The reliability, and discriminative ability of the identification of functional ankle instability questionnaire, Japanese version

Factors associated with persistent pain in college athletes with a history of lateral ankle sprain

OBJECTIVES

To determine the factors associated with and prevalence of persistent pain in college athletes with chronic ankle instability (CAI) and with previous lateral ankle sprain (LAS) without CAI.

DESIGN

Cross-Sectional Study.

SETTING

Online survey at one university.

PARTICIPANTS

Of the 385 respondents surveyed online, 140 were identified as having experienced at least one LAS (CAI group: 69, coper group: 24, LAS group not classified as either: 47).

MAIN OUTCOME MEASURES

Factors associated with the presence of pain during activities of daily living (ADL) and sports were identified using multivariate logistic regression analyses. Independent variables were demographics, injury characteristics, the Identification of Functional Ankle Instability (IdFAI) score, the Foot and Ankle Ability Measure Sports (FAAM-Sports) and ADL subscales, and the Tampa Scale for Kinesiophobia-11 score.

RESULTS

The prevalence of pain during ADL and sports in the three groups was 16.7%-42.0% and 33.3%-56.5%, respectively. FAAM-Sports and IdFAI score were significantly associated with pain during ADL and sports in the CAI group (odd ratio: 0.923 and 1.145), respectively. No significant pain-related factors were found in the coper and LAS groups.

CONCLUSIONS

Lower self-reported function and greater perceived ankle instability may be important factors in pain management in athletes with CAI.

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.

Less impact absorption at the ankle joint is related to the single-leg landing stability deficit in patients with chronic ankle instability

Single-leg landing (SLL) stability deficits are common dysfunctions after lateral ankle sprain (LAS), and are associated with reinjury and needs to be addressed. SLL stability deficits could be associated with impact absorption ability. Thus, we evaluated these relationships. We recruited 46 patients with chronic ankle instability (CAI) and 64 control patients and measured their kinematics, SLL stability, and impact absorption ability. The SLL stability was evaluated by calculating the anterior-posterior stability index (APSI) and medial-lateral stability index (MLSI). The impact absorption ability was evaluated by calculating the energy absorption (EA). The large negative value of the EA indicated the absorption of a large amount of energy. The Japanese version of identification of functional ankle instability (IdFAI-J) score (P < 0.001), MLSI value (P = 0.004), and sagittal plane ankle EA value (less EA at ankle joint) (P < 0.001) were significantly high in CAI, and sagittal plane knee EA value (more EA at knee joint) (P < 0.041) was significantly low in CAI than in the control group. Multiple regression analysis showed that the APSI was associated with sagittal plane ankle EA (β = 0.275, P = 0.004). The MLSI was associated with sagittal plane ankle EA (β = 0.204, P = 0.034) and the idFAI score (β = 0.234, P = 0.015). The SLL stability impairment after LAS was related to decreased impact absorption ability at the ankle joint.

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.

Validity and Reliability of the Sport Readiness Questionnaire Focused on Musculoskeletal Injuries

Background: The pre-participation physical evaluation (PPE), which includes a musculoskeletal system evaluation, identifies factors that may be a risk for athletes while practicing sport. Thus, the Sport Readiness Questionnaire, focused on musculoskeletal injuries (MIR-Q) was developed to screen athletes at risk of future injuries or worsening pre-existing injuries during training or competition. However, the criterion-related validity and reliability of the MIR-Q have not yet been analyzed. Objectives: To test the criterion-related validity and reliability (internal consistency and test-retest) of the MIR-Q. Methods: One hundred and twenty adult athletes from different sports (17 women) completed the MIR-Q and underwent a physical orthopedic examination (POE) performed by an orthopedic physician. At least one affirmative answer on the MIR-Q, as well as one positive finding on the POE, was considered “a risk factor for sport injury”. The validity was assessed from sensitivity, specificity, and accuracy measurements. Internal consistency was obtained through the KR-20 test. Reliability was measured using the test-retest method in a 7-14-day interval with a sub-sample (n = 41) and verified by the Kappa index. Results: Eighty-one (67.5%) questionnaires contained positive responses. The sensitivity of the MIR-Q against POE was high (84.4%), while specificity and accuracy were considered moderate, with values of 42.7% and 58.0%, respectively. Internal consistency was moderate (KR-20 = 0.57), and test-retest was reduced (K = 0.30; P = 0.02). Conclusions: The MIR-Q was associated with high values of validity and low values of reliability. The questionnaire may be an alternative tool for musculoskeletal screening during PPE in limited medical settings (sports OR orthopedic physician) conditions. Future studies should investigate the predictive validity of the MIR-Q, and psychometric properties of the questionnaire with younger athletes.

