Agreement among equine veterinarians and between equine veterinarians and inertial sensor system during clinical examination of hindlimb lameness in horses

Effect of video angle on detection of induced front limb lameness in horses

BACKGROUND

Lameness examinations are commonly performed in equine medicine. Advancements in digital technology have increased the use of video recordings for lameness assessment, however, standardization of ideal video angle is not available yielding videos of poor diagnostic quality. The objective of this study was to evaluate the effect of video angle on the subjective assessment of front limb lameness. A randomized, blinded, crossover study was performed. Six horses with and without mechanically induced forelimb solar pain were recorded using 9 video angles including horses trotting directly away and towards the video camera, horses trotting away and towards a video camera placed to the left and right side of midline, and horses trotting in a circle with the video camera placed on the inside and outside of the circle. Videos were randomized and assessed by three expert equine veterinarians using a 0-5 point scoring system. Objective lameness parameters were collected using a body-mounted inertial sensor system (Lameness Locator®, Equinosis LLC). Interobserver agreement for subjective lameness scores and ease of grading scores were determined.

RESULTS

Induction of lameness was successful in all horses. There was excellent agreement between objective lameness parameters and subjective lameness scores (AUC of the ROC = 0.87). For horses in the "lame" trials, interobserver agreement was moderate for video angle 2 when degree of lameness was considered and perfect for video angle 2 and 9 when lameness was considered as a binary outcome. All other angles had no to fair agreement. For horses in the "sound" trials, interobserver agreement was perfect for video angle 5. All other video angles had slight to moderate agreement.

CONCLUSIONS

When video assessment of forelimb lameness is required, a video of the horse trotting directly towards the video camera at a minimum is recommended. Other video angles may provide supportive information regarding lameness characteristics.

Objective movement asymmetry in horses is comparable between markerless technology and sensor-based systems

BACKGROUND

A markerless artificial intelligence (AI) system for lameness detection has recently become available but has not been extensively compared with commonly used inertial measurement unit (IMU) systems for detecting asymmetry under field conditions.

OBJECTIVE

Comparison of classification of asymmetric limbs under field conditions and comparison of normalised asymmetry data using a markerless AI system (SleipAI; recorded on a tripod mounted iPhone 14pro [SL]); the Equinosis Q Lameness Locator (LL); the EquiMoves (EM); and subjective evaluation (SE).

STUDY DESIGN

Descriptive clinical study.

METHODS

Straight line trot data were collected from 52 client-owned horses in regular training. Limbs were categorised as symmetric or asymmetric. Number of analysed strides were compared with Wilcoxon's each pairs test. Inter-rater reliability in classification of asymmetric limbs was assessed with Light's Kappa. Bland Altman analysis of normalised asymmetry data was performed.

RESULTS

Data from 41 horses were included. Most horses showed mild asymmetry. The EM analysed significantly more strides than the other systems, both for forelimbs and for hindlimbs (53 ± 11 strides for both, respectively; p < 0.006). The LL analysed significantly more hindlimbs strides (45 ± 13) than the SL (27 ± 6; p < 0.001). Moderate inter-rater agreement for asymmetry classification was found between systems (k = 0.59 forelimbs; 0.44 hindlimbs); agreement decreased when including the SE. For the normalised asymmetry data, the strongest agreement was found between the two IMU systems.

MAIN LIMITATIONS

Horses were assessed during straight-line trot only.

CONCLUSIONS

The objective systems were comparable in classification of asymmetric limbs under field conditions when using defined asymmetry thresholds. Discrepancies stemmed largely from the imposed thresholds (i.e., systems largely identified same-side asymmetry). Overall, the strongest agreement was found between LL and EM. The SL analysed significantly fewer hindlimb strides than the LL and EM which could represent a limitation of the Sleip AI.

