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
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
  • Journal Article


This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

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).


  • 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.


  • 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

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.


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.


This article includes 37 references
  1. Asplin KE, Sillence MN, Pollitt CC, McGowan CM. Induction of laminitis by prolonged hyperinsulinaemia in clinically normal ponies.. Vet J 2007 Nov;174(3):530-5.
    doi: 10.1016/j.tvjl.2007.07.003pubmed: 17719811google scholar: lookup
  2. Dalla Costa E, Stucke D, Dai F, Minero M, Leach MC, Lebelt D. Using the Horse Grimace Scale (HGS) to Assess Pain Associated with Acute Laminitis in Horses (Equus caballus).. Animals (Basel) 2016 Aug 3;6(8).
    doi: 10.3390/ani6080047pmc: PMC4997272pubmed: 27527224google scholar: lookup
  3. de Laat MA, McGowan CM, Sillence MN, Pollitt CC. Equine laminitis: induced by 48 h hyperinsulinaemia in Standardbred horses.. Equine Vet J 2010 Mar;42(2):129-35.
    doi: 10.2746/042516409x475779pubmed: 20156248google scholar: lookup
  4. Dern K, van Eps A, Wittum T, Watts M, Pollitt C, Belknap J. Effect of Continuous Digital Hypothermia on Lamellar Inflammatory Signaling When Applied at a Clinically-Relevant Timepoint in the Oligofructose Laminitis Model.. J Vet Intern Med 2018 Jan;32(1):450-458.
    doi: 10.1111/jvim.15027pmc: PMC5787192pubmed: 29282770google scholar: lookup
  5. Donaldson MT, Jorgensen AJ, Beech J. Evaluation of suspected pituitary pars intermedia dysfunction in horses with laminitis.. J Am Vet Med Assoc 2004 Apr 1;224(7):1123-7.
    doi: 10.2460/javma.2004.224.1123pubmed: 15074858google scholar: lookup
  6. Floyd A. Grading the laminitic horse. In: Floyd A, Mansmann R, editors. Equine Podiatry. St Louis: Saunders Elsevier; 2007. pp. 320u2013327.
  7. Frank N. Safety and efficacy of canagliflozin and octreotide for managing insulin dysregulation. Journal of Veterinary Internal Medicine. 2018;32(6):2123u20132143. doi: 10.1111/jvim.15314.
    doi: 10.1111/jvim.15314google scholar: lookup
  8. Fuller CJ, Bladon BM, Driver AJ, Barr AR. The intra- and inter-assessor reliability of measurement of functional outcome by lameness scoring in horses.. Vet J 2006 Mar;171(2):281-6.
    doi: 10.1016/j.tvjl.2004.10.012pubmed: 16490710google scholar: lookup
  9. Garner M. Various coefficients of interrater reliability and agreement. 2015. [7 August 2018].
  10. Karikoski NP, Horn I, McGowan TW, McGowan CM. The prevalence of endocrinopathic laminitis among horses presented for laminitis at a first-opinion/referral equine hospital.. Domest Anim Endocrinol 2011 Oct;41(3):111-7.
  11. Karikoski NP, McGowan CM, Singer ER, Asplin KE, Tulamo RM, Patterson-Kane JC. Pathology of Natural Cases of Equine Endocrinopathic Laminitis Associated With Hyperinsulinemia.. Vet Pathol 2015 Sep;52(5):945-56.
    doi: 10.1177/0300985814549212pubmed: 25232034google scholar: lookup
  12. Kawasako K, Higashi T, Nakaji Y, Komine M, Hirayama K, Matsuda K, Okamoto M, Hashimoto H, Tagami M, Tsunoda N, Taniyama H. Histologic evaluation of the diversity of epidermal laminae in hooves of horses without clinical signs of laminitis.. Am J Vet Res 2009 Feb;70(2):186-93.
    doi: 10.2460/ajvr.70.2.186pubmed: 19231949google scholar: lookup
  13. Keegan KG, Wilson DA, Wilson DJ, Smith B, Gaughan EM, Pleasant RS, Lillich JD, Kramer J, Howard RD, Bacon-Miller C, Davis EG, May KA, Cheramie HS, Valentino WL, van Harreveld PD. Evaluation of mild lameness in horses trotting on a treadmill by clinicians and interns or residents and correlation of their assessments with kinematic gait analysis.. Am J Vet Res 1998 Nov;59(11):1370-7.
    pubmed: 9829392
  14. Krippendorff K. Bivariate agreement coefficients for reliability of data. Sociological Methodology. 1970;2:139u2013150. doi: 10.2307/270787.
    doi: 10.2307/270787google scholar: lookup
  15. Lane HE, Burns TA, Hegedus OC, Watts MR, Weber PS, Woltman KA, Geor RJ, McCutcheon LJ, Eades SC, Mathes LE, Belknap JK. Lamellar events related to insulin-like growth factor-1 receptor signalling in two models relevant to endocrinopathic laminitis.. Equine Vet J 2017 Sep;49(5):643-654.
    doi: 10.1111/evj.12663pubmed: 28078757google scholar: lookup
