Cross-cultural adaptation and validation of an ankle instability questionnaire for use in Chinese-speaking population

Systematic review of the methodological quality of patient-reported outcome measure for patients with chronic ankle instability

OBJETIVE

Chronic ankle instability is generally associated with ankle sprain. Its consequences can be measured by means of patient-reported outcome measures (PROMs). The aim of this review is to identify the PROMs specifically available for chronic ankle instability and to evaluate their methodological quality and that of the cross-cultural adaptations made.

DATA SOURCES

Papers were retrieved from PubMed, Embase, Scopus and Google Scholar databases, with no time limit applied, based on the following inclusion criteria: (1) type of participants: patients with chronic ankle instability, over 18 years of age; (2)type of study: those specifically focused on this pathology, using PROMs specific to chronic ankle instability and published in English; (3) type of outcome: measurement properties based on COSMIN criteria in patient-reported outcomes associated with chronic ankle instability.

METHODS

This systematic review, following the COSMIN checklist, was conducted to determine the methodological quality of PROMs specific to foot and ankle pathologies, for patients presenting chronic ankle instability.

RESULTS

Of the 576 studies identified in the initial search, 34 were included in the final analysis of measurement properties. Four - the Ankle Instability Instrument, the Chronic Ankle Instability Scale, the Cumberland Ankle Instability Tool and the Identification of Functional Ankle Instability - were original questionnaires, and the remaining 30 were cross-cultural adaptations.

CONCLUSION

The Cumberland Ankle Instability Tool and the Identification of Functional Ankle Instability questionnaires can be useful instruments for evaluating chronic ankle instability, both in patients with this condition and also in non-pathological patients.

Cross-cultural adaptation and validation of the Chinese version of the ankle joint functional assessment tool (AJFAT) questionnaire

BACKGROUND

Ankle joint functional assessment tool (AJFAT) is gradually becoming a popular tool for diagnosing functional ankle instability (FAI). However, due to the lack of standard Chinese versions of AJFAT and reliability and validity tests, the use of AJFAT in the Chinese population is limited. This study aimed to translate and cross-culturally adapt the AJFAT from English into Chinese, and evaluate the reliability and validity of the Chinese version of AJFAT and to investigate its psychometric properties.

METHODS

The translation and cross-cultural adaptation of AJFAT was performed according to guidelines for cross-cultural adaptation of self-report measures. 126 participants with a history of ankle sprain completed the AJFAT-C twice within 14 days and completed the Cumberland ankle instability tool (CAIT-C) once. Test-retest reliability, internal consistency, ceiling and floor effects, convergent and structure validity and discriminative ability were investigated.

RESULTS

The test-retest reliability (ICC = 0.91, 95%CI = 0.87-0.94) and internal consistency (Cronbach's alpha = 0.87) of the AJFAT-C were excellent. No ceiling or floor effects were detected. A moderate correlation between the AJFAT-C and the CAIT-C suggested a moderate convergent validity. The AJFAT-C had a two-factor structure: 1. function of the unstable side of the ankle joint (9 items) and 2. symptoms of the unstable side of the ankle (2 items). The ideal cut-off point of the AJFAT-C was calculated as 26 points.

CONCLUSION

The Chinese version of AJFAT can be considered as a valid and reliable ankle joint function evaluation tool that can be applied in clinical and research work.

Validity and reliability of the French translation of the Identification of Functional Ankle Instability (IdFAI)

PURPOSE

To translate and validate the Identification of Functional Ankle Instability (IdFAI) into French.

METHODS

The IdFAI was translated according to international recommendations. Discriminative power, floor and ceiling effects, construct validity (including confirmatory factorial analysis (CFA)), internal consistency and test-retest reliability were measured. Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were also calculated.

RESULTS

160 participants were included. The IdFAI-F showed a very good test-retest reliability (ICC = 0.95). The SEM was 1.37 and the MDC was 3.79. The internal consistency was moderate (Cronbach's alpha coefficient = 0.68). The correlation between the IdFAI and the Cumberland Ankle Instability Tool (CAIT) was high (r = -0.75, p < 0.001). No floor, nor ceiling effects were observed. The CFA analyses did not confirm the factor structure proposed by the authors of the original English version.

