Advances in the Canine Cranial Cruciate Ligament, 2nd edition

358 Future Directions

Table 43.1 Owner-completed outcomes measures developed to measure various aspects of canine orthopaedic disease.

Instrument Domains

Access and references§for studies

using them as outcomes

Reported reliability and

validity testing§

ACVS Canine

Orthopaedic

Index (COI)

Stiffness

Gait

Function

QOL

http://www.CanineOrthopaedicIndex

.com

[1]#

Factor analysis [2]

Cronbach’s alpha [2]

Inter-item correlations [2]

Test–retest reliability [1]

Responsiveness [1]

Canine Brief Pain

Inventory (CBPI)

Pain severity

Pain interference

with function

http://www.CanineBPI.com

[3, 4]∗

[5–11]#

Factor analysis [11, 12]

Cronbach’s alpha [11, 12]

Inter-item correlations [12]

Test–retest reliability [10]

Convergent validity [11, 12]

Extreme groups validation [12]

Criterion assessment [11, 13]

Responsiveness [10]

Responder’s analysis [14]

Helsinki Chronic

Pain Index (HCPI)

Chronic pain http://www.vetmed.helsinki.fi/

english/animalpain/hcpi/index.html

[15]∗

[11, 16–18]#

Factor analysis [11, 18]

Cronbach’s alpha [11, 18]

Test–retest reliability [18]

Convergent validity [11, 18]

Responsiveness [18]

Liverpool

Osteoarthritis in

Dogs (LOAD)

Mobility [email protected]

[5, 11]#

Factor analysis [11]

Cronbach’s alpha [11]

Test–retest reliability [19]

Convergent validity [11]

Criterion validity [19]

Responsiveness [19]

#Studies in which dogs with osteoarthritis of the stifle are included.
∗Studies of dogs with cruciate ligament rupture specifically.

QOL, Quality of life.
References. 1. Brown 2014c; 2. Brown 2014b; 3. Gordon-Evanset al. 2013; 4. Wuchereret al. 2013; 5. Lascelleset al.
2015; 6. Sullivanet al. 2013; 7. Imhoffet al. 2011; 8. Rausch-Derraet al. 2016; 9. Fahieet al. 2013; 10. Brownet al. 2008;

11. Waltonet al. 2013; 12. Brownet al. 2007; 13. Brownet al. 2013b; 14. Brownet al. 2013a; 15. Molsa ̈ et al. 2013;


12. Heikkila ̈et al. 2014; 17. Hielm-Bjorkman ̈ et al. 2012; 18. Hielm-Bjorkman ̈ et al. 2009; 19. Hercocket al. 2009.

Randomization minimizes bias by ensuring that
each study subject has the same chance of being
placed in either group. Then, with an adequate
sample size, the study groups tend to be compa-
rable with respect to all variables except for the
intervention being studied. The ultimate power
of randomization is that even factors that are not
known to be important at the time the trial is ini-
tiated are evenly distributed amongst groups.
Sometimes, randomization is not possible. For
example, when comparing two surgical inter-
ventions, owners may not be willing to have the
procedure performed determined by chance. In
these cases, the ideal of randomization can be
replaced with a pragmatic design in which the
owner chooses the treatment group to which

their dog is allocated. There is a continuum

between pragmatic and explanatory (ideal –

randomized) trials, and while there are clear

limitations to pragmatic designs, they can pro-

duce results that can be generalized to routine

practice settings. Pragmatic designs can also be

useful when a surgical intervention is compared

to no surgery. There are always owners who, for

a variety of reasons, choose conservative treat-

ment over surgical intervention. A pragmatic

design allows the recruitment of such a control

group. A crucial point in these designs is that

dogs of owners that are choosing the control

group would qualify for the intervention group

if the owner had chosen that group instead.

This ensures that dogs with a worse prognosis