Cumberland Ankle Instability Tool Score Research Articles

Screening for laterally deviated plantar pressure during stance using the Cumberland ankle instability tool and anthropometric measures

ABSTRACT This study developed a method that predicts laterally deviated plantar pressure during stance by lower limb anthropometrics and self-reported ability to stop an ankle which has started to roll over. Thirty-two males ran on a treadmill for 2 minutes at 11 km/h. Foot pressure data were collected by a pressure insole system for classifying the participants as medial or lateral strikers. Cumberland Ankle Instability Tool score, Tegner Activity Scale score, foot arch height, active and passive ankle and knee range of motion, bi-malleolar width, foot length, foot width and calf circumference were measured. Binary logistic regressions were performed to produce a model which estimated if an individual showed laterally deviated foot pressure during stance. The model utilized the score of Cumberland Ankle Instability Tool Question 8, active and passive knee joint external rotation, height, body mass and bimalleolar width (explained variance of 47.3%, p = 0.037), producing a sensitivity of 71.4% and a specificity of 54.5%. A validation trial on another 15 runners reported a 73.3% accuracy in prediction if they are medial or lateral strikes.

Effects of Different Rehabilitation Training Methods Under Color Doppler Flow Imaging on Functional Ankle Instability

The research aimed to evaluate the therapeutic effect of functional ankle instability (FAI) and to monitor the rehabilitation effect of neuromuscular training based on color doppler ultrasound. In this research, 70 patients with FAI who were admitted to XYZ hospital on January 30, 2018, solstice and July 30, 2019 were selected and divided into experimental group (EG) and control group (CG) randomly. In the EG, 35 patients underwent routine muscle strength training combined with neuromuscular training. In the CG, 35 patients received routine muscle strength training. Color doppler flow imaging (CDFI) was used to make imaging diagnosis of ankle joint condition before and after rehabilitation training in the two groups, and the Cumberland ankle instability tool (CAIT), American Orthopaedic Foot and ankle Societ (AOFAS), t-type agility test and Sargent longitudinal jump test were performed in the two groups before and after training. Multivariate Logistic regression model (LRM) was adopted to analyze the relation between ankle instability score and age, height, weight, total leg length, course of disease and training years. It was concluded that CAIT score, AOFAS score, and Sargent longitudinal jump test results of the EG were greatly higher than those of the CG after training, with statistically significant differences (SSD) (P < 0.05). After rehabilitation training, the test results of t-type agility in the EG were significantly lower than those in the CG, with SSD (P < 0.05). CAIT score, AOFAS score and Sargeant longitudinal jump test results in the two groups after rehabilitation training were greatly higher than those before training, with SSD (P < 0.05), and t-type agility test results were greatly lower than those in the CG, with SSD (P < 0.05). The CAIT score of the patients were negatively related to age and course of disease (P < 0.05), indicating that the two rehabilitation training methods could effectively improve the recovery of ankle instability score, agility variability ability, lower limb eruption and flexibility of the patients, and the neuromuscular training methods were more effective. Age and course of the disease are the risk factors that affect the rehabilitation effect of patients. In the early stage of functional ankle joint instability, medical treatment should be timely to avoid greater injury.

The Relationship Between Perception Of Ankle Instability And Dynamic Balance In Individuals With A History Of Ankle Sprains

