Study design
The study consisted of two parts. To prevent bias, which is common with behavioural observations, a onequestion blinded questionnaire( OQ) was developed, which was sealed after completion and was not viewed by the researcher until all observations were complete [ 20 ]. The question allowed categories to be created depending on the level of outdoor access each patient had in their home environment( Table 1).
The second stage involved patient observations and the completion of an ethogram. The ethogram was adapted from a validated feline behavioural ethogram( Seven-Level Cat-Stress Score) and the Feline Grimace Scale, in line with previous studies [ 18, 19, 21, 22 ]. A resident veterinary behaviourist assessed the ethogram design before its use in the study.
Before cats were enrolled in the study, admission appointments were carried out, as per the practice ' s protocol. Once the owner had provided full informed consent for the procedure, the researcher discussed the study and determined their level of interest. Patients were secured in their kennel and, in line with previous studies, a 15-minute acclimatisation period was provided, so the patient could adapt to its new surroundings and to the observer [ 23 – 25 ].
An adapted version of the Glasgow Feline Composite Pain Score( CMPS-F) [ 26 ] was employed during the acclimatisation period, before any physical contact with the patient. This assessment followed any immediate interventions deemed necessary by the clinical team, for example, a clinical examination( including auscultation of the heart and lungs, palpation of the pulse, palpation of the abdomen and rectal temperature measurement), weight measurement and the application of Eutectic Mixture of Local Anaesthetics( EMLA)( MHRA).
Interval structured observations occurred at 0 minutes( T0), 5 minutes( T5) and 10 minutes( T10), as per previous research [ 27 ]. Multiple observations allowed observation of a larger repertoire of behaviours per participant, increasing the accuracy of the results [ 28 ]. During the observational phase, the participant was not interacted with in any way.
Pilot study
Before assessing the first patient, a pilot study was conducted. Videos of feline behaviour were assessed by the researcher alongside the ethogram, the veterinary behaviourist reviewed the outcomes and agreement was reached in each case.
Data handling and analysis
Statistical tests, including Shapiro – Wilk, Kruskal – Wallis, and Friedman test with post-hoc Wilcoxon signed-rank test, were used to evaluate the data gathered.
Results
Demographic analysis and central tendencies
The study recruited 27 participants over a 3-month period; one participant was excluded for not fulfilling the inclusion criteria. Results of the OQ enabled demographic analysis( Table 1). To allow patterns to be more easily recognised, the total mean stress score( TMSS) was calculated for each participant, for each behavioural observation( Figure 1, page 35).
Category 1 participants with no outdoor access had the lowest TMSS at T0, compared with the other categories, and the TMSS for Category 1 participants subsequently rose until the end of the observations. In contrast, for Category 2 and Category 3 participants, the TMSS initially decreased, then increased above the T0 score. TMSS for Category 1 participants remained below that of Category 2 and 3 participants throughout the behavioural observations( Table 2).
Table 2. Total mean ± standard deviation stress score( out of 20) of participant categories at different behavioural observation times.
Time Category 1 Category 2 Category 3 T0 11.00 ± 2.45 13.18 ± 4.16 14.20 ± 5.40 T5 12.00 ± 4.00 13.12 ± 4.48 13.80 ± 5.36 T10 13.00 ± 2.94 13.59 ± 4.42 14.60 ± 5.07
Table 1. Categories of outdoor access of patients and demographic analysis of participants ' categorisation status based on level of outdoor access.
Category Category criteria Percentage( number) of participants Category 1 Indoor access only 15.4 %( 4 cats) Category 2
Category 3
Supervised outdoor access( enclosed run or while being watched) OR free outdoor access but spends less than 50 % of their time outdoors
Free outdoor access and spends 50 % or more of their time outdoors
65.4 %( 17 cats)
19.2 %( 5 cats)
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