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RESEARCH Laboratories – Department of Clinical Sciences 

Comparative Pain Research – Clinical Metrology Instruments 

Clinical Metrology tools may be used for veterinary studies evaluating an intervention or treatment; translational studies using naturally occurring disease in animals as a model of human disease; clinical veterinary patient management.

Prior to using a tool, one must know that it reliably measures what it is purported to measure and that it is able to pick up clinically significant changes in the population in which it is being used.

The process of validation is thus an important one, and consists of several stages:

  • Item generation: The generation of the questions to be tested needs to be carefully undertaken, and have input from appropriate stakeholders.
    • Using patients (painful and healthy populations)
    • Using focus groups only
  • Readability: it is important the instrument can be easily understood by those using it (i.e. the target population)
  • Reliability: The stability of a tool examines the reproducibility of the tool administered on different occasions. When the tool is a questionnaire, its internal consistency is based on a single administration of the tool and represents the average of the correlations among the questions in the tool. Both internal consistency and stability must be proven before a questionnaire is to be deemed reliable.
    • Test – retest stability
    • Internal consistency
  • Validity
    • Face Validity: indicates whether, on the face of it, the tool appears to be assessing the desired qualities
    • Content Validity: a judgment regarding whether the tool covers all of the relevant content
    • Construct validity: Testing that is used when the tool is measuring something (a construct) that cannot be directly observed (pain, quality of life etc.). While the construct can not be directly seen, behaviors resulting from it can be observed. Obviously, it will be impossible to ‘prove’ that something that cannot be measured directly is being measured. Several approaches can be used:
      • Hypothesized factors tested with factor analysis
      • Discriminatory validity: Does the instrument discriminate between animals with and without the condition? Does it discriminate between different severities of the condition?
      • Responsiveness of the tool to a treatment known to change what is being measured, or to a change in the condition over time
      • Correlation to overall QoL
  • Criterion or Concurrent Validity: the correlation of an instrument with some other measure – a measure accepted as the ‘gold standard’. Often, in the development of subjective assessment tools, the best approach is to use an accepted objective measure. Because pain cannot (yet) be directly measured, an objective surrogate measure can be used, e.g. an objective measure of activity if pain is expected to impact activity

Metrology Instruments

Feline Musculoskeletal Pain Index (FMPI)

Feline Musculoskeletal Pain Index (FMPI)

Purpose:

The owner’s assessment of the severity of chronic pain in their cat, and the impact this has on everyday activity and interaction

Description and Characteristics:

The FMPI is a questionnaire with appropriate readability, reliability and proven discriminatory ability. Full validity testing is continuing, and further versions of the FMPI may well take place in the future.

Funding for Development:

The CPRL is very grateful to Morris Animal Foundation and to Novartis Animal Health for sponsoring the work that has led to the FMPI. Further development of the FMPI has been possible through its use in studies funded by Boehringer Ingelheim Vetmedica, and also by Nexvet Australia Pty Ltd. 

References:

  • Caregiver Placebo Effect in Analgesic Clinical Trials for Painful Cats with Naturally-Occurring Degenerative Joint Disease.
    Gruen ME, Dorman D, Lascelles BDX.    |   Vet Rec. 2017 May 13;180(19):473 PMID: 28270539
  • A feline-specific anti-nerve growth factor antibody improves mobility in cats with degenerative joint disease-associated pain: A pilot proof of concept study.Gruen ME, Thomson AE, Griffith EH, Paradise H, Gearing DP, Lascelles BDX.    |   J Vet Intern Med. 2016 Jul;30(4):1138-48. PMID: 27334504
  • Criterion Validation Testing of Clinical Metrology Instruments for Measuring Degenerative Joint Disease Associated Mobility Impairment in Cats.Margaret E. Gruen, Emily H. Griffith, Andrea E. Thomson, Wendy Simpson, B. Duncan X. Lascelles     |    PLOS ONE. 10 Jul 2015 | PLOS ONE 10.1371/journal.pone.0131839
  • A novel approach to the detection of clinically relevant pain relief in cats with degenerative joint disease associated pain.Gruen M, Griffith E, Thomson A, Simpson W, Lascelles BDX   |   Journal of Veterinary Internal Medicine, 2014 Feb 10. doi: 10.1111/jvim.12312. [Epub ahead of print]
  • Feline Musculoskeletal Pain Index (FMPI): Responsiveness and Criterion Validity Testing.
    Benito J, Hansen B, DePuy V, Davidson G, Thomson A, Simpson W, Roe S, Hardie E, Lascelles BDX    |   Journal of Veterinary Internal Medicine, 2013 May-Jun;27(3):474-82
  • Reliability and discriminatory testing of a client-based metrology instrument, Feline Musculoskeletal Pain Index – FMPI, for the evaluation of degenerative joint disease associated pain in cats. Benito J, Hardie E, Zamprogno H, Thomson A, Simpson W, Roe S, Hansen B, Lascelles BDX     |   The Veterinary Journal, 2013 Jun;196(3):368-73
  • Item generation and design testing of a questionnaire to assess degenerative joint disease-associated pain in cats.
    Zamprogno H, Hansen BD, Bondell HD, Thomson Sumrell A, Simpson W, Robertson I, Brown J, Pease A, Roe SC, Hardie E, Wheeler SJ, Lascelles BDX     |    Am J Vet Res. 2010; 71(12): 1417-24