PURPOSE: Ankle sprains are common injuries which can progress to chronic ankle instability (CAI) and balance impairments. While objective data guide treatment for individuals with CAI, the patient’s subjective experience is often overlooked and not counted in the adoption of plan of care. Individual perception of ankle instability is an important factor and has the potential to influence presentation of sensorimotor impairments either through neuromotor or fear-avoidance mechanisms. The purpose of this study was to explore the contribution of perception of unilateral and bilateral CAI on a dynamic balance test. METHODS: Subjects were males and females 18-35 years old (n=25, age= 23.8 ± 1.8 yr.). All subjects completed the Cumberland Ankle Instability Tool (CAIT) to measure perceived ankle instability (lower CAIT scores are associated with greater perceived instability). Dynamic balance was assessed using 3 repetitions in each direction (anterior, postero-medial, and postero-lateral) of the Y-Balance Test (YBT). Asymmetries in CAIT scores and reach distances were calculated by subtracting right leg values from left leg values. Further comparisons were analyzed between groups of bilaterally highest (>80%) and lowest (<20%) combined CAIT scores. RESULTS: There was a significant positive moderate correlation between CAIT asymmetries and asymmetries in the anterior reach (r=0.526, p=0.007) and the posteromedial reach scores (r= 0.554, p=0.004). Significant differences were found between participants with the highest (n=5) and lowest (n=5) bilateral CAIT scores in right posteromedial reach (101.60 ± 9.91 vs 86.80 ± 5.89, p=0.02), right posterolateral reach (96.40 ± 7.70 vs 76.80 ± 4.87, p=0.001), and right composite score (89.96 ± 5.93 vs 78.44 ± 3.85, p=0.007). CONCLUSION: Subjects reporting increased perceived ankle instability demonstrated decreased YBT performance on the side of perceived instability. Decreased reach distances may be attributable to neuromuscular consequences of ankle injury, changes in movement strategy associated with apprehension, or both. In fact, the larger the perceived asymmetries the greater the performance deficits. These findings may help clinicians contextualize sensorimotor assessment results in patients with a history of ankle sprain.

Comparison of Health-Related Quality of Life in Different Types of Chronic Ankle Instability

Abstract Introduction People with chronic ankle instability (CAI) have decreased health-related quality of life (HRQOL), but the differences in HRQOL status between subgroups of CAI have not been determined. This observational, cross-sectional study aimed to evaluate and compare physical, social and psychological aspects of HRQOL in subgroups of patients with CAI. Methods Ninety patients with CAI and 30 healthy participants were included. The patients were assigned to 3 subgroups with functional ankle instability (FAI), mechanical ankle instability (MAI), or mixed functional and mechanical instability (MIX), based on the talar tilt test, anterior drawer test, and Cumberland Ankle Instability Tool score. Participants completed the self-assessed Foot and Ankle Ability Measure (FAAM), Tampa Scale of Kinesophobia-11 (TSK-11), Fear-Avoidance Beliefs Questionnaire (FABQ), and Short-Form Health Survey (SF‑36). Results Significant differences were observed between healthy participants and each CAI subgroup in regional (FAAM), psychological (TSK-11 and FABQ) and global (SF-36) measures (p&lt;0,05). The MIX subgroup had a significantly lower score on the FAAM-sport component, and a higher score on the TSK-11 and FABQ (p&lt;0,05), than the FAI subgroup. There were no diffirences between other CAI subgroups in quality of life measures. Conclusions Patients with MAI and FAI had similar functional deficits in activities of daily living and sport activities, and greater fear of re-injury. The MIX subgroup had greater deficits in sport activities and greater fear of re-injury than the FAI subgroup.

Ankle Sprains Risk Factors in a Sample of French Firefighters: A Preliminary Prospective Study.

Firefighters participating in mandatory physical exercise sessions are exposed to a high risk of ankle sprain injury. Although both physiological and psychological risk factors have been identified, few prospective studies considered the complex interaction of these factors in firefighters. To prospectively determine whether intrinsic physical risk factors and work-related environments predict ankle sprains occurring during on-duty physical exercise in firefighters during an 8-month follow-up period. Prospective. Fire Department and Rescue Service. Thirty-nine firefighters were selected based on convenience sampling. Participants performed physical tests and completed questionnaires. Lower Quarter Y-Balance Test, Weight-Bearing Lunge Test, anthropometric measures, postural stability, chronic ankle instability (Cumberland Ankle Instability Tool) scores, previous injuries, and perceived psychosocial work environment (Copenhagen Psychosocial Questionnaire [COPSOQ]). During the follow-up, 9 firefighters sustained an injury. Lower Quarter Y-Balance Test and Weight-Bearing Lunge Test performances, Cumberland Ankle Instability Tool scores, history of previous ankle sprain, and specific dimensions of the COPSOQ significantly differed between injured and uninjured firefighters. Lower-limbs asymmetries of the Lower Quarter Y-Balance Test (ie,anterior, posteromedial, and posterolateral directions) and the Weight-Bearing Lunge Test were predictors of ankle sprains. These findings originally provide evidence that intrinsic factors mainly contribute to ankle sprains, although psychosocial work environment assessment could also characterize firefighters at risk.

