Identification Of Functional Ankle Instability Research Articles

Exercise combined with electrical stimulation for the treatment of chronic ankle instability – A randomized controlled trial

PurposeTo compare the short, medium, and long-term effects of balance exercises combined with either peroneal neuromuscular electrical stimulation (NMES) or peroneal transcutaneous electrical nerve stimulation (TENS) on dynamic postural control and patient reported outcome measures (PROMs) in patients with chronic ankle instability (CAI). MethodsThirty-four participants with CAI were randomly assigned to a 12-session home based exercise program combined with NMES (Ex-NMES) or TENS (Ex- TENS). Baseline postural control was tested with the modified Star Excursion Balance Test (mSEBT) and time to stabilization (TTS) after a single-leg drop-jump. The self-reported function was measured using the Cumberland Ankle Instability Tool (CAIT), the Identification of Functional Ankle Instability (IdFAI), and the Sports subscale of the Foot and Ankle Ability Measure (FAAMSport). ResultsBoth groups showed significant improvements in all self-reported outcome measures at the 12-month follow-up. Subjects in the Ex-NMES group had significantly better IdFAI (-4.2 [95% CI −8.1, −0.2]) and FAAMSport (13.7 [95% CI 2.2, 25.2]) scores at 6- and 12-month follow-up, respectively, compared to the Ex-TENS group. Medium to large between-group effect sizes were observed in self-reported functional outcomes and the mSEBT. ConclusionThe consistent trend of improvement in self-reported functional outcomes when training is combined with NMES compared with training with TENS may indicate a potential benefit that should be further investigated as a treatment for patients with CAI.

Does a rupture of the lateral ankle ligament need to be repaired in supination-adduction type II (OTA/AO 44A2) fractures?

To evaluate the outcomes of patients with supination-adduction (SAD) type II (OTA/AO 44A2) fractures who had a lateral ankle ligament rupture repaired compared with patients who did not have a lateral ankle ligament repaired using patients who underwent fibula fracture fixation as a control group. A retrospective analysis of all 104 patients diagnosed with SAD type II fractures from January 2011 to December 2020 and managed operatively was performed. The patients were divided into three groups: 32 patients with ruptures of the lateral ligaments that were not repaired (group A), 34 patients with ruptures of the lateral ligaments that were repaired (group B), and 38 patients with fibula fracture fixation acting as the control group (group C). The objective outcomes including radiographic findings, the ankle range of motion, the manual ankle stress tests, and complications were gained from the record of the last time in outpatient clinics. The functional outcomes including the identification of functional ankle instability (IdFAI) scores were collected postoperatively at 12-month intervals to assess clinical outcomes. The Manchester Oxford Foot Questionnaire (MOXFQ) and Karlsson scoring scale were also recorded at the last follow-up. The mean follow-up of the objective and subjective functional outcomes was 23.4 (range, 13-42) and 76.9 (range, 25-134) months, respectively. There was no significant difference in the radiographic findings, the ankle range of motion and complications between the three groups. All ankles were found to be stable using the manual ankle stress test in both group A and group B. The IdFAI scores showed a significant difference between group A and group B (1.12 ± 1.3 vs 0.35 ± 0.69; p < 0.001) in the first year of follow-up and no significant difference after the first year. No differences were noted in MOXFQ scores or Karlsson scores among the groups. Directly repairing the lateral ligament could minimize the proportion of the first year of postoperative functional ankle instability, although the final stability of the ankle and clinical outcomes were not significantly different in SAD type II fractures. Level III, retrospective comparative case series.

Examination of functional ankle instability in soccer players: a prospective study.

