Research priorities, horse owner perceptions and practices regarding management and treatment for pituitary pars intermedia dysfunction (PPID)

Older horses now make up a significant proportion of the equine population, meaning that geriatric medicine is increasingly important. Pituitary pars intermedia dysfunction (PPID) is a progressive disease prevalent in older horses, however, studies investigating diagnosis, treatment and prognosis are limited. The evidence base needs to be built on to inform management and treatment approaches and improve quality of life (QoL) of horses with PPID. The aims of this thesis were to i) identify and prioritise key research questions regarding PPID; ii) investigate management, health care and treatment strategies undertaken by owners iii) understand owner perceptions of treatment and QoL. A four-phase mixed methods approach was applied. Phase one used patient and public involvement (PPI), to prioritise the top 10 unanswered research questions for PPID. The questions focused on disease progression, diagnostic accuracy, treatment efficacy and additional management/treatment strategies. Literature on PPID diagnosis and treatment was subsequently evaluated in two systematic reviews, which highlighted the lack of high-quality evidence regarding current protocols. Phase two comprised a cross-sectional questionnaire to evaluate management and treatment strategies undertaken by 374 participating owners of PPID cases. Most horses were treated with pergolide (86.9%), while 17.4% received an alternative/complementary treatment. Pergolide had a higher efficacy rating compared to alternative/complementary treatments (p