Implementation lessons learnt when trialling palliative care interventions in the intensive care unit: relationships between determinants, implementation strategies, and models of delivery-a systematic review protocol.

BACKGROUND: Heterogeneity amongst palliative care interventions in the intensive care unit (ICU) and their outcomes has meant that, even when found to be effective, translation of evidence into practice is hindered. Previous evidence reviews have suggested that the field of ICU-based palliative care would benefit from well-designed, targeted interventions, with explicit knowledge translation research demonstrating valid implementation strategies. Reviewing effectiveness studies alongside process evaluations for these interventions will give insight into the implementation barriers or constraints identified, and the implementation strategies adopted. METHODS: A systematic review to identify and synthesise knowledge on how models of integrating palliative care into the ICU have been implemented and provide critical recommendations for successful future development and implementation of complex interventions in the field. The search will be carried out using MEDLINE, Embase, Cochrane, CINAHL, and PsycINFO. The search strategy will combine terms related to palliative care, intensive care, and implementation. Only full-text articles will be considered and conference abstracts excluded. There will be no date or language restrictions. The Implementation Research Logic Model will be used as a framework for synthesis. Findings will be reported following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. DISCUSSION: This review will provide understanding of implementation facilitators, barriers, and strategies, when employing palliative care interventions within the ICU. This will provide valuable recommendations for successful future development of complex interventions using implementation frameworks or theories. This can increase the potential for sustained change in practice, reduce heterogeneity in interventions, and therefore help produce measurable and comparable outcomes. SYSTEMATIC REVIEW REGISTRATION: International Prospective Register of Systematic reviews PROSPERO (CRD42022311052).

Exploring factors having an impact on attitudes and motivations towards volunteering in the undergraduate nursing student population - A comparative study of the UK and Ghana.

This study explores attitudes and motivations towards volunteering in nursing students in Ghana compared with nursing students in the United Kingdom (UK). Ghana traditionally follows a western model of nurse education, with students studying programmes commensurate in theory and practice, making Ghana a suitable location for a comparative study. We explored similarities and differences in attitudes and motivation towards volunteering to challenge and inform our common place practice towards nursing pedagogy. Ghanaian students displayed positive attitudes towards volunteering, although these did not translate into increased motivation to volunteer while at university. Students reported financial constraints as reasons for not volunteering as did UK students, although Ghanaian students used available resources for daily living expenses, whereas UK students prioritised available resources to pay down student debt. Structured volunteering was absent from both Ghanaian and UK nursing programmes, despite its potential to increase the variety of social groups or situations to which students are exposed, to increase self-confidence and to encourage greater reflection on practice through doing. Structural challenges within countries may provide a better explanation of variation in student motivation towards volunteering, than cross-cultural variation in attitudes towards volunteering between countries.

"You have to find a caring man, like your father!" gendering sickle cell and refashioning women's moral boundaries in Sierra Leone.

Most research on sickle cell disorders has tended to be gender-blind. This qualitative study undertaken in 2018, explores if and how sickle cell disorders become gendered in Sierra Leone through the analytical framework of a feminist ethics of care. It argues that women have to navigate moral blame when they have children with the condition. At the same time women refashion moral boundaries so that gendered norms around childhood and parenting for such children become suspended, in favour of creation of careful spaces. Parental fears of physical and sexual violence mean that gendered sexual norms are enforced for teenage boys as they are encouraged into early adulthood. In contrast, girls are kept in enforced ignorance about the consequences of sickle cell for reproduction and are encouraged to delay motherhood. This is because, as women relate, relationships and giving birth are fraught with embodied dangers and risks of violence.

Alterations in body lean angle in lame horses before and after diagnostic analgesia in straight lines in hand and on the lunge.

