“…These data provide strong evidence that a RHpE score of ≥8/24 is likely to reflect the presence of musculoskeletal pain, although some lame horses score <8/24. The results of application of the RHpE by 23 assessors have been documented, including skilled assessors [1, 2,5,6,8,9], equine veterinarians after preliminary training [4], an equine physiotherapist after on-line training and additional repeatability assessment [7], and non-trained assessors from a variety of equine-related professions [3]. When the RHpE was applied to 20 horses by 10 veterinarians and one expert assessor, there was excellent consistency in overall agreement for total scores among raters (Intra-class correlation coefficient (ICC) 0.97, p < 0.001, Confidence Intervals (CI) 0.95, 0.99), and, for exact agreement between individual observers, there was good to moderate agreement (ICC 0.7, p < 0.001, CI 0.56, 0.84) [4].…”