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Liu S, Tang J, Hu G, Xiong Y, Ji W, Xu D. Blood flow restriction training improves the efficacy of routine intervention in patients with chronic ankle instability. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:159-166. [PMID: 38708328 PMCID: PMC11067764 DOI: 10.1016/j.smhs.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/18/2023] [Accepted: 11/07/2023] [Indexed: 05/07/2024] Open
Abstract
As a new means of rehabilitation, blood flow restriction training (BFRT) is widely used in the field of musculoskeletal rehabilitation. To observe whether BFRT can improve the efficacy of routine rehabilitation intervention in patients with chronic ankle instability (CAI). Twenty-three patients with CAI were randomly divided into a routine rehabilitation group (RR Group) and a routine rehabilitation + blood flow restriction training group (RR + BFRT Group) according to the Cumberland Ankle Instability Tool (CAIT) score. The RR Group was treated with routine rehabilitation means for intervention, and the RR + BFRT Group was treated with a tourniquet to restrict lower limb blood flow for rehabilitation training based on routine training. Before and after the intervention, the CAIT score on the affected side, standing time on one leg with eyes closed, comprehensive scores of the Y-balance test, and surface electromyography data of tibialis anterior (TA) and peroneus longus (PL) were collected to evaluate the recovery of the subjects. Patients were followed up 1 year after the intervention. After 4 weeks of intervention, the RR + BFRT Group CAIT score was significantly higher than the RR Group (19.33 VS 16.73, p < 0.05), the time of standing on one leg with eyes closed and the comprehensive score of Y-balance were improved, but there was no statistical difference between groups (p > 0.05). RR + BFRT Group increased the muscle activation of the TA with maximum exertion of the ankle dorsal extensor (p < 0.05) and had no significant change in the muscle activation of the PL with maximum exertion of the ankle valgus (p > 0.05). There was no significant difference in the incidence of resprains within 1 year between the groups (36.36% VS 16.67%, p > 0.05). The incidence of ankle pain in the RR + BFRT Group was lower than that in the RR Group (63.64% VS 9.09%, p < 0.01). Therefore, four-weeks BFRT improves the effect of the routine intervention, and BFRT-related interventions are recommended for CAI patients with severe ankle muscle mass impairment or severe pain.
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Affiliation(s)
- Shen Liu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jiafu Tang
- Sports Health College, Tianjin University of Sport, Tianjin, China
| | - Guangjun Hu
- Sports Health College, Tianjin University of Sport, Tianjin, China
| | - Yinghong Xiong
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Weixiu Ji
- Sports Health College, Tianjin University of Sport, Tianjin, China
| | - Daqi Xu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Contri A, Ballardin F, De Marco G, Gaucci M, Scariato A, Zanoni V, Vanti C, Pillastrini P. Italian version of the Cumberland Ankle Instability Tool (CAIT-I). Foot (Edinb) 2023; 56:102043. [PMID: 37295293 DOI: 10.1016/j.foot.2023.102043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/07/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
STUDY DESIGN Evaluation of the psychometric properties of a translated, culturally adapted questionnaire. OBJECTIVE Translating, culturally adapting, and validating the Italian version of the Cumberland Ankle Instability Tool (CAIT-I). SUMMARY OF BACKGROUND DATA Ankle sprains are one of the most common musculoskeletal injuries and can lead to chronic ankle instability (CAI). The International Ankle Consortium recommends the Cumberland Ankle Instability Tool (CAIT) as a valid and reliable self-report questionnaire assessing the presence and severity of CAI. At this moment, there is no validated Italian version of CAIT. METHODS The Italian version of the CAIT (CAIT-I) was developed by an expert committee. Test-retest reliability of the CAIT-I was measured in 286 healthy and injured participants within a 4-9-day period, by using Intraclass Correlation Coefficients (ICC2,1). Construct validity, exploratory factor analysis, internal consistency and sensitivity were examined in a sample of 548 adults. Instrument responsiveness over 4 time points was determined in a subgroup of 37 participants. RESULTS The CAIT-I demonstrated excellent test-retest reliability (ICC≥0.92) and good internal consistency (α = .84). Construct validity was confirmed. Identified cut-off for the presence of CAI was 24.75, with sensitivity= 0.77 and specificity= 0.65. There were significant differences across time for CAIT-I scores (P < .001), demonstrating responsiveness to change, but no floor or ceiling effects. CONCLUSION The CAIT-I demonstrates acceptable psychometric performance as a screening and outcome measure. The CAIT-I is a useful tool to assess the presence and severity of CAI.
