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Evaluation of the Biceps Tendon Reflex in Dogs

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Evaluation of the Biceps Tendon Reflex in Dogs Central Journal of Veterinary Medicine and Research Research Article *Corresponding author Shenja Loderstedt, Small Animal Clinic (WE20), FreieUniversität Berlin, Oertzenweg 19b, 14163 Berlin, Evaluation of the biceps tendon Germany, Tel: 49 30 838 62356 / 422; Email: Submitted: 17 October 2014 reflex in dogs Accepted: 13 December 2014 Felix Giebels1, Barbara Kohn1, Nadia Shihab2, Holger A Volk3 and Published: 15 December 2014 Shenja Loderstedt1* Copyright © 2014 Loderstedt et al. 1Small Animal Clinic (WE20), Department of Veterinary Medicine, Freie Universität Berlin, Germany OPEN ACCESS 2Southern Counties Veterinary Specialists, Unit 6 Forest Corner Farm, UK 3 Department of Clinical Science and Services, Royal Veterinary College, University of Keywords London, UK • Biceps tendon reflex • Dog; Interobserver-agreement Abstract The biceps tendon reflex (BTR) of thirty-two dogs with a median age of 5 (0.5- 15) years and a median weight of 17.5 (5.8-57) kg was assessed by two examiners. The examinations were videotaped and evaluated by 12 observers. The observers were divided in three groups depending on level of expertise (neurologists, veterinary surgeons and students). Each group evaluated the reflex-presence and reflex-briskness. Kappa-analysis and Intercorrelation-coefficient (ICC) were applied for analysis of interobserver-agreement. Logistic regression analysis was used to investigate the influence of sex, age, weight, fur length and examiner on the interobserver-agreement. The interobserver-agreement was highest for the neurologist-group and lowest for the student-group. Neither sex, weight, age, fur length or the person who did the exam influences the interobserver-agreement. The level of expertise is an influencing factor on interobserver-agreement of canine BTR evaluation. In healthy dogs the BTR can be reliable assessed by veterinary neurologists. The clinical significance is still unknown as the BTR was only assessed in healthy dogs. ABBREVIATIONS ANOVA: Analysis of Variance; BTR: examination to determine the neuroanatomical localization of a CI (95%): ICC: lesion and therefore requires being comparable between different KC: Cohen´s Kappa; KF: Fleiss-Kappa;Biceps Tendon KW: Reflex; observers [10]. Different studies in human medicine aimed to Kappa; SE: 95% ConfidenceSEM: interval; Inter Correlation identify such influencing factors and objectify the reflex-activity Coefficient; Weighted by different standardization procedures of the examination and INTRODUCTION Standard Error; Standard Error of the Mean the evaluation of the reflex-activity [8,11-13]. The aims of this study were: (1) evaluation of interobserver- In veterinary literature, authors rarely report the biceps agreement of BTR assessment depending on the observer´s level tendon reflex (BTR) when describing the neurological of expertise and (2) detection of influencing factors for the BTR examination findings in dogs. The BTR has been described to response.MATERIALS AND METHODS be non-consistent and challenging to elicit [1-4]. In human medicine, on the other hand the BTR is thought to be reliable and is commonly used for the assessment of the integrity of the Thirty-two dogs of different breeds with a median age of 5 cervical segments C5-C6 and the brachial plexus and also for the (0.5-15) years and a median weight of 17.5 (5.8-57) kg were diagnosis and follow-up of cervical myelopathies [5,6]. In dogs, included. There were twenty female and twelve male dogs. Eleven the musculocutaneous nerve, the function of which is tested by (34.4%) dogs were mixed breed (Table 1). Including criteria this reflex, originates from the spinal-cord-segments C6-C8 and were a normal clinical, orthopedic and neurological examination innervates the canine biceps brachii muscle, a flexor of the elbow. and no history of neurological disorders. Examinations were The reflex response involves an elbow flexion and/ or movement performed by two of the authors (FG, SL) and videotaped under over the biceps brachii muscle [3]. standardised conditions: same room, fixed camera position, lateral recumbency of the dog, same reflex-hammer. Each dog In general, segmental spinal cord reflexes can be influenced was examined by one or both examiners within one hour, each by a number of factors [4,7] and its evaluation is highly subjective examination took about 3 minutes. The owner was watching the [8,9]. It remains, however, an integral part of the neurological dog´s head during the examination. Dogs were anonymised by Cite this article: Giebels F, Kohn B, Shihab N, Volk HA, Loderstedt S (2014) Evaluation of the