Altered body lean has been subjectively observed during lungeing in lame horses. The objectives were to quantify the influence of lameness on body lean in trot on the lunge and to investigate the influence of improvement in lameness on the differences in body lean between reins. Thirteen lame horses were trotted in straight lines and lunged on a 10m-diameter circle on both reins before and after lameness was subjectively substantially improved by diagnostic analgesia. A global position system-aided inertial measurement unit attached to the tubera sacrale quantified body lean. Differences between reins in body lean before and after diagnostic analgesia were calculated and means were determined. Five and eight horses had unilateral and bilateral hindlimb lameness, respectively. Two of five horses with unilateral and three of eight horses with bilateral lameness leaned more on the rein with the lame or lamer hindlimb on the inside of the circle (difference between reins 5-8°). Two of five horses with unilateral and two of eight horses with bilateral lameness leaned more on the rein with the lame or lamer hindlimb on the outside of the circle (4-10°). Four horses, one with unilateral and three with bilateral lameness, had only 1° difference in body lean angle between left and right reins. When lameness was improved by diagnostic analgesia, the body lean changed significantly towards similar leaning on left and right reins (mean angle changed from 8.8° to 10.0° (P=0.03) on one rein and 13.4° to 10.8° (P=0.002) on the other rein). It was concluded that body lean becomes more symmetrical between reins after improvement in lameness using diagnostic analgesia.

Mental health and well-being in parents of excessively crying infants: Prospective evaluation of a support package.

BACKGROUND: During the first 4 months of age, approximately 20% of infants cry a lot without an apparent reason. Most research has targeted the crying, but the impact of the crying on parents, and subsequent outcomes, need to receive equal attention. This study reports the findings from a prospective evaluation of a package of materials designed to support the well-being and mental health of parents who judge their infant to be crying excessively. The resulting "Surviving Crying" package comprised a website, printed materials, and programme of Cognitive Behaviour Therapy-based support sessions delivered to parents by a qualified practitioner. It was designed to be suitable for United Kingdom (UK) National Health Service (NHS) use. METHODS: Parents were referred to the study by 12 NHS Health Visitor/Community Public Health Nurse teams in one UK East Midlands NHS Trust. Fifty-two of 57 parents of excessively crying babies received the support package and completed the Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7 anxiety questionnaire, as well as other measures, before receiving the support package and afterwards. RESULTS: Significant reductions in depression and anxiety were found, with numbers of parents meeting clinical criteria for depression or anxiety halving between baseline and outcome. These improvements were not explained by reductions in infant crying. Reductions also occurred in the number of parents reporting the crying to be a large or severe problem (from 28 to 3 parents) or feeling very or extremely frustrated by the crying (from 31 to 1 parent). Other findings included increases in parents' confidence, knowledge of infant crying, and improvements in parents' sleep. CONCLUSIONS: The findings suggest that the Surviving Crying package may be effective in supporting the well-being and mental health of parents of excessively crying babies. Further, large-scale controlled trials of the package in NHS settings are warranted.

Proximal suspensory desmopathy in hindlimbs: Magnetic resonance imaging, gross post-mortem and histological study.

BACKGROUND: There have been no previous studies correlating high-field magnetic resonance imaging (MRI) findings with gross and histological post-mortem examination in horses with hindlimb proximal suspensory desmopathy (PSD). OBJECTIVES: To determine if adhesions between the suspensory ligament (SL) and adjacent tissues could be detected using high-field MRI and if collagen, adipose tissue and muscle pathology could be differentiated. STUDY DESIGN: Retrospective study. METHODS: Nineteen horses with hindlimb PSD were humanely destroyed; 12 limbs of 11 horses with PSD underwent high-field MRI. All lame limbs were examined grossly and all SLs were examined histologically. The MR and histological images were graded blindly. Statistical analysis used a numerical Bayesian approach to simultaneously determine a pathology rating and the contribution of each MRI, gross post-mortem and histological observation to this measure. RESULTS: Signal intensity (SI) in the collagenous tissue was abnormal in 2/12 limbs. Abnormalities of SI in the adipose tissue and muscle were identified in 6 and 11 limbs, respectively. Adhesions between the SL and adjacent tissues were suspected in eight limbs, but only confirmed in six limbs. Histopathological observations of abnormal muscle tissue were associated most closely with the measure of disease used in the study and were abnormal in every limb. Gross adhesions were also a sensitive indicator, along with changes to nerves which were observed in 10 limbs. Assessments of adipose tissue signal intensity and muscle tissue signal homogeneity in both lobes of the suspensory ligament were the MRI indicators most closely associated with the measure of disease. MAIN LIMITATIONS: Small sample size. Model assumption that all abnormalities reflected degrees of a single disease. CONCLUSIONS: Adhesion formation between the SL and adjacent structures was detected by high-field MRI with reasonable accuracy. Muscle and adipose tissue pathology was identified either alone or in association with collagenous tissue pathology.

