Pressure pain mapping of equine distal joints: feasibility and reliability.
Abstract: Osteoarthritis is a prevalent degenerative joint disease initiating chronic pain and lameness in horses. While several objective gait analysis systems have been developed and validated to quantify lameness severity in horses, methods to evaluate whether peripheral sensitization contributes to the pain experienced are missing. Unassigned: To evaluate whether periarticular pressure pain mapping could be proposed as an auxiliary assessment tool in horses. Specific aims were to evaluate the feasibility and intra- and inter-rater reliability of pressure pain thresholds (PPT) determination at sites overlying the distal thoracic limb joints of clinically healthy horses. Unassigned: Prospective, randomized validation study. Unassigned: For feasibility assessment, PPT were measured with a hand-held digital algometer at six periarticular landmarks (2 sites per joint, 3 joints) bilaterally on the distal thoracic limb of 40 healthy horses (20 warmblood and 20 Freiberger). The joints tested were the metacarpophalangeal, on the latero-palmar and dorsal aspects (L-MCP and D-MCP), the proximal interphalangeal, on the dorsal and palmar aspect (D-PIP and P-PIP) and the distal interphalangeal, on the dorsal and lateral aspect (D-DIP and L-DIP). A feasibility score, ranging from 0 to 5, was attributed to each testing session. For intra- and inter-rater reliability assessment, L-MCP and D-MCP were selected to be tested again at 2 weeks intervals in 20 out of the 40 horses. Data were analyzed using a mixed-effect linear model to test differences in threshold per site and limb. Intra- and inter-rater correlation was calculated. Bland-Altman plots were performed to evaluate the variability of the measures. Unassigned: The procedure was considered feasible (score <2) in 95% of horses (95% CI 88%-100%). Overall, median [interquartile range (IQR)] PPT was 9.4 (7.5-11.3) . No significant side differences were found. P-PIP and D-DIP recorded significantly lower PPT ( < 0.001 and = 0.002, respectively) than L-MCP. Median (IQR) were 9.9 (7.3-12.4) , 8.4 (6.1-10.5) and 9.0 (7.4-10.6) for L-MCP, P-PIP and D-DIP, respectively. The intra-rater agreement was 0.68 (95% CI 0.35-0.86) for L-MCP, and 0.50 (95% CI 0.08-0.76 for D-MCP. Inter-rater agreement was 0.85 (95% CI 0.66-0.94 for L-MCP and 0.81 (0.57, 0.92) for D-MCP. Unassigned: Evaluation of feasibility was performed only for distal thoracic limbs joints; no data are provided for hind limbs or proximal joints. Only warmblood and Freiberger horses were included. Intra- and inter-rater reliability assessments were performed exclusively on data collected at the MCP joint. Unassigned: Pressure pain mapping of distal thoracic limb joints was feasible in horses. Local sensitivity differed among sites and no side differences were noticed. Data collected from the MCP joint suggest highly variable, subject dependent intra-rater reliability, ranging from poor to good, and good to excellent inter-rater reliability. Further studies evaluating pathologic vs. healthy joints are needed before recommendations can be made about clinical usability and diagnostic validity.
© 2024 Gisler, Chiavaccini, Blum, Montavon and Spadavecchia.
Publication Date: 2024-04-25 PubMed ID: 38726353PubMed Central: PMC11079115DOI: 10.3389/fpain.2024.1342954Google Scholar: Lookup
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Summary
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The research focuses on the feasibility and reliability of pressure pain mapping, an evaluative approach for identifying pain in the joints of equine (horse) species. The technique uses a digital tool to measure pain thresholds at multiple points around the horse’s lower foreleg joints. The findings reveal that this approach is feasible in most horses and shows different sensitivity levels across various joint sites.
Study Goal and Design
- The research aimed to examine if periarticular pressure pain mapping, a diagnostic tool, can be utilized consistently and feasibly on horses to identify chronic issues like Osteoarthritis.
- The researchers wanted to validate the method’s intra-rater (same person undertaking measurements multiple times) and inter-rater (various people performing the measurements) reliability.
- The study was a prospective, randomized validation study.
Methods and Procedure
- Pain thresholds were gauged at six periarticular locations on both lower forelimbs of 40 healthy horses using a hand-held digital algometer, a device used for measuring pain sensitivity.
- Three different joints were tested and given a feasibility score (0-5).
- Reliability between and within examiners was assessed in 20 of the horses over a two-week interval.
Results
- The procedure had a feasibility score of less than 2 in 95% of the horses, indicating high applicability for the approach.
- There was no significant side difference in pain thresholds.
- Pressure readings differed significantly among the joints tested.
- The reliability of repeated measurements by the same person (intra-rater) was variable depending on the individual horse.
- The agreement between different examiners (inter-rater reliability) was good to excellent.
Limitations and Further Study
- This study only assessed the lower forelimbs of the horses; data for hind limbs or upper joints was not collected.
- Only two breeds of horses (warmblood and Freiberger) were included in the study, potentially limiting the generalizability of the findings.
- The study recommends further research involving horses with unhealthy joints to evaluate the method’s clinical usability and diagnostic validity.
Cite This Article
APA
Gisler J, Chiavaccini L, Blum S, Montavon S, Spadavecchia C.
(2024).
Pressure pain mapping of equine distal joints: feasibility and reliability.
Front Pain Res (Lausanne), 5, 1342954.
https://doi.org/10.3389/fpain.2024.1342954 Publication
Researcher Affiliations
- Department of Clinical Veterinary Medicine, Anaesthesiology and Pain Therapy Section, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
- Veterinary Department of the Swiss Armed Forces, Bern, Switzerland.
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States.
- Department of Clinical Veterinary Medicine, Anaesthesiology and Pain Therapy Section, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
- Veterinary Department of the Swiss Armed Forces, Bern, Switzerland.
- Veterinary Department of the Swiss Armed Forces, Bern, Switzerland.
- Department of Clinical Veterinary Medicine, Anaesthesiology and Pain Therapy Section, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
Conflict of Interest Statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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