biceps tendon reflex in dogs. J etV Med Res 1(3): 1013. Loderstedt et al. (2014) Email: Central Table 1: Age Weight Number OverviewSex of the examinedBreed dogs. by both examiners and nineteen by only one examiner, so that (years) (kg) altogether one hundred and three examination-sequences were fa observed.Data analysis 1 f Mixed 0,5 16 2 f Bavarian scenthound 2 19 For statistical data analysis SigmaPlot 11.1 (Systat Software 3 f Marshall Beagle 4 10 table of agreement Inc.) and SPSS Statistics 22.0 (IBM) were used. The results were 5 f 4 Mixed 3 8 tabulated in a ‘ ’ [15] depending on their level of f Mixed 2 16 agreement among each group. Interobserver-agreement between C W 6 f Dalmatian 6 26,5 the observers and between the groups was analysed using Kappa analysis. The Cohen´s Kappa (K )- and weighted Kappa (K )- 7 f Giant Schnauzer 2 18 values were calculated for each pair of observers, including 98 Mixed 96 17 thepoor pair of examiners,slight within eachfair group. According moderateto Landis’ m b Golden Retriever 39 and Koch (1977)substantial the strength of agreement wasnear designated perfect asto 10 m Mixed 12 18,5 perfect‘ ’ (Κ<0.0), ‘ ’ (0.0≤Κ≤0.2), ‘ ’ (0.21≤Κ≤0.4), ‘ f (0.41≤Κ≤0.6), ‘ ’ (0.61≤Κ≤0.8), and ‘ 11 m Mixed 7 30 C W F ’ (0.81≤Κ≤1.0). ANOVA was used to test significance of 12 f Mixed 2 27,5 the mean Κ , mean Κ - and Fleiss-Kappa (K )-values between f 13 Labrador 2,5 25,5 the three groups of observers. For every K-value standard error KF 14 f Mixed 1,25 10 (SE) and the 95% Confidence interval (CI 95%) were calculated. 15 f Mixed 8,5 23 does not take into account the grade of discrepancy between the observers, so the Intercorrelation Coefficient (ICC; two- 16 f Labradoodle 4,5 23 way random, absolute agreement definition) was additionally f 17 Belgian Malinois 7,5 24,7 calculated for the reflex-briskness for each group. The ICC of each 18 French bulldog 4,5 10,6 group was compared to each other using one-way ANOVA under 19 mf Greater swiss mountaindog 7 57 estimation of the standard error of the mean (SEM). The p-values were Holm-Šidak adjusted. Furthermore, data from reflex- 20 Mixed 6 11,8 presence evaluation were used for regression analysis. The dogs 21 m Labrador 1,5 28 were subdivided into groups depending on sex, weight, age, fur 22 m Australianshepherd 1 12 length and Pthe examining person (Table 2). The interobserver- 23 mf Australianshepherd 2,5 15 agreement was set as dependent variable, all others were RESULTS 24 Australiancattledog 5,5 20 covariates. <0.05 was considered significant. 25 m BostonTerrier 14 6,4 Analysis of reliability 26 mf Bernese mountaindog 6,75 40,5 a) Reflex-presence: C F 27 Dachshund 12,2 14,75 substantial Mean K (0.706)- and K (0.753)-value 28 m German Shorthairedpointer 2,5 40 C near perfect to perfect’ are significantly highest (‘ ’) for Group 1, where the (‘fair’) C F 29 m Wire-haired dachshund 12 7,35 highest K -value (0.852) is ‘ . Group 2 shows 30 mf YorkshireTerrier 4,5 5,8 the second highest mean K (0.401)- and K (0.380)-value (‘fair’) C f and Group 3 has the lowest interobserver-agreement in the 31 AustralianTerrier 11,25 10 and a KF C Abbreviations: a reflex-presence evaluation with a mean K -value of 0.313 32 Mixed 6 8,4 (‘substantial’) b -value of 0.304. The K -value for the pair of examiners f: female; m: male wasb) 0.658 Reflex-briskness: (Figure 1). randomised numbering. The examination footage was evaluated The number of Complete agreement- by 12 observers. Observers were divided into three groups of four evaluations was highest for Group 1 (65.1%; n=67) and lowest for depending on their level of expertise: veterinary neurologists Group 3 (24.3%; n=25). Group 2 shows most often a discrepancy (Group 1), veterinary surgeons without special affinity to of one point among the observers; Group 3 has the highest neurology and three to four years of work experience (Group number of two-point-discrepancy decisions. The total amount 2) and final year veterinary students (Group 3). Both examiners of non-agreement-decisions (sum of Partial (dis)agreement and were included in Group 1 and evaluated the anonymised video Complete disagreement-decisions) is 36/103 (35%) for Group 1; in the same manner. Each observer evaluated if the reflex was 66/103 (64.1%) for Group 2 and 79/103 (76.7%) for Group 3 present or absent (0=absent, 1=present) and scored the level (Figure 2). W F W ‘moderate’- of reflex briskness using a scoring-scale (0=absent; 1=reduced; Mean K (0.542)- and the K (0.331)-value are highest for F ‘fair’ 2=normal; 3=exaggerated; 4=clonus) [14]. One dog had an Group 1. For Group 1 and 2 the mean K is within the amputated right forelimb and two examination-videos had to level, whereas the K -value for both groups reach the -level.
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