PeerJ2019; 7; e7084; doi: 10.7717/peerj.7084

A “modified Obel” method for the severity scoring of (endocrinopathic) equine laminitis.

Abstract: Laminitis is a common equine disease characterized by foot pain, and is commonly diagnosed using a five-grade Obel system developed in 1948 using sepsis-related cases. However, endocrinopathic laminitis is now the most common form of the disease and clinical signs may be mild, or spread across two Obel grades. This paper describes a modified method which assigns scores to discreet clinical signs, providing a wider scale suitable for use in a research setting. Methods: The "modified Obel" method was developed using an iterative process. First, a prototype method was developed during the detailed observation of 37 ponies undergoing a laminitis induction experiment. The final method was refined and validated using video footage taken during the induction study and from a clinical trial of naturally occurring endocrinopathic laminitis cases. The Obel method was deconstructed and key laminitis signs were evaluated to develop a three-stage, five criteria method that employs a severity scale of 0-12. Veterinarians ( = 28) were recruited to watch and assess 15 video recordings of cases of varying severity, using the Obel and "modified Obel" methods. The inter-observer agreement (reproducibility) was determined using Kendall's coefficient of concordance (Kendall ) and Krippendorf's alpha reliability coefficient. A total of 14 veterinarians repeated the exercise 2-4 weeks after their original assessment, to determine intra-observer agreement (repeatability), assessed using a weighted kappa statistic (). Agreement between methods was calculated by converting all "modified Obel" scores to Obel grades and calculating the mean and distribution of the differences. Results: The "modified Obel" and Obel methods showed excellent and similar inter-observer agreement based on the Kendall value (0.87, < 0.001 vs. 0.85, < 0.001) and Krippendorf's alpha (95% CI) value (0.83 [0.53-0.90] vs. 0.77 [0.55-0.85]). Based on the value, the "modified Obel" method also had substantial repeatability, although slightly less than the Obel method, (0.80 vs. 0.91). Excellent agreement between the methods was found, with the mean difference (95% CI), comparing the Obel grade, with the "modified Obel" score converted to an Obel grade, being -0.12 (-0.19 to -0.06) grades. The Obel and converted "modified Obel" grades were identical 62% of the time (259/420) and a difference of one grade (higher or lower) occurred in 35% of cases (148/420). Conclusions: Both methods show excellent agreement, reproducibility and repeatability when used to diagnose endocrinopathic laminitis. The "modified Obel" method is a three-step examination process for severity-scoring of endocrinopathic laminitis, initially proposed for use within a research setting. When using the modified method a diagnosis of laminitis also requires clinical acumen. The allocation of scores for specific clinical signs should be particularly useful in research trials monitoring laminitis recovery.
Publication Date: 2019-06-07 PubMed ID: 31211020PubMed Central: PMC6557244DOI: 10.7717/peerj.7084Google Scholar: Lookup
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  • Journal Article

Summary

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The research article discusses the development and validation of a “modified Obel” method for scoring the severity of endocrinopathic equine laminitis, a common horse disease. The study finds that the modified method is effective in diagnosing the disease and could be useful in monitoring recovery in research trials.

Development of the Modified Obel Method:

  • The researchers created the modified method using an iterative process.
  • Initially, a prototype was developed while closely observing 37 ponies in a laminitis induction experiment.
  • The final method was further refined and validated using video footage from the induction study and from a clinical trial of naturally occurring cases.

Modified Obel Method Details:

  • The traditional Obel method was deconstructed and key signs of laminitis were evaluated.
  • The modified method uses a three-stage, five-criteria system and a severity scale of 0-12.
  • 28 veterinarians were recruited to watch and assess 15 video cases of varying severity using both the Obel and modified Obel methods.

Inter and Intra-Observer Agreement:

  • The inter-observer agreement (reproducibility) was evaluated using Kendall’s and Krippendorf’s reliability coefficients.
  • 14 of the veterinarians repeated the assessment 2-4 weeks later to evaluate intra-observer agreement (repeatability).

Results:

  • The modified Obel and Obel methods showed excellent and similar inter-observer agreement.
  • The modified method also showed substantial repeatability, albeit slightly less than the Obel method.
  • Excellent agreement between the two methods was found when comparing the converted “modified Obel” scores to Obel grades.
  • The Obel and converted “modified Obel” grades were the same 62% of the time and differed by one grade in 35% of cases.

