这是骨关节炎吗?在一般的实践环境中,狗主人和兽医外科医生如何描述识别犬骨关节炎。

Could it be osteoarthritis? How dog owners and veterinary surgeons describe identifying canine osteoarthritis in a general practice setting.

机构信息

School of Veterinary Medicine and Science, University of Nottingham Sutton Bonington Campus, Loughborough, Leicestershire, LE12 5RD, UK.

School of Veterinary Medicine and Science, University of Nottingham Sutton Bonington Campus, Loughborough, Leicestershire, LE12 5RD, UK.

出版信息

Prev Vet Med. 2020 Dec;185:105198. doi: 10.1016/j.prevetmed.2020.105198. Epub 2020 Nov 2.

Abstract

Canine osteoarthritis is a common, painful condition that is typically managed in a general practice setting. Osteoarthritis may have significant negative impacts on the welfare of both dogs and their owners. Anticipated early clinical signs of canine osteoarthritis and the preferred route to its diagnosis are well described by veterinary subject experts in published literature. However, little is known about changes owners first recognise in a dog ultimately diagnosed with osteoarthritis, how they make decisions about when to present that dog to a general practitioner, or whether the described diagnostic pathways are followed by general practitioners. The aim of this research was to investigate how dog owners and veterinary surgeons describe identifying and diagnosing canine osteoarthritis. Owners of osteoarthritic dogs were recruited for semi-structured interview, and veterinary surgeons working in general practice were invited to take part in practice-based focus groups. Transcripts from both datasets were thematically analysed using a contextualist epistemology with an ontology based on critical realism to construct convergent themes from latent and semantic codes. Thirty-two interviews were completed with 40 owners from 32 households who discussed 35 dogs with osteoarthritis, and 26 veterinary surgeons engaged in four practice-based focus groups. Owners described identifying a wide range of acute and chronic, typically subtle and intermittent, behavioural and demeanour changes prior to their dogs' osteoarthritis diagnosis. Few attributed these changes to canine osteoarthritis, and some waited many months before presenting their dog to a veterinary practice. Veterinary surgeons described a consistent 'typical osteoarthritis' presentation that they recognised through history taking and clinical examination. Their diagnostic work-up rarely followed that advocated by subject experts for reasons including lack of time and perceptions that it would not change the outcome. Many veterinary surgeons described frustration that some owners did not accept their recommendations to provide analgesia for affected dogs. Short consultation lengths, poor awareness of owner knowledge levels, and lack of recognition of the importance of owners' prior knowledge, beliefs and assumptions may contribute to these consultations being perceived as challenging by some veterinary surgeons and owners. This research demonstrates that veterinary surgeons and owners want dogs with clinical signs of osteoarthritis to be happy and comfortable, but that ineffective communication and lack of trust in the consulting room may be a barrier. Our data identifies many new avenues for future research and improved communication strategies that could facilitate earlier identification and treatment of canine osteoarthritis in general practice.

摘要

犬骨关节炎是一种常见的、痛苦的疾病,通常在全科医疗环境中进行管理。骨关节炎可能对狗和它们的主人的福利产生重大的负面影响。兽医专家在已发表的文献中详细描述了犬骨关节炎的预期早期临床症状和首选诊断途径。然而,对于最终被诊断为骨关节炎的狗,主人首先注意到的变化是什么,他们如何决定何时将狗带到全科医生那里,或者全科医生是否遵循了描述的诊断途径,人们知之甚少。本研究的目的是调查狗主人和兽医外科医生如何描述识别和诊断犬骨关节炎。招募了患有骨关节炎的狗的主人进行半结构化访谈,并邀请在全科实践中工作的兽医外科医生参加基于实践的焦点小组。使用基于语境主义认识论和基于批判现实主义的本体论,对来自两个数据集的转录本进行主题分析,以从潜在和语义代码中构建收敛主题。完成了 32 次访谈,涉及 32 个家庭的 40 位主人,他们讨论了 35 只患有骨关节炎的狗,26 位兽医外科医生参加了 4 次基于实践的焦点小组。主人描述了在他们的狗被诊断为骨关节炎之前,发现了一系列广泛的急性和慢性、通常是微妙和间歇性的行为和举止变化。很少有人将这些变化归因于犬骨关节炎,有些人在将狗带到兽医诊所之前等了好几个月。兽医外科医生描述了他们通过病史采集和临床检查识别的一致的“典型骨关节炎”表现。他们的诊断工作很少遵循学科专家所倡导的,原因包括缺乏时间和认为这不会改变结果。许多兽医外科医生描述说,有些主人不接受他们为受影响的狗提供止痛药的建议,这让他们感到沮丧。咨询时间短、对主人知识水平的认识不足以及缺乏对主人先前知识、信念和假设的重视,可能导致一些兽医外科医生和主人认为这些咨询具有挑战性。本研究表明,兽医外科医生和主人希望有临床症状的狗快乐舒适,但沟通不畅和对咨询室缺乏信任可能是一个障碍。我们的数据确定了许多未来研究和改进沟通策略的新途径,这些途径可以促进犬骨关节炎在全科医疗中的早期识别和治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e9a0/7755036/a7a6bb75fbe6/ga1.jpg

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