Changes in Head and Pelvic Movement Symmetry after Diagnostic Anaesthesia: Interactions between Subjective Judgement Categories and Commonly Applied Blocks

Limited evidence is available relating gait changes to diagnostic anaesthesia. We investigated associations between specific movement patterns and diagnostic anaesthesia of different anatomical structures in a retrospective analysis. Referral-level lameness cases were included with the following criteria: presence of diagnostic anaesthesia of a forelimb and/or hind limb; subjective efficacy classified as "negative", "partially positive", or "positive"; quantitative gait data available from inertial measurement units. Gait changes were calculated for three forelimb (palmar digital, abaxial sesamoid, low 4-point nerve block) and five hind limb diagnostic blocks (tarso-metatarsal, metatarsophalangeal joint block, deep branch of lateral plantar, low 6-point, abaxial sesamoid nerve block). Mixed models (random factor "case", fixed factors "diagnostic anaesthesia type" and "efficacy", two-way interaction) assessed the head and pelvic movement (p < 0.05, Bonferroni correction). Four parameters were significantly affected by forelimb anaesthesia (N = 265) (all p ≤ 0.031) and six by hind limb anaesthesia (N = 342) efficacy (all p ≤ 0.001). All head movement parameters and pelvic push-off asymmetry were significantly affected by the two-way interaction after forelimb anaesthesia (all p ≤ 0.023) and two pelvic movement symmetry parameters by the two-way interaction after hind limb anaesthesia (all p ≤ 0.020). There are interactions between block efficacy and type resulting in changes in weight-bearing and push-off-associated head and pelvic movement symmetry after diagnostic anaesthesia.

Inertial Sensor Technologies-Their Role in Equine Gait Analysis, a Review

Objective gait analysis provides valuable information about the locomotion characteristics of sound and lame horses. Due to their high accuracy and sensitivity, inertial measurement units (IMUs) have gained popularity over objective measurement techniques such as force plates and optical motion capture (OMC) systems. IMUs are wearable sensors that measure acceleration forces and angular velocities, providing the possibility of a non-invasive and continuous monitoring of horse gait during walk, trot, or canter during field conditions. The present narrative review aimed to describe the inertial sensor technologies and summarize their role in equine gait analysis. The literature was searched using general terms related to inertial sensors and their applicability, gait analysis methods, and lameness evaluation. The efficacy and performance of IMU-based methods for the assessment of normal gait, detection of lameness, analysis of horse-rider interaction, as well as the influence of sedative drugs, are discussed and compared with force plate and OMC techniques. The collected evidence indicated that IMU-based sensor systems can monitor and quantify horse locomotion with high accuracy and precision, having comparable or superior performance to objective measurement techniques. IMUs are reliable tools for the evaluation of horse-rider interactions. The observed efficacy and performance of IMU systems in equine gait analysis warrant further research in this population, with special focus on the potential implementation of novel techniques described and validated in humans.

Comparison of Asymmetry During Trot In-Hand With Evaluations of Discomfort and Pain in Horses While Exercised

Traditional visual lameness assessment is subjective. Ethograms have been developed for evaluating pain and objective sensors to detect lameness. Heart rate (HR) and heart rate variability (HRV) have been used to evaluate stress and pain. The aim of our study was to compare subjective and behavioral lameness scores, a sensor system measuring movement asymmetry, HR, and HRV. We hypothesized that these measures would show related trends. In 30 horses, an inertial sensor system was used to measure movement asymmetries during trot in-hand. A horse was categorized as sound if each asymmetry was less than 10 mm. We recorded riding to observe lameness and evaluate behavior. Heart rate and RR intervals were measured. Root mean squares of successive RR intervals (RMSSD) were calculated. Five horses were categorized as sound and 25 horses as lame by the inertial sensor system. No significant differences were detected between sound and lame horses in the ethogram, subjective lameness score, HR, and RMSSD. Overall asymmetry, ethogram, and lameness score had no significant correlation with each other, whereas overall asymmetry and ethogram correlated significantly with HR and RMSSD during certain phases of the ridden exercise. The main limitation of our study was the small number of sound horses detected by the inertial sensor system. The association between gait asymmetry and HRV suggests that the more gait asymmetry a horse shows during trot in-hand, the more pain or discomfort it probably experiences when ridden with a higher intensity. The threshold for lameness used by the inertial sensor system may require further evaluation.

