Validity and Responsiveness of the Generic Health-Related Quality of Life Instrument (VetMetrica™) in Cats With Osteoarthritis. Comparison of Vet and Owner Impressions of Quality of Life Impact.

Validity is not an inherent property of a measurement scale and so evidence for validity relating to its use for particular purposes, with defined populations and in specified contexts must be accumulated. We have published the development of a web-based, generic health-related quality of life instrument (VetMetrica™) to measure the affective impact of chronic disease in cats and provided evidence for its validity in a mixed population of cats, some of which, according to veterinary judgement, were healthy and others of which were suffering from chronic conditions likely to affect their quality of life, often with multiple co-morbidities present. The first aim of the current study was to demonstrate the construct validity of the VetMetrica™ generic instrument when used with cats suffering from osteoarthritis, by testing the hypothesis that the health-related quality of life profile of cats with different severities of osteoarthritis would differ and by demonstrating convergent validity between the health-related quality of life profile scores and independently quantified vet-assessed pain and quality of life impact scores. The latter involved simple correlation analysis and investigation of the relationship between health-related quality of life domain scores and vet-assessed scores, when adjusted for other potential explanatory variables including number of comorbidities and age. Responsiveness-the ability to detect clinically relevant change-is an essential quality for an evaluative instrument and it also provides evidence for "longitudinal validity". Therefore, a second aim of this study was to demonstrate that changes in health-related quality of life domain scores concurred with the clinician's impression of change over time in the health status of cats with osteoarthritis, thus providing evidence for the instrument's responsiveness. Previously, we have reported disagreement between owner and vet impression as to health status in cats in general, but not in relation to any specific disease. Accordingly, the third study aim was to investigate the extent of agreement or disagreement between owner impression of the impact of osteoarthritis on their cats' quality of life and vet impression of such impact. Fifty one percentage of cat owners believed their cats to be perfectly healthy despite a clinician diagnosis of osteoarthritis.

Corrigendum: Development of an Early Warning System for Owners Using a Validated Health-Related Quality of Life (HRQL) Instrument for Companion Animals and Its Use in a Large Cohort of Dogs.

[This corrects the article DOI: 10.3389/fvets.2020.575795.].

Development of an Early Warning System for Owners Using a Validated Health-Related Quality of Life (HRQL) Instrument for Companion Animals and Its Use in a Large Cohort of Dogs.

Preventive measures in human healthcare are recognized as a means of providing early detection of disease, however, the veterinary profession has not been as effective in communicating the benefits of preventive measures to pet owners. Readily available pet healthcare information on the internet, owners not understanding that regular health evaluations can ensure the well-being of their pets and owners confusing the signs of chronic disease with normal aging have contributed to declining numbers of veterinary visits. The use of web-based generic health-related quality of life (HRQL) measures to evaluate health status (wellness) remotely could facilitate veterinary preventive medicine. This publication describes the development and practical application of an integrated alert system for an online generic HRQL measurement instrument (VetMetrica™) which generates scores in four domains of HRQL-Energetic/Enthusiastic (E/E), Happy/Content (H/C), Active/Comfortable (A/C), and Calm/Relaxed (C/R)-for 2 age groups (young/middle-aged, ≤7 years and old, ≥8 years). The alert provides an early warning, via email to owners, that a potentially significant deterioration in health status has occurred. The model accurately predicted the health status of 93 and 83% of sick young/middle aged and old dogs respectively, with healthy dogs predicted with 83% accuracy. HRQL data, collected via a white-labeled veterinary clinic branded app designed to facilitate connected care between owner and veterinarian, were analyzed for 6,108 dogs, aged between 6 weeks and 16 years. Of these 5,002 were deemed to be in perfect health by their owners, yet the alert was triggered for 1,343 (27%) of these, 75% of which were young/middle-aged and 25% were old, indicating that acute injuries notwithstanding, many middle aged dogs may have been suffering from undetected chronic disease such as osteoarthritis. This work has demonstrated that the use of VetMetrica™ delivered via the PetDialog™ app, which supports 24/7 remote health monitoring is an efficient way for vets to provide all their owners with the opportunity to monitor their animal's wellness throughout their lifetime, providing the vet with a mechanism to identify health problems early while stimulating owners to be more proactive in seeking veterinary attention.

Optimising outputs from a validated online instrument to measure health-related quality of life (HRQL) in dogs.

