Clinical metrology instruments, or CMIs, are questionnaires that a client completes specific for their pet’s level of pain and functional activity. Examples of CMIs include the Canine Brief Pain Inventory (CBPI), Canine Orthopedic Index (COI), and Liverpool Osteoarthritis in Dogs (LOAD).
These questionnaires have been validated, meaning that they have stood up to rigorous testing to show that they are able to detect pain or disability in dogs. More importantly, these tests have also been shown to be responsive, meaning that they can detect response to treatment in dogs with OA. Client-Specific Outcome Measures (CSOM) is a type of CMI that allows clients to identify (typically 3) functional limitations specific to their dog and assign a score.
The first time a client fills out a CMI, it may help you detect OA and educate the client by showing them that they have identified symptoms of chronic pain in their dog. In this way, CMIs can serve as a screening tool for OA and chronic pain.
The true value of a CMI, however, lies in the ability to monitor response to treatment. Clients should complete additional CMIs at follow-up examinations in order to help you determine changes that need to be made to the plan.
Client Metrology Instruments (CMI)
Do:
- Use them! Chronic pain is best recognized by the people who know the animal best (hint-this is usually not the veterinarian!). When clients fill out the questionnaire, they may recognize that some subtle signs or changes in behavior are a sign of pain.
- Always have the same owner complete the questionnaires when doing follow-ups. This is very important as different caregivers may have different ideas of their dog’s activity and pain. It’s always interesting to have multiple caregivers each fill out their own form, but it is crucial that follow-up CMIs are compared directly back to the original person.
- Completing CMIs should not be a family affair. These tools have only been validated for a single user, meaning that 2 or more pet parents should not be collaborating on the answer.
- Become familiar with several validated questionnaires and use the one that you feel works best for your practice and clients. Examples of validated client-specific outcome measures are:
- Canine Brief Pain Inventory
- Canine Orthopedic Index (see form link to the right)
- Client-Specific Outcome Measures. (see form link to the right)
- Utilize objective scoring systems such as CMIs to help owners understand quality of life and end-of-life concerns.
- Have a client fill out a CMI prior to instituting a new treatment for OA. Have them return in 4 weeks and fill out the same questionnaire again. If the treatment you instituted is going to have an effect, you should have seen a change or improvement in scores in 4 weeks.
Don’t:
- Allow owners to collaborate on their answers. One client should fill out the form alone.
- Don’t inadvertently influence the client’s thinking—Clients should fill out the questionnaire before hearing someone say “Oh, Bella looks great today!”
- Let owners think there are right and wrong answers. These answers are specific for their dog.