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.

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.

Greater knee varus angle and pelvic internal rotation after landing are predictive factors of a non-contact lateral ankle sprain

OBJECTIVES

This study aimed to clarify the kinematic, kinetic characteristics associated with lateral ankle sprain.

DESIGN

A 16-month prospective cohort study.

SETTING

Laboratory.

PARTICIPANTS

A total of 179 college athletes.

MAIN OUTCOME MEASURES

Joint kinematics, moment during single-leg landing tasks, and ankle laxity were measured. The attendance of each participating team, injury mechanism, existence of body contact, presence of orthosis, with or without medical diagnosis, and periods of absence were recorded.

RESULTS

Twenty-nine participants incurred lateral ankle sprain during non-contact motion. The Cox regression analysis revealed that greater knee varus peak angle (hazard ratio: 1.16 [95% confidence interval: 1.10-1.22], p < 0.001) and greater pelvic internal rotation peak angle toward the support leg were associated with lateral ankle sprain (hazard ratio: 1.08 [95% confidence interval: 1.02-1.15], p = 0.009). The cut-off values for each predictive factor were -0.17° (area under the curve = 0.89, p < 0.001) and 6.63° (area under the curve = 0.74, p < 0.001), respectively.

CONCLUSIONS

A greater knee varus peak angle and pelvic internal rotation peak angle after single-leg landing are predictive factors for lateral ankle sprain.

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.

Adaptation and psychometric evaluation of the simplified Chinese version of the identification of functional ankle instability questionnaire in Chinese-speaking patients with chronic ankle instability disorders

BACKGROUND

The aims of this study were to adapt the Identification of Functional Ankle Instability (IdFAI) questionnaire into a simplified Chinese version and to assess its reliability, validity, and responsiveness in Chinese-speaking patients with chronic ankle instability (CAI) disorders.

METHODS

The simplified Chinese version of the IdFAI (SC-IdFAI) questionnaire was developed with a five-step procedure involving cross-cultural translation and adaptation. Three questionnaires, including the SC-IdFAI, Medical Outcomes Study Short-Form 36 (SF-36), and Foot and Ankle Ability Measure (FAAM), were administered to the recruited patients. Then, the Cronbach's alpha value, intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), Spearman's correlation coefficient (r_s), effect size (ES), and standardized response mean (SRM) were calculated to evaluate the reliability, validity, and responsiveness of the SC-IdFAI questionnaire.

RESULTS

A total of 131, 119, and 86 patients with CAI successfully completed the first, second, and third rounds of the questionnaires, respectively. Good or excellent internal consistency and test-retest reliability were found for the overall scale and subscales of the SC-IdFAI questionnaire. The values for the SEM (1.346) and MDC (3.73) were low, indicating that small clinical changes can be detected by the SC-IdFAI questionnaire. The correlations of the SC-IdFAI with FAAM and SF-36 were generally in agreement with the a priori hypotheses (85%, 34/40), suggesting the SC-IdFAI questionnaire has good construct validity. Moreover, the results suggest that the SC-IdFAI (ES = 1.123 and SRM = 1.554) has an acceptable level of responsiveness.

CONCLUSION

The SC-IdFAI scale may be an effective tool, and it is responsive, reliable and valid for the assessment of Chinese patients suffering from CAI.