Select a Questionnaire

REQUEST the FMPI as used in PlosOne 2015

REQUEST the Currently RECOMMENDED FMPI

Subjective Nighttime Restlessness Evaluation (SNORE)

Subjective Nighttime Restlessness Evaluation (SNORE)

Purpose:
To measure the pet owner’s assessment of the severity of disturbed sleep due to chronic pain

Description and Characteristics:
The SNoRE is a questionnaire with appropriate readability and proven discriminatory ability. Full validity testing is continuing, and further versions of the SNoRE may well take place in the future.

Funding for Development:
The development of this instrument was funded by the Comparative Pain Research Laboratory

References:
Knazovicky D, Tomas A, Motsinger-Reif A, Lascelles BDX. Initial evaluation of nighttime restlessness in a naturally occurring canine model of osteoarthritis pain. PeerJ. 2015 Feb 17;3:e772. doi: 10.7717/peerj.772. eCollection 2015. PMID: 25722957

Request the SNoRE Evaluation

SNoRE Evaluation

Client Specific Outcome Measures (CSOMf)

Client Specific Outcome Measures (CSOMf)

Purpose:
To measure the pet owner’s assessment of difficult it is for their cat to perform certain specific activities. It has been used to evaluate the impact of osteoarthritis or degenerative joint disease associated pain in cats.

Description and Characteristics:
The Client Specific Outcome Measure was originally developed for use in dogs where it was adapted from the Cincinatti Orthopedic Disability Index (Gingerich & Strobel 2003) and then further adapted for use in cats (Lascelles et al. 2010). Its appeal is that the activities followed are individualized for each individual animal in their own environment, making it potentially more relevant than set questions on a questionnaire. It allows owners, working with a trained clinician, to select a set number of activities that their cat is impaired in performing, rate the amount of difficultly the cat has in performing those activities (currently recommended scale from 5=impossible to 1=no problem). The CSOM, once constructed, is used to follow this set of activities over time. Change from baseline in total score (the sum of scores across the 3 activities) is used as the outcome of interest to monitor the progression of impairment, or response to therapy.

Funding for Development:
The CPRL is very grateful to Morris Animal Foundation and to Novartis Animal Health for sponsoring the work that has led to the adaptation and assessment of the CSOM for cats. Further assessment of the CSOM has been possible through its use in studies funded by Boehringer Ingelheim Vetmedica, and also by Nexvet Australia Pty Ltd.

References and studies using and evaluating the CSOM:

  • Gingerich DA, Strobel JD. Use of client-specific outcome measures to assess treatment effects in geriatric, arthritic dogs: Controlled clinical evaluation of a nutraceutical. Vet Ther. 2003;4(4):376-86
  • Lascelles BDX, Hansen BD, Roe S, Depuy V, Thomson A, Pierce CC, et al. Evaluation of client-specific outcome measures and activity monitoring to measure pain relief in cats with osteoarthritis. Journal of Veterinary Internal Medicine. 2007;21(3):410-6.
  • Gruen ME, Thomson AE, Griffith EH, Paradise H, Gearing DP, Lascelles BDX. A feline-specific anti-nerve growth factor antibody improves mobility in cats with degenerative joint disease-associated pain: A pilot proof of concept study. J Vet Intern Med. 2016 Jul;30(4):1138-48. doi: 10.1111/jvim.13972. Epub 2016 Jun 22. PMID: 27334504
  • Margaret E. Gruen, Emily H. Griffith, Andrea E. Thomson, Wendy Simpson, B. Duncan X. Lascelles. Criterion validation testing of Clinical Metrology Instruments for measuring degenerative joint disease associated mobility impairment in cats. PLoS One. 2015 Jul 10;10(7):e0131839. doi: 10.1371/journal.pone.0131839. eCollection 2015. PMID: 26162101
  • Reliability and discriminatory testing of a client-based metrology instrument, Feline Musculoskeletal Pain Index – FMPI, for the evaluation of degenerative joint disease associated pain in cats. Benito J, Hardie E, Zamprogno H, Thomson A, Simpson W, Roe S, Hansen B, Lascelles BDX     |   The Veterinary Journal, 2013 Jun;196(3):368-73