Agreement and reliability of the Feline Grimace Scale among cat owners, veterinarians, veterinary students and nurses

This study aimed to evaluate the agreement and reliability of the Feline Grimace Scale (FGS) among cat owners, veterinarians, veterinary students and nurses/technicians. Raters (n=5/group) scored 100 images using the FGS (ear position, orbital tightening, muzzle tension, whiskers position and head position). Intra-class correlation coefficients (ICC) were used to assess inter- and intra-rater reliability. Agreement between each group and the veterinarian group (gold-standard) was calculated using the Bland-Altman method. Effects of gender, age and number of cats owned on FGS scores were assessed using linear mixed models. Inter-rater reliability was good for FGS final scores (ICC>0.8). The muzzle and whiskers yielded lower reliability (ICC=0.39 to 0.74). Intra-rater reliability was excellent for students and veterinarians (ICC=0.91), and good for owners and nurses (ICC=0.87 and 0.81, respectively). A very good agreement between all groups and veterinarians (bias<0.1 and narrow limits of agreement) was observed. Female raters assigned higher FGS scores than males (p=0.006); however, male raters were underrepresented in this study. Scores were not affected by age or number of cats owned. The FGS is reliable for feline acute pain assessment when used by individuals with different experience.