Cross-cultural Adaptation, Reliability and Validity of the Cantonese-Chinese Cumberland Ankle Instability Tool (CAIT-HK)

Acute ankle sprains are common amongst athletes, and screening is essential in preventing these long-term sequelae. Self-reported questionnaires, such as the Cumberland Ankle Instability Tool (CAIT), may help identify individuals with chronic ankle instability. To date, a Cantonese-Chinese version of the CAIT does not exist. Although several studies have cross-culturally adapted the CAIT into Chinese and Taiwan-Chinese, there are cultural differences in language use. A cross-cultural adaptation and validation of the CAIT were carried out: 46 individuals who were native in Cantonese completed the Cantonese-Chinese version of the CAIT and Chinese Foot and Ankle Outcome Score. For the test-retest analysis, the intraclass correlation coefficient was 0.874. Internal consistency showed a Cronbach's ɑ value of 0.726. Construct validity against the FAOS was fair but significant with a Spearman's correlation coefficient of 0.353, 0.460, 0.303, 0.369 and 0.493 for the categories of symptoms, pain, daily function, sports function, and quality of life respectively. A cut-off score of 20.5 was determined to differentiate healthy individuals from those with chronic ankle instability for this study population. The original English CAIT was successfully translated, cross-culturally adapted and validated into Cantonese-Chinese.

Validity and reliability of smartphone-based application for chronic ankle instability

Background/aims Ankle instability is one of the most common injuries that can occur during everyday life, sports and exercise. Recently, smartphone accelerometers have been used to measure single leg balance associated with ankle instability, because they are easy to use, inexpensive and can be used in small spaces. Thus, the purpose of this study was to introduce and investigate the intra- and inter-rater reliability of the smartphone accelerometer when assessing ankle instability. Methods A total of 26 individuals who had ankle instability were recruited. The single leg stance balance was measured using a smartphone accelerometer (Accelerometer application) and a force platform (I-Balance) for 5 seconds with their eyes open or their eyes closed. Results In the eyes open position, intra-rater reliability of the smartphone accelerometer was excellent for both raters (intraclass correlation coefficient: 0.87–0.90); and the inter-rater reliability was moderate (intraclass correlation coefficient: 0.71). In the eyes closed position, the intra-rater reliability of the smartphone accelerometer was excellent for both raters (intraclass correlation coefficient: 0.90–0.93); the inter-rater reliability was good (intraclass correlation coefficient: 0.82). Additionally, there were fair positive correlations between the smartphone accelerometer and the Cumberland Ankle Instability Tool, and between the smartphone accelerometer and I-Balance (r=0.33, 0.30 respectively). Conclusions The present study demonstrated excellent intra-rater reliabilities of two raters and moderate to good inter-rater reliabilities. The smartphone accelerometer offers several important advantages as a potential portable medical device to assess ankle instability accurately. Although there was a positive correlation, the relationships between the smartphone accelerometer and Cumberland Ankle Instability Tool and that between the smartphone accelerometer and I-Balance were fair. Future studies should investigate the validity of the smartphone accelerometer as a portable medical device for determining ankle instability.

Development of a valid Chinese version of the Cumberland Ankle Instability Tool in Chinese-speaking patients with chronic ankle instability disorders

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.

PENAMBAHAN CORE STABILITY PADA STAR EXCURSION BALANCE EXERCISE LEBIH MENINGKATKAN KESEIMBANGAN DINAMIS DAN MENURUNKAN FUNGSIONAL ANKLE INSTABILITAS DARIPADA STAR EXCURSION BALANCE EXERCISE PADA BELA DIRI TAEKWONDO