CONCLUSIONS

The IdFAI-F is a valid and reliable tool to accurately identify and measure chronic ankle instability in research and clinical settings for French-speaking individuals.

Translation, cross-cultural adaptation, and psychometric properties of the Thai version of the Identification of Functional Ankle Instability (IdFAI-THAI) questionnaire

BACKGROUND

This study developed a Thai version of the Identification of Functional Ankle Instability (IdFAI-THAI) questionnaire.

METHODS

To determine construct validity, 200 participants with a history of lateral ankle sprain completed the IdFAI-THAI, the Modified Thai Lower Extremity Functional Scale (LEFS), the Visual Analog Scale of Instability (VAS-I), and the Thai Foot and Ankle Ability Measure (FAAM). Eight days later, 100 randomly selected participants refilled the IdFAI-THAI to assess test-retest reliability and internal consistency.

RESULTS

The IdFAI-THAI moderate correlated with the LEFS (r_s = -0.62), the VAS-I (r_s = 0.62), and the FAAM (r_s = -0.63 and -0.69 for the activities of daily living and sports subscales, respectively). The IdFAI-THAI had good test-retest reliability (ICC_2,1 = 0.89) and excellent internal consistency (Cronbach's alpha = 0.94). Ceiling and floor effects were absent.

CONCLUSION

The valid and reliable IdFAI-THAI can identify chronic ankle instability among Thai speakers in clinical and research settings.

Cross cultural adaptation, reliability and validity of the Greek version of Identification of Functional Ankle Instability (IdFAI) questionnaire

BACKGROUND

The objectives of our study were to develop the Greek version of the Identification of Functional Ankle Instability (IdFAI) questionnaire and to evaluate its psychometric properties.

METHODS

The IdFAI was translated and adapted into Greek according to the guidelines for cross-cultural adaptation of self report measures. It was tested for test-retest reliability, validity, internal consistency and floor-ceiling effects in 141 participants (54 males, 87 females; 23.5 ± 7.2 years). All participants were asked to fill the Greek IdFAI (IdFAI-GR), the Cumberland Ankle Instability Tool (CAIT), and the Lower Extremity Functional Scale (LEFS), in order to determine construct validity. To determine the test-retest reliability, fifty randomly selected individuals re-filled IdFAI seven days after the first session.

RESULTS

The IdFAI-GR had high internal consistency (Cronbach alpha = 0.94) and excellent test-retest reliability (ICC_2,1 = 0.97; SEM = 0.7). The IdFAI-GR had strong correlation with the CAIT (r = 0.7; p < 0.001) and moderate correlation with the LEFS (r = 0.5; p < 0.001). No ceiling or floor effects were observed.

CONCLUSION

The Greek IdFAI questionnaire has proven to be a valid and reliable instrument to identify functional ankle instability. It can therefore, be used for both clinical and research purposes in Greek-speaking individuals.

Responsiveness of the Brazilian IdFAI questionnaire in patients with chronic ankle instability

PURPOSE

This study aimed to determine the responsiveness of the Brazilian version of the Identification of Functional Ankle Instability (IdFAI) questionnaire in students who received an eight-week treatment for chronic ankle instability (CAI).

METHODS

Twenty-five college students (aged 23.12 ± 2.80 years) with CAI, as identified by the IdFAI questionnaire, were recruited. We used distribution and anchor-based methods to assess the responsiveness of the questionnaire, and its ability to determine clinical changes in participants. Eleven anchors were used: Visual Analog Scale for instability (VAS-i); Cumberland Ankle Instability Tool (CAIT); Isometric dorsiflexion, plantar flexion, inversion, and eversion muscle strength measured using a manual dynamometer; Dynamic balance as assessed through the Star Excursion Balance Test (SEBT-Y); Active ankle dorsiflexion range of motion as measured using the weight-bearing lunge test; and Functional performance assessment using three hop tests: single hop, triple crossover hop, and side hop. The distribution-based method used effect size (ES) and standardized response mean (SRM), whereas the anchor-based method used paired t-tests. Both methods allowed the calculation of the minimal important difference (MID).

