Small Animal Clinic (WE20), Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.
Department of Clinical Veterinary Medicine, Division of Clinical Neurology, Vetsuisse Faculty of Bern, University of Bern, Bern, Switzerland.
PLoS One. 2019 Jul 10;14(7):e0219171. doi: 10.1371/journal.pone.0219171. eCollection 2019.
The reliability of reflex-assessment is currently debatable, with current literature regarding the patellar tendon reflex (PTR) as highly reliable, while the biceps tendon reflex (BTR) is regarded to be of low reliability in the dog. Such statements are, however, based on subjective observations rather than on an empirical study. The goals of this study were three-fold: (1) the quantification of the interobserver agreement (IA) on the evaluation of the canine bicipital (BTR) and patellar tendon (PTR) reflex in healthy dogs, (2) to compare the IA of the BTR and PTR evaluation and (3) the identification of intrinsic (sex, age, fur length, weight) and extrinsic (observer´s expertise, body side) risk factors on the IA of both reflexes. The observers were subdivided into three groups based on their expected level of expertise (neurologists = highest -, practitioners = middle-and veterinary students = lowest level of expertise). For the BTR, 54 thoracic limbs were analyzed and compared to the evaluation of the PTR on 64 pelvic limbs. Each observer had to evaluate the reflex presence (RP) (present or absent) and the reflex activity (RA) using a 5-point ordinal scale. Multiple reliability coefficients were calculated. The influence of the risk factors has been calculated using a mixed regression-model. The Odds Ratio for each factor was presented. The higher the level of expertise the higher was the IA of the BTR. For RP(BTR), IA was highest for neurologists and for RA(BTR) the IA was lowest for students. The level of expertise had a significant impact on the degree of the IA in the evaluation of the bicipital tendon reflex: for the RA(BTR), practitioners had a 3.4-times (p = 0.003) and students a 7.0-times (p < 0.001) higher chance of discordance. In longhaired dogs the chance of disagreement was 2.6-times higher compared to shorthaired dogs in the evaluation of RA(BTR) (p = 0.003). Likewise, the IA of the RP(PTR) was the higher the higher the observers´ expertise was with neurologists having significantly highest values (p < 0.001). The RA(PTR) has been evaluated more consistent by practitioners and students than the RA(BTR). For practitioners this difference was significant (< 0.01). Our data suggests that neurologists assess the bicipital and patellar tendon reflex in dogs most reliably. None of the examined risk factors had a significant impact on the degree of IA in the evaluation of RP(PTR), while students had a 4.4-times higher chance of discordance when evaluating the RA(PTR) compared to the other groups. This effect was significant (p < 0.001). Neurologists can reliably assess the bicipital and patellar tendon reflex in healthy dogs. Observer´s level of expertise and the fur length of the dog affect the degree of IA of RA(BTR). The influence of the observer´s expertise is higher on the evaluation of the BTR than on the PTR.
目前，关于腱反射评估的可靠性存在争议，目前有关髌腱反射（PTR）的文献认为其可靠性很高，而关于桡骨肌腱反射（BTR）的文献则认为其在狗中可靠性较低。然而，这些说法是基于主观观察，而不是基于实证研究。本研究的目的有三：（1）量化健康犬桡骨（BTR）和髌腱（PTR）反射评估的观察者间一致性（IA）；（2）比较 BTR 和 PTR 评估的 IA；（3）确定内在（性别、年龄、毛长、体重）和外在（观察者专业知识、身体侧位）风险因素对两种反射 IA 的影响。观察者根据预期的专业知识水平分为三组（神经科医生=最高-，医生=中等-和兽医学生=最低水平的专业知识）。对于 BTR，分析了 54 个胸肢，并与 64 个骨盆肢的 PTR 评估进行了比较。每个观察者必须使用 5 点有序量表评估反射存在（RP）（存在或不存在）和反射活动（RA）。计算了多个可靠性系数。使用混合回归模型计算了风险因素的影响。每个因素的优势比都有介绍。专业知识水平越高，BTR 的 IA 就越高。对于 RP（BTR），神经科医生的 IA 最高，而对于 RA（BTR），学生的 IA 最低。专业知识水平对桡骨肌腱反射评估中的 IA 程度有显著影响：对于 RA（BTR），医生的差异率为 3.4 倍（p = 0.003），学生的差异率为 7.0 倍（p < 0.001）。长发犬与短发犬相比，在评估 RA（BTR）时，出现不一致的几率高 2.6 倍（p = 0.003）。同样，观察者专业知识水平越高，PTR 的 RP（PTR）的 IA 就越高，神经科医生的 IA 具有显著的最高值（p < 0.001）。与 BTR 相比，医生和学生对 PTR 的 RA 评估更为一致。对于医生来说，这种差异具有统计学意义（<0.01）。我们的数据表明，神经科医生在评估狗的桡骨和髌腱反射时最可靠。在评估 RP（PTR）时，检查的风险因素均未对 IA 程度产生显著影响，而学生在评估 RA（PTR）时的不一致率比其他组高 4.4 倍。这种影响具有统计学意义（p < 0.001）。神经科医生可以可靠地评估健康犬的桡骨和髌腱反射。观察者的专业知识水平和犬的毛长会影响 RA（BTR）的 IA 程度。观察者专业知识对 BTR 的评估影响高于 PTR。
