Skip to main content

Cross-cultural adaptation and validation of the Spanish version of the Cumberland Ankle Instability Tool (CAIT): an instrument to assess unilateral chronic ankle instability

Clinical Rheumatology volume 32, pages 91–98 (2013)Cite this article

Abstract

The Cumberland Ankle Instability Tool (CAIT) is a valid instrument to determine the presence of chronic ankle instability (CAI) and to assess its severity. Self-report test is very useful for researchers and clinical practice, and CAI is a widespread tool. Nevertheless, there is lack of measurement instruments validated into Spanish, which represents a major difficulty for research dealing with a Spanish-speaking population. The questionnaire was cross-culturally adapted into Spanish. The psychometric properties tested in the Spanish version of the CAIT were measured for internal consistency, test–retest reliability, construct validity, criterion validity, and responsiveness in 108 participants who were recruited from several fitness centers. The Spanish version of the CAIT had high internal consistency (Cronbach's α = 0.766) and reliability (intraclass correlation coefficient = 0.979, 95 % confidence interval (CI) = 0.958–0.990). Correlation with the 36-item Short-Form Health Survey (SF-36) physical component summary score (rho = 0.241, p = 0.012) was greater than the SF-36 mental component summary score (rho = −0.162, p = 0.094). The construct validity shows three different factors in the questionnaire and good responsiveness with a mean change of −2.43 (95 % CI = −3.12 to 1.73, p < 0.0001) and a size effect of Cohen's d = 1.07. The Spanish version of the CAIT has been shown to be a valid and reliable instrument for measuring chronic ankle instability and constitutes a useful instrument for the measurement of CAI in the clinical setting in Spain.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Fong DT, Chan YY, Mok KM, Yung PSH, Chan KM (2009) Understanding acute ankle ligamentous sprain injury in sports. Sports Med Arthrosc Rehabil Ther Technol 1:14

    PubMed  Article  Google Scholar 

  2. Wilkerson LA (1992) Ankle injuries in athletes. Prim Care 19(2):377–392

    PubMed  CAS  Google Scholar 

  3. Kerkhoffs GMMJ, Rowe BH, Assendelft WJJ, Kelly K, Struijs PAA, van Dijk CN (2002) Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev (3)

  4. Denegar CR, Hertel J, Fonseca J (2002) The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity. J Orthop Sports Phys Ther 32(4):166–173

    PubMed  Google Scholar 

  5. Simoneau GC, Degner RM, Kramper CA, Kittleson KH (1997) Changes in ankle proprioception resulting from strips of athletic tape applied over the skin. J Athl Train 32:141–147

    PubMed  CAS  Google Scholar 

  6. Wilkerson GB, Nitz AJ (1994) Dynamic ankle stability: mechanical and neuromuscular interrelationships. J Sport Rehabil 3:43–57

    Google Scholar 

  7. Freeman MAR (1965) Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg 47:678–685

    CAS  Google Scholar 

  8. Tropp H, Odenrick P, Gillquist J (1985) Stabilometry recordings in functional and mechanical instability of the ankle joint. Int J Sports Med 6:180–182

    PubMed  Article  CAS  Google Scholar 

  9. Hiller CE, Refshauge KM, Bundy AC, Herbert RD, Kilbreath SL (2006) The Cumberland Ankle Instability Tool: report of validity and reliability. Arch Phys Med Rehabil 87:1235–1241

    PubMed  Article  Google Scholar 

  10. Docherty CL, Gansneder BM, Arnold BL, Hurwitz SR (2006) Development and reliability of the ankle instability instrument. J Athl Train 41(2):154–158

    PubMed  Google Scholar 

  11. Pynsent PB (2001) Choosing an outcome measure. J Bone Joint Surg Br 83-B:792–794

    Article  Google Scholar 

  12. Guillemin F (1995) Cross-cultural adaptation and validation of health status measures. Scand J Rheumatol 24:61e3

    Article  Google Scholar 

  13. Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 5(24):3186–3191

    Article  Google Scholar 

  14. Serra-Sutton V, Herdman M, Rajmil L, Santed R, Ferrer M, Siméoni MC, Auquier P (2002) Cross-cultural adaptation to Spanish of the Vécu et Santé Perçue de l’Adolescent (VSP-A): a generic measure of the quality of life of adolescents. Rev Esp Salud Publica 76(6):701–712

    PubMed  Article  Google Scholar 

  15. Mulero-Portela AL, Colon-Santaella CL, Cruz-Gomez C (2009) Cross-cultural adaptation of the disability of arm, shoulder, and hand questionnaire: Spanish for Puerto Rico version. Int J Rehabil Res 32(4):287–293

    PubMed  Article  Google Scholar 

  16. Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, Bouter LM, de Vet HCW (2007) Quality criteria are proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60(1):34–42

    PubMed  Article  Google Scholar 

  17. Menz HB (2005) Analysis of paired data in physical therapy research: time to stop double-dipping? J Orthop Sports Phys Ther 35(8):477–478