Patient-Reported Outcomes and Perceived Confidence Measures in Athletes With a History of Ankle Sprain.

Patient-reported outcome measures (PROs) and functional performance tests are recommended in the National Athletic Trainers' Association's position statement on the prevention and management of ankle sprains during the return-to-play process. Evaluating perceived confidence may be another valuable method to evaluate an athlete's readiness to return-to-play following an ankle sprain. To evaluate the relationship between PROs and perceived confidence when performing functional performance tasks in high school athletes with a history of ankle sprain. Descriptive study. Public high school. A total of 25 high school student-athletes (6 males and 19 females, age 16.2 [1.1]y, height 169.3 [7.7]cm, mass 63.2 [9.8]kg). None. The Cumberland Ankle Instability Tool, visual analog scale (VAS) for pain, Identification of Functional Ankle Instability, and Tampa Scale of Kinesiophobia-11 were completed by all participants. Participants then completed the weight-bearing lunge test; star excursion balance test; lateral, up-down, and triple hop tests; the single-leg vertical jump; and Southeast Missouri agility test and were asked to report their confidence in completing each task using a VAS with anchors of "no confidence" and "complete confidence." Pearson r correlations were calculated between the PROs and the confidence VAS scores of the functional tests. Moderate to strong negative correlations were identified between pain VAS measures and confidence VAS measures for all functional tests except the star excursion balance test and vertical jump. Moderate negative correlations were found between Tampa Scale of Kinesiophobia-11 scores and perceived confidence during the star excursion balance test and vertical jump. Finally, a moderate positive correlation was identified between Cumberland Ankle Instability Tool scores and perceived confidence measures during the Southeast Missouri agility test. High school athletes with a history of ankle sprain demonstrated significant correlations between several PROs and perceived confidence during various functional performance tests. The value of perceived confidence measures when making return-to-play decisions after ankle sprains warrants further investigation.

Pressure pain sensitivity over nerve trunk areas and physical performance in amateur male soccer players with and without chronic ankle instability

ObjectiveChronic ankle instability (CAI) is reported after ankle sprain. Our aim was to assess differences in mechanical pain sensitivity of lower extremity nerve trunks and physical performance between amateur soccer players with and without CAI. DesignA cross-sectional case-control study. SettingAmateur soccer teams. ParticipantsFifty-five male soccer players, 28 with and 27 without CAI participated. Main outcome measuresThe perceived instability was assessed with the Cumberland Ankle Instability Tool (CAIT). Pressure pain thresholds (PPTs) on the common peroneal and tibialis nerve trunks, vertical jump, lateral step-down test and joint position sense of the knee were assessed by a blinded assessor. ResultsSoccer players with CAI showed lower PPTs over the common peroneal nerve than those without CAI (between-groups mean difference: 1.0 ± 0.8 kg/cm2, P < 0.001). No differences for PPT over the tibialis posterior (P = 0.078) or any physical performance outcome (knee joint positioning sense [P = 0.798], lateral step-down test [P = 0.580] and vertical jump variables [all, P > 0.310]) were found. PPT over the common peroneal nerve exhibited a significant moderate correlation with the CAIT score (r = 0.528, P < 0.001). ConclusionAmateur soccer players with CAI have higher pressure pain sensitivity over the common peroneal nerve but exhibit similar physical performance to amateur soccer players without CAI.

Ankle Strength Deficits in a Cohort of College Athletes With Chronic Ankle Instability.

Lateral ankle sprains commonly occur in an athletic population and can lead to chronic ankle instability. To compare ankle strength measurements in athletes who have mechanical laxity and report functional instability after a history of unilateral ankle sprains. Retrospective cohort. Athletic Training Research Lab. A total of 165 National Collegiate Athletic Association Division I athletes, 97 males and 68 females, with history of unilateral ankle sprains participated. Functional ankle instability was determined by Cumberland Ankle Instability Tool scores and mechanical ankle instability by the participant having both anterior and inversion/eversion laxity. Peak torque strength measures, concentric and eccentric, in 2 velocities were measured. Of the 165 participants, 24 subjects had both anterior and inversion/eversion laxity and 74 self-reported functional ankle instability on their injured ankle. The mechanical ankle instability group presented with significantly lower plantar flexion concentric strength at 30°/s (139.7 [43.7]N·m) (P = .01) and eversion concentric strength at 120°/s (14.8 [5.3]N·m) (P = .03) than the contralateral, uninjured ankle (166.3 [56.8]N·m, 17.4 [6.2]N·m, respectively). College athletes who present with mechanical laxity on a previously injured ankle exhibit plantar flexion and eversion strength deficits between ankles.