Conclusion:

  • Both methods demonstrated excellent agreement, reproducibility, and repeatability in diagnosing endocrinopathic laminitis.
  • The modified Obel method has been proposed for use in a research setting and requires clinical acumen for diagnosing laminitis.
  • Assigning scores for specific clinical signs might be especially beneficial in research trials monitoring laminitis recovery.

Cite This Article

APA
Meier A, de Laat M, Pollitt C, Walsh D, McGree J, Reiche DB, von Salis-Soglio M, Wells-Smith L, Mengeler U, Mesa Salas D, Droegemueller S, Sillence MN. (2019). A “modified Obel” method for the severity scoring of (endocrinopathic) equine laminitis. PeerJ, 7, e7084. https://doi.org/10.7717/peerj.7084

Publication

ISSN: 2167-8359
NlmUniqueID: 101603425
Country: United States
Language: English
Volume: 7
Pages: e7084
PII: e7084

Researcher Affiliations

Meier, Alexandra
  • Earth, Environmental and Biological Sciences School, Queensland University of Technology, Brisbane, QLD, Australia.
de Laat, Melody
  • Earth, Environmental and Biological Sciences School, Queensland University of Technology, Brisbane, QLD, Australia.
Pollitt, Christopher
  • Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia.
Walsh, Donald
  • Animal Health Foundation, Pacific, MO, USA.
McGree, James
  • School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
Reiche, Dania B
  • Boehringer-Ingelheim Vetmedica, Ingelheim am Rhein, Germany.
von Salis-Soglio, Marcella
  • Boehringer-Ingelheim Vetmedica, Ingelheim am Rhein, Germany.
Wells-Smith, Luke
  • Motion Equine Podiatry Consulting, Melbourne, Vic, Australia.
Mengeler, Ulrich
  • Veterinary Practice for Horses, Hamminkeln, Germany.
Mesa Salas, Daniel
  • Veterinary Practice Datteln, Datteln, Germany.
Droegemueller, Susanne
  • Practice for Horses and Pets, Gehrden, Germany.
Sillence, Martin N
  • Earth, Environmental and Biological Sciences School, Queensland University of Technology, Brisbane, QLD, Australia.

Conflict of Interest Statement

Alexandra Meier is supported by a PhD scholarship sponsored by Boehringer Ingelheim. Marcella von Salis-Soglio and Dania Reiche are employees of Boehringer Ingelheim. Donald Walsh is a Director of the Animal Health Foundation, Luke Wells-Smith is employed by Motion Equine Podiatry Consulting, Ulrich Mengeler is employed by Veterinary Practice for Horses, Hamminkeln, Daniel Mesa Salas is employed by Veterinary Practice Datteln, Datteln and Susanne Droegemueller is employed by Practice for Horses and Pets, Gehrden.

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Citations

This article has been cited 5 times.
  1. Sillence M, Meier A, de Laat M, Klee R, Reiche D. Demographic, morphologic, hormonal and metabolic factors associated with the rate of improvement from equine hyperinsulinaemia-associated laminitis.. BMC Vet Res 2022 Jan 18;18(1):49.
    doi: 10.1186/s12917-022-03149-zpubmed: 35042535google scholar: lookup
  2. Delarocque J, Reiche DB, Meier AD, Warnken T, Feige K, Sillence MN. Metabolic profile distinguishes laminitis-susceptible and -resistant ponies before and after feeding a high sugar diet.. BMC Vet Res 2021 Jan 28;17(1):56.
    doi: 10.1186/s12917-021-02763-7pubmed: 33509165google scholar: lookup
  3. Meier A, McGree J, Klee R, Preuu00df J, Reiche D, de Laat M, Sillence M. The application of a new laminitis scoring method to model the rate and pattern of improvement from equine endocrinopathic laminitis in a clinical setting.. BMC Vet Res 2021 Jan 7;17(1):16.
    doi: 10.1186/s12917-020-02715-7pubmed: 33413384google scholar: lookup
  4. Rahnama S, Vathsangam N, Spence R, Medina-Torres CE, Pollitt CC, de Laat MA, Bailey SR, Sillence MN. Effects of an anti-IGF-1 receptor monoclonal antibody on laminitis induced by prolonged hyperinsulinaemia in Standardbred horses.. PLoS One 2020;15(9):e0239261.
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  5. Gehlen H, Jaburg N, Merle R, Winter J. Can Endocrine Dysfunction Be Reliably Tested in Aged Horses That Are Experiencing Pain?. Animals (Basel) 2020 Aug 14;10(8).
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