Initial development of a novel disease specific

health-related quality of life (HRQL) instrument

for osteoarthritis (OA) in cats

1NewMetrica Ltd, 196 Bath Street, Glasgow, G2 4HG, UK; 2School of Mathematics and

Statistics, 15 University Gardens, University of Glasgow G12 8QW; 3Edinburgh Napier

University, Sighthill Campus, Sighthill Court EH 11 4BN, UK; 4UK College of Medical,

Veterinary and Life Sciences, University of Glasgow G12 8QQ, UK

Cory E Noble1, Andrea M Nolan3, Marian E Scott2,

Lesley Wiseman-Orr2 Jacky Reid1,4

39 Item Generic Core

19 Item OA Module: OC

17 Item OA Module: CC

Prototype pre-testing and appropriate revision – Final instruments for Field Test 1

11 Item OA

Module: CC

9 item OA Module:

OC

51 Item Generic

Core

3. Content Validity & Testing

CVI < 60% Relevance

CVI < 70% Clarity6 Revised, 9 Added to OAMCC

12 Revised in GC

4 Revised, 12 added OAMOC

Figure 3: Schematic of contentvalidation. Items were removed(red arrows) or revised forprototype pre-testing.

Contact: Cory NobleTelephone: +44 (0)7557 123143

Email: cory.noble@newmetrica.com

.

References:1. Reid, J., et al. (2013). Development, validation and reliability of a web-based questionnaire to measure health-related quality of life in dogs. Journal of Small Animal Practice, 54(5), 227–233.2. Glaser, B. (2013). Grounded theory methodology. Introducing Qualitative Research in Psychology, 69–82. 3. Merola, I. et al. (2015). Systematic review of the behavioural assessment of pain in cats. Journal of Feline Medicine and Surgery4. Gartner, M.C., & Weiss, A. (2013). Personality in felids: A review. Applied Animal Behaviour Science, 144(1-2), 1–13

PROJECT AIMS:Develop the FIRST structured questionnaire assessment to:

Measure HRQL in cats-providing a clinical outcome measure for pet cats

Measure the impact of OA on QOL, beyond physical limitation

Combine responses from both clinician and owners into a single

measurement of HRQL

Figure 1: Screen shot of the VetMetrica HRQL for Cats OA Module Clinician Component (OAMCC)(left).and the OA Module Owner Component (OAMOC). Owners are asked to rate their catsbehaviour at the time of the assessment on a 7-point scale (0 to 6). Response options aredesigned to optimise clarity.

Language

• Key Informant interviews with expert panel and cat owners – collecting the language of the user, and behaviours associated with HRQL (Figure 1).

• Reduction of raw interview data into “Theoretical Domains”, forming item banks using approach outlined in Grounded Theory2.(Figure 1)

Item Generation

• Potential items were reviewed by NewMetrica team (CN, AN, LW, MS, JR)-Relevant to domain; ease of understanding, preference and rationale for retention or deletion was decided (Figure 2).

• Items were assigned to the Generic Core (n=51) and the OA Module Owner (9) and Clinician Components (11)

Content Validity

• 10 Clinicians & owners of healthy (34) and unhealthy (14) cats completed online content validity surveys.

• Asked to rate each item for Relevance to feline HRQL and Clarity and to suggest “anything we missed”.

• Content Validity Index (CVI) was calculated, items were retained if CVI>0.60 for relevance, and >0.75 for clarity, or were revised. Nine (9) new items suggested by clinicians were added (Figure 3).

Prototype Testing

• Following pre-testing of the prototype instrument with 15 owners and 5 clinicians, appropriate revisions were made.

• Final prototype currently being field tested includes 39 item Generic Core (GC), 19 Item OA Module Owner Component (OC), and 17 Item OA Module Clinician Component (CC) (Figure 3).

• RECRUITING FOR FIELD TESTING (Validity and Responsiveness)

Quality of life is the subjective and dynamic evaluation by the individual of its circumstances(internal and external) and the extent to which these meet its expectations…, which results in, or includes, an affective(emotional) response to those. Wiseman-Orr et al, 2006

A natural continuation of NewMetrica's extensive

research on HRQL in dogs1, since currently no

valid and reliable instrument exists for cats. Figure 1: Key informant interview panel demographics and schematic of excerpt“coding” by health status & interview topics based in Grounded Theory2. This ensuredadequate coverage of feline HRQL and chronic pain3. Analysis of interview dataresulted in 164 (owners) & 134 (clinicians) descriptors from both informant groups.

134 descriptors

Code Excerpts by Interview Topics-Health Status

1. Key Informant Interview Data Analysis: Coding

165 descriptors

19 Cat Owners; 27 Cats

•Single & multi-cat households (2 to 4)•Cat Age Range 1.75 to 21 years•19 Symptom Free, 4 OA and

Hyperthyroidism, 4 OA only.

18 Clinicians; Experience from 7

to 37 years• Shelter Medicine (2)•Animal behaviour (2)•Orthopaedics (1)•Neurology (1)

• Feline Medicine (8)•General Practice (4)

OWNERS BOTH CLINICIANS• Change of Routine

• Engaging with the

Environment

• Sociability

• Changes in routine

• Impact/effects of chronic disease

• Indicators of health status

• Descriptions of poor, good, and/or no

quality of life

• Interaction with owner and other pets

• Observations made in consultation

• End of Life

• Sleeping

• Posture

• Playing/Hunting

• Vocalisation

• Vomiting

• Personality

• Activity

• Thirst/appetite

• Attitude/

• demeanour

• Grooming

• Mobility

• Physical appearance

• Respiration

• Toileting

Dementia Stress

Dental diseaseChronic pain

HealthyHyperthyroidismKidney diseaseOsteoarthritis

CancerHeart failureStrokeTumour“Unwell”End of life

Code Theoretical Domains, Ensuring HRQL Coverage

4. Prototype Testing

2. Item Generation

Figure 2: Following review items were revised or added (grey), or removed from the list of potential items reported by owners (blue) and clinicians (green).

-12 Generic Core-5 OA Module OC-5 OA Module CC

Quality of life

Health Status

• aspects of QOL that change as a result of ill health and

medical interventions.• Uniquely personal,

subjective experience

Health-related

quality of life

(HRQL)

Level of health of an individual animal as assessed by that animals owner/ carer/clincianor by objective measures.