In vivo kinematics of functional ankle instability patients during the stance phase of walking

BackgroundPrevious studies showed functional ankle instability (FAI) patients have morphological ligamentous abnormality, despite having no apparent joint laxity. Research questionWhether tibiotalar and subtalar joints hypermobility exists in FAI patients during stance phase of walking, remains controversial. MethodsTen unilateral FAI patients, ten unilateral lateral ankle sprain (LAS) copers and ten healthy controls were included. A dual fluoroscopy imaging system was utilized to capture the fluoroscopic images of tibiotalar and subtalar joint during the stance phase of walking. Kinematic data from six degrees of freedom were calculated utilizing a solid modeling software. The range of motion and joint excursions about six degrees of freedom were compared among the three groups. The correlations between range of motion and Cumberland Ankle Instability Tool (CAIT) scores were assessed utilizing the Spearman’s correlation coefficient (r). ResultsDuring the stance phase, the FAI patients and LAS copers showed larger tibiotalar anterior/posterior translation than the healthy controls (FAI patients, p = .013; LAS copers, p = .002). The FAI patients also showed significantly larger lateral/medial translation (p = .035) and inversion/eversion rotation (p = .003) of subtalar joints than healthy controls. By contrast, the subtalar joints of the LAS copers were not different from those of the healthy controls in the lateral/medial translation (p = .459) and inversion/eversion rotation (p = .091). CAIT scores were negatively correlated with range of motion. SignificanceDuring the stance phase of walking, FAI patients showed significantly larger hypermobility of subtalar joints than healthy controls, contrary to the LAS copers. These findings justify the utilization of dual fluoroscopy imaging system to detect joint hypermobility in FAI patients. Treatment for FAI patients may require stabilization of the subtalar joint.

Reliability and Recalibration of the Persian Version of Cumberland Ankle Instability Tool Cut-off Score in Athletes with Functional Ankle Instability.

Introduction:The Cumberland Ankle Instability Tool (CAIT) is a valid instrument for determining the presence and severity of functional ankle instability. This questionnaire was recently cross-culturally adapted into Persian; however, the reliability of the Persian version has not been examined in athletes. CAIT has also been used with various independently-selected cut-off scores to determine instability.Objective:The present study was conducted to evaluate the psychometric properties of the Persian version of CAIT and to determine its optimal cut-off score in athletic populations.Method:One-hundred and sixteen athletes (volleyball, basketball and track and field players) over 18 years old both with and without ankle instability completed the Persian version of the CAIT. The internal consistency, test-retest reliability and discriminative ability of the tool were assessed. A receiver operating characteristic (ROC) curve was drawn to confirm the cut-off point of the Persian version of CAIT using the Youden index.Results:The average CAIT score was 25.14±4.98 for the right and 25.76±4.94 for the left ankle. The Persian version of CAIT had a good internal consistency (Cronbach’s α of 0.78 for the right ankle and 0.79 for the left ankle) and substantial reliability (ICC2, 1 = 0.88; 95% CI: 0.86 – 0.90) in athletes. No ceiling or floor effects were observed. The optimal cut-off score for discriminating between athletes with and without FAI was 24.Conclusion:The Persian version of CAIT was shown to be a reliable tool for assessing functional ankle instability among Iranian athletes.

Alterations in Cortical Activation Among Individuals With Chronic Ankle Instability During Single-Limb Postural Control.

