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

BACKGROUND: 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...

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Autores principales: Meier, Alexandra, de Laat, Melody, Pollitt, Christopher, Walsh, Donald, McGree, James, Reiche, Dania B., von Salis-Soglio, Marcella, Wells-Smith, Luke, Mengeler, Ulrich, Mesa Salas, Daniel, Droegemueller, Susanne, Sillence, Martin N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: PeerJ Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557244/
https://www.ncbi.nlm.nih.gov/pubmed/31211020
http://dx.doi.org/10.7717/peerj.7084
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author Meier, Alexandra
de Laat, Melody
Pollitt, Christopher
Walsh, Donald
McGree, James
Reiche, Dania B.
von Salis-Soglio, Marcella
Wells-Smith, Luke
Mengeler, Ulrich
Mesa Salas, Daniel
Droegemueller, Susanne
Sillence, Martin N.
author_facet Meier, Alexandra
de Laat, Melody
Pollitt, Christopher
Walsh, Donald
McGree, James
Reiche, Dania B.
von Salis-Soglio, Marcella
Wells-Smith, Luke
Mengeler, Ulrich
Mesa Salas, Daniel
Droegemueller, Susanne
Sillence, Martin N.
author_sort Meier, Alexandra
collection PubMed
description BACKGROUND: 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 (n = 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 W) 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 (kw). 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 W value (0.87, P < 0.001 vs. 0.85, P < 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 kw 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). CONCLUSION: 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.
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spelling pubmed-65572442019-06-17 A “modified Obel” method for the severity scoring of (endocrinopathic) equine laminitis Meier, Alexandra de Laat, Melody Pollitt, Christopher Walsh, Donald McGree, James Reiche, Dania B. von Salis-Soglio, Marcella Wells-Smith, Luke Mengeler, Ulrich Mesa Salas, Daniel Droegemueller, Susanne Sillence, Martin N. PeerJ Veterinary Medicine BACKGROUND: 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 (n = 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 W) 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 (kw). 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 W value (0.87, P < 0.001 vs. 0.85, P < 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 kw 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). CONCLUSION: 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. PeerJ Inc. 2019-06-07 /pmc/articles/PMC6557244/ /pubmed/31211020 http://dx.doi.org/10.7717/peerj.7084 Text en © 2019 Meier et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ) and either DOI or URL of the article must be cited.
spellingShingle Veterinary Medicine
Meier, Alexandra
de Laat, Melody
Pollitt, Christopher
Walsh, Donald
McGree, James
Reiche, Dania B.
von Salis-Soglio, Marcella
Wells-Smith, Luke
Mengeler, Ulrich
Mesa Salas, Daniel
Droegemueller, Susanne
Sillence, Martin N.
A “modified Obel” method for the severity scoring of (endocrinopathic) equine laminitis
title A “modified Obel” method for the severity scoring of (endocrinopathic) equine laminitis
title_full A “modified Obel” method for the severity scoring of (endocrinopathic) equine laminitis
title_fullStr A “modified Obel” method for the severity scoring of (endocrinopathic) equine laminitis
title_full_unstemmed A “modified Obel” method for the severity scoring of (endocrinopathic) equine laminitis
title_short A “modified Obel” method for the severity scoring of (endocrinopathic) equine laminitis
title_sort “modified obel” method for the severity scoring of (endocrinopathic) equine laminitis
topic Veterinary Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557244/
https://www.ncbi.nlm.nih.gov/pubmed/31211020
http://dx.doi.org/10.7717/peerj.7084
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