Alterations in thoracolumbosacral movement when pain causing lameness has been improved by diagnostic analgesia.

Lameness, thoracolumbosacral pain and reduced range of motion (ROM) often coexist; better understanding of their relationship is needed. The objectives were to determine if thoracolumbosacral movement of horses changes when pain causing lameness is improved by diagnostic analgesia. We hypothesised that reduction of lameness will increase ROM of the thoracolumbosacral region. Thirteen horses with different types of hind limb lameness were trotted in straight lines and lunged on a 10m diameter circle on left and right reins before and after lameness was subjectively substantially improved by diagnostic analgesia. Inertial sensor data were collected from the withers, thirteenth (T13) and eighteenth thoracic (T18) vertebrae, third lumbar (L3) vertebra, tubera sacrale (TS), left and right tubera coxae. ROM of flexion-extension, axial rotation, lateral bending, dorsoventral, lateral-lateral motion and vertical movement symmetry were quantified at each thoracolumbar site. Hiphike difference (HHD), maximum difference (MaxDiff) and minimum difference (MinDiff) for the pelvic sensors were measured. Percentage changes for before and after diagnostic analgesia were calculated; mean±standard deviation (SD) or median [interquartile range] were determined. Associations between the change in pelvic versus thoracolumbar movement symmetry after each local analgesic technique were tested. After resolution of lameness, HHD decreased by 7% [68%] (P=0.006). The MinDiff decreased significantly by 33% [61%] (P=0.01), 45±13% (P=0.005) and 52±23% (P=0.04), for TS, L3 and T18, respectively. There was significantly increased ROM in flexion-extension at T13, in axial rotation at T13, T18, L3 and in lateral-lateral ROM at L3. Thoracolumbosacral asymmetry and reduced ROM associated with lameness were both altered immediately by improvement in lameness using diagnostic analgesia.

Veterinary problems of endurance horses in England and Wales.

Several studies have shown that a considerable proportion of horses are eliminated from endurance rides due to lameness and metabolic problems. Limited information is available on specific veterinary issues in endurance horses and there are no descriptive data on veterinary problems in a large population of endurance horses. The aim of this study was to describe veterinary problems occurring in endurance horses in England and Wales, the regions of the United Kingdom where endurance rides are organised and regulated by Endurance Great Britain (Endurance GB). A comprehensive online self-completed questionnaire was used for data collection (30th December 2015-29th February 2016) All members of Endurance GB who were the main rider of one or more endurance horses were eligible to participate. From the target population of 1209 horses, 190 questionnaires were completed by riders, resulting in a 15.7% response rate. The most common rider-reported veterinary problem was lameness, affecting 152/190 (80.0%) of endurance horses at some point during their careers and 101/190 (53.2%) of horses in the previous 12 months. Detailed information on the most recent episode of lameness was available for 147 horses. Seventy-six percent of these lameness episodes (112/147) had been initially identified by a veterinarian, but only 52% of these lameness episodes were investigated further by a veterinarian, despite the high proportion of horses affected by lameness and the proportion of horses with recurrent lameness episodes. The second most common veterinary problem was thoracolumbar region pain, followed by non-specific cough, skin disease and colic. Education of endurance riders may improve the number, quality and timing of veterinary investigations, especially for lameness and thoracolumbar region pain.

Thoracolumbar movement in sound horses trotting in straight lines in hand and on the lunge and the relationship with hind limb symmetry or asymmetry.