Chronic ankle instability (CAI) is characterized by repetitive ankle sprains and perceived instability. Whereas the underlying cause of CAI is disputed, alterations in cortical motor functioning may contribute to the perceived dysfunction. To assess differences in cortical activity during single-limb stance among control, coper, and CAI groups. Cross-sectional study. Biomechanics laboratory. A total of 31 individuals (10 men, 21 women; age = 22.3 ± 2.4 years, height = 169.6 ± 9.7 cm, mass = 70.6 ± 11.6 kg), who were classified into control (n = 13), coper (n = 7), and CAI (n = 11) groups participated in this study. Participants performed single-limb stance on a force platform for 60 seconds while wearing a 24-channel functional near-infrared spectroscopy system. Oxyhemoglobin (HbO2) changes in the supplementary motor area (SMA), precentral gyrus, postcentral gyrus, and superior parietal lobe were measured. Differences in averages and standard deviations of HbO2 were assessed across groups. In the CAI group, correlations were analyzed between measures of cortical activation and Cumberland Ankle Instability Tool (CAIT) scores. No differences in average HbO2 were present for any cortical areas. We observed differences in the standard deviation for the SMA across groups; specifically, the CAI group demonstrated greater variability than the control (r = 0.395, P = .02; 95% confidence interval = 0.34, 0.67) and coper (r = 0.38, P = .04; 95% confidence interval = -0.05, 0.69) groups. We demonstrated a strong correlation that was significant in the CAI group between the CAIT score and the average HbO2 of the precentral gyrus (ρ = 0.64, P = .02) and a strong correlation that was not significant between the CAIT score and the average HbO2 of the SMA (ρ = 0.52, P = .06). The CAI group displayed large differences in SMA cortical-activation variability. Greater variations in cortical activation may be necessary for similar static postural-control outcomes among individuals with CAI. Consequently, variations in cortical activation for these areas provide evidence for an altered neural mechanism of postural control among populations with CAI.

Neuromuscular control of ankle and hip during performance of the star excursion balance test in subjects with and without chronic ankle instability.

Background/PurposeAnkle sprains are common and potentially disabling musculoskeletal injuries that often lead to chronic ankle instability (CAI). CAI has been linked to impairments in postural and neuromuscular control; however, inconsistent findings have been reported. Individuals who experience a lateral ankle sprain, but do not develop instability, termed copers, may adapt different neuromuscular control strategies after injury. This study aimed to compare postural control and electromyographic (EMG) activity of hip and ankle muscles during the performance of the Star Excursion Balance Test (SEBT) in subjects with and without CAI.Method48 participants were classified into three groups (16 control, 16 copers, 16 CAI) based on ankle sprain history and Cumberland Ankle Instability Tool score. Outcome measures included normalized reach distance, center of pressure (COP), and integrated EMG activation of gluteus medius (Gmed), gluteus maximus (Gmax), tibialis anterior (TA), and peroneus longus (PL) during each reach direction of SEBT.ResultsCompared to copers and controls, CAI group demonstrated significantly diminished postural control (reach distance and COP measures, p< 0.05) and less EMG activity of TA during the anterior direction (CAI: 33.1% ± 10.1% versus copers: 44.8% ± 12.7% versus controls: 51.7% ± 8.4%, p<0.01) and Gmax in the posterolateral direction (CAI: 25.6% ± 9.4% versus copers: 37.5% ± 13.8% versus controls: 40.2% ± 17.2%, p = 0.011).ConclusionAlteration in proximal and distal muscle activity appears to negatively affect postural control and quality of movement, which may lead to prolonged functional impairments. Hence, implementing hip and ankle muscle exercises in the rehabilitation of ankle instability might benefit these patients.

EFFECT OF 4 WEEKS COMPREHENSIVE REHABILITATION PROGRAM ON FENCERS WITH FAI (FUNCTIONAL ANKLE INSTABILITY) USING CAIT (CUMBERLAND ANKLE INSTABILITY TOOL)