    PubMed  Google Scholar 

  18. Hefford C, Abbott JH, Arnold R, Baxter GD (2012) The patient-specific functional scale: validity, reliability, and responsiveness in patients with upper extremity musculoskeletal problems. J Orthop Sports Phys Ther 42(2):56–65

    PubMed  Google Scholar 

  19. Ware JE, Snow KK, Kosinski M, Gandek B (1993). SF-36 health survey (manual and interpretation guide). Boston, MA: Health Institute, New England Medical Center

  20. Alonso J, Prieto L, Antó JM (1995) The Spanish version of the SF-36 Health Survey (the SF-36 health questionnaire): an instrument for measuring clinical results. Med Clin (Barc) 104(20):771–776

    CAS  Google Scholar 

  21. Kline P (1994) An easy guide to factor analysis. Routledge, New York

    Google Scholar 

  22. Husted JA, Cook RJ, Farewell VT, Gladman DD (2000) Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol 53(5):459–468

    PubMed  Article  CAS  Google Scholar 

  23. Cohen, J, (1988). Statistical power analysis for the behavioral sciences 2nd edition. Hillsdale, NJ (ed) Erlbaum (first edition, 1977 New York: Academic Press)

  24. O’Driscoll J, Kerin F, Delahunt E (2011) Effect of a 6-week dynamic neuromuscular training programme on ankle joint function: a case report. Sports Med Arthrosc Rehabil Ther Technol 3:13

    PubMed  Article  Google Scholar 

  25. de Noronha M, Refshauge KM, Kilbreath SL, Crosbie J (2007) Loss of proprioception or motor control is not related to functional ankle instability: an observational study. Aust J Physiother 53(3):193–198

    PubMed  Article  Google Scholar 

  26. van der Wees PJ, Lenssen AF, Hendriks EJ, Stomp DJ, Dekker J, de Bie RA (2006) Effectiveness of exercise therapy and manual mobilisation in ankle sprain and functional instability: a systematic review. Aust J Physiother 52(1):27–37

    PubMed  Article  Google Scholar 

  27. Verhagen EALM, Van Tulder M, Van der Beek AJ, Bouter L, Van Mechelen W (2005) An economical evaluation of a proprioceptive balance board training program for the prevention of ankle sprains in volleyball. Br J Sports Med 39:111–115

    PubMed  Article  CAS  Google Scholar 

  28. Cacchio A, De Blasis E, Necozione S, Rosa F, Riddle DL, di Orio F, De Blasis D, Santilli V (2010) The Italian version of the lower extremity functional scale was reliable, valid, and responsive. J Clin Epidemiol 63(5):550–557

    PubMed  Article  Google Scholar 

  29. Liang MH (2000) Longitudinal construct validity: establishment of clinical meaning in patient evaluative instruments. Med Care 38(9 Suppl):II84e90

    Google Scholar 

Download references

Acknowledgments

The authors wish to express their gratitude to Medicarim Centro Company for their logistic support, Mr. Agustín Pérez-Barroso for his help with technical and practical issues in this study, Dr. Valentín Rocandio-Cilveti for his collaboration in the theoretical framework of this study, and every athlete who kindly agreed to take part in this research.

Disclosures

Cross-cultural adaptation to spanish speaker population of CAIT.

Author information

Affiliations

  1. Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071, Jaén, Spain

    David Cruz-Díaz, Fidel Hita-Contreras, Rafael Lomas-Vega, M. C. Osuna-Pérez & Antonio Martínez-Amat

  2. Institute of Biopathology and Regenerative Medicine (IBIMER), Departmento de Anatomía y Embriología, Facultad de Medicina, University of Granada, 18071, Granada, Spain

    Fidel Hita-Contreras & Antonio Martínez-Amat

Authors
  1. David Cruz-Díaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fidel Hita-Contreras
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rafael Lomas-Vega
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. C. Osuna-Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio Martínez-Amat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Martínez-Amat.

Appendices

Appendix 1. Cumberland Ankle Instability Tool

Please tick the statement that best describes your ankles.

figure a

Note: The scoring scale is on the right. The scoring system is not visible on the subject's version

Appendix 2. Spanish version of the CAIT

Por favor, marque en cada pregunta la ÚNICA afirmación que describa mejor sus tobillos

figure b

NOTA. La escala de puntuación está en la derecha. El sistema de puntuación no está visible en la versión del participante

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Cruz-Díaz, D., Hita-Contreras, F., Lomas-Vega, R. et al. Cross-cultural adaptation and validation of the Spanish version of the Cumberland Ankle Instability Tool (CAIT): an instrument to assess unilateral chronic ankle instability. Clin Rheumatol 32, 91–98 (2013). https://doi.org/10.1007/s10067-012-2095-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-012-2095-0

Keywords

  • Ankle instability
  • CAIT
  • Cross-cultural adaptation
  • Spanish version