Stress in client‐owned dogs related to clinical exam location: a randomised crossover trial

Abstract

Objectives To quantify the effects of wellness examinations conducted in the common treatment area on fear, anxiety and stress indicators in client‐owned dogs. Materials and Methods The study was a prospective, non‐blinded, randomised, two‐period two‐treatment crossover trial. Client‐owned healthy adult dogs presenting for wellness or dental evaluations at a single veterinary teaching hospital received three consecutive rapid assessment exams; a baseline exam (owner present), followed by two identical physical exams differing in location and presented in random order (isolated exam room with owner present versus common treatment area, owner absent). Primary endpoints were a cumulative fear, anxiety and stress score for five standardised behaviours and heart rate (bpm) measured for each exam. Results Forty‐four dogs were enrolled. Modal fear, anxiety and stress score at baseline was 1 of 5, indicating none to mild stress. Both fear, anxiety and stress and heart rates measured in the common treatment area were clinically elevated relative to assessments conducted in the exam room. Relative to baseline, animals examined in the common treatment area showed increased fear, anxiety and stress (+2.6 units, se 0.5; P<0.0001) and heart rate (20 bpm, 95% confidence interval 13, 28; P<0.0001. Twenty‐eight dogs (64%) exhibited fear, anxiety and stress scores ≥3 of 5 (moderate to severe stress) in the common treatment area, compared to 19 (43%) during exam room assessments. Clinical Significance Stress assessments in this study may have been biased by inability to blind assessors to location. However, stress metrics showed clinically significant, consistent and directionally symmetrical increases when dogs were examined in the common treatment area. When physical exam locations are highly stimulating, dogs may experience increased stress and anxiety, with detrimental effects on clinical assessments and behavioural welfare. Whenever possible, physical exams and procedures should take place in low‐stress environments with the owner present.

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

“…When management and low-stress handling methods are not sufficient to moderate an animal’s fear, anxiolytic medication is indicated alongside a behavioural treatment plan. Although accommodating perceived “difficult” animals may initially cost more time, investing in individual routines and enabling the animals to feel safe lead to more efficient examinations and treatment in the long term [ 3 , 60 ] and reduces the risk of injury to the staff [ 29 , 39 , 54 ]. Relationship building measures not only increase client loyalty [ 38 ], but also improve staff satisfaction (reviewed in [ 40 ]).…”

“…Towels and blankets are often recommended for the restraint of cats and smaller dogs, to shield animals from visual stimuli and to create a sense of hiding [ 36 , 37 , 54 ] ( Figure 6 ). Providing a protective barrier between person and patient, towel wraps can constitute effective safety measures [ 36 ], as they can also protect against cats‘ claws.…”

“…‘Taking the animal to the back’ for minor procedures should be avoided. Moreover, [ 54 ] performed a crossover trial in which dogs were examined in an exam room in the presence of their owners vs in the owner’s absence in a common treatment area. The common treatment area included two exam tables, two tables for dental procedures, cages holding cats and small dogs as well as a row of large dog runs.…”

“…The common treatment area included two exam tables, two tables for dental procedures, cages holding cats and small dogs as well as a row of large dog runs. Compared to the examination in the exam room, dogs exhibited a significantly elevated behavioural score for measuring fear, anxiety and stress, and heart rate was on average 20 bpm higher in the common area [ 54 ].…”

“…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 ].…”