Abstract
BackgroundThe assessment of outcomes from the patient's perspective becomes more recognized in health care. Also in patients with chronic ankle instability, the degree of present impairments, disabilities and participation problems should be documented from the perspective of the patient. The decision about which patient-assessed instrument is most appropriate for clinical practice should be based upon systematic reviews. Only rating scales constructed for patients with acute ligament injuries were systematically reviewed in the past. The aim of this study was to review systematically the clinimetric qualities of patient-assessed instruments designed for patients with chronic ankle instability.MethodsA computerized literature search of Medline, Embase, Cinahl, Web of Science, Sport Discus and the Cochrane Controlled Trial Register was performed to identify eligible instruments. Two reviewers independently evaluated the clinimetric qualities of the selected instruments using a criteria list. The inter-observer reliability of both the selection procedure and the clinimetric evaluation was calculated using modified kappa coefficients.ResultsThe inter-observer reliability of the selection procedure was excellent (k = .86). Four instruments met the eligibility criteria: the Ankle Joint Functional Assessment Tool (AJFAT), the Functional Ankle Outcome Score (FAOS), the Foot and Ankle Disability Index (FADI) and the Functional Ankle Ability Measure (FAAM). The inter-observer reliability of the quality assessment was substantial to excellent (k between .64 and .88). Test-retest reliability was demonstrated for the FAOS, the FADI and the FAAM but not for the AJFAT. The FAOS and the FAAM met the criteria for content validity and construct validity. For none of the studied instruments, the internal consistency was sufficiently demonstrated. The presence of floor- and ceiling effects was assessed for the FAOS but ceiling effects were present for all subscales. Responsiveness was demonstrated for the AJFAT, FADI and the FAAM. Only for the FAAM, a minimal clinical important difference (MCID) was presented.ConclusionThe FADI and the FAAM can be considered as the most appropriate, patient-assessed tools to quantify functional disabilities in patients with chronic ankle instability. The clinimetric qualities of the FAAM need to be further demonstrated in a specific population of patients with chronic ankle instability.
Highlights
The assessment of outcomes from the patient's perspective becomes more recognized in health care
The development of chronic ankle instability has been ascribed to different causes like a delayed muscle reflex of stabilizing lower leg muscles, deficits in lower leg muscle strength, deficits in kinaesthesia, or an impaired postural control [5,6,7,8]
When evaluating treatments for chronic ankle instability one mainly focusses on the use of clinician-related outcome measures like radiographs [9,10], postural sway [11,12], muscle reaction time [13] or muscle strength [14,15,16]
Summary
The assessment of outcomes from the patient's perspective becomes more recognized in health care. The decision about which patient-assessed instrument is most appropriate for clinical practice should be based upon systematic reviews. The aim of this study was to review systematically the clinimetric qualities of patient-assessed instruments designed for patients with chronic ankle instability. Nineteen to 72% of individuals who sustain a lateral ankle sprain have been reported to have residual symptoms and/or develop chronic ankle instability [2,3,4]. When evaluating treatments for chronic ankle instability one mainly focusses on the use of clinician-related outcome measures like radiographs [9,10], postural sway [11,12], muscle reaction time [13] or muscle strength [14,15,16]
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