Rater agreement of visual lameness assessment in horses during lungeing.

REASONS FOR PERFORMING STUDY: Lungeing is an important part of lameness examinations as the circular path may accentuate low-grade lameness. Movement asymmetries related to the circular path, to compensatory movements and to pain make the lameness evaluation complex. Scientific studies have shown high inter-rater variation when assessing lameness during straight line movement. OBJECTIVES: The aim was to estimate inter- and intra-rater agreement of equine veterinarians evaluating lameness from videos of sound and lame horses during lungeing and to investigate the influence of veterinarians' experience and the objective degree of movement asymmetry on rater agreement. STUDY DESIGN: Cross-sectional observational study. METHODS: Video recordings and quantitative gait analysis with inertial sensors were performed in 23 riding horses of various breeds. The horses were examined at trot on a straight line and during lungeing on soft or hard surfaces in both directions. One video sequence was recorded per condition and the horses were classified as forelimb lame, hindlimb lame or sound from objective straight line symmetry measurements. Equine veterinarians (n = 86), including 43 with >5 years of orthopaedic experience, participated in a web-based survey and were asked to identify the lamest limb on 60 videos, including 10 repeats. The agreements between (inter-rater) and within (intra-rater) veterinarians were analysed with κ statistics (Fleiss, Cohen). RESULTS: Inter-rater agreement κ was 0.31 (0.38/0.25 for experienced/less experienced) and higher for forelimb (0.33) than for hindlimb lameness (0.11) or soundness (0.08) evaluation. Median intra-rater agreement κ was 0.57. CONCLUSIONS: Inter-rater agreement was poor for less experienced raters, and for all raters when evaluating hindlimb lameness. Since identification of the lame limb/limbs is a prerequisite for successful diagnosis, treatment and recovery, the high inter-rater variation when evaluating lameness on the lunge is likely to influence the accuracy and repeatability of lameness examinations and, indirectly, the efficacy of treatment.

Outcome of treatment for post-traumatic stress disorder in a primary care unit serving Vietnam veterans.

Veterans diagnosed with PTSD (PTSD in-treatment, N = 39), newly admitted to a comprehensive 90-day inpatient treatment program, were tracked at 4-week intervals from admission to discharge. Two control groups were also tracked over 12-week periods--one of previously PTSD diagnosed and treated veterans (PTSD out-of-treatment, N = 26), and a second that combined non-PTSD Vietnam era veterans (N = 17) and non-veterans (N = 16) (non-PTSD nontreatment). As measured by the Penn Inventory for PTSD, 48% of those who completed treatment showed some or substantial gains, 39% showed no gain, and 13% reported some increase in symptoms at the time of discharge. Several patterns were observed on other assessment measures. One year follow-up for those who completed treatment showed a return to pretreatment levels on the PTSD symptom measures employed in this study. These results are discussed in relation to other treatment program outcome studies as a baseline for further research.