The foot area is one of the most active body parts in soccer branch. There may be various loads on the foot in soccer players and ankle instability may be occur. The present study aimed to evaluate functional ankle instability in soccer players and examine it in terms of some variables. A total of 175 male soccer players were included in the present study. The ankle instability of soccer players was evaluated with the Identification of Functional Ankle Instability (IdFAI) scale. It was determined that 35.4% of the soccer players had functional ankle instability in their right foot, 29.7% in their left foot, and 46.3% on at least one side. The average IdFAI total score of the all players was 9.39±6.18 for the right side and 8.20±5.55 for the left side. When the soccer players were evaluated regarding the position they played, it was determined that the mean of the IdFAI total score for both feet was higher in the midfielders. It is thought that the results of the study may contribute to the determination of risk factors for the foot part and shed light on the development of prevention strategies for injuries in soccer players.

Evaluation of Chronic Lateral Ankle Instability with a Sprain Stimulator: A Controlled Study in Physically Active Subjects

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Chronic Lateral Ankle Instability (CLAI) represents a significant socioeconomic burden. Paradoxically, its management has changed little over the years, notably because research is divided into functional and mechanical instability, whereas CLAI encompasses both. Sprain simulators can encompass both functional and mechanical instability by assessing the maximal ankle inversion velocity (MIV) during a simulated inversion trauma. We built a sprain simulator capable of producing a sudden ankle inversion motion during walking. We aimed to differentiate subjects with chronic lateral ankle instability (CLAI) from controls and quantify functional CLAI as well as impairments in activities of daily living and sports using a sprain simulator. Methods: Forty-five physically active subjects were included and assigned to a CLAI group, a control group, or excluded according to the International Ankle Consortium selection criteria. Each subject walked on a treadmill with instability boots after completing the Identification of Functional Ankle Instability (IdFAI) and the Foot Ankle Ability Measurement (FAAM) questionnaires. A simulated trauma was unexpectedly triggered by the observer. Maximal inversion velocities (MIV) were measured at this very moment using inertial moment units. We normalized these values by the average MIV of the 5 stance phases of the same foot preceding the simulated trauma (Ratio MIV). Normality of data were assessed with the Shapiro-Wilk test. The groups were compared using Student T test for normal and Mann-Whitney U test for nonnormal variables. Multivariate linear regressions were performed to assess the relation between, the IdFAI, the FAAM Activities of Daily Living Subscale, the FAAM Sports Subscale and the explanatory variables. Results: Twenty-six ankles were excluded, 32 composed the CLAI group and 32 the control group. Mean MIV were 213.5+/-54.7°/s and 177+/-64.2°/s (p=0.02), and mean Ratio MIV were 1.22+/-0.13 and 1.08+/-0.08 (p &lt; 0.001) in the CLAI and Control groups respectively. In multivariate analysis, Ratio MIV was associated with higher values of IdFAI (β=42.8 [12.9;72.8],p=0.006), lower values of FAAM Activities of Daily Living Subscale (β=-14.1 [-27.8;-0.5],p=0.04) and lower values of FAAM Sports Subscale (β=-7.2 [-13.7;- 0.6],p=0.03) whereas MIV was not. Conclusion: Inversion velocities caused by a sprain simulator clearly differentiated CLAI from controls in our study. Ratio MIV showed good ability to quantify functional CLAI as well as impairments in activities of daily living and sports. This tool should be used in future studies in an attempt to provide a complete picture of CLAI encompassing its functional and mechanical aspects which may lead to improved LAS and CLAI management.

Effects of Ankle Stabilization Exercises Using Sonic Balance Pad on Proprioception and Balance in Subjects with Ankle Instability.

