Feline Musculoskeletal Pain Index: Responsiveness and Testing of Criterion Validity

Abstract

Background: Progress in establishing if therapies provide relief to cats with degenerative joint disease (DJD)-associated pain is hampered by a lack of validated owner-administered assessment methods.Hypothesis: That an appropriately developed subjective owner-completed instrument (Feline Musculoskeletal Pain Index-FMPI) to assess DJD-associated impairment would have responsiveness and criterion validity.Animals: Twenty-five client-owned cats with DJD-associated pain. Methods: FMPI responsiveness (ability to detect the effect of an analgesic treatment) and validity (correlation with an objective measure) were explored through a stratified, randomized, double blinded, placebo-controlled, crossover 10-week clinical study. Meloxicam was administered to effect pain relief. A linear mixed model, backward stepwise regression, and Pearson correlations were used to assess responsiveness and criterion validity with the assumption that the NSAID would increase activity.Results: Positive responses of cats to placebo (P = .0001) and meloxicam treatment (P = .0004) were detected; however, the instrument did not detect any difference between placebo and meloxicam (linear mixed model), even for the high impairment cases. Percent meloxicam target dose administered, temperament, and total baseline FMPI score were covariates that most affected FMPI scores. Controlling for significant covariates, most positive effects were seen for placebo treatment. Positive treatment effects on activity were detected, but only for the cases designated as most highly impaired.Conclusions and Clinical Importance: Neither responsiveness nor criterion validity were detected by the inclusion criteria for cases in this study. The data suggest that further work is indicated to understand factors affecting activity in cats to optimize inclusion criteria.

The Use of Functional Data Analysis to Evaluate Activity in a Spontaneous Model of Degenerative Joint Disease Associated Pain in Cats

“…those without DJD) (previously unpublished data). Two other trials included in the exploratory analyses [25, 30] were designed to evaluate outcome measures and efficacy for a non-steroidal anti-inflammatory medication in cats with DJD and owner-rated mobility impairment. All trials were carried out with approval by the North Carolina State University College of Veterinary Medicine’s Institutional Animal Care and Use Committee (Protocols 11-102-O, 08-124-O).…”

“…Inclusion criteria for the intervention trials have been previously described [25, 30, 50]. Briefly, cats were required to be greater than one year of age and weigh more than one kg, and to have a qualifying degree of owner-rated mobility impairment, joint pain on orthopedic examination, and radiographic evidence of DJD.…”

“…Exclusion criteria, common across trials, have been described previously [25, 30, 50] and included the presence of suspected or diagnosed infectious diseases, symptomatic cardiac disease, immune-mediated disease, neoplasia, inflammatory bowel disease, urinary tract infection, hyperthyroidism, and diabetes mellitus. Cats with stable chronic kidney disease (CKD) up to and including IRIS stage two [51] were eligible to enroll following demonstration of stable serum biochemistry and urinalysis results.…”

“…The activity data for the cats with DJD have appeared in two separate publications using a very simplistic approach to analysis [25, 30]. …”

2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats

“…The first validated clinical metrology tool for the evaluation of feline musculoskeletal pain has now been produced and is available for use in practices (see Table 2). 139,140 NSAiDs are the mainstay of pharmacologic treatment for DJD in other species, and there is considerable evidence to support their effectiveness in cats as well. [141][142][143][144][145] in the USA, however, NSAiDs are not approved for long-term use in cats, and the potential side effects often deter many clinicians from routinely using them in cats.…”