Equine movement symmetry is changed when turning, which may induce alterations in thoracolumbosacral kinematics; however, this has not previously been investigated. Our objectives were to document thoracolumbar movement in subjectively sound horses comparing straight lines with circles on both reins and to relate these observations to the objectively determined symmetry/asymmetry of hindlimb gait. Fourteen non-lame horses were assessed prospectively in a non-random, cross-sectional survey. The horses were trotted in straight lines and lunged on both reins and inertial sensor data collected at landmarks: withers, T13 and T18, L3, tubera sacrale, and left and right tubera coxae. Data were processed using published methods; angular motion range of motion (ROM; flexion-extension, axial rotation, lateral bending) and translational ROM (dorsoventral and lateral) and symmetry within each stride were assessed. The dorsoventral movement of the back exhibited a sinusoidal pattern with two oscillations per stride. Circles induced greater asymmetry in dorsoventral movement within each stride (mean ± standard deviation, up to 9 ± 6%) compared with straight lines (up to 6 ± 6%). The greatest amplitude of dorsoventral movement (119 ± 14 mm in straight lines vs. 126 ± 20 mm in circles) occurred at T13. Circles induced greater flexion-extension ROM (>1.3°; P = 0.002), lateral bending (>16°; P <0.001), and lateral motion (>16 mm; P = 0.002) compared with straight lines. Circles induced a movement pattern similar to an inside hindlimb lameness, which was significantly associated with the circle-induced greater asymmetry of dorsoventral movement of the thoracolumbar region (P = 0.03). Moving in a circle induces measurable changes in thoracolumbar movement compared with moving in straight lines, associated with alterations in the hindlimb gait.

The extent, variability, and attitudes towards volunteering among undergraduate nursing students: Implications for pedagogy in nurse education.

In the aftermath of the Francis Report nurses are being called to account for an apparent lack of care and compassion, leading to debate around pedagogy in nurse education. Absent from this debate is a consideration of student volunteering within undergraduate nursing programmes and its potential to promote student nurses self-esteem and to enhance the development of critical thinking skills. The aim of this study was therefore to understand the extent of and attitudes towards volunteering among nursing students. A mixed methods approach using a specifically developed questionnaire, followed by in-depth interviews to ascertain extent, variability, and attitudes towards volunteering revealed low levels of volunteering among nursing students. Limited time, limited access, and lack of academic support were cited as reasons. Nevertheless, students displayed positive attitudes towards volunteering. While volunteering has been shown to impact upon students abilities to think critically, to develop personal values and respond to the needs of others, volunteering within the UK undergraduate nursing programme considered here is neither structured nor formalized. Nurse educators should pay attention to the positive benefits of volunteering for nursing students and consider ways in which volunteering might be incorporated into the curriculum.

Comparison of limb kinematics between collected and lengthened (medium/extended) trot in two groups of dressage horses on two different surfaces.

BACKGROUND: Dressage horses are often asked to work in lengthened paces during training and competition, but to date there is limited information about the biomechanics of dressage-specific paces. Preliminary work has shown increased fetlock extension in extended compared with collected paces, but further investigation of the kinematic differences between collected, medium and extended trot in dressage horses is warranted. OBJECTIVES: Investigation of the effect of collected vs. medium/extended trot on limb kinematics of dressage horses. STUDY DESIGN: Prospective kinematic evaluation. METHODS: Twenty clinically sound horses in active dressage training were used. Group 1: Ten young horses (≤6 years) were assessed at collected and medium trot and Group 2: Ten mature horses (≥9 years) were assessed at collected and extended trot. All horses were evaluated on two different surfaces. High speed motion capture (240 Hz) was used to determine kinematic variables. Fore- and hindlimb angles were measured at mid-stance. Descriptive statistics and mixed effect multilevel regression analyses were performed. RESULTS: Speed and stride length were reduced and stride duration increased at collected compared with medium/extended trot. Lengthened trot (medium/extended trot) was associated with increased fetlock extension in both the fore- and hindlimbs in both groups of horses. Changes were greater in mature horses compared with young horses. Shoulder and carpus angles were associated with forelimb fetlock angle. Hock angle was not significantly influenced by pace. Surface had no effect on fetlock or hock angles. MAIN LIMITATIONS: Only 2D motion analysis was carried out. Results may have differed in horses with more extreme gait characteristics. CONCLUSIONS: Medium/extended trot increases extension of the fore- and hindlimb fetlock joints compared with collected trot in both young and mature dressage horses, respectively.

Proximal suspensory desmopathy in hindlimbs: A correlative clinical, ultrasonographic, gross post mortem and histological study.