Sound waves generate acoustic resonance energy that penetrates deeply and safely into body areas normal mechanical vibrations cannot reach. The sonic balance pad utilizes these sound waves to create an optimal musculoskeletal response. The purpose of this study was to investigate the effects of a 4-week ankle stabilization exercise program using a sonic balance pad on proprioceptive sense and balance ability in individuals with ankle instability. This study was conducted as a randomized control-group pre-and post-test design in 30 participants (21 females and 9 males) who had experienced an ankle fracture or sprain within the last 5 years or who scored 11 points or more on The Identification of Functional Ankle Instability. The ankle stabilization exercise program was conducted for 4 weeks in the experimental group (n = 15), to which sonic pads were applied, and the control group (n = 15), to which balance pads were applied. All participants were assessed for their intrinsic proprioceptive sense of dorsiflexion and plantarflexion, static balance test, dynamic balance test, and long jump test were measured before and after 4 weeks as dependent variables. After 4 weeks of training, a significant difference was shown in the right dorsiflexion error (Balance pad = PRE: 2.47 ± 0.92; POST: 2.33 ± 1.40, Sonic pad = PRE: 3.27 ± 1.39; POST: 1.20 ± 0.77) and the left plantar flexion error (Balance pad = PRE: 2.00 ± 1.36; POST: 2.73 ± 1.22, Sonic pad = PRE: 3.53 ± 1.25; POST: 2.20 ± 1.01) (p < 0.05) between the experimental and control groups in the proprioception test. In the static balance test, there was no significant difference between the experimental and control groups during the pre, post, and variation stages. However, in the Y-Balance test, which is one of the dynamic balance tests, there was a significant difference between the experimental and control groups at various points, including anterior left (Balance pad = PRE: 72.85 ± 19.95; POST: 63.41 ± 8.66, Sonic pad = PRE: 68.16 ± 6.38; POST: 76.17 ± 3.67), posteromedial right (Balance pad = PRE: 78.59 ± 15.34; POST: 81.41 ± 10.37, Sonic pad = PRE: 86.33 ± 16.44; POST: 102.23 ± 11.53), posteromedial left (Balance pad = PRE: 78.00 ± 16.99; POST: 83.36 ± 10.15, Sonic pad = PRE: 88.96 ± 19.92; POST: 102.45 ± 12.98), posterolateral right (Balance pad = PRE: 78.16 ± 14.33; POST: 82.61 ± 10.73, Sonic pad = PRE: 87.95 ± 17.51; POST: 101.34 ± 15.37), and posterolateral left (Balance pad = PRE: 80.86 ± 14.96; POST: 81.31 ± 7.16, Sonic pad = PRE: 91.23 ± 17.35; POST: 104.18 ± 11.78) (p < 0.05). Moreover, in the single-leg long jump test, which is another dynamic balance test, the experimental group (Sonic pad = PRE: 100.27 ± 29.00; POST: 116.80 ± 28.86) also demonstrated a significant difference in the right single-leg long jump compared to the control group (Balance pad = PRE: 91.87 ± 17.74; POST: 97.67 ± 17.70) (p < 0.05). When a sonic balance pad using sound waves was applied in addition to a 4-week ankle stabilization exercise program for participants with ankle stability, it helped to improve proprioception and dynamic balance ability.

Collegiate Dancers With Chronic Ankle Instability Possess Altered Strength and saut de chat Leap Landing Mechanics.

Ankle sprains are among the most common injuries in dancers. Following one or more severe sprains, some individuals will experience residual mechanical and functional deficits, otherwise known as chronic ankle instability (CAI). Dancers who suffer from CAI may have weaker musculature surrounding the ankle and altered landing mechanics. The purpose of this study was to compare ankle strength and saut de chat landing mechanics between dancers with and without CAI. Dancers with and without CAI, defined by the Identification of Functional Ankle Instability (IdFAI), participated in the study (CAI n = 8; IdFAI = 18.75 ± 5.50 points; age = 20 ± 1.5 years; training = 15.5 ± 3.5 years) (Control n = 8; IdFAI = 7.13 ± 3.40 points; age = 19 ± 0.6 years; training = 15.9 ± 2.5 years). Strength and leap landing mechanics were measured on the affected ankle for the CAI group and on the preferred landing leg of a leap for the control group. Concentric and eccentric ankle plantar flexion, and subtalar inversion and eversion strength were determined with dynamometry set at an angular velocity of 60°•s-1. Force plates and motion capture cameras were used to calculate lower extremity kinematic and kinetic data as participants performed 3 saut de chat leaps. Independent t-tests were calculated to determine differences between groups. Compared to dancers without CAI, dancers with CAI had lower eccentric plantar flexor strength, landed with higher vertical ground reaction forces, and absorbed greater power at the knee-joint during landing. Whether dancers who are weaker are more prone to injury or ankle-joint injury leads to muscular weakness is unknown. Dancers with CAI appear to lack control during leap landing while concomitantly shifting loads proximally away from the ankle-joint. We encourage dancers with and without CAI to engage in additional training that enhances ankle strength.