Artificial Intelligence for Lameness Detection in Horses-A Preliminary Study

Lameness in horses is a long-known issue influencing the welfare, as well as the use, of a horse. Nevertheless, the detection and classification of lameness mainly occurs on a subjective basis by the owner and the veterinarian. The aim of this study was the development of a lameness detection system based on pose estimation, which permits non-invasive and easily applicable gait analysis. The use of 58 reference points on easily detectable anatomical landmarks offers various possibilities for gait evaluation using a simple setup. For this study, three groups of horses were used: one training group, one analysis group of fore and hindlimb lame horses and a control group of sound horses. The first group was used to train the network; afterwards, horses with and without lameness were evaluated. The results show that forelimb lameness can be detected by visualising the trajectories of the reference points on the head and both forelimbs. In hindlimb lameness, the stifle showed promising results as a reference point, whereas the tuber coxae were deemed unsuitable as a reference point. The study presents a feasible application of pose estimation for lameness detection, but further development using a larger dataset is essential.

Development of a Novel Approach for Detection of Equine Lameness Based on Inertial Sensors: A Preliminary Study

Both as an aid for less experienced clinicians and to enhance objectivity and sharp clinical skills in professionals, quantitative technologies currently bring the equine lameness diagnostic closer to evidence-based veterinary medicine. The present paper describes an original, inertial sensor-based wireless device system, the Lameness Detector 0.1, used in ten horses with different lameness degrees in one fore- or hind-leg. By recording the impulses on three axes of the incorporated accelerometer in each leg of the assessed horse, and then processing the data using custom-designed software, the device proved its usefulness in lameness identification and severity scoring. Mean impulse values on the horizontal axis calculated for five consecutive steps above 85, regardless of the leg, indicated the slightest subjectively recognizable lameness, increasing to 130 in severe gait impairment. The range recorded on the same axis (between 61.2 and 67.4) in the sound legs allowed a safe cut-off value of 80 impulses for diagnosing a painful limb. The significance of various comparisons and several correlations highlighted the potential of this simple, affordable, and easy-to-use lameness detector device for further standardization as an aid for veterinarians in diagnosing lameness in horses.

Accelerometry-Based Step Count Validation for Horse Movement Analysis During Stall Confinement

Quantitative tracking of equine movement during stall confinement has the potential to detect subtle changes in mobility due to injury. These changes may warn of potential complications, providing vital information to direct rehabilitation protocols. Inertial measurement units (IMUs) are readily available and easily attached to a limb or surcingle to objectively record step count in horses. The objectives of this study were: (1) to compare IMU-based step counts to a visually-based criterion measure (video) for three different types of movements in a stall environment, and (2) to compare three different sensor positions to determine the ideal location on the horse to assess movement. An IMU was attached at the withers, right forelimb and hindlimb of six horses to assess free-movement, circles, and figure-eights recorded in 5 min intervals and to determine the best location, through analysis of all three axes of the triaxial accelerometer, for step count during stall confinement. Mean step count difference, absolute error (%) and intraclass correlation coefficients (ICCs) were determined to assess the sensor's ability to track steps compared to the criterion measure. When comparing sensor location for all movement conditions, the right-forelimb vertical-axis produced the best results (ICC = 1.0, % error = 6.8, mean step count difference = 1.3) followed closely by the right-hindlimb (ICC = 0.999, % error = 15.2, mean step count difference = 1.8). Limitations included the small number of horse participants and the lack of random selection due to limited availability and accessibility. Overall, the findings demonstrate excellent levels of agreement between the IMU's vertical axis and the video-based criterion at the forelimb and hindlimb locations for all movement conditions.

