Abstract
Background: The 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.
Methods: A 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 interobserver
reliability of both the selection procedure and the clinimetric evaluation was calculated using
modified kappa coefficients.
Results: The 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.
Conclusion: The 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.
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.
Methods: A 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 interobserver
reliability of both the selection procedure and the clinimetric evaluation was calculated using
modified kappa coefficients.
Results: The 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.
Conclusion: The 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.
| Original language | English |
|---|---|
| Journal | BMC Musculoskeletal Disorders |
| Volume | 8 |
| Issue number | 6 |
| Publication status | Published - 18 Jan 2007 |
Bibliographical note
BMC MUSCULOSKELETAL DISORDERSKeywords
- ankle instability
- systematic review
- clinimetrics
- questionnaire