Over the past two decades, rapidly accelerating advances in veterinary medicine have provided an amazing array of diagnostic imaging technologies, and a number of sensitive tests are now available to detect illnesses and even measure equine stress levels.
Yet the next big step forward in improving veterinary care for your horse may come, not from a laboratory or hospital suite, but from a survey---simple questions about your horse’s health and management that you could answer in just a few minutes. The questions would be designed to give your veterinarian insights into your horse’s management, which could point to adjustments that will keep him healthier for years to come.
One veterinarian thinks a survey like this could provide tremendous benefits to horses and their owners, and he’s working hard to make it a reality.
Health-related quality of life
Standardized questionnaires called health-related quality of life surveys (HQOL or HRQOL) are widely used in human medicine to assess an individual’s physical and emotional well-being. For example, how well a person recovers after a heart attack is related only in part to physical healing---factors including gender, family and social support, finances, employment and spirituality all play a role in an overall sense of health and well-being.
By asking questions relating to scientifically established risk factors, a survey of a recovering patient’s life experiences can help a physician identify the signs of depression, relapse or other issues. The same HQOL survey administered every few months might reveal changes in a person’s life that could affect health and well-being. HQOL surveys have been adapted to address a number of different chronic illnesses and situations in human medicine.
HQOL surveys have also been used in small-animal veterinary medicine---for example, to help owners objectively assess the overall well-being of geriatric pets or those with severe or chronic illness. Veterinarians also find them useful for ferreting out small details of an animal’s behavior and/or management that can provide important clues to current, emerging or chronic health issues. The surveys can be used to track changes in an animal’s health status over time or reveal how his ongoing management and care may be influencing his health and well-being.
“Health quality of life surveys can be anywhere from 20 to 100 questions long,” says William Muir, DVM, MS, PhD, DACVA, DACVECC. “And they can be easily answered in a clinic visit or even by an owner at home online. The questions generally refer to how the animal behaves at home or how he’s being cared for. For instance: How’s his appetite? Does he seem more or less energetic than usual?
Of course, veterinarians have always asked questions like these during routine examinations. “But by having these questions in a standardized, validated survey form that can be taken repeatedly, easily saved and compared directly to each other, you’re much less likely to forget the details,” says Muir, who specializes in veterinary anesthesiology, pharmacology, pain management and critical care and for decades taught at Ohio State University. “Having the questions asked in a uniform manner over time also makes any patterns or relationships easier to detect.
Yet no official HQOL surveys have ever been created for horses. Muir says that he became interested in developing one earlier this year when he learned that a research group in Glasgow, Scotland, had scientifically validated one for use in canine medicine.
“‘Scientifically validated’ means that they were able to field-test the survey on hundreds of cases, then carefully analyze the data to determine which questions yielded the most consistently useful and easily replicated information,” Muir says. “It means that it’s not just a good idea or guesswork. It’s a scientifically sound method for establishing a baseline for a particular animal and then tracking any changes you may see over time.”
The Glasgow group produced a 46-question survey whose answers could be reliably correlated to the health status of the dog, specifically with regard to chronic pain. “These surveys often deal with behaviors and management as they correlate to pain because it has such a direct impact on quality of life,” says Muir. “But they can be used to detect other things, such as generalized stress or the overall health of the animal.
The Glasgow canine HQOL survey was designed to be taken over the Internet by owners, outside of a clinical setting. “That’s particularly useful,” says Muir. “The ability of owners to provide this information very easily to the veterinarian between visits is a real benefit and breakthrough. You can incorporate the survey into an annual wellness visit. But to be able to ask the same questions again three months later and then another three months later---that’s a scorecard of sorts being kept on a regular basis. And it will give you a great idea of what is really going on with that particular animal, much more than you can get in a single visit, no matter how thorough it is.”
Reading the paper published by the Glasgow group (“Development, validation and reliability of a web-based questionnaire to measure health-related quality of life in dogs,” Journal of Small Animal Practice, May 2013) spurred Muir to begin raising interest in getting a similar project done for horses. “I’m actually very surprised one doesn’t exist already,” he says
An HQOL for horses?
An equine HQOL survey would likely have several components, says Muir. “There may be one section on nutrition, another on behavior and another on husbandry to find out how the horse is being managed,” he says. The information the questions solicit would create a detailed profile of health information tailored to the individual horse.
“It’s not a one-size-fits-all type of thing,” Muir says. “The survey’s purpose would be to develop a baseline for that particular horse and identify things that could be changed or modified in order to improve his quality of life specifically. Some horses, for instance, simply are unable to exercise as much as others. There is no ‘optimal’ exercise amount that the survey would measure a horse against, but rather the optimal amount for that particular horse.”
Muir believes that HQOL surveys may be particularly suited to horses and their owners: “Horse owners tend to be much more in touch with their animals’ health status than dog or cat owners. I think because they generally spend a lot more time paying attention to these sorts of things, the reporting you’re going to get will be much more accurate and thorough.”
The trend of horses living longer, and owners keeping them longer, makes an HQOL survey even more useful, says Muir: “One of the reasons this came to a level of importance in small animals is the aging dog and cat population. It became important to be able to collect and compare information over a period of many years. We see the same thing happening with horses. Over time, we can use these surveys to produce an increasingly clear and detailed picture of this horse’s health and how it may be changing over time. Veterinary visits provide snapshots of time, but repeated HQOL surveys can tell the entire timeline of a horse’s health.”
One example of how an HQOL survey might help horses is in identifying factors that lead to an increase in an unwanted behavior. “If we have a horse who has suddenly started to stall walk, for instance, we can look back and see what else had changed in his environment or management that may have led to an increase in anxiety and the associated behavior,” Muir says. “We can look to see what is adversely affecting his quality of life. In that process, we might even be prompted to check the horse for ulcers because of factors we uncover that we know are related. A well-administered survey provides background as well as the current picture of health and helps project what may be coming down the road.”
The way forward
The biggest obstacle to producing an equine HQOL survey, says Muir, is funding: “The path has already been laid with the work in cats and dogs, and we have very smart people at the ready who are willing to work on the project,” he says. “We would need to test it on a large scale, but the equine veterinary community has collaborated on such studies in the past. What we lack is the funding to put together a scientific study. To get it done, we’d need about $175,000.”
Funding for the canine study came from nutrition companies, says Muir: “It makes sense from a marketing standpoint. They get to say that they are involved in helping make this tool that keeps animals healthy. That they are invested in your animal’s health beyond nutrition.” Muir hopes an equine nutrition company is similarly interested in helping fund the formation and testing of an HQOL survey for horses. “It’s a natural fit,” he says.
As he continues to approach companies for funding, Muir says owners can help by being vocally supportive of the initiative. “If they have the ear of anyone with influence in the industry, they can certainly speak up and let them know what a benefit this could be to everyone,” he says. “Eventually, I think we will have an HQOL for horses. But the sooner that can be, the better.”