Background: The main purpose of this study was to evaluate FAI (functional ankle instability) in fencers using CAIT (Cumberland ankle instability tool) and to check balance, strength & endurance using SLS (single leg stance test) and CRT (calf raise test). Using ZEBRIS HP Cosmos Gait Analysis System and find out the alterations in the gait parameters and effect of 4 week comprehensive rehabilitation program that targets strength, endurance, flexibility, balance, agility, mind body connection and functional tasks and to reevaluate the effect of the rehabilitation program on each of the above parameters. Methods: 40 male fencers with FAI with the age groups between 18-25 years. Experimental group (n=20) age (21.55 + 2.08) and the Controlled group (n=20) with age (21.95 + 1.905). Subjects were classified on the severity based upon the scores of CAIT scale. Age, BMI, height, weight were the baseline evaluations. Dominance, side of injury, no. of times ankle was injured, and treatment taken was also documented. The experimental group underwent a 4 weeks rehabilitation program and the control group was not put on any rehab program. Each of the parameters were measured again after 4 weeks. Conclusions: There were significant differences in the balance, balance improved significantly in the experimental group (P value of 0.00), the strength and endurance was also improved in the experimental group (P value of 0.00), the CAIT score was also improved significantly in the experimental group indicating the improvement in the stability of the affected ankle (P value of 0.00). The foot rotation degree showed no significant differences with (P value of 0.34). Step length showed significant differences in the experimental group (P value of 0.00). Stride length also showed significant post rehabilitation in the experimental group (P value of 0.00). No significant differences were seen in step width, step time and cadence. Velocity showed significant differences in the experimental group in post rehab readings (P value of 0.01). Finally the evidence suggests that the 4 weeks rehabilitation program improves the ankle instability in fencers, strength and balance was improved rendering the joint less chances of repeated & concurrent injuries, possibly improves the performance and game quality. Article visualizations:

Association between Cumberland Ankle Instability Tool score and postural stability in collegiate soccer players with and without functional ankle instability

ObjectiveThe purpose of this study was to investigate the association between Cumberland Ankle Instability Tool (CAIT) scores and postural stability during a diagonal landing, and to investigate whether postural stability is altered in collegiate soccer players with and without functional ankle instability (FAI). DesignCross-sectional study. SettingLaboratory. ParticipantsNinety-one soccer players were classified into a FAI group (history of at least two ankle sprains and a CAIT-Japanese version score ≤25, n = 28), a copers group (history of one ankle sprain and a CAIT-Japanese version score ≥26, n = 32), or a control group (no history of ankle sprain, n = 31). Main outcome measuresTime to anteroposterior stabilisation (TTSAP) and mediolateral stabilisation (TTSML) were measured during the diagonal single-leg landing. ResultsThe CAIT scores were correlated with TTSAP (P < 0.05, rs = −0.214) and TTSML (P < 0.01, rs = −0.566). TTSAP was longer in the FAI group than in the control group, and TTSML was longer in the FAI group than in the other groups. ConclusionsOur findings indicate the presence of an association between the CAIT-J score and TTSML, as well as postural stability deficits in collegiate soccer players with FAI during diagonal landings.

Predictors of chronic ankle instability: Analysis of peroneal reaction time, dynamic balance and isokinetic strength

BackgroundPrevious studies have reported the factors contributing to chronic ankle instability, which could lead to more effective treatments. However, factors such as the reflex response and ankle muscle strength have not been taken into account in previous investigations. MethodsFifty recreational athletes with chronic ankle instability and 55 healthy controls were recruited. Peroneal reaction time in response to sudden inversion, isokinetic evertor muscle strength and dynamic balance with the Star Excursion Balance Test and the Biodex Stability System were measured. The relationship between the Cumberland Ankle Instability Tool score and performance on each test was assessed and a backward multiple linear regression analysis was conducted. FindingsParticipants with chronic ankle instability showed prolonged peroneal reaction time, poor performance in the Biodex Stability System and decreased reach distance in the Star Excursion Balance Test. No significant differences were found in eversion and inversion peak torque. Moderate correlations were found between the Cumberland Ankle Instability Tool score and the peroneal reaction time and performance on the Star Excursion Balance Test. Peroneus brevis reaction time and the posteromedial and lateral directions of the Star Excursion Balance Test accounted for 36% of the variance in the Cumberland Ankle Instability Tool. InterpretationDynamic balance deficits and delayed peroneal reaction time are present in participants with chronic ankle instability. Peroneus brevis reaction time and the posteromedial and lateral directions of the Star Excursion Balance Test were the main contributing factors to the Cumberland Ankle Instability Tool score. No clear strength impairments were reported in unstable ankles.

Effects of visual feedback balance training on the balance and ankle instability in adult men with functional ankle instability.

