From ‘Better or Worse’ to Structured Grading: The Reliability of the Equine Quality of Movement Score.
- abphysio
- Aug 1
- 3 min read
How well clinicians agree when grading movement and what this means for everyday practice
Visually assessing equine quality of movement is something every equine clinician does daily. But how often do we stop and ask - how reliable is “I think it looks better?"
Right now, most movement assessment boils down to an instinctive “better or worse” call. It works, but it’s blunt, binary, and highly individual. What you consider a mild restriction might be my idea of moderate. Without a structured system, even experienced clinicians struggle to compare notes or to track subtle changes over time.
The Equine Quality of Movement Score (EQoMS) was developed to bring structure and consistency to this process. But even with training and clear directives, how reliably do different clinicians see the same thing?
The Study: Who, What, When, Where, How, Why
Who: 6 assessors (3 equine physiotherapists, 3 specialist veterinarians)
What: Used the EQoMS to score video footage of 20 horses completing 30 standardised in-hand movement tests.
When: 2023 – 2024, as part of my PhD research
Where: Filmed in Wagga Wagga, Australia and scored online.
How: Videos were randomised, and scored twice with a 2-week gap, then the scores and comments were analysed.
Why: To find out how consistent clinicians are with themselves (intra-rater) and with each other (inter-rater).
The full journal article is available here: [The Equine Quality of Movement Score: How reliable is it?]
The Results
Intra-rater reliability was excellent.
When clinicians scored the same horse twice, their own results were highly consistent (Spearman’s rho = 0.952, P<0.001).
✅ You can trust your own grading over time.
Inter-rater reliability was moderately strong.
When comparing across assessors, agreement was good on the relative quality of movement, but less precise on the extent of movement quality (Spearman’s rho = 0.667–0.950, P<0.001).
⚖️ Clinicians see the same patterns, but don’t always give the same score.
Comments revealed bias and nuance.
Assessors tended to make more negative than positive comments.
Vets and physios used different language - physios avoided direct lameness terms, focusing on function instead.
Different gaits, figures, and surfaces lead to different features being commented on.
Even with training, subjectivity remained.
Clinicians weighted key features differently. This means the same horse can be scored differently by equally skilled eyes.
What Does This Tell Us?
The EQoMS gives structure and granularity, helping clinicians move beyond simple better/worse judgements. But subjectivity remains - even with training and clear directives. Therefore, we need further collaboration to refine descriptors and boundaries between grades to strengthen agreement. Yet even an imperfect structured tool is an improvement over the current free-for-all, where no standard exists.
Why It Matters for Clinicians
In the “Wild West” of equine clinical movement assessment, where everyone is using their own informal system, credibility suffers. Without common ground, interdisciplinary communication is harder, research comparisons are limited, and clients may get mixed messages. By focusing on standardisation, grading and functional movement quality, not medical pathology, the EQoMS helps strengthen evidence-informed practice in the field.
It’s not Perfect – but it’s Progress
Think of the EQoMS as a step towards consistency. It is not perfect, but without this first step, no one progresses anywhere. Foundational steps are essential, even if future technologies overtake them. Not everyone will have access to advanced gait analysis tech in the field. But with EQoMS, you can:
✅ Do the basics better
✅ Move beyond “better/worse” to structured grading based on clear guidelines
✅ Track changes with more granularity than before, and
✅ Use a shared language for professional discussions
Ready to Take the Next Step?
If you want to bring structure, consistency, and clearer communication into your daily clinical practice, sign up to the EQoMS training program
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