Hammarberg M, Egenvall A, Pfau T, Rhodin M
Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.
Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, Hatfield, UK.
Equine Vet J. 2016 Jan;48(1):78-82. doi: 10.1111/evj.12385. Epub 2015 Feb 2.
Lungeing is an important part of lameness examinations as the circular path may accentuate low-grade lameness. Movement asymmetries related to the circular path, to compensatory movements and to pain make the lameness evaluation complex. Scientific studies have shown high inter-rater variation when assessing lameness during straight line movement.
The aim was to estimate inter- and intra-rater agreement of equine veterinarians evaluating lameness from videos of sound and lame horses during lungeing and to investigate the influence of veterinarians' experience and the objective degree of movement asymmetry on rater agreement.
Cross-sectional observational study.
Video recordings and quantitative gait analysis with inertial sensors were performed in 23 riding horses of various breeds. The horses were examined at trot on a straight line and during lungeing on soft or hard surfaces in both directions. One video sequence was recorded per condition and the horses were classified as forelimb lame, hindlimb lame or sound from objective straight line symmetry measurements. Equine veterinarians (n = 86), including 43 with >5 years of orthopaedic experience, participated in a web-based survey and were asked to identify the lamest limb on 60 videos, including 10 repeats. The agreements between (inter-rater) and within (intra-rater) veterinarians were analysed with κ statistics (Fleiss, Cohen).
Inter-rater agreement κ was 0.31 (0.38/0.25 for experienced/less experienced) and higher for forelimb (0.33) than for hindlimb lameness (0.11) or soundness (0.08) evaluation. Median intra-rater agreement κ was 0.57.
Inter-rater agreement was poor for less experienced raters, and for all raters when evaluating hindlimb lameness. Since identification of the lame limb/limbs is a prerequisite for successful diagnosis, treatment and recovery, the high inter-rater variation when evaluating lameness on the lunge is likely to influence the accuracy and repeatability of lameness examinations and, indirectly, the efficacy of treatment.
牵遛是跛行检查的重要组成部分，因为圆周运动路径可能会使轻度跛行更加明显。与圆周运动路径、代偿性运动及疼痛相关的运动不对称性使得跛行评估变得复杂。科学研究表明，在评估直线运动时的跛行情况时，不同评估者之间的差异很大。
旨在评估马匹兽医根据牵遛时健康和跛行马匹的视频评估跛行情况时，评估者之间及评估者自身的一致性，并研究兽医经验以及运动不对称客观程度对评估者一致性的影响。
横断面观察性研究。
对23匹不同品种的骑乘马进行视频记录及使用惯性传感器进行定量步态分析。让马匹在直线上以快步进行检查，并在软质或硬质地面上双向牵遛。每种情况下记录一个视频序列，并根据客观的直线对称性测量将马匹分类为前肢跛行、后肢跛行或健康。86名马匹兽医（其中43名具有超过5年的骨科经验）参与了一项基于网络的调查，被要求在60个视频（包括10个重复视频）中识别最跛的肢体。使用κ统计量（Fleiss、Cohen）分析兽医之间（评估者间）以及兽医自身（评估者内）的一致性。
评估者间一致性κ为0.31（经验丰富/经验较少者分别为0.38/0.25），前肢跛行评估的一致性（0.33）高于后肢跛行（0.11）或健康状况（0.08）评估。评估者内一致性κ中位数为0.57。
经验较少的评估者之间以及所有评估者在评估后肢跛行时，评估者间一致性较差。由于识别跛行肢体是成功诊断、治疗及康复的前提条件，因此在牵遛时评估跛行情况时评估者间的高变异性可能会影响跛行检查的准确性和可重复性，进而间接影响治疗效果。
