Abstract
This study aims to validate a tool, the Bologna healing stifle injury index (BHSII), for the evaluation of the clinical picture and the healing after surgical treatment for cranial cruciate ligament (CCL) rupture. The study included 158 client-owned dogs with CCL rupture and 20 healthy dogs. The BHSII is a questionnaire made up of 34 multiple-choice questions, divided into a part directed to the clinician and a part for the dog's owners. It was applied twice in the healthy dogs in order to test and retest the device. It was evaluated for reliability, validity, and responsiveness to clinical changes involving the dogs treated at the time of surgery, and 1, 3, and 6 months postoperatively. Statistical analyses were performed and the intraclass correlation coefficient test was ≥0.9 and the Cronbach-α was 0.84 suggesting good stability and good internal consistency of the tool. The area under the curve of the receiver operating characteristic curve was >0.9, indicative of the high accuracy of this tool. The clinician survey correlated with the owner questionnaire. In dogs with CCL rupture, the scores of the BHSII increased significantly postoperatively as compared with baseline. In conclusion, this clinical study proved the reliability, validity, and responsiveness of the BHSII. The results achieved from the BHSII provided an instantaneous, collective complete vision of the healing process of the stifle joints treated. It can be considered a valid tool for collecting data and for assessing successful surgical treatment in clinical practice.
Highlights
Cranial cruciate ligament (CCL) rupture is one of the most common canine orthopedic injuries, and a very frequent cause of pain and lameness in dogs [1,2,3,4].The treatment of CCL rupture aims to anatomically or mechanically resolve joint instability and to provide long-term functioning of the affected hindlimb
A receiver operating characteristic (ROC) curve analysis was used to test the ability of the BSHII to differentiate between healthy dogs and those with CCL rupture
A questionnaire score >27 and ≤85.6 should predict the health level of dogs with CCL rupture with 100% sensitivity [95% confidence interval [CI]: 97.7–100%] and 100% specificity
Summary
The treatment of CCL rupture aims to anatomically or mechanically resolve joint instability and to provide long-term functioning of the affected hindlimb. Tool for Evaluating Healing Process many clinical research reports comparing the different surgical techniques, only a few studies reached the standards for level I evidence [8]. In small animal orthopedics, level I evidence is reported to be optimally achieved by means of three evaluations or outcome assessment methods: force plate analysis, the surgeon’s subjective and objective evaluation, and the pet owner’s subjective evaluation [8]. Force plate analysis data offers an objective measurement, it evaluates the animal only at a specific moment in time and only regarding specific weight bearing on an affected limb, constituting only one part of a larger clinical picture of intervention responses [9]. Based on the results of the Hielm-Björkman studies [10, 11], a multifactorial questionnaire which focused on behavior and locomotion, completed by both a veterinarian and an owner would be better for evaluating chronic pain when compared with only a clinical evaluation carried out by an orthopedic veterinarian [10, 11]
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