RESULTS

The Brazilian IdFAI showed high responsiveness, with a large magnitude of change (ES = 1.34) and a high responsiveness index (SRM = 1.28) when assessed after a treatment for CAI. The IdFAI total score (p < .001) and all the 11 anchors [VAS-i (p < .001); CAIT (p < .001); Isometric dorsiflexion (p < .001), plantar flexion (p < .001), inversion (p < .001), and eversion (p < .001) muscle strength; SEBT-Y (p < .001); Lunge test (p = .002); Single hop (p < .001); triple crossover hop (p < .001); and side hop tests (p < .001)] showed significant differences. The anchor and distribution-based methods demonstrated MID values of 3.72 and 1.49-2.27, respectively.

CONCLUSION

The Brazilian IdFAI questionnaire is a patient-reported outcome measure sensitive to clinical changes in individuals with CAI. It can be used as an identification of patients with CAI, and as a parameter to verify clinical changes of clinical trials or therapeutic interventions in the population with CAI.

The fibula and talus position difference in functional and mechanical ankle instability: MRI findings

PURPOSE

This study aimed to use MRI to evaluate the fibula and talus position difference in functional and mechanical ankle stability patients.

METHODS

61 and 68 patients with functional and mechanical instability, and 60 healthy volunteers were involved. Based on the axial MRI images, the rotation of the talus was identified through the Malleolar Talus Index (MTI). The position relative to the talus (Axial Malleolar Index, AMI) and medial malleolus (Intermalleolar Index, IMI) were used to evaluated the displacement of the fibula.

RESULTS

Post hoc analysis showed that the values of malleolar talus index was significantly larger among mechanical instability (89.18° ± 2.31°) than that in functional instability patients (86.55° ±61.65°, P < 0.001) and healthy volunteers (85.59° ± 2.42°, P < 0.001). The axial malleolar index of the mechanical instability patients (11.39° ± 1.41°) were significantly larger than healthy volunteers (7.91° ± 0.83°) (P < 0.0001). There were no statistically significant differences in the above three indexes between the functional instability patients and healthy volunteers.

CONCLUSION

The functional instability patients didn't have a posteriorly positioned fibula and an internally rotated talus. The malleolar talus index was significantly larger among mechanical instability patients than that in functional instability patients. Increased malleolar talus index may become a new indirect MRI sign for identifying functional and mechanical instability patients.

Validity and Reliability of the Malay Version of the Identification of Functional Ankle Instability (IdFAI-M) Questionnaire among Malaysian University Athletes

Introduction:

This study was designed to produce a validated and reliable Malay version of the Identification of Functional Ankle Instability (IdFAI-M) questionnaire.

Materials and method:

The cross-cultural adaptation was conducted based on standard guidelines to produce the Malay version of the Identification of Functional Ankle Instability (IdFAI-M) questionnaire. The reliability and validity testing were then performed among one hundred and twenty-three physically active University of Malaya students. Among them, twenty-two students also participated in the second return of the questionnaire over a two-week interval, which was then evaluated for test-retest reliability testing.

Results:

The content validity for item-level (I-CVI) and Kappa values for all items were more than 0.7, respectively and the all scales-level (S-CVI) values were 0.983 (consistency), 0.967 (representativeness), 1.00 (relevance) and 0.983 (clarity). The questionnaire also demonstrated excellent reliability with an intraclass correlation coefficient (ICC2.1) above 0.850 for all items. It was observed that outer loading of most items were more than the minimum acceptable value (0.7). Fornell-Larcker criterion demonstrate all values for each reflective construct was larger than the correlations with other constructs, indicating discriminant. The cross-loading values of each item has shown a weak correlation with all other constructs, except for the one to which it was theoretically associated.

Conclusions:

The Malay version of the IdFAI (IdFAI-M) is a reliable and valid instrument that can be readily utilised to subjectively assess ankle instability.

Adaptation and transcultural translation into Spanish of the Identification of Functional Ankle Instability questionnaire

BACKGROUND

Functional ankle instability can hinder the ability to work and perform leisure tasks. Some questionnaires have been used to identify subjects with ankle instability. The English version of the identification functional ankle instability (IdFAI) questionnaire has been broadly used, but there is not a cross-cultural adaptation into Spanish.

OBJECTIVE

The purpose of this study was to cross-culturally adapt the Identification of Functional Ankle Instability questionnaire to a Spanish speaking population from Spain.

