The Cumberland Ankle Instability Tool: A Report of Validity and Reliability Testing

Abstract

Hiller CE, Refshauge KM, Bundy AC, Herbert RD, Kilbreath SL. The Cumberland Ankle Instability Tool: a report of validity and reliability testing. Objective To test the Cumberland Ankle Instability Tool (CAIT), a 9-item 30-point scale, for measuring severity of functional ankle instability. Design Cross-sectional study. Setting General community. Participants Volunteer sample of 236 subjects. Interventions Not applicable. Main Outcome Measures Concurrent validity by comparison with the Lower Extremity Functional Scale (LEFS) and a visual analog scale (VAS) of global perception of ankle instability by using the Spearman ρ. Construct validity and internal reliability with Rasch analysis using goodness-of-fit statistics for items and subjects, separation of subjects, correlation of items to the total scale, and a Cronbach α equivalent. Discrimination score for functional ankle instability by maximizing the Youden index and tested for sensitivity and specificity. Test-retest reliability by intraclass correlation coefficient, model 2,1 (ICC 2,1). Results There were significant correlations between the CAIT and LEFS (ρ=.50, P<.01) and VAS (ρ=.76, P<.01). Construct validity and internal reliability were acceptable (α=.83; point measure correlation for all items, >0.5; item reliability index, .99). The threshold CAIT score was 27.5 (Youden index, 68.1); sensitivity was 82.9% and specificity was 74.7%. Test-retest reliability was excellent (ICC 2,1=.96). Conclusions CAIT is a simple, valid, and reliable tool to measure severity of functional ankle instability.