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

ObjectivesTo 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. DesignCross-Sectional Study. SettingOnline survey at one university. ParticipantsOf 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 measuresFactors 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. ResultsThe 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. ConclusionsLower 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.

Correlation of Balance and Functional Ankle Instability in Elderly Women

Objectives: To evaluate and find the correlation of balance and functional ankle instability in elderly women. Methodology: A cross-sectional correlation study was conducted from June 2020 to December 2020, in which 61 participants (i.e., elderly women) were included. In the selected old age homes the self-reported questionnaire (Identification of Functional Ankle Instability [IdFAI]) had been distributed to the participants fulfilling the inclusion criteria as hand-outs and the performance-based questionnaire (Performance Oriented Mobility Assessment [POMA]) have been assessed and filled by the researcher. Chi square was used for associations and Pearson correlation for balance score and functional instability score. Results: The mean age of the participants was 64.89±4.30 years. According to the result of Tinetti Balance score, 31.1% elderly women with low risk of fall, medium risk of fall was 32.8% whereas with high risk of fall was 36.1%. The IdFAI showed, elderly women with Ankle Instability 62.3% while elderly women with No Ankle Instability were 37.7%. There was negative (inverse) Pearson linear correlation (r = -0.550) between age and balance (p ≤ 0.05) which means when the age increases, the balance decreases and also a weak association between age and functional ankle instability (p ≥ 0.05). Conclusion: This study concluded that there was not adequate evidence to propose an association between Balance and self-reported functional ankle instability.

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.

Reliability and Validity of Patient-Reported Outcome Measures for Ankle Instability in Hebrew.

BackgroundThe International Ankle Consortium has recommended several instruments for assessing and diagnosing chronic ankle instability. These include the Ankle Instability Instrument (AII), Cumberland Ankle Instability Tool (CAIT), Identification of Functional Ankle Instability (IdFAI), and Foot and Ankle Ability Measure (FAAM). This study aimed to translate, culturally adapt, and assess the reliability, validity, discriminative power, and classification agreement of the Hebrew online versions of the AII, CAIT, IdFAI, and FAAM.Material/MethodsAfter translation and cross-cultural adaptation of the questionnaires, we recruited 87 participants with self-reported ankle disorders to evaluate the psychometric properties of the questionnaires. To evaluate each questionnaire’s discriminative power, we recruited 75 healthy participants. Reliability was assessed by calculating internal consistency (Cronbach’s alphas) and test-retest intraclass correlation coefficients. Convergent and divergent validity were assessed by Spearman’s correlation between each instrument and the Short-Form-12 (SF-12) score for physical and mental components, respectively.ResultsAll instruments had acceptable internal consistency (α>0.7) and good test-retest reliability (ICC2,1>0.8), except for the IdFAI (ICC2,1=0.73). All instruments had moderate convergent validity (ρ>0.4 with SF-12 physical component) except for AII (ρ=0.36). No instrument was correlated with the SF-12 mental component score (good divergent validity, ρ<0.3). All instruments had excellent discriminative power (area under the receiver operator characteristic curve >0.9). Strong correlations were found between all instruments.ConclusionsThe Hebrew online versions of the AII, CAIT, IdFAI, and FAAM are valid, consistent, and reliable and may be used in research or clinical settings.