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Affiliation(s)
- Angela Contri
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio, Via del Pozzo n.74, 41100 Modena, Italy
| | - Francesco Ballardin
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna BO Bologna, Italy
| | - Gianluca De Marco
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna BO Bologna, Italy
| | - Matteo Gaucci
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna BO Bologna, Italy.
| | - Angela Scariato
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna BO Bologna, Italy
| | | | - Carla Vanti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna BO Bologna, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna BO Bologna, Italy; Unità Operativa di Medicina del Lavoro - IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Via Pelagio Palagi 9, 40123 Bologna BO Bologna, Italy
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Tan J, Li J, Lei J, Lu S, Feng Y, Ma T, Luan L, Adams R, Song Y, Han J, Zou Y. Effects of whole-body vibration on sensorimotor deficits and brain plasticity among people with chronic ankle instability: a study protocol for a single-blind randomized controlled trial. BMC Sports Sci Med Rehabil 2023; 15:88. [PMID: 37464427 DOI: 10.1186/s13102-023-00698-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Chronic ankle instability (CAI) is a form of musculoskeletal disease that can occur after a lateral ankle sprain, and it is characterized by pain, recurrent ankle sprains, a feeling of "giving way" at the ankle joint, and sensorimotor deficits. There has been increasing evidence to suggest that plastic changes in the brain after the initial injury play an important role in CAI. As one modality to treat CAI, whole-body vibration (WBV) has been found to be beneficial for treating the sensorimotor deficits accompanying CAI, but whether these benefits are associated with brain plasticity remains unknown. Therefore, the current study aims to investigate the effect of WBV on sensorimotor deficits and determine its correlation with plastic changes in the brain. METHODS The present study is a single-blind randomized controlled trial. A total of 80 participants with CAI recruited from the university and local communities will be divided into 4 groups: whole-body vibration and balance training (WBVBT), balance training (BT), whole-body vibration (WBV), and control group. Participants will be given the WBV intervention (25-38 Hz, 1.3-2 mm, 3-time per week, 6-week) supervised by a professional therapist. Primary outcome measures are sensorimotor function including strength, balance, proprioception and functional performance. Brain plasticity will be evaluated by corticomotor excitability, inhibition, and representation of muscles, as measured by transcranial magnetic stimulation. Activation of brain areas will be assessed through functional near-infrared spectroscopy. Secondary outcome measures are self-reported functional outcomes involving the Cumberland Ankle Instability Tool and the Foot and Ankle Ability Measure. All tests will be conducted before and after the WBV intervention, and at 2-week follow-up. Per‑protocol and intention-to-treat analysis will be applied if any participants withdraw. DISCUSSION This is the first trial to investigate the role of brain plasticity in sensorimotor changes brought by WBV for individuals with CAI. As plastic changes in the brain have been an increasingly important aspect in CAI, the results of the current study can provide insight into the treatment of CAI from the perspective of brain plasticity. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2300068972); registered on 02 March 2023.
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Affiliation(s)
- Jingwang Tan
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China
| | - Jiatao Li
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China
| | - Jianbin Lei
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China
| | - Shuyi Lu
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China
| | - Yongjian Feng
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China
| | - Tao Ma
- School of Elite Sport, Shanghai University of Sport, Shanghai, China
| | - Lijiang Luan
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Yagang Song
- Department of Physical Education Teaching, Shanghai Sanda University, Shanghai, China
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, 279 Zhouzhu Highway, Shanghai, 201318, China.
- Faculty of Health, Arts and Design, Swinburne University of Technology, VIC, Hawthorn, Australia.
| | - Yu Zou
- Department of Sport and Exercise Science, College of Education, Zhejiang University, 886 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China.
