On our journey to increase the validity of our profession, as well as our continual striving for improved patient outcomes, the use of clinical metrology instruments (CMI) can provide us with validated outcome measures to assess patient response to treatment, and valuable information to guide our clinical goal-setting and planning.
Validated CMIs include the Canine Brief Pain Inventory, the Helsinki Chronic Pain Index, Liverpool Osteoarthritis in Dogs, and the Cincinnati Orthopedic Disability Index. These questionnaire-based, owner-driven outcome measurement tools can form a valuable part of our patient outcome reporting, in addition to providing useful data for research purposes.
If you are not yet using a CMI in your practice, or have been looking for a CMI to use, then you are in the right place. We will discuss a few of the most commonly used CMIs, and where to download them for your practice.
What are Clinical Metrology Instruments (CMIs)?
CMIs are questionnaire-based measurement tools used to quantify chronic pain in our patients, based on the observations of the owner over a period of time in relation to their pet’s daily living activities, quality of life, function, stiffness, response to exercise and pain severity.
As we strive for objectivity in our measurements, CMIs offer a way to overcome some of the challenges we may experience with owner observations and feedback. Using CMIs can improve the objectivity of owner feedback, and improve their awareness and understanding of particular behaviours related to pain, shown by their dog at home.
Because the owner completes the CMI without your input, they tend to have more faith in the results. The tool can be incredibly powerful, since owners see the improvement or progression of their dog over time from their own observations, instead of from your outcome measurements alone. Placing these improvements on a graph can be very impactful and motivating for an owner, and can provide a quick, clear overview in a veterinary report.
Because CMIs are validated and are tools used often in the veterinary profession, incorporating them into your practice will also improve your credibility with referring veterinarians, allowing you to share objective, measurable data with them in vet reports, rather than your observations only. This can increase the trust they place in your abilities.
As validated tools to measure treatment outcomes, CMIs can also make it easier for you to take the necessary steps towards data collection and ultimately publishing research based on your practice.
Owner assessment of functional activity
Functional activity, or the activities of daily living, refer to the dog’s ability to engage in normal life with their families. Chronic pain can greatly impact the dog’s ability and motivation to engage in activities of daily living, and can lead not only to physical degeneration, but also to mental and emotional side effects.
It is important to consider not only the dog’s ability to engage in functional activities, but also their mental and emotional response to these activities. We need to note the activities that increase joy and motivation in their lives, and their ability to engage freely in these activities. While functional mobility and ability are pretty general or common – the ability to walk, run, climb stairs, get up from a lying position, etc. – activities that motivate and bring joy to the dog are very individual to the patient/owner combination.
Different CMIs have different focus points, and for that reason it is important to compare the different options and evaluate which CMI will best fit our clients and our needs in practice.
Canine Brief Pain Inventory (CBPI)
The CBPI is validated for canine osteoarthritis and osteosarcomas. This is probably the most commonly used CMI in our industry, and covers pain severity, functional activity and quality of life. The CBPI comes with a user guide, which I highly recommend reading, regardless of the CMI you choose to use in practice.
For pain, the CBPI asks the owner to rate their dog’s pain at its worst, best and average over the last 7 days, as well as at this moment. The owner is also asked to rate their dog’s function in terms of general activity, enjoyment of life, and multiple functional activities. A quality of life score is also given.
For the Vetrehabber, this questionnaire can be limited in clinical value, since it reveals little that may be applied directly to our treatment, goals and development of an exercise programme for the owner. Because it is very widely used in the veterinary and research fields, it is a great tool to use when working together with veterinary practices or if you are wanting to start doing research.
Download the CBPI user guide from the University of Pennsylvania.
Download the CBPI from the University of Pennsylvania.
Helsinki Chronic Pain Index (HCPI)
The HCPI was validated in 2009, and includes scoring for demeanor, behaviour and functional activities. The HCPI places more value on different functional activities than the Canine Brief Pain Inventory, making it a useful guide for rehabilitation goals and establishing patients’ improvements in these specific activities.
Download the Helsinki Chronic Pain Index in the Onlinepethealth Free Zone or your members portal.
Liverpool Osteoarthritis in Dogs (LOAD)
LOAD was validated for elbow OA in 2009, and has since correlated well with other CMIs. The questionnaire includes questions on the chronicity of symptoms, co-morbidities and medications, and particularly focuses on exercise parameters and patient response to exercise.
This questionnaire will give us valuable information for the development of a home exercise programme for patient and owner, as it provides a good understanding of what owner and dog are currently doing together that may be adjusted and developed to meet the patient’s needs and the owner’s available resources.
Download the Liverpool Osteoarthritis in Dogs in the Onlinepethealth Free Zone or your members portal.
Cincinnati Orthopedic Disability Index (CODI)
CODI asks the owner questions about general functional activities that are affected by OA, and to identify five specific activities with which their pet has the most trouble, with a score for each activity.
This information can be incredibly valuable in several ways. It helps us to identify the most challenging behaviours for the patient, and to include these in our goal-setting and rehabilitation programme. This can result in an especially rewarding experience for both owner and patient.
Download the Cincinnati Orthopedic Disability Index in the Onlinepethealth Free Zone or your members portal.
Visual Analogue Scale (VAS)
A VAS is the simplest CMI you can use, and basically includes a line with ‘no pain’ on one side, and ‘unbearable pain’ on the opposite side. The owner is asked to place a mark on the line for where they think their pet’s pain level is.
This is a simple tool, and it’s usefulness will be dependent on the owner’s observational skills and understanding of pain behaviour. It also does not provide us with any additional information that will allow us to optimise and individualise our treatments, exercise programme and goals for the patient.
Feel free to create your own VAS with your unique branding.
There are many benefits to incorporating CMIs into your practice, including improved measurement of patient outcomes, identification of specific activities that are challenging to the patient, and improved communication and validity with referring veterinarians. They also provide a great source of data collection for participation in research studies.
There are no disadvantages to including your favourite CMI into your practice. Why not give one a try?