[Purpose] This study examined the effects of visual feedback balance training on the balance and ankle instability in adult men with functional ankle instability. [Subjects and Methods] Twenty eight adults with functional ankle instability, divided randomly into an experimental group, which performed visual feedback balance training for 20 minutes and ankle joint exercises for 10 minutes, and a control group, which performed ankle joint exercise for 30 minutes. Exercises were completed three times a week for 8 weeks. Bio rescue was used for balance ability. It measured limit of stability at one minute. For ankle instability was measured using Cumberland ankle instability tool (CAIT). This measure was performed before and after the experiments in each group. [Results] The experimental group had significant increase in the Limit of Stability and CAIT score. The control group had significant increase in CAIT score. While the Limit of Stability increased without significance. [Conclusion] In conclusion, visual feedback balance training can be recommended as a treatment method for patients with functional ankle instability.

Establishing the Minimal Clinical Important Difference and Minimal Detectable Change for the Cumberland Ankle Instability Tool

ObjectiveTo establish the minimal detectable change (MDC) and minimal clinically important difference (MCID) for the Cumberland Ankle Instability Tool (CAIT) in a population with chronic ankle instability (CAI). DesignExperimental cohort. SettingLaboratory. ParticipantsA convenience sample of individuals with CAI (N=50; 12 men; 38 women; episodes of giving way, 5.84±12.54mo). CAI inclusion criteria included a history of an ankle sprain, recurrent episodes of giving way, and a CAIT score ≤25. InterventionsParticipants completed demographic information, an injury history questionnaire, and the CAIT. Participants then either participated in 4 weeks of wobble board balance training, resistance tubing strength training, or no intervention. After 4 weeks, participants recompleted the CAIT and recorded their global rating of change (GRC). Main Outcome MeasuresDependent variables were pre- and postintervention scores on the CAIT and postintervention GRC. The MDC with 95% confidence interval was calculated. A receiver operating characteristic (ROC) curve identified the optimal CAIT cut point (MCID) between improved and unimproved individuals on the basis of their GRC. The area under the curve was used to identify a significant ROC curve (α=.05). ResultsThe average CAIT score preintervention was 16.8±5.6, and postintervention, it was 20.0±5.2. Thirty-one participants (62%) rated themselves as improved on the GRC scale, whereas 19 (38%) were not improved. The ROC curve was significant (area under the curve, .797; P=.001), indicating that the CAIT change score significantly predicted clinical status. The MDC was 3.08, and the MCID was ≥3 points. ConclusionsThe CAIT has an MDC and MCID of ≥3 points. When CAIT scores are used to assess patient change over time, these scores should be used as a minimum threshold to indicate detectable and clinically meaningful improvement.

Evaluation of a smartphone-based assessment system in subjects with chronic ankle instability

BackgroundAnkle sprain is the most common sports-related injury, and approximately 80% of patients studied suffered recurrent sprains. These repeated ankle injuries could cause chronic ankle instability, a decrease in sports performance, and a decrease in postural control ability. At the present time, smartphones have become very popular and powerful devices, and smartphone applications (apps) that have been shown to have good validity have been designed to measure human body motion. However, the app focusing on ankle function assessment and rehabilitation is still not widely used and has very limited functions. The purpose of this study is to evaluate the feasibility of smartphone-based systems in the assessment of postural control ability for patients with chronic ankle instability. MethodsFifteen physically active adults (6 male, 9 female; aged = 23.4 ± 5.28 years; height = 167.13 ± 7.3 cm; weight = 62.06 ± 10.82 kg; BMI = 22.08 ± 2.57 kg/ m2) were recruited, and these participants had at least one leg that was evaluated as scoring lower than 27 points according to the Cumberland Ankle Instability Tool (CAIT). The smartphone used in the study was ASUS Zenfone 2, and an app developed using MIT App Inventor was used to record built-in accelerometer data during the assessment process. Subjects were asked to perform single leg stance for 20 s in eyes-open and eyes-closed conditions with each leg. The smartphone was fixed in an upright position on the middle of the shin, using an exercise armband, with the screen facing forward. The average of recorded acceleration data was used to represent the postural control performance, and higher values indicated more instability. Data were analyzed with a paired t-test with SPSS 17.0, and the statistical significance was set as alpha <0.05. ResultsA significant difference was found between CAIT scores from the healthier leg and injured leg (healthier leg 23.07 ± 3.80 vs. injured leg 18.27 ± 3.92, p < 0.001). Significant differences were also found between the scores for the healthier leg and injured leg during both eyes-open and eyes-closed conditions (eyes-open: healthier leg 0.051 ± 0.018 vs. injured leg 0.072 ± 0.034, p = 0.027; eyes-closed: healthier leg 0.100 ± 0.031 vs. injured leg 0.123 ± 0.038, p = 0.001, unit: m/s2). Significant differences were also found between eyes-open and eyes-closed conditions during both single leg standing with healthier leg and injured leg (healthier leg: eyes-open 0.051 ± 0.018 vs. eyes-closed 0.100 ± 0.031, p < 0.001; injured leg: eyes-open 0.072 ± 0.034 vs. eyes-closed 0.123 ± 0.038, p = 0.001, unit: m/s2). The results demonstrate that the smartphone software can be used to discriminate between the different performances of the healthier leg and injured leg, and also between eyes-open and eyes-closed conditions. ConclusionThe smartphone may have the potential to be a convenient, easy-to-use, and feasible tool for the assessment of postural control ability on subjects with chronic ankle instability.