DESIGN

Cross-sectional study.

METHODS

One hundred and four patients with history of lateral ankle sprain completed the Spanish version of this questionnaire and the Spanish version of the Cumberland Ankle Instability Tool. The psychometric properties were measured for structural validity, internal consistency, convergent validity, test-retest reliability, standard error of each measurement, ceiling effect and floor effect.

RESULTS

The Spanish version of the Identification of Functional Ankle Instability questionnaire had a strong correlation with the Cumberland Ankle Instability Tool (rho = -0.717) with excellent reliability (ICC = 0.9) and internal consistency (Cronbach's α = 0.9). No ceiling or floor effects were detected.

CONCLUSION

The results of the present study show that the Spanish version of the Identification of Functional Ankle Instability questionnaire is a valid and reliable measurement tool that can be use in a Spanish population from Spain with functional ankle instability for clinical and research purposes.

Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021

This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.

Validity and reliability of the Arabic version of the Identification of Functional Ankle Instability questionnaire (IdFAI-Ar) in college-aged population

OBJECTIVES

The aims of this work are to culturally adapt the Identification of Functional Ankle Instability questionnaire (IdFAI) into Arabic language and to examine its psychometrics.

DESIGN

Cross-sectional study.

SETTING

This research took place at Cairo University in Egypt.

PARTICIPANTS

Twenty eight college-aged students participated in the translation and cultural adaptation, while another 86 college-aged students participated in the measurements (validity and reliability).

MAIN OUTCOME MEASURES

The original IdFAI was translated into Arabic language using standard guidelines. The Arabic version of the IdFAI (IdFAI-Ar) and the Arabic version of the Lower Extremity Functional Scale (LEFS-Ar) were applied to 86 college-aged students with and without functional ankle instability. The IdFAI-Ar was tested on two occasions with an interval of one week to investigate its psychometrics.

RESULTS

The IdFAI-Ar had a moderate correlation with LEFS-Ar and a strong correlation with ankle status classification. The reliability and internal consistency were excellent. The accuracy, sensitivity, and specificity were 0.91, 0.80, and 0.99 respectively.

CONCLUSION

The IdFAI-Ar has high validity and reliability. It can be used in clinical and research practices as a region-specific tool to discriminate between participants with and without functional ankle instability in the Arabic-speaking countries.

Transcultural adaptation and validation of the Spanish version of the Identification of Functional Ankle Instability questionnaire (IdFAI-Sp)

OBJECTIVE

The study aim was to cross-culturally adapt the Identification of Functional Ankle Instability (IdFAI) into a Spanish-language version (IdFAI-Sp), which would then be validated and its psychometric properties evaluated for use in possible cases of ankle instability.

METHODS

The cross-cultural adaptation was performed following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research. Pearson correlations were calculated to assess the convergent validity between IdFAI and the Cumberland Ankle Instability Tool. Cronbach's alpha and test re-test reliability values were calculated and floor/ceiling effects analysed. Construct validity was assessed by confirmatory factor analysis (CFA).

RESULTS

The study population was composed of 110 participants, with a mean age of 40.49 years (10.43) and of whom 62 (56.36%) were female. Good test-retest results were obtained, with an intraclass correlation coefficient of 0.85 (ICC₂,₁: 95% CI: 0.82 - 0.88). The structure matrix was examined by CFA, which revealed a three-factor solution that accounted for 79.89% of the variance. The IdFAI-Sp obtained an excellent fit (RMSEA 0.068, GFI 0.94, CFI 0.98 and NFI 0.97).

CONCLUSIONS

This study validates the IdFAI-Sp questionnaire, corroborating its value to researchers and medical professionals as a self-reported outcomes measure for use with a Spanish-speaking population.IMPLICATIONS FOR REHABILITATIONThe Spanish-language version of the Identification of Functional Ankle Instability questionnaire (IdFAI-Sp) is a valid and reliable tool.The IdFAI-Sp enables researchers and healthcare professionals to identify and classify chronic ankle instability among Spanish-speaking patients.Accordingly, it can be considered a useful clinical instrument.Aapplication of the questionnaire before and after treatment can reveal the patient's degree of recovery over time.