Evaluation of clinical examination location on stress in cats: a randomized crossover trial

Abstract

Objectives The objective of this study was to quantify the effects of owner separation and physical examination location on fear, anxiety and stress (FAS) behavioral indicators in cats. Methods The study was a prospective, non-blinded, randomized, two-period, two-treatment crossover trial. Healthy adult cats presenting for wellness or dental evaluations at a single veterinary teaching hospital received three physical examinations: a baseline assessment (owner present) followed by physical examinations in both a treatment area (owner absent [TAOA]) and an examination room (owner present [EROP]). The physical examination sequence order was randomized. Low-stress handling techniques were used for all examinations. The primary endpoints were heart rate (HR; beats per min [bpm]) and total FAS scores. HR was measured by auscultation, and FAS by five specific behaviors scored as 0/1 and summed for each assessment period. Results Twenty-one healthy cats were enrolled. HR measured at entry (baseline) was a significant determinant of subsequent HR readings. HR measured during examinations conducted in both EROP and TAOA were elevated to levels indicative of stress (>180 bpm). HR was significantly higher for TAOA relative to EROP (30 bpm, 95% confidence interval 18–43; P <0.001). Behavioral FAS scores showed no statistically significant effects of sequence or room. FAS scores for TAOA assessments were clinically elevated relative to baseline (1.5 FAS, SE 0.7; P = 0.05); EROP FAS scores relative to baseline did not differ statistically (0.5 units, SE = 0.5; P = 0.43). Conclusions and relevance Owner separation coupled with physical examination location can result in clinically significant increases in perceived stress in cats, and compromise vital sign assessments. Whenever possible, physical examinations and procedures should take place with the owner present with separation from unfamiliar dogs and cats.

A Review on Mitigating Fear and Aggression in Dogs and Cats in a Veterinary Setting

“…Similarly, a study using the same methodology with client-owned cats demonstrated that heart rate was 30 bpm higher in the common treatment area than in the exam room with the owner. Additionally the behavioural score during the examination was higher than baseline in the common area, whereas no significant change was noted in the exam room [ 55 ].…”

“…These studies demonstrated that, whenever possible, examinations or minor procedures should be performed in the exam room, with the owner present [ 54 , 55 ]. If, for any reason, the owner’s presence is not desirable; it is recommendable to request the owner to leave the examination room and perform the intervention in that room, instead of taking the animal to the common treatment area [ 55 ].…”

Low and No-Contact Euthanasia: Associated Ethical Challenges Experienced by Veterinary Team Members during the Early Months of the COVID-19 Pandemic

“…A randomized crossover trial of 44 client-owned dogs examined in the consultation room in the presence of their owner, and the common treatment area (“out the back”) without the owner present, reported higher levels of fear, anxiety and stress in more dogs examined in the common treatment area, without their owners [ 53 ]. Similarly, a randomized crossover trial of 21 client-owned cats found that separation from owners and examination in the common treatment area were associated with clinically significant increases in perceived stress in cats [ 54 ]. These findings suggest that, where possible, examinations and minor procedures should be performed in the consultation room, with the owner present [ 49 ].…”

2022 AAFP/ISFM Cat Friendly Veterinary Interaction Guidelines: Approach and Handling Techniques

“…67 Unless insurmountable barriers exist, any additional outpatient procedures required should also be performed in the examination room, to increase the accuracy of certain diagnostic tests, to reduce sensory arousal and exposure to unfamilar animals, and to avoid separation of cats from their caregivers. 67 All veterinary visits are likely to induce protective emotions to some degree, as these are natural and necessary responses to experiences the cat perceives as threatening. it is important to minimize the triggering of these emotions, including fear-anxiety, pain and frustration, and to enable the cat to select appropriate behavioral responses.…”

“…67 Unless insurmountable barriers exist, any additional outpatient procedures required should also be performed in the examination room, to increase the accuracy of certain diagnostic tests, to reduce sensory arousal and exposure to unfamilar animals, and to avoid separation of cats from their caregivers. 67…”