Validation of Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in individuals with chronic ankle instability: a cross-sectional observational study

BackgroundAnkle sprain is the most common lower limb injury in physically active individuals. Loss of function, decreased postural control (PC), strength deficit, and reduced range of motion (ROM) are common after acute lateral ankle sprains. Some patients experienced long lasting symptoms, with recurrent sprains, and episodes of giving-way: a condition known as chronic ankle instability (CAI). Evaluating the function in patients with CAI in the clinical environment is important to identify the severity of the condition, in addition to allowing to assess the effectiveness of a given treatment. The aim of this study was to investigate the validation of the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in terms of muscle strength, PC and ROM in adults with CAI.MethodsThis is a cross-sectional study. Individuals with CAI aged between 18 and 45 years were eligible. Individuals with CAI were identified using the Identification of Functional Ankle Instability (IdFAI). All patients filled in the FAAM and FAOS scores. Muscle strength was assessed by manual dynamometry, ROM by the Lunge test, PC by computerized posturography, modified Star Excursion Balance Test (mSEBT) and modified Balance Error Score System (mBESS).Results50 participants were enrolled in the present study. The mean age of the patients was 27.2 ± 6.3 years, and the mean body mass index was 26.4 ± 4.8 kg/m2. 58% (29 of 50) were men and 42% (21 of 50) women. 18 individuals had unilateral (36%) and 32 bilateral (64%) CAI. The results of FAAM were associated with MCT, mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, and external hip rotator muscles strength (P < 0.05). The results of FAOS were associated with mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, evertor muscles strength, and external hip rotator muscles strength, and mBEES (P < 0.05).ConclusionBoth the FAAM and FAOS demonstrated validity to evaluate postural control and muscle strength in patients with CAI, while no association was found in relation to ankle dorsiflexion.

Translation, cross-cultural adaptation, and psychometric properties of the Thai version of the Identification of Functional Ankle Instability (IdFAI-THAI) questionnaire

BackgroundThis study developed a Thai version of the Identification of Functional Ankle Instability (IdFAI-THAI) questionnaire. MethodsTo 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. ResultsThe IdFAI-THAI moderate correlated with the LEFS (rs = −0.62), the VAS-I (rs = 0.62), and the FAAM (rs = −0.63 and −0.69 for the activities of daily living and sports subscales, respectively). The IdFAI-THAI had good test-retest reliability (ICC2,1 = 0.89) and excellent internal consistency (Cronbach’s alpha = 0.94). Ceiling and floor effects were absent. ConclusionThe valid and reliable IdFAI-THAI can identify chronic ankle instability among Thai speakers in clinical and research settings.

Validity and reliability of the French translation of the Identification of Functional Ankle Instability (IdFAI)

PurposeTo translate and validate the Identification of Functional Ankle Instability (IdFAI) into French. MethodsThe IdFAI was translated according to international recommendations. Discriminative power, floor and ceiling effects, construct validity (including confirmatory factorial analysis (CFA)), internal consistency and test-retest reliability were measured. Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were also calculated. Results160 participants were included. The IdFAI-F showed a very good test-retest reliability (ICC = 0.95). The SEM was 1.37 and the MDC was 3.79. The internal consistency was moderate (Cronbach's alpha coefficient = 0.68). The correlation between the IdFAI and the Cumberland Ankle Instability Tool (CAIT) was high (r = −0.75, p < 0.001). No floor, nor ceiling effects were observed. The CFA analyses did not confirm the factor structure proposed by the authors of the original English version. ConclusionsThe IdFAI-F is a valid and reliable tool to accurately identify and measure chronic ankle instability in research and clinical settings for French-speaking individuals.

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.

Cross cultural adaptation, reliability and validity of the Greek version of Identification of Functional Ankle Instability (IdFAI) questionnaire

BackgroundThe 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. MethodsThe 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. ResultsThe IdFAI-GR had high internal consistency (Cronbach alpha = 0.94) and excellent test-retest reliability (ICC2,1 = 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. ConclusionThe 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.

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 REHABILITATION The 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.

Cross-cultural adaptation, validity, and reliability of Turkish version of Identification of Functional Ankle Instability (IdFAI) scale.

