Development of a checklist for the detection of degenerative joint disease-associated pain in cats

Abstract

Objectives The aim of this study was to develop an evidence-based, clinically expedient checklist to identify cats likely to have degenerative joint disease (DJD)-associated pain. Methods Data were compiled from previously conducted studies that employed a standardized subjective outcome measure consisting of a series of questions. These studies included a prevalence study (with DJD non-informed owners) and therapeutic trials (with DJD-informed owners). For each cat, and each question, response scores were converted to ‘impaired’ and ‘unimpaired’. Cats were categorized as ‘DJD pain’ and ‘non-DJD’ based on orthopedic pain and radiographic DJD scores. These binary data were compared between cat phenotypes (non-DJD and DJD pain) for each question. Sensitivity and specificity of each question were calculated using the binary data; based on this, potential questions for the checklist were selected. Sensitivity and specificity across this group of questions were calculated, and questions sequentially removed to optimize length, sensitivity and specificity. Finally, the proposed checklist was applied to a novel data set to evaluate its ability to identify cats with DJD pain. Results In total, 249 DJD pain cats and 53 non-DJD cats from five studies were included. Nine questions with adequate sensitivity and specificity were initially identified. Following sequential removal of questions, a checklist with six binary questions was proposed. Based on the data from the cohorts of DJD-informed and DJD non-informed owners, the sensitivity and specificity of the proposed checklist were approximately 99% and 100%, and 55% and 97%, respectively. Conclusions and relevance The proposed checklist represents a data-driven approach to construct a screening checklist for DJD pain in cats. This checklist provides a clinically expedient tool likely to increase veterinarians’ ability to screen for DJD pain in cats. The identified behaviors comprising the checklist may further provide a foundation for increasing awareness of DJD pain among cat owners.

Refinement of the Feline Musculoskeletal Pain Index (FMPI) and development of the short-form FMPI

“…To assess the discriminatory ability of the FMPI-sf, FMPI data from musculoskeletally normal cats were also gathered from another published study. 20 The average FMPI score across 17 items and FMPI-sf items that were obtained at the initial visit from normal cats and DJD cats (from the above four studies) were calculated, and then they were compared.…”

“…In the included studies, scoring of the FMPI data had been performed in various ways (for statistical reasons) as previously described. 20 To align each study, the scoring for each was converted to a 0–4 scale (0 = activity performed normally; 4 = activity was impossible to perform). For example, if the original study employed a 5 (normal) to 1 (impossible) scale for each item, the data were converted as shown in Table 4.…”

“…Next, an item was removed if prevalence of impairment (of that item) in the population of cats with DJD was <50% based on our prevalence data. 20 After each item was removed, statistical analysis was performed on the remaining items to calculate the group difference across the set of remaining items. After the stepwise elimination, a proposed new FMPI-sf was constructed.…”

Feline musculoskeletal ageing: How are we diagnosing and treating musculoskeletal impairment?

“…28 Most recently it has formed the basis of a six-question checklist that can be used as a DJD screening tool, with the complete FMPI being used on cats that score highly on the checklist. 42 It is able to distinguish between normal cats and cats with painful OA/DJD. 28 It has subsequently been used to test the effectiveness of meloxicam as an analgesic for cats with DJD.…”

Surgical and Behavioral Relationships With Welfare

“…Whereas previously it was thought that some pain post-op helps keep the animal quiet, thankfully these beliefs are changing. There are different checklists and criteria by which veterinarians can measure pain in animals (19). Even with these measurements, there is sometimes a lack of agreement between veterinarians when evaluating levels of pain (20,21).…”