Latar belakang: Taekwondo merupakan bela diri yang banyak menggunakan anggota gerak bawah terutama pergelangan kaki sehingga sering terjadi fungsional ankle instabilitas (FAI). FAI terjadi akibat adanya gangguan dari postural kontrol, keseimbangan dinamis dan fungsi otot. Salah satu latihan yang dapat dipergunakan adalah star excursion balance exercise, namun masih ada kekurangan dalam kontrol postural akibat tidak terjadi aktivasi otot core untuk pembentukan postural stabilisasi. Tujuan: Untuk membuktikan penambahan core stability pada star excursion balance exercise lebih meningkatkan keseimbangan dinamis dan menurunkan fungsional ankle instabilitas daripada star excursion balance exercise pada bela diri taekwondo. Metode: Rancangan penelitian ini adalah randomized pretest-postest control group design, Kelompok 1 mendapatkan star excursion balance exercise dan Kelompok 2 mendapatkan core stability dan star excursion balance exercise. Fungsional ankle instabilitas diukur menggunakan cumberland ankle instability tool (CAIT) dan keseimbangan dinamis menggunakan star excursion balance test (SEBT). Dilakukan 3 kali seminggu selama 6 minggu. Hasil: Peningkatan SEBT sebelum pelatihan pada Kelompok 1 sebesar 86,4±6,3 cm, setelah pelatihan sebesar 92,3±6,7cm dan pada Kelompok 2 sebelum sebesar 86,2±6,1 cm, setelah pelatihan sebesar 96,7±7,9 cm. Penurunan fungsional ankle instabilitas dari peningkatan nilai CAIT sebelum pelatihan pada Kelompok 1 sebesar 20,4±1,8, setelah pelatihan sebesar 23,4±2,1 dan pada Kelompok 2 sebelum sebesar 20,3±2,8, setelah pelatihan sebesar 25,0±1,9. Perbedaan peningkatan keseimbangan dinamis pada Kelompok 1 dan 2 bermakna (p<0,05). Perbedaan penurunan FAI pada Kelompok 1 dan 2 bermakna (p<0,05). Kesimpulan: Penambahan core stability pada star excursion balance exercise lebih meningkatkan keseimbangan dinamis dan menurunkan fungsional ankle instabilitas daripada star excursion balance exercise pada bela diri taekwondo. Kata kunci: fungsional ankle instabilitas, keseimbangan dinamis, star excursion balance exercise, core stability.

Performance Differences Between the Modified Star Excursion Balance Test and the Y-Balance Test in Individuals With Chronic Ankle Instability

Context: The modified Star Excursion Balance Test (mSEBT) and Y-Balance Test (YBT) are common dynamic postural stability assessments for individuals with chronic ankle instability (CAI). However, the reach distance measurement technique and movement strategy used during the mSEBT and YBT differ. To date, no studies have compared task performance differences on these tests in CAI patients. Objective: To determine whether individuals with CAI perform the mSEBT and YBT differently. Design: Cross-sectional. Setting: Biomechanics laboratory. Participants: Of 97 consented participants, 86 (43 females, 43 males; age 21.5 [3.3] y, height 169.8 [10.3] cm, mass 69.5 [13.4] kg), who reported ≤25 on the Cumberland Ankle Instability Tool, ≥11 on the Identification of Functional Ankle Instability, and had a history of a moderate to severe ankle sprain(s) participated. Interventions: Participants were instructed to perform the mSEBT and YBT in a predetermined counterbalanced order. Three anterior, posteromedial, and posterolateral trials of each test were completed on the involved limb after 4 practice trials. Test direction order was randomized for each participant. Main Outcome Measures: Normalized (expressed in percentage) reach distance in each direction. Paired sample t tests were performed to compare each of the 3 directions between the mSEBT and YBT. Results: Significantly shorter reach distances in the anterior (58.9% [5.8%] vs 61.4% [5.4%], P = .001) and the posteromedial (98.8% [8.6%] vs 100.8% [8.1%], P = .003) directions were noted on the mSEBT relative to the YBT. No differences in the posterolateral directions were observed. Conclusions: Within those with CAI, mSEBT and YBT normalized reach distances differ in the anterior and posteriomedial directions. As a result, clinicians and researchers should not directly compare the results of these tests.