Evidence Based Practice :
Your opportunity to share your expertise : how do you evaluate clinical outcomes from cruciate surgery in the dog?
Whether you are a dog owner with years of experience or a novice, I want to hear your views through today’s enclosed questionnaire.
I believe there is considerable expertise in dog owning people, and the purpose of this survey is to draw that expertise together and find out what the dog owners as a whole think about the question of lameness, and of outcome evaluation from a common orthopaedic procedure in the dog.
I believe that everyone’s opinion is important, so please note that your opinions are valued, and please fill in and post your copy of the questionnaire to me so that I can produce an analysis of the profession’s view of these questions.
Why is this important?
We have been doing cruciate surgery since 1952 and even before that, but 1952 marked the pivotal success of Saki Paatsama in Helsinki with his tunnel and graft technique that he argued through his critics to gain his MSc. Since then, variations and changes in thinking have taken place in the veterinary profession, and a commonly held view is that ‘no one surgical technique has been shown to be better than any other’. In many debates, the arguments tend to develop around the current prowess and prominence of the surgeon advocating his or her preferred technique, but sadly the arguments are rarely based on an evidence base, but rather on the propounding of theory which some may support and some may not.
The question of how we evaluate lameness first needs to be studied because without a definition of how lameness is evaluated we have no baseline with which to study one case and then compare it to another.
Lameness is a part of an evaluation of the clinical outcome of a cruciate surgery, but there are different facets of lameness which could include the ability to sit down for example, the ability to get up, as well as the ability to walk, run, jump through hoops or run 10 kilometres without showing any difficulty or lameness. Clinicians have opinions and so do clients who own the dogs, so which parts of the clinical evaluation and which person or persons have the most consistent view and ability to assess the outcome?
The purpose of this survey to which I hope you will contribute by completing the enclosed questionnaire is to find out what relative importance dog owners attach to the various ways of evaluating lameness and clinical outcome so that there is a possibility of designing a questionnaire that can be used by the whole community, which is built on a collection of data from a wide audience, followed by analysis of what is currently practiced, and should be included for practice and research.
This has been done in the medical profession where there are various accepted methods of evaluating clinical outcomes such as the International Knee Development Committee (IKDC). I would like to point out that even if the surgeon is confident of his or her clinical outcome, if the patient is still limping in pain, the patient may have a different but valid viewpoint, so dog owners who are nursing the veterinary surgeons’ cases have some very important observations that I would like to see represented in the returns of the questionnaires.
Ultimately, if we can develop a method of asking clients and clinicians the most relevant and useful questions about lameness and clinical outcomes, we should be able to deliver a better service by responding to this, and also we should have acquired the ability to better our clinical and surgical approaches to our patients through the obtaining of better and more focussed feedback.
Dr Paul R. Manning, MRCVS.,
Astonlee Veterinary Hospital,