Evidence-based medicine in equine clinical practice

Smith, Luisa J. (2006) Evidence-based medicine in equine clinical practice. PhD thesis, University of Glasgow.

Abstract

The principles of Evidence-Based Medicine (EBM) have been well documented in the
medical literature, with many examples of the successful application of these principles to
the clinical environment. Despite this widespread acceptance of these principles
throughout the medical profession, there has been resistance to adopt such an approach in
the veterinary profession. To date, there are. few examples in the literature of the
application of the principles of evidence-based medicine to either clinical or scientific
research. The aim of this study was to design a series of investigations of equine diseases,
and implement them at three private equine hospitals. A variety of study designs were
used, providing different classes of evidence when using the classification system proposed
by Yusuf et al. (1998). The main focus of this investigation was to ascertain whether it
was possible to apply the ethos of EBM to the veterinary profession, and provide good
quality research and evidence form private practice.
It was found that 85.6% of horses (95% c.l. 81.3 to 89.3) treated for septic arthritis were
successfully discharged from the hospital, with 65% of these horses (95% C.l. 57.9 to
71.6) able to return to their previous level of athletic function. When considering those
horses treated for septic digital tenosynovitis, 87.8% survived to be discharged from the
hospital. However, the prognosis for future soundness was poorer than that achieved
following resolution of septic arthritis, with only 50% of horses treated for septic digital
tenosynovitis able to return to their previous level of athletic function. Racing
Thoroughbreds, both neonates and mature horses, were identified as an important subset of
the population. It was found that the occurrence of septic arthritis in neonatal
Thoroughbreds significantly reduced the likelihood of those foals going on to make at least
one start on a racecourse, with those foals being 3.5 times less likely to start on a
racecourse when compared to their siblings. In contrast, when considering mature
Thoroughbred racehorses it was found that the occurrence of septic arthritis did not affect
the likelihood that they would make at least one start on a racecourse when compared to
their siblings, or be able to achieve an Official Rating awarded by the British Horseracing
Board's handicappers equal to, or higher than, either the highest rating achieved prior to
the onset of sepsis in cases in which horses had raced previously, or equal to the highest
rating achieved by their siblings.
In a controlled, randomised trial it was found that 31.6% (95% c.l. 17.5 to 48.7) of horses
wearing a belly band following an exploratory laparotomy developed incisional
complications, compared with 76.6% (95% c.I. 62.0 to 87.7) of horses where no belly
band was used. If a belly band was used following an exploratory laparotomy, the risk of
developing post-operative incisional complications was reduced by 45% compared to those
cases where no belly band was used.
Following a clinical audit of elective surgical procedures at three private equine hospitals,
there was found to be a higher rate of post-operative complications, when compared to
results reported in both the medical and small animal veterinary literature.
It was concluded that it was possible to apply the ethos of EBM to the veterinary
profession, and provide good quality research and evidence from research performed in
private practice. However, in order to be able to achieve sufficient case numbers to
provide answers that are directly relevant to practice-based clinical situations, multi-centre
studies are likely to be the best way forward.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: R Medicine > R Medicine (General)
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine
• Supervisor's Name: Love, Professor Sandy, Marr, Dr. Celia and Reid, Professor Stuart
• Date of Award: 2006
• Depositing User: Ms Dawn Pike
• Unique ID: glathesis:2006-5004
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 06 Mar 2014 16:00
• Last Modified: 06 Mar 2014 16:00
• URI: https://theses.gla.ac.uk/id/eprint/5004