PICO question In domestic cats in a shelter setting, does clicker training decrease proxy measures of a stressed emotional state (behavioural or physiological) compared to no clicker training?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Two papers were critically reviewed. One was a prospective quasi-randomised clinical trial, the other was a quasi-experimental before-and-after study with each cat being its own control Strength of evidence Weak Outcomes reported Both papers reported a decrease in behavioural stress indicators in shelter cats following a clicker training programme. Not all of these decreases were statistically significant and there are large issues with confounding factors in both papers Conclusion Preliminary evidence suggests that clicker training can be implemented as one form of enrichment to reduce stress in shelter cats alongside other means. Further evidence is required to demonstrate superiority to other forms of enrichment to reduce stress in shelter cats, especially given the practical limitations of implementing such a programme in most shelters   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

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