Measurement of health-related quality of life (HRQL) is becoming increasingly valuable within veterinary preventative health care and chronic disease management, as well as in outcomes research. Initial reliability and validation of a 22 item shortened version of VetMetrica (VM), structured questionnaire instrument to measure HRQL in dogs via a mobile application was reported previously. Meaningful interpretation and presentation of the 4 domain scores comprising the HRQL profile generated by VM is key to its successful use in clinical practice and research. Study one describes transformation of domain scores from 0-6 to 0-100 and normalisation of these based on the healthy canine population in two age ranges, such that a score of 50 on a 0-100 scale represents the score for the age-related average healthy dog, and establishment of a threshold to assess domain-specific health status for individual dogs. This provides the clinician with a simple method of ascertaining the health status of an individual dog relative to the average healthy population in the same age group (norm-based scoring). Study two determines the minimum important difference (MID) in domain scores which represents the smallest improvement in score that is meaningful to the dog owner, thus providing the clinician with a means of recognising what is likely to be a significant improvement in scores for an individual dog over time. Visual representation of these guidelines for the purpose of interpreting VM profile scores is presented using case studies.

Validation of a structured questionnaire as an instrument to measure chronic pain in dogs on the basis of effects on health-related quality of life.

OBJECTIVE: To validate the use of a novel questionnaire as an instrument for measurement of chronic pain in dogs through its impact on health-related quality of life (HRQL). ANIMALS: 108 dogs with chronic degenerative joint disease and 26 healthy dogs. PROCEDURES: Questionnaire responses were subjected to factor analysis (FA) and questionnaire scores to discriminant analysis to evaluate construct validity. Questionnaire scores were used to explore the potential of this instrument for minimizing respondent bias and for evaluative purposes. RESULTS: FA results revealed a sensible factor structure accounting for 65% of the variance in data, with factors identifiable as domains of HRQL in dogs affected by chronic pain. Further evidence for construct validity was provided when questionnaire scores were used to discriminate, on the basis of 218 questionnaires, between dogs with clinician-awarded pain scores of 0 and dogs with pain scores >or= 1 (88% discrimination, with 95% of no-pain group dogs and 87% of some-pain group dogs correctly categorized). Use of the questionnaire provided minimized respondent bias. CONCLUSIONS AND CLINICAL RELEVANCE: Validation of the questionnaire as an instrument for discriminative and evaluative measurements of orthopedic chronic pain through its impact on HRQL in dogs was provided. Use of the questionnaire, with further testing and refinement, may support improved clinical decision making, facilitate development of evidence-based therapeutic options for chronic diseases, and help veterinarians and owners define humane end points in dogs. IMPACT FOR HUMAN MEDICINE: Information gained here may provide improved measurements of clinical change in animal studies that use dogs with naturally occurring chronic pain to evaluate novel human treatment protocols.

Development of a questionnaire to measure the effects of chronic pain on health-related quality of life in dogs.

OBJECTIVE: To develop a reliable, validated questionnaire that can be used for the assessment of chronic pain and its impact on health-related quality of life (HRQL) in dogs. SAMPLE POPULATION: 17 owners of dogs that had chronic pain associated with chronic degenerative joint disease and 165 other dog owners. PROCEDURES: Psychometric methods were used to identify relevant domains, create an item pool, select and validate items, and construct and preliminarily test a structured questionnaire. Relevant domains were identified through semi structured interviews. Descriptor-generating exercises provided the terms owners used to describe these domains and formed an item pool. A selection from this pool was validated and used to construct a questionnaire that underwent preliminary testing. RESULTS: The structured questionnaire contained 109 simple, familiar, descriptive terms associated with good health or chronic pain (most describing subtle aspects of behavior that owners interpreted as expressions of subjective experiences of their dogs) for 13 possible HRQL domains. Each descriptor was associated with a 7-point numeric scale. CONCLUSIONS AND CLINICAL RELEVANCE: The questionnaire was intended to facilitate rapid, sensitive, and accurate rating of a comprehensive range of relevant domains by naïve raters with minimal burden on respondents. The principles underlying the development and design of this structured questionnaire offer a novel approach to the proxy measurement of HRQL and changes in HRQL associated with chronic pain for a range of animal species. IMPACT FOR HUMAN MEDICINE: This novel approach may be applicable to other nonverbal populations (eg, young children or elderly people with cognitive impairment).