The Cumberland Ankle Instability Tool (CAIT) in the Dutch population with and without complaints of ankle instability

PurposeTo develop a translated Dutch version of the Cumberland Ankle Instability Tool (CAIT) and test its psychometric properties in a Dutch population with foot and ankle complaints.MethodsThe CAIT was translated into the Dutch language using a forward–backward translation design. Of the 130 subsequent patients visiting the outpatient clinic for foot and ankle complaints who were asked to fill out a questionnaire containing the CAIT, the Foot and Ankle Outcome Score (FAOS), and the numeric rating scale (NRS) pain, 98 completed the questionnaire. After a 1-week period, patients were asked to fill out a second questionnaire online containing the CAIT and NRS pain. This second questionnaire was completed by 70 patients. With these data, the construct validity, test–retest reliability, internal consistency, measurement error, and ceiling and floor effects were assessed. Additionally, a cut-off value to discriminate between stable and unstable ankles, in patients with ankle complaints, was calculated.ResultsConstruct validity showed moderate correlations between the CAIT and FAOS subscales (Spearman’s correlation coefficient (SCC) = 0.36–0.43), and the NRS pain (SCC = −0.55). The cut-off value was found at 11.5 points of the total CAIT score (range 0–30). Test–retest reliability showed to be excellent with an intraclass correlation coefficient of 0.94. Internal consistency was high (Cronbach’s α = 0.86). No ceiling or floor effects were detected.ConclusionBased on the results, the Dutch version of the CAIT is a valid and reliable questionnaire to assess ankle instability in the Dutch population and is able to differentiate between a functionally unstable and stable ankle. The tool is the first suitable tool to objectify the severity of ankle instability specific complaints and assess change in the Dutch population.Level of evidence II.

Construction and application effects of CAI secondary prevention model in nursing staff

Objective To study the clinical effect of the secondary prevention of chronic ankle instability (CAI) for nursing staff. Methods From September 2014 to January 2015, we screened 100 nurse with functional ankle instability in Shandong Provincial Hospital. The subjects were divided into the intervention group (n=51) and the control group (n=49) by random number table. The nurses of intervention group accepted measures of the secondary prevention, including bundle health education, bracing and rehabilitation, while the nurses of control group received only routine health education. Before intervention and 4 months later, we evaluated the ankle instability by Chinese version Cumberland ankle instability tool (CAIT) in two groups and compared the intervention effects and relevant knowledge of the two groups. Results Before the intervention, the CAIT score of intervention group was (19.0±4.8), and was (28.2±3.0) after intervention (t=9.210, P 0.05); after intervention, the difference of two groups had statistical significance (t=9.317, P<0.05). Conclusions The secondary prevention of CAI can improve CAI nurse staff′s ankle stability and the recognition level of CAI prevention knowledge, and promote the clinical symptom prevention effectively, so it has significance for the improvement of nurse′s ankle function. Key words: Nurses; Ankle; Instability; Secondary prevention