REASONS FOR PERFORMING STUDY: It has been suggested that ultrasonography is unreliable for the detection of hindlimb proximal suspensory desmopathy (PSD) based on comparisons between ultrasonographic and magnetic resonance images. OBJECTIVES: To compare ultrasonography with gross and histopathological post mortem examination in horses with PSD diagnosed based on ultrasonography and control horses. STUDY DESIGN: Retrospective descriptive study. METHODS: Part 1: 19 horses with hindlimb PSD and 10 control horses were humanely destroyed. Twenty control limbs and 37 lame limbs were examined grossly and 40 suspensory ligaments (SLs) were examined histologically and graded blindly. Part 2: 3 horses with recurrent lameness after surgical management of PSD and 4 with PSD were assessed ultrasonographically and by gross post mortem examination. RESULTS: Part 1: ultrasonographic lesions were graded moderate in 31/38 (81.6%) and severe in 7/38 (18.4%) lame limbs; in 4/37 (10.8%) limbs adhesion formation between the proximal aspect of the SL and the accessory ligament of the deep digital flexor tendon was predicted. Gross post mortem and histological examinations of control limbs revealed no abnormalities. Gross post mortem examination revealed substantial adhesions between the proximal aspect of the SL and adjacent soft tissues in 10/37 (27.0%) lame limbs; in 10/37 (27.0%) limbs there were adhesions between the body of the SL and the mid plantar aspect of the third metatarsal bone, extending distally in 6 (16.2%) limbs. Histology revealed abnormalities (grades 1-3) of the collagenous tissue in 25/36 (69.4%) limbs; muscle was abnormal (grades 1-3) in 35/36 (97.2%) limbs and adipose tissue (grades 1-3) in 16/36 (44.4%) limbs. Part 2: adhesions between the SL and adjacent soft tissues were predicted ultrasonographically and confirmed post mortem. CONCLUSIONS: Ultrasonography was reliable for the detection of SL pathology based on histology as the gold standard. Adhesions may be a reason for recurrent lameness after surgery.

The centrodistal joint interosseous ligament region in the tarsus of the horse: Normal appearance, abnormalities and possible association with other tarsal lesions, including osteoarthritis.

REASONS FOR PERFORMING STUDY: There have been no detailed descriptions of the radiological appearance of the centrodistal joint interosseous ligament region in horses with and without distal tarsal joint pain. OBJECTIVES: To describe the normal radiological appearance of the centrodistal joint interosseous ligament region; to determine the prevalence of mineralisation or ossification of the interosseous ligament; and to describe radiological abnormalities surrounding the interosseous space and concurrent radiological abnormalities in the tarsus. The association between interosseous ligament region abnormalities and radiological evidence of osteoarthritis of the centrodistal joint was assessed. STUDY DESIGN: Retrospective study. METHODS: Case records and radiographs of all horses/ponies (n = 700) that underwent radiographic examination of one/both tarsi over 7 years were reviewed. Case history, height, bodyweight and cause(s) of lameness were recorded. Factors associated with abnormalities of the centrodistal interosseous ligament region were assessed using logistic regression analysis. RESULTS: The normal interosseous space was an oval or circular-shaped radiolucent area bordered proximally and distally by a rim of bone of uniform opacity and thickness, which varied in thickness among animals. Abnormalities of the interosseous ligament region of the lame(r) limb were evident in 121/700 (17.3%; 95% confidence interval 14.5-20.1%) animals. Increasing bodyweight was associated with decreased odds of interosseous ligament region abnormalities. Forty-seven animals (6.7%; 95% confidence interval 4.9-8.6%) had radiological evidence of osteoarthritis of the centrodistal joint. A greater proportion of animals with interosseous ligament region abnormalities (36.4%) had radiological evidence of osteoarthritis of the centrodistal joint, compared to those with normal interosseous ligament regions (0.5%; P<0.001). Interosseous ligament region abnormalities and osteoarthritis of the centrodistal joint were not necessarily associated with distal tarsal joint pain. CONCLUSIONS: There is an association between abnormalities of the centrodistal joint interosseous ligament region and osteoarthritis. Radiological evidence of abnormalities of the centrodistal intertarsal ligament region alone or in association with osteoarthritis may be present asymptomatically.