Rater agreement for assessment of equine back mobility at walk and trot compared to quantitative gait analysis

Background

Lameness assessment in horses is still predominantly performed using subjective methods. Visual assessment is known to have moderate to good intra-rater agreement but relatively poor inter-rater agreement. Little is known about inter- and intra-rater agreement on the evaluation of back motion, for which no objective measurement technique in a clinical setting is available thus far.

Objectives

To describe inter- and intra-rater agreement of visual evaluation of equine back mobility.

Study design

Rater reliability study using a fully crossed design in which all horses are rated by all observers. This data is compared with objective gait analysis.

Methods

Seventy equine professionals (veterinarians and physiotherapists) and veterinary students evaluated videos of 12 healthy horses at walk and trot on a hard, straight line. Nine parameters related to back mobility were scored: general mobility, thoracic, lumbar, lumbosacral flexion and extension and left and right thoracolumbar latero-flexion. All parameters were compared with simultaneously measured quantitative motion parameters. After 1 month, six randomly chosen horses were re-evaluated by 57 observers.

Results

For each parameter inter- and intra-rater agreements were calculated using intra-class correlation coefficients. For all parameters, inter-rater agreement was very poor (<0.2). The mean intra-rater agreement of all observers and for all parameters was poor (~0.4) but varied between 0.0 and 0.96 for individual observers. There was no correlation between the visual subjective scoring and objective gait analysis measurements.

Main limitations

Horses were scored from videos and by lack of any existing (semi-) quantitative system, a custom-made system had to be used.

Conclusions

The poor inter- and intra-rater agreements of visual scoring of mobility of the equine back and the disagreement between subjective and objective gait analysis data, demonstrate the need for the development and introduction of objective, quantitative and repeatable techniques to assess equine back motion.

Smartphone-Based Pelvic Movement Asymmetry Measures for Clinical Decision Making in Equine Lameness Assessment

Simple Summary

As visual evaluation of hindlimb lameness in the horse is challenging, objective measurements could aid clinical decision making. Our study investigated the association of pelvic movement asymmetry, recorded via a smartphone, with lameness scores of one experienced veterinarian. In general, cut-off points between lameness grades increased with increasing severity of lameness. Pelvic upward movement amplitude difference was the asymmetry parameter with the highest discriminative power based on subjective lameness scoring of a specialist veterinarian. This parameter classified a higher proportion of lame and non-lame horses correctly compared to the parameters assessing differences between pelvic vertical movement minima and maxima. Although the use of a smartphone measuring only the symmetry of pelvis cannot replace a full lameness examination, it presents a useful adjunct to subjective evaluation alone. Quantification of pelvic asymmetry with a smartphone may also be a useful tool in the context of tracking progress after a treatment or during the rehabilitation process.

Abstract

Visual evaluation of hindlimb lameness in the horse is challenging. Objective measurements, simultaneous to visual assessment, are used increasingly to aid clinical decision making. The aim of this study was to investigate the association of pelvic movement asymmetry with lameness scores (UK scale 0–10) of one experienced veterinarian. Absolute values of pelvic asymmetry measures, quantifying differences between vertical minima (AbPDMin), maxima (AbPDMax) and upward movement amplitudes (AbPDUp), were recorded during straight-line trot with a smartphone attached to the sacrum (n = 301 horses). Overall, there was a significant difference between lameness grades for all three asymmetry measures (p < 0.001). Five pair-wise differences (out of 10) were significant for AbPDMin (p≤ 0.02) and seven for AbPDMax (p≤ 0.03) and AbPDUp (p≤ 0.02). Receiver operating curves assessed sensitivity and specificity of asymmetry measures against lameness scores. AbPDUp had the highest discriminative power (area under curve (AUC) = 0.801–0.852) followed by AbPDMax (AUC = 0.728–0.813) and AbPDMin (AUC = 0.688–0.785). Cut-off points between non-lame (grade 0) and lame horses (grades 1–4) with a minimum sensitivity of 75% were identified as AbPDUp ≥ 7.5 mm (67.6% specificity), AbPDMax ≥ 4.5 mm (51.9% specificity) and AbPDMin ≥ 2.5 mm (33.3% specificity). In conclusion, pelvic upward movement amplitude difference (AbPDUp) was the asymmetry parameter with the highest discriminative power in this study.