This study aimed to develop the Turkish version of Identification of Functional Ankle Instability (TV_IdFAI) scale and evaluate its validity and reliability. A total of 100 participants (54 men and 46 women; 50 volleyball players and 50 sedentary individuals) between 18 and 38 years of age were included this study. The construct validity, reference validity, sensitivity, specificity, and test-retest reliability of TV_IdFAI were evaluated. For the test-retest reliability, the scale was applied to all participants again in 10-14 days. A correlation between the scale scores and test-retest results was examined with intraclass correlation coefficient. To evaluate the construct validity, a factor analysis method was used. For reference validity, a sports physician evaluated all participants and the clinical diagnoses were compared with total score of the scale. Sensitivity and specificity were calculated to evaluate the classification success of the scale with specified cutoff. TV_IdFAI scale was grouped under two separate factors. It was determined that the variance for factor 1, factor 2 and for scale was 46.68%, 15.70%, and 62.38%, respectively. There was a statistically significant relationship 0.74 (95% CI 0.64-0.84; p<0.001) between the physician's diagnosis and TV_IdFAI in terms of reference validity. The sensitivity and specificity of TV_IdFAI was 0.61 and 0.80, respectively. The reliability of TV_IdFAI was 0.94 (95% CI 0.92-0.96; p<0.001). This study shows that TV_IdFAI is a simple, easy to apply, reliable, and valid scale to define functional ankle instability in Turkish population. Level II, Diagnostic study.

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

BackgroundThe 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.MethodsThe 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 (rs), effect size (ES), and standardized response mean (SRM) were calculated to evaluate the reliability, validity, and responsiveness of the SC-IdFAI questionnaire.ResultsA 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.ConclusionThe SC-IdFAI scale may be an effective tool, and it is responsive, reliable and valid for the assessment of Chinese patients suffering from CAI.

Prevalence and Impact of Chronic Ankle Instability in Adolescent Athletes.

Background:The prevalence and impact of chronic ankle instability (CAI) in adolescent athletes are unknown. To better develop and justify prevention strategies of lateral ankle sprains and CAI, it is important to understand the origin and associated long-term impact of CAI within populations other than adults.Purpose/Hypothesis:The purpose of this study was to determine the prevalence and impact of CAI on ankle function, health-related quality of life (HRQoL), and physical activity in adolescent athletes. The hypothesis was that the presence of CAI will be commonly reported among adolescent athletes and that participants with CAI will have lower self-reported ankle function, HRQoL, and physical activity when compared with participants without CAI.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A cohort of 1002 healthy (able to fully participate) adolescent athletes (50.4% female; mean age, 15.6 ± 1.6 years) across 8 club sport facilities and high schools completed paper-and-pencil surveys to establish the presence of CAI (Identification of Functional Ankle Instability [IdFAI]) and estimate perceived ankle function (Foot and Ankle Ability Measure [FAAM]–Activities of Daily Living and FAAM-Sport), HRQoL (Pediatric Quality of Life Inventory 4.0 [PedsQL]), and physical activity (Hospital for Special Surgery Pediatric Functional Activity Brief Scale [HSS Pedi-FABS]).Results:The overall prevalence of CAI was 20.0%. Participants with unilateral CAI reported significantly lower (P < .001) ankle function (FAAM-Sport: 87.0 ± 14.8) and HRQoL (total PedsQL: 89.8 ± 9.8) than participants who did not have CAI (FAAM-Sport: 97.7 ± 6.0; total PedsQL: 93.5 ± 9.1). Physical activity was not different between participants with and without CAI.Conclusion:The prevalence of CAI was high among adolescent athletes. The presence of CAI negatively affected ankle function and HRQoL in adolescent athletes. Given the high prevalence and negative impact of CAI in an adolescent population, strategies to prevent ankle injuries and maintain physical activity are needed to alleviate future long-term consequences associated with developing CAI. These strategies should be implemented as soon as sport participation begins, as it appears that the origin of CAI may occur before adulthood.