Pfau T, Spicer-Jenkins C, Smith R K, Bolt D M, Fiske-Jackson A, Witte T H
Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK.
Equine Vet J. 2014 Nov;46(6):759-63. doi: 10.1111/evj.12220. Epub 2014 Jan 23.
Subjective evaluation of the response to diagnostic analgesia of hindlimb lameness is influenced by expectation bias. Quantification of pelvic movement with inertial measurement units is possible, but it is unclear which measure of movement symmetry best reflects the changes seen after diagnostic analgesia.
To test our hypothesis that objective measures closely relating to those used for subjective visual lameness scoring (quantifying the difference between sacral upward or downward movement or between movement amplitudes of the left and right tubera coxae) would show the largest and most consistent response.
Retrospective analysis of subjective and objective clinical lameness data.
Thirteen horses with hindlimb lameness underwent visual lameness scoring and independent gait assessment with inertial measurement units. Established objective measures were calculated and changes before/after diagnostic analgesia regressed against the change in lameness grade. Slopes of regression lines were calculated and confidence intervals assessed.
All objective parameters showed variation between horses and across lameness grades. The following 3 measures documented a consistent increase in symmetry for each grade of change in lameness score: difference between sacral displacement minima; upward movement difference; and range of motion difference between the tubera coxae.
Several pelvic parameters are suitable for objective quantification of changes after diagnostic analgesia in hindlimb-lame horses. A change of 9-13% per lameness grade can be expected. Upward movement of the tubera coxae is the most sensitive objective measure for quantifying a response to diagnostic analgesia. However, when assessed visually, this measure requires simultaneous focusing on pelvic and limb movements. Other parameters that show a similar response might be more easily perceived, requiring only assessment of tubera coxae range of motion or downward displacement of the sacrum without simultaneous focus on limb movement.
对后肢跛行诊断性镇痛反应的主观评估受期望偏差影响。使用惯性测量单元对骨盆运动进行量化是可行的,但尚不清楚哪种运动对称性测量方法最能反映诊断性镇痛后出现的变化。
检验我们的假设,即与用于主观视觉跛行评分的指标密切相关的客观测量指标(量化骶骨向上或向下运动之间的差异或左右髋结节运动幅度之间的差异)将显示出最大且最一致的反应。
对主观和客观临床跛行数据进行回顾性分析。
13匹后肢跛行的马接受了视觉跛行评分,并使用惯性测量单元进行独立的步态评估。计算既定的客观测量指标,并将诊断性镇痛前后的变化与跛行等级的变化进行回归分析。计算回归线的斜率并评估置信区间。
所有客观参数在马匹之间以及不同跛行等级之间均存在差异。以下3种测量方法记录了随着跛行评分每变化一个等级,对称性持续增加:骶骨位移最小值之间的差异;向上运动差异;以及髋结节之间的运动范围差异。
几个骨盆参数适用于客观量化后肢跛行马在诊断性镇痛后的变化。预计每一个跛行等级会有9%-13%的变化。髋结节向上运动是量化对诊断性镇痛反应的最敏感客观测量指标。然而,在视觉评估时,该测量指标需要同时关注骨盆和肢体运动。其他显示类似反应的参数可能更容易察觉,仅需评估髋结节的运动范围或骶骨的向下位移,而无需同时关注肢体运动。