Riding Soundness-Comparison of Subjective With Objective Lameness Assessments of Owner-Sound Horses at Trot on a Treadmill

Lameness is a symptom indicative of pain or injury of the locomotor apparatus. Lame horses generally should not be ridden. However, owners' ability to assess lameness has been questioned. This study's aim was to use subjective lameness assessments and objective gait analysis to generate a descriptive overview of movement and weight-bearing asymmetries of owner-sound riding horses. 235 horses were subjectively assessed in a field study, and the owner's perception of their horse's orthopedic health was recorded through an online survey. 69 horses were re-evaluated by gait analysis at an equine hospital. During trot on an instrumented treadmill, the gait was scored by a veterinarian using lameness grades from 0/5 (sound) to 3/5 (moderate lameness visible at trot). Movement asymmetry of the head (HDmin) and pelvis (PDmin) and weight-bearing asymmetry were quantified simultaneously. The prevalence of subjectively scored lameness grade ≥2/5 in one or more limbs was 55% during study part 1 and 74% during study part 2. Movement asymmetry of the head and/or pelvis exceeding HDmin ≥12 mm and/or PDmin ≥6 mm was found in 57% of the horses. 58% showed weight-bearing asymmetries between contralateral front and/or hind limbs of ≥3% body mass. Gait analysis showed considerable variability of movement and weight-bearing asymmetry values, sometimes independent of the clinical lameness grade, especially in the forehand. Several horses with lameness grade ≤1/5 had asymmetry values greater than mentioned thresholds. The analysis of movement and weight-bearing asymmetry revealed that these objective variables did not necessarily act uniformly and therefore should be interpreted with caution.

Inter-observer variability of two grading systems for equine glandular gastric disease

BACKGROUND

Equine glandular gastric disease (EGGD) is recognised as a separate entity to equine squamous gastric disease (ESGD) and it is recommended that lesions are graded differently. Currently, no validated scoring system exists for EGGD.

OBJECTIVES

To determine inter-observer reliability of two previously described grading systems for EGGD and to assess if agreement improved with gastroscopy experience, specialist training or familiarity with the descriptive system.

STUDY DESIGN

Cross-sectional survey.

METHODS

A link to an electronic questionnaire containing 20 images of glandular lesions was circulated. Respondents were asked to score lesions using descriptive terminology and a 0-2 verbal rating scale (VRS). Krippendorff's alpha reliability estimate was used to assess inter-rater agreement. A mixed effects model was used to determine which descriptive categories were associated with lesions being described as severe and decision to treat.

RESULTS

Eighty-two veterinarians responded, 49 diplomates and 33 non-diplomates. There was no agreement when all four descriptive variables were combined (α = 0.19). Agreement was fair to moderate for severity (α = 0.52), distribution (α = 0.44), appearance (α = 0.38) and shape (α = 0.32). Agreement for the VRS was similar to that for severity (α = 0.53). Agreement was better among diplomates across all categories. Lesion appearance and shape, but not distribution, were associated with both a decision to treat; and lesions being described as severe (P =< .05). A VRS score 2/2 was associated with a lesion being described as severe (OR 75.2, 95% CI 51.12-110.48, P =< .001).

MAIN LIMITATIONS

Intra-observer variability was not assessed. The number of images is relatively small, and the decision to treat is based on several factors in practice.

CONCLUSIONS

Overall, agreement for the descriptive system was poor. Better delineation of descriptive category boundaries and characteristics should be determined. Agreement was similar when comparing the severity category and the VRS. Extrapolation to a VRS based on lesion severity may therefore be possible.