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Shao X, Kang M, Luan L, Deng F, Adams R, Wu T, Han J. Reliability and validity of the ankle inversion discrimination apparatus during walking in individuals with chronic ankle instability. Front Physiol 2023; 14:1036194. [PMID: 36744024 PMCID: PMC9893012 DOI: 10.3389/fphys.2023.1036194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
Purpose: 1) to explore the test-retest reliability of a new device for measuring ankle inversion proprioception during walking, i.e., the Ankle Inversion Discrimination Apparatus-Walking (AIDAW) in individuals with or without Chronic Ankle instability (CAI); 2) to assess its discriminant validity in differentiating individuals with or without CAI; 3) to investigate its convergent validity by examining its association with Cumberland Ankle Instability Tool (CAIT) and the Y Balance Test (YBT). Methods: For test-retest reliability, 15 participants with CAI and 15 non-CAI healthy controls were recruited. Participants completed the AIDAW test twice with a 7-day interval. The area under the receiver operating curve (AUC) was obtained as the AIDAW score. The intraclass correlation coefficient (ICC) and MDC90 were calculated. For the validity study, another 20 individuals with CAI and 20 non-CAI healthy controls were involved. The AIDAW scores were analyzed by an independent samples t-test, and the optimal cutoff value of AIDAW scores to best distinguish individuals with CAI was calculated by Youden's index. Spearman or Pearson correlation analysis was used to analyze the correlation between AIDAW proprioceptive scores and the CAIT and final YBT scores. Results: For test-retest reliability, the ICC values for the CAI, non-CAI, and the whole group were 0.755, 0.757, and 0.761 respectively. The MDC90 of the CAI and non-CAI group was 0.04 and 0.05. Regarding discriminant validity, the AIDAW proprioceptive discrimination scores in the CAI group were significantly lower than those in the non-CAI group (p = 0.003); and the cutoff score for distinguishing CAI from the non-CAI participants was 0.759. For convergent validity, the AIDAW scores were significantly correlated with the functional balance YBT final scores (p = 0.001) and the CAIT scores (p = 0.009). Conclusion: The AIDAW is a reliable and valid device for evaluating ankle inversion proprioception during walking in individuals with and without CAI. AIDAW can be used as a clinical assessment tool to discriminate CAI from non-CAI individuals and to monitor effects of rehabilitation. The AIDAW proprioceptive discrimination scores were significantly and positively correlated with YBT and CAIT scores.
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Affiliation(s)
- Xuerong Shao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China,Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ming Kang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Lijiang Luan
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Fawei Deng
- Department of Rehabilitation, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Roger Adams
- Research Institute for Sports and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Tao Wu
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China,*Correspondence: Tao Wu, ; Jia Han,
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China,Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia,*Correspondence: Tao Wu, ; Jia Han,
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Zhang C, Chen N, Wang J, Zhang Z, Jiang C, Chen Z, Fang J, Peng J, Li W, Song B. The Prevalence and Characteristics of Chronic Ankle Instability in Elite Athletes of Different Sports: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11247478. [PMID: 36556094 PMCID: PMC9783869 DOI: 10.3390/jcm11247478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/05/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Ankle sprains are one of the most common injuries in athletic populations. Misdiagnosed and untreated ankle sprains will cause chronic ankle instability (CAI), which can significantly affect the performance of athletes. This study aimed to investigate the prevalence and characteristics of CAI in elite athletes of different sports. METHOD This cross-sectional study included 198 elite athletes from Guangdong provincial sports teams. All participants answered a questionnaire about ankle sprains and ankle instability. The severity of their ankle instability was evaluated by the Cumberland Ankle Instability Tool (CAIT). Participants further underwent clinical examinations from sports medicine doctors to determine the presence and characteristics of ankle instability. The datasets were analyzed to determine the differences in prevalence between age, gender, sports teams, and sports categories. RESULTS In 198 athletes, 39.4% (n = 78) had bilateral CAI while 25.3% (n = 50) had unilateral CAI. Female athletes had a higher prevalence of CAI than male athletes in the study (p = 0.01). Prevalence showed differences between sports categories, and were significantly higher in acrobatic athletes than non-contact athletes (p = 0.03). CONCLUSIONS CAI was highly prevalent among elite athletes in this study, with female athletes and athletes in acrobatic sports being associated with a higher risk of developing CAI in their professional careers. Therefore, extra precautions need to be taken into account when applying ankle protections for these athletes.
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Affiliation(s)
- Congda Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Guangzhou 510130, China
| | - Na Chen
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Guangzhou 510130, China
| | - Jingsong Wang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Guangzhou 510130, China
| | - Zhengzheng Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Guangzhou 510130, China
| | - Chuan Jiang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Guangzhou 510130, China
| | - Zhong Chen
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Guangzhou 510130, China
| | - Jianhui Fang
- Department of Rehabilitation, Guangdong Sport Hospital, Guangzhou 510105, China
| | - Juhua Peng
- Department of Rehabilitation, Guangdong Sport Hospital, Guangzhou 510105, China
- Correspondence: (J.P.); (B.S.)
| | - Weiping Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Guangzhou 510130, China
| | - Bin Song
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Guangzhou 510130, China
- Correspondence: (J.P.); (B.S.)
