title: Rater agreement on gait assessment during neurologic examination of horses.
abstract: BACKGROUND
  Reproducible and accurate recognition of presence and severity of ataxia in horses with neurologic disease is important when establishing a diagnosis, assessing response to treatment, and making recommendations that might influence rider safety or a decision for euthanasia.
  
  
  OBJECTIVE
  To determine the reproducibility and validity of the gait assessment component in the neurologic examination of horses.
  
  
  METHODS
  Twenty-five horses referred to the Royal Veterinary College Equine Referral Hospital for neurological assessment (n = 15), purchased (without a history of gait abnormalities) for an unrelated study (n = 5), or donated because of perceived ataxia (n = 5).
  
  
  METHODS
  Utilizing a prospective study design; a group of board-certified medicine (n = 2) and surgery (n = 2) clinicians and residents (n = 2) assessed components of the equine neurologic examination (live and video recorded) and assigned individual and overall neurologic gait deficit grades (0-4). Inter-rater agreement and assessment-reassessment reliability were quantified using intraclass correlation coefficients (ICC).
  
  
  RESULTS
  The ICCs of the selected components of the neurologic examination ranged from 0 to 0.69. "Backing up" and "recognition of mistakes over obstacle" were the only components with an ICC > 0.6. Assessment-reassessment agreement was poor to fair. The agreement on gait grading was good overall (ICC = 0.74), but poor for grades ≤ 1 (ICC = 0.08) and fair for ataxia grades ≥ 2 (ICC = 0.43). Clinicians with prior knowledge of a possible gait abnormality were more likely to assign a grade higher than the median grade.
  
  
  CONCLUSIONS
  Clinicians should be aware of poor agreement even between skilled observers of equine gait abnormalities, especially when the clinical signs are subtle.
authors.affiliation: Department of Large Animals Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark; Department of Clinical Sciences and Services, The Royal Veterinary College, London, UK; Structure & Motion Laboratory, The Royal Veterinary College, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Olsen
authors.forename: B
authors.initials: B
authors.lastname: Dunkel
authors.forename: W H J
authors.initials: WH
authors.lastname: Barker
authors.forename: E J T
authors.initials: EJ
authors.lastname: Finding
authors.forename: J D
authors.initials: JD
authors.lastname: Perkins
authors.forename: T H
authors.initials: TH
authors.lastname: Witte
authors.forename: L J
authors.initials: LJ
authors.lastname: Yates
authors.forename: P H
authors.initials: PH
authors.lastname: Andersen
authors.forename: K
authors.initials: K
authors.lastname: Baiker
authors.forename: R J
authors.initials: RJ
authors.lastname: Piercy
mesh_terms: D000818:Animals; D001259:Ataxia / Q000175:diagnosis / Q000662:veterinary*; D005260:Female; D005684:Gait; D006734:Horse Diseases / Q000175:diagnosis*; D006736:Horses; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis / Q000662:veterinary*; D015588:Observer Variation; D010808:Physical Examination / Q000379:methods / Q000592:standards / Q000662:veterinary; D015203:Reproducibility of Results; D014741:Video Recording
keywords: Agreement; Ataxia; Physical examination; Reliability