Saddle fit and management: An investigation of the association with equine thoracolumbar asymmetries, horse and rider health.

REASONS FOR PERFORMING STUDY: No previous studies have investigated interrelationships between saddle fit/management, equine thoracolumbar asymmetries, rider and horse health. OBJECTIVES: To assess associations between data obtained by clinical assessment and those provided by riders via a questionnaire. STUDY DESIGN: Clinical assessment of a convenience sample of horses and riders compared with a Web-based questionnaire survey (n = 205). METHODS: Horse thoracolumbar asymmetries at predetermined sites, the presence of lameness (in hand and/or ridden), saddle slip, saddle fit/management and rider straightness were assessed. Kappa statistics were used to assess the relationship between categorical clinical data and questionnaire data from riders. Spearman's correlation was used to investigate associations between outcomes from clinical assessment (horse, saddle and rider data) and information provided by riders. RESULTS: There was a 40.5% (205 of 506) questionnaire response rate. Thirty horses (14.6%) had saddle slip, which was significantly associated with hindlimb lameness or gait abnormalities (P<0.001), but only 2 riders had considered a link between saddle slip and lameness. Rider back pain was common (38.5%) and associated with ill-fitting saddles (P = 0.03) and either a quadrupedally reduced cranial phase of the step or a stiff, stilted canter (P = 0.006). Well-fitted saddles were associated with frequent saddle fit checks (P = 0.004). Minor thoracolumbar asymmetries (P = 0.04) were negatively associated with ill-fitting saddles and positively associated with rider skill level (P = 0.001). CONCLUSIONS: The interaction between the horse, saddle and rider is complex. Ill-fitting saddles and a stiff, stilted canter or quadrupedally reduced cranial phase of the step are associated with rider back pain. Equine back pain and minor thoracolumbar asymmetries are associated with ill-fitting saddles. Saddle fit should be checked more often than once yearly to lower the number of ill-fitting saddles. Riders, trainers and other professionals involved in equine care and performance need better education to recognise ill-fitting saddles, lameness, saddle slip and rider crookedness.

Descriptive epidemiology and risk factors for eliminations from Fédération Equestre Internationale endurance rides due to lameness and metabolic reasons (2008-2011).

REASONS FOR PERFORMING THE STUDY: There is limited information on international endurance rides and on risk factors for eliminations. OBJECTIVES: To describe and compare the frequency of occurrence of elimination due to lameness and metabolic reasons from Fédération Equestre Internationale (FEI) endurance rides (≥100 km) during 2008-2011 in all countries and to assess risk factors for elimination due to lameness and metabolic reasons. STUDY DESIGN: Retrospective unmatched case-control study. METHODS: Data collected from the FEI website included the following: the country where the ride was held; the year; the result for each horse-rider combination; the number of entries in each class; whether the class was restricted to young riders; and the winning speed. Descriptive data were summarised, and univariable and multivariable logistic regression analyses were performed to assess risk factors for eliminations due to lameness and metabolic reasons. RESULTS: Between 2008 and 2011, there were 30,741 horse starts at FEI endurance rides of 100-160 km distance in 47 countries. Of all started horses, 30% were eliminated for lameness. Eliminations for metabolic reasons were recorded for 8.7% of all started horses. There was a large range of winning speeds amongst countries (10.2-29.5 km/h). Multivariable analysis revealed that the risk of elimination due to lameness was significantly associated with the country where the ride was held, the year, the distance of the ride and the number of entries. Elimination for metabolic reasons was significantly associated with the country where the ride was held, the year and the number of entries. CONCLUSIONS: Differences existed among elimination rates at FEI endurance rides in different countries (2008-2011). Lameness was the most common reason for elimination globally. POTENTIAL RELEVANCE: These results provide objective global data on endurance riding that can replace anecdotal information, which has been the base of opinions, decisions and regulations. The Summary is available in Chinese - see Supporting information.

Horse-, rider-, venue- and environment-related risk factors for elimination from Fédération Equestre Internationale endurance rides due to lameness and metabolic reasons.