  16. Legere R, Ruffin-Taylor D, Bello K, Parker C, Judd R, Wooldridge A. Pioglitazone in equids increases high-molecular-weight adiponectin concentrations and decreases insulin response after oral sugar [Abstract] Seattle: American College of Veterinary Internal Medicine; 2018.
  17. Luthersson N, Mannfalk M, Parkin T, Harris P. Laminitis: risk factors and outcome in a group of Danish horses. Journal of Equine Veterinary Science. 2017;53:68u201373. doi: 10.1016/j.jevs.2016.03.006.
  18. McGowan C. The role of insulin in endocrinopathic laminitis. Journal of Equine Veterinary Science. 2008;28(10):603u2013607. doi: 10.1016/j.jevs.2008.08.004.
  19. Meier AD, de Laat MA, Reiche DB, Pollitt CC, Walsh DM, McGree JM, Sillence MN. The oral glucose test predicts laminitis risk in ponies fed a diet high in nonstructural carbohydrates.. Domest Anim Endocrinol 2018 Apr;63:1-9.
  20. Meier A, Reiche D, de Laat M, Pollitt C, Walsh D, Sillence M. The sodium-glucose co-transporter 2 inhibitor velagliflozin reduces hyperinsulinemia and prevents laminitis in insulin-dysregulated ponies.. PLoS One 2018;13(9):e0203655.
  21. Menzies-Gow NJ, Stevens KB, Sepulveda MF, Jarvis N, Marr CM. Repeatability and reproducibility of the Obel grading system for equine laminitis.. Vet Rec 2010 Jul 10;167(2):52-5.
    doi: 10.1136/vr.c3668pubmed: 20622203google scholar: lookup
  22. Morgan SJ, Hood DM, Wagner IP, Postl SP. Submural histopathologic changes attributable to peracute laminitis in horses.. Am J Vet Res 2003 Jul;64(7):829-34.
    doi: 10.2460/ajvr.2003.64.829pubmed: 12856766google scholar: lookup
  23. Obel N. Studies on the histopathology of acute laminitis. 1948. D. Phil., Thesis. Almquisst and Wiksells Boktryckeri, Uppsala.
  24. Patterson-Kane JC, Karikoski NP, McGowan CM. Paradigm shifts in understanding equine laminitis.. Vet J 2018 Jan;231:33-40.
    doi: 10.1016/j.tvjl.2017.11.011pubmed: 29429485google scholar: lookup
  25. Pollitt C. Equine laminitis. Clinical Techniques in Equine Practice. 2004;3(1):34u201344. doi: 10.1053/j.ctep.2004.07.003.
  26. Pollitt C. The illustrated horseu2019s foot. St Louis: Elsevier; 2016.
  27. Robinson WS. The statistical measurement of agreement. American Sociological Review. 1957;22(1):17u201325. doi: 10.2307/2088760.
    doi: 10.2307/2088760google scholar: lookup
  28. Signorell A. Tools for descriptive statistics. 2018. [7 August 2018].
  29. Swanson TD. Clinical presentation, diagnosis, and prognosis of acute laminitis.. Vet Clin North Am Equine Pract 1999 Aug;15(2):311-9, vi.
    doi: 10.1016/s0749-0739(17)30147-5pubmed: 10472114google scholar: lookup
  30. van Eps AW. Acute laminitis: medical and supportive therapy.. Vet Clin North Am Equine Pract 2010 Apr;26(1):103-14.
    doi: 10.1016/j.cveq.2009.12.011pubmed: 20381739google scholar: lookup
  31. van Eps AW, Pollitt CC. Equine laminitis induced with oligofructose.. Equine Vet J 2006 May;38(3):203-8.
    doi: 10.2746/042516406776866327pubmed: 16706272google scholar: lookup
  32. Van Eps AW, Pollitt CC. Equine laminitis model: cryotherapy reduces the severity of lesions evaluated seven days after induction with oligofructose.. Equine Vet J 2009 Nov;41(8):741-6.
    doi: 10.2746/042516409x434116pubmed: 20095220google scholar: lookup
  33. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic.. Fam Med 2005 May;37(5):360-3.
    pubmed: 15883903
  34. Viu00f1uela-Fernu00e1ndez I, Jones E, Chase-Topping ME, Price J. Comparison of subjective scoring systems used to evaluate equine laminitis.. Vet J 2011 May;188(2):171-7.
    doi: 10.1016/j.tvjl.2010.05.011pubmed: 20541956google scholar: lookup
  35. Walsh DM. Field treatment and management of endocrinopathic laminitis in horses and ponies.. Vet Clin North Am Equine Pract 2010 Aug;26(2):379-90.
    doi: 10.1016/j.cveq.2010.05.001pubmed: 20699182google scholar: lookup
  36. Wylie CE, Collins SN, Verheyen KL, Newton JR. A cohort study of equine laminitis in Great Britain 2009-2011: estimation of disease frequency and description of clinical signs in 577 cases.. Equine Vet J 2013 Nov;45(6):681-7.
    doi: 10.1111/evj.12047pubmed: 23489181google scholar: lookup
  37. Wylie CE, Shaw DJ, Verheyen KL, Newton JR. Decision-tree analysis of clinical data to aid diagnostic reasoning for equine laminitis: a cross-sectional study.. Vet Rec 2016 Apr 23;178(17):420.
    doi: 10.1136/vr.103588pubmed: 26969668google scholar: lookup


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.
    doi: 10.1371/journal.pone.0239261pubmed: 32991593google scholar: lookup
  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).
    doi: 10.3390/ani10081426pubmed: 32824027google scholar: lookup