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Yin Y, Yu Z, Wang J, Sun J. Effectiveness of the Rehabilitation Training Combined with Maitland Mobilization for the Treatment of Chronic Ankle Instability: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15328. [PMID: 36430049 PMCID: PMC9690276 DOI: 10.3390/ijerph192215328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
The study aims to determine whether routine rehabilitation training combined with the Maitland mobilization is more effective than routine rehabilitation training alone in patients with chronic ankle instability, intending to provide a novel rehabilitation strategy for chronic ankle instability. A total of 48 subjects were divided into three groups: EG (Maitland mobilization and routine rehabilitation), CG (routine rehabilitation), and SG (sham mobilization and routine rehabilitation). The intervention was performed three times each week for 4 weeks, for a total of 12 sessions. Before and after the intervention, the muscle strength, star excursion balance test (SEBT), weight-bearing dorsiflexion range of motion (WB-DFROM), ankle range of movement, Cumberland ankle instability tool (CAIT), self-comfort visual analog scale (SCS-VAS), and self-induced stability scale (SISS-VAS) were assessed. The results showed that the improvement of SEBT, WB-DFROM, and active ankle range of movement without the pain in EG was more obvious than CG and SG, but the improvement of the self-report of ankle severity and muscle strength was not. Compared with routine rehabilitation training alone, routine rehabilitation training combined with Maitland mobilization for patients with chronic ankle instability may provide more benefit in terms of balance and ankle range of movement than routine rehabilitation alone, but the improvement in muscle strength was not evident enough.
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Affiliation(s)
- Yikun Yin
- College of Physical and Health Education, Guangxi Normal University, Guilin 541006, China
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, China
| | - Zhengze Yu
- College of Physical and Health Education, Guangxi Normal University, Guilin 541006, China
| | - Jialin Wang
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, China
| | - Junzhi Sun
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu 610041, China
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Wang W, Liao D, Kang X, Zheng W, Xu W, Chen S, Xie Q. Development of a valid Chinese version of the Cumberland Ankle Instability Tool in Chinese-speaking patients with chronic ankle instability disorders. Sci Rep 2021; 11:9747. [PMID: 33963201 PMCID: PMC8105356 DOI: 10.1038/s41598-021-87848-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/05/2021] [Indexed: 11/29/2022] Open
Abstract
As an effective scale for the condition assessment of patients with chronic ankle instability (CAI), the Cumberland Ankle Instability Tool (CAIT) is the most widely used scale, and its original version is written in English. Therefore, the purpose of our study is to apply the CAIT to Chinese patients and evaluate its responsiveness, reliability, and validity in terms of Chinese patients with CAI. First, we adapted the CAIT into the Chinese edition (CAIT-C), through which cross-cultural adaptation and translation can be carried out in a five-step procedure. Next, recruited patients completed the three periods of the Foot and Ankle Ability Measure (FAAM), CAIT-C, and the Medical Outcomes Study Short-Form 36 (SF-36) scales. Afterward, to assess the responsiveness, reliability, and validity, we calculated the standardized response mean (SRM), effect size (ES), Spearman's correlation coefficient (rs), minimal detectable change (MDC), standard error of measurement (SEM), intraclass correlation coefficient (ICC), and Cronbach’s alpha. Generally, in the use of CAI, 131, 119, and 86 patients favorably completed the three periods of the scales. The CAIT-C was proven to have good test–retest reliability (ICC = 0.930) and fine internal consistency (Cronbach’s alpha = 0.845–0.878). The low-value of MDC (0.04–2.28) and SEM (1.73) show it is possible to detect clinical changes when we take advantage of CAIT-C. Good or moderate correlations (rs = 0.422–0.738) were gained from the physical subscales of the SF-36 and the subscales of the FAAM and the CAIT-C. Fair or poor correlations (rs = 0.003–0.360) were gained between the mental subscales of the SF-36 and the CAIT-C, which sufficiently indicated that the CAIT-C had good validity. Moreover, good responsiveness was observed in the CAIT-C (ES = 1.316, SRM = 1.418). The CAIT-C scale is an effective, valid, and reliable tool to evaluate Chinese CAI patients.
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Affiliation(s)
- Wei Wang
- Department of Orthopedics, The General Hospital of Western Theater Command, Tianhui Road 270, Chengdu City, 610000, People's Republic of China.
| | - Dongfa Liao
- Department of Orthopedics, The General Hospital of Western Theater Command, Tianhui Road 270, Chengdu City, 610000, People's Republic of China
| | - Xia Kang
- Department of Orthopedics, The General Hospital of Western Theater Command, Tianhui Road 270, Chengdu City, 610000, People's Republic of China
| | - Wei Zheng
- Department of Orthopedics, The General Hospital of Western Theater Command, Tianhui Road 270, Chengdu City, 610000, People's Republic of China.
| | - Wei Xu
- Department of Orthopedics, The General Hospital of Western Theater Command, Tianhui Road 270, Chengdu City, 610000, People's Republic of China
| | - Song Chen
- Department of Orthopedics, The General Hospital of Western Theater Command, Tianhui Road 270, Chengdu City, 610000, People's Republic of China
| | - Qingyun Xie
- Department of Orthopedics, The General Hospital of Western Theater Command, Tianhui Road 270, Chengdu City, 610000, People's Republic of China.
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