This document describes the initial development of a health-related quality of life (HRQL) instrument specifically for cats with osteoarthritis (OA). It involved: 1) Conducting interviews with experts and cat owners to understand behaviors associated with HRQL and OA, which were analyzed to generate potential items. 2) Experts reviewed items, which were assigned to instrument components and revised based on relevance and clarity feedback. 3) A prototype was tested, and appropriate revisions were made, resulting in instruments to be field tested measuring the impact of OA on cats' quality of life.

1. 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% Clarity
6 Revised, 9 Added to
OAMCC
12 Revised in
GC
4 Revised, 12
added OAMOC
Figure 3: Schematic of content
validation. Items were removed
(red arrows) or revised for
prototype pre-testing.
Contact: Cory Noble
Telephone: +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 Surgery
4. 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 cats
behaviour at the time of the assessment on a 7-point scale (0 to 6). Response options are
designed 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 ensured
adequate coverage of feline HRQL and chronic pain3. Analysis of interview data
resulted 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 disease
Chronic pain
Healthy
Hyperthyroidism
Kidney disease
Osteoarthritis
Cancer
Heart failure
Stroke
Tumour
“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/clincian
or by objective measures.