REASONS FOR PERFORMING THE STUDY: There is limited information on risk factors for elimination from endurance rides. OBJECTIVES: To assess risk factors for elimination for lameness and metabolic reasons from Fédération Equestre Internationale (FEI) endurance rides of 80-160 km distance. STUDY DESIGN: Unmatched case-control. METHODS: Venue-, horse- and rider-related data were collected from the FEI website. Data on weather conditions and terrain were collected at the venue. Univariable and multivariable logistic regression analyses were used to assess risk factors for elimination for lameness and metabolic reasons, respectively. RESULTS: Multivariable logistic regression on 1435 horse starts revealed that the venue was significantly associated with elimination for lameness (P = 0.013). The horse's previous experience at a greater distance than the current ride (odds ratio [OR] = 0.82, 95% confidence interval [CI] 0.71-0.95, P = 0.008) and > 90 days elapsed since the last FEI ride (OR = 0.78, 95% CI 0.62-0.99, P = 0.044) significantly reduced the risk of elimination for lameness. In the multivariable model for elimination for metabolic reasons, the venue (P = 0.011), increasing number of started horses (OR = 1.008, 95% CI 1.00-1.01, P = 0.001) and deep sand or soil on the track (OR = 1.98, 95% CI 1.17-3.35, P = 0.001) significantly increased the risk of elimination for metabolic reasons. CONCLUSIONS: Reducing the frequency of racing may contribute to decreased risk of elimination for lameness. Competing in deep sand or soil may contribute to exhaustion, leading to elimination for metabolic reasons. Eliminations are likely to be the end result of a complex process, and not every aspect was or can be measured. Further studies with a larger number of horse starts and assessment of variables that could not be measured in this study may identify additional risk factors that can be modified.

The interrelationship of lameness, saddle slip and back shape in the general sports horse population.

REASONS FOR PERFORMING STUDY: Saddle slip is usually blamed on saddle fit, crooked riders or horse shape, but may reflect hindlimb lameness. There are no studies of the frequency of occurrence of saddle slip and risk factors within a tested sample population of the general sports horse population. OBJECTIVES: To quantify the frequency of saddle slip and to describe the association with lameness, thoracolumbar shape/symmetry, crooked riders and ill-fitting saddles. STUDY DESIGN: Nonrandom, cross-sectional survey using convenience sampling. METHODS: Five hundred and six sports horses in normal work were assessed prospectively. Thoracolumbar shape/symmetry were measured at predetermined sites; the presence of lameness (in hand and/or ridden) and saddle slip was recorded. Descriptive statistics, univariable and multiple logistic regression were performed to assess the relationship between horse-saddle-rider factors and saddle slip. RESULTS: The frequency of lameness, quadrilaterally reduced cranial phase of the stride or stiff, stilted canter was 45.7%, saddle slip 12.3%, left-right thoracolumbar shape asymmetries ≥ coefficient of variance of 8% (1.2 cm) 0.6%; and 103 of 276 riders (37.3%) sat crookedly. The saddle consistently slipped to one side in 24.4% of horses with hindlimb lameness alone, 45.5% of horses with concurrent hindlimb and forelimb lameness, compared with 5.4% with forelimb lameness, 17.4% with stiff, stilted canter, 20% with quadrilaterally reduced cranial phase of stride and 5.5% nonlame horses. Nineteen horses (30.6%) with saddle slip had no detectable hindlimb lameness; however, 14 had a gait abnormality, particularly in canter. Multivariable analysis revealed that saddle slip was significantly associated with hindlimb lameness and gait abnormalities (odds ratio [OR] = 52.62, 95% confidence interval [CI] 17.3-159.7), a saddle fitted with even contact and uniform flocking (OR = 15.49, 95% CI 1.9-125.5), riders sitting crookedly (OR = 6.32, 95% CI 2.9-13.7), a well-balanced saddle (OR = 3.05, 95% 1.4-6.9) and large back shape ratio at T18 (OR = 1.2, 95% 1.1-1.3). CONCLUSIONS: Many horses with hindlimb and/or forelimb lameness go unrecognised. Saddle slip may be a sign of hindlimb lameness. Education of the equestrian population to identify lameness and saddle slip is required. The Summary is available in Chinese - see Supporting information.