History, Rest and Exercise Score (HRE-S) for assessment of disease severity in horses with trigeminal-mediated headshaking.
Authors: Kloock Tanja, Pickles Kirstie J, Roberts Veronica, Uhlendorf Frauke, Twele Lara, Wilkens Henriette L, Stehle Eva, Feige Karsten, Niebuhr Tobias
Journal: Equine veterinary journal
Summary
# Editorial Summary: HRE-S Scoring System for Trigeminal-Mediated Headshaking Trigeminal-mediated headshaking (TMHS) causes neuropathic facial pain in affected horses, yet clinicians currently rely on subjective assessment to gauge disease severity and welfare impact. Kloock and colleagues developed and validated the History, Rest and Exercise Score (HRE-S)—a three-component scoring system combining historical information with observations of clinical signs during rest and ridden exercise—testing its reliability across seven observers of varying experience using video recordings of nine TMHS cases and three controls. The HRE-S demonstrated exceptional inter- and intraobserver reliability (intraclass correlation coefficient = 0.98) regardless of observer experience level, substantially outperforming intuitive assessment (κ = 0.48–0.63), whilst successfully discriminating between disease severity grades and showing strong convergent validity with existing grading systems. This standardised, experience-independent scoring tool offers equine practitioners a precise, reproducible means of objectively quantifying TMHS severity for clinical decision-making, prognostic discussions, and therapeutic monitoring—a significant advancement over current subjective approaches that may mask subtle but clinically important variations in disease expression. The practical utility of HRE-S is particularly valuable for farriers, physiotherapists and coaches working alongside veterinarians, enabling more consistent communication about disease status and welfare compromise across the equine care team.
Read the full abstract on PubMed
Practical Takeaways
- •HRE-S offers practitioners a standardized, reliable scoring tool that doesn't depend on observer experience—useful for consistent monitoring and communication of TMHS severity across clinics and time points
- •The system's validity across different raters means treatment response and disease progression can be objectively tracked and compared, improving clinical decision-making for this neuropathic pain condition
- •Scoring integrates clinical history with objective rest and exercise observations, capturing disease severity comprehensively and providing better welfare assessment than intuitive visual judgment alone
Key Findings
- •HRE-S demonstrated excellent intraobserver reliability (Spearman's Rho = 0.946, p < 0.001) and interobserver reliability (ICC = 0.98, p < 0.001) independent of observer experience
- •HRE-S showed discriminant validity with significantly different resting and exercise subscores between intuitive global-type-scale severity groups (p < 0.05)
- •Horses with grade 3/3 severity had significantly higher exercise scores and total scores compared to grade 0/3 or 1/3 (p < 0.001), confirming convergent validity
- •The three-component scoring system (history, rest, exercise) provides a valid and objective alternative to subjective assessment of TMHS disease severity