New research published last week on the open access scientific platform PLOS ONE has become the first academic paper to use data from RCVS Knowledge’s Canine Cruciate Registry (CCR) to determine its findings. The research provides estimates on the minimal clinically-important differences (MCIDs) for the two validated outcomes measures that are used by the CCR.
Based on a year of accumulated data, the research demonstrates the CCR’s utility and impact on the profession, and how it fills a crucial knowledge gap.
The new paper, titled ‘Minimal clinically-important differences for the “Liverpool Osteoarthritis in Dogs” (LOAD) and the “Canine Orthopaedic Index” (COI) client-reported outcomes measures’, looks at important statistical parameters of the outcome measures that are used in the CCR.
LOAD, developed at the University of Liverpool and licensed to Elanco, and COI, developed by the American College of Veterinary Surgeons, are a series of pre- and post-operative questionnaires, answered by owners, which give a numerical score to track recovery.
The research includes a combination of anchor-based and distribution-based methods to provide MCID estimates.
MCID is defined as ‘the smallest change in the score of an outcome measure that a client would identify as important’.
The research team were, for the first time, able to provide estimates of MCID for LOAD and COI. This is useful for the purposes of study design and sample-size estimates in research and clinical trials. In addition, regulators may use the MCID to define the threshold between ‘responder’ and ‘non-responder’ in regulatory clinical trials. The MCID is also useful in the context of monitoring patients’ responses to interventions, and in clinical-decision-making.
Professor John Innes, a director of Movement Referrals, an independent veterinary referrals provider in UK, and Honorary Professor at University of Liverpool, led the research study. He said: “I’ve been interested in canine orthopaedics outcomes for most of my career. As an academic, I developed LOAD with the vision that it would help to standardise outcomes and facilitate projects such as the RCVS Knowledge Canine Cruciate Registry. Both LOAD and COI are used internationally now and having estimates of the MCID for these clinical tools will be useful step forward for researchers, regulators, clinicians and clients.”
Mark Morton, clinical lead of the CCR and also an author on the study, commented: “It’s fantastic to see the data from the RCVS Knowledge CCR being used for the first time in a peer-reviewed publication. The automated registry makes it easy to collect this data; previously this was challenging and time-consuming. We’re very grateful to all the veterinary surgeons and owners who have participated so far, and hope this will encourage others to do so too. This study demonstrates that not only does the CCR mean we can track the progress of individual patients after cruciate surgery, but it also shows how the data can benefit all canine orthopaedic patients going forward.”
The CCR, launched in July 2021, addresses a crucial knowledge gap in cruciate ligament surgery by gathering data on techniques and their impact on large populations of dogs. Using free, anonymised data collection and an audit tool to build case data to guide decision-making, it provides information including rates of success and potential complications with different techniques. It relies on the involvement of both surgeons and dog owners.
The CCR is continuously accepting new registrants, and RCVS Knowledge encourages veterinary surgeons and clients to join and help grow the evidence base on cruciate ligament surgery. Veterinary surgeons must be registered before owners of their patients can participate.
“The use of the Canine Cruciate Registry data in the research demonstrates that engagement with improvement activities can help advance the knowledge of the profession”, says Chris Gush, Executive Director of RCVS Knowledge. “This is the first tangible use of the Canine Cruciate Registry, and it will help clinicians to provide better care, and ultimately many dogs in the future will have better outcomes.
“A huge thank you to the American College of Veterinary Surgeons, Elanco and the University of Liverpool for allowing us to use these questionnaires in this project, and to all the surgeons and clients who have already contributed their data – this success today would not have been possible without them. But it is vital that we get more veterinary surgeons to register their patients and advise clients on the difference they can make by contributing their pet’s data.”
The research is co-authored by John Innes, Mark Morton and Duncan Lascelles.