly, when evaluating treatments where a smaller treatment effect is anticipated than with pharmacological pain killers. This study thus aimed at determining the technical validity of some clinical endpoints on OA pain in dogs using the green-lipped mussel (GLM)-enriched diet.Twenty-three adult dogs with clinical OA completed the prospective controlled study. All the dogs were fed a balanced diet over a 30-day control period followed by a GLM-enriched diet over a 60-day period. The kinetic gait analysis parameter (PVF(BW), peak vertical force adjusted for body weight change), electrodermal activity (EDA), and a standardized multifactorial pain questionnaire (MFQ) were performed on day (D) 0 (inclusion), D30 (start) and D90 (end). The owners completed a client-specific outcome measures (CSOM) instrument twice a week. Motor activity (MA) was continuously recorded in seven dogs using telemetered accelerometric counts. We hypothesized that these methods would produce convergent results related to diet changes. A Type I error of 0.05 was adjusted to correct for the multiplicity of the primary clinical endpoints.

Results: Neither the EDA nor the MFQ were found reliable or could be validated. Changes in the PVFBW (P(adj) = 0.0004), the CSOM (P(adj) = 0.006) and the MA intensity (P(adj) = 0.02) from D0 to D90 suggested an effect of diet(s). Only the PVFBW clearly increased after the GLM-diet (P(adj) = 0.003). The CSOM exhibited a negative relationship with the PVF(BW) (P = 0.02) and MA duration (P = 0.02).

Conclusions: The PVF(BW) exhibited the best technical validity for the characterization of the beneficial effect of a GLM-enriched diet. The CSOM and MA appeared less responsive following a GLM-diet, but these measures appeared complementary to gait analysis. Apparently, the CSOM provides the capacity to rely on pain OA assessment influenced by both lameness quantification (PVF(BW)) and physical functioning (MA).

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Figures

Figure 1
Figure 1
Evolution of primary clinical endpoints in osteoarthritic dogs fed subsequentially with control and green-lipped mussel-enriched diets.A) PVFBW: Peak vertical ground reaction force adjusted to change in body weight (%BW). B) CSOMMed: Box plot of the median-value of client-specific outcome measures (score). C) EDA: electrodermal activity. Data are represented as mean ± SEM for PVFBW and EDA, and as median + 75th percentile for CSOMMed at day(D)0, D30, and D90. General linear mixed model for repeated measures: (a) and (b) were significant difference of Least Squares Means when compared with D0 and D30, respectively. Multinomial logistic regression for repeated measures: *significant odds ratio (when compared to D0). Significance was reached at P-value lower than 0.017 with Bonferroni’s adjustment.
Figure 2
Figure 2
Evolution of motor activity in osteoarthritic dogs fed subsequentially with control and green-lipped mussel-enriched diets. Motor activity (MA) is represented as box plot (median and 25th to 75th percentile) per two consecutive weeks (periods P(i)) for n = 7 dogs. General linear mixed model for repeated measures: asignificant difference of Least Squares Means when compared with P1. Significance was reached at P-value lower than 0.003 with Bonferroni’s adjustment. As descriptive statistics, MA was presented by age category, and represented as median (25th to 75th percentile) for dogs under 6-y (black circle and short dashed lines) and dogs older than 6-y (black triangle and long dashed line).
Figure 3
Figure 3
Evolution of a multifactorial questionnaire (MFQ) in osteoarthritic dogs fed subsequentially with control and green-lipped mussel-enriched diets. MFQ-NRS: MFQ-Numerical Rating Scale, MFQ-S: MFQ-Static, MFQ-D: MFQ-Dynamic, MFQ-RTx: MFQ-Response to Treatment. Data are represented as median, 25th to 75th percentile at day(D)0, D30, and D90. General linear mixed model for repeated measures: (a) was significant difference of Least Squares Means when compared with D0. Multinomial logistic regression for repeated measures: *significant odds ratio (D0 vs D30). Significance was reached at P-value lower than 0.017 with Bonferroni’s adjustment.

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