Cross-cultural adaptation, reliability, and validation of the Taiwan-Chinese version of Cumberland Ankle Instability Tool

Figures & data

Figure 1. The flow chart of data collection. CAIT-TW: Taiwan-Chinese version of Cumberland Ankle Instability Tool; LEFS-TW: Taiwan-Chinese version of Lower Extremity Function Scale; NRS: Numeric Rating Scale; CAI: chronic ankle instability.

Table 1. Taiwan-Chinese version of Cumberland Ankle Instability Tool.

康柏蘭腳踝穩定性評估量表 在以下問題中, 請選擇最能描述您腳踝狀況的選項:

1. 我有腳踝疼痛	左踝	右踝
A從來沒有5
B在運動的過程中4
C在不平坦的路面跑步3
D在平坦的路面跑步2
E在不平坦的路面行走1
F在平坦的路面行走0
2. 我感覺到腳踝不穩定	左踝	右踝
A從來沒有4
B偶爾發生在運動過程中(並非每次運動)3
C經常發生在運動過程中(每次運動)2
D偶爾發生在日常活動中1
E經常發生在日常活動中0
3. 快速轉換方向時, 我會感覺到腳踝不穩定	左踝	右踝
A從來沒有3
B偶爾發生在跑步過程中2
C經常發生在跑步過程中1
D發生在走路時0
4. 下樓梯時, 我會感覺到腳踝不穩定	左踝	右踝
A從來沒有3
B只有快速下樓時2
C偶爾發生1
D總是發生0
5. 單腳站立時, 我會感覺到腳踝不穩定	左踝	右踝
A從來沒有2
B墊腳尖站立時1
C全腳掌平貼地面時0
6. 做下列哪個動作時, 我感覺到腳踝不穩定?	左踝	右踝
A從來沒有3
B單腳左右來回跳2
C單腳原地反覆向上跳1
D雙腳向上跳0
7. 做下列哪個動作時, 我感覺到腳踝不穩定?	左踝	右踝
A從來沒有4
B在不平坦的路面跑步3
C在不平坦的路面慢跑2
D在不平坦的路面行走1
E在平坦的路面行走0
8. 當腳踝快要扭傷(翻腳刀)時,	左踝	右踝
A我都能立刻阻止扭傷發生3
B我時常能阻止扭傷發生2
C我偶爾能阻止扭傷發生1
D我無法阻止扭傷發生0
E我不曾扭傷腳踝3
9. 在扭傷之後, 我的腳踝通常需要多久才能恢復正常？	左踝	右踝
A立刻恢復3
B一天以內2
C一到兩天1
D兩天以上0
E我不曾扭傷腳踝3

Table 2. Participants’ characteristics for testing construct validity.

	CAI	CON	Homogeneity
N (Men/Women)	58 (36/22)	58 (51/7)
Age (year)	20.5 ± 1.5	20.1 ± 1.3	p = 0.56
Height (m)	171.7 ± 9.9	173.1 ± 8.5	p = 0.05
Weight (kg)	68.5 ± 14.9	65.5 ± 14.2	p = 0.40
Training hours per week	20.6 ± 7.0	18.1 ± 5.6	p = 0.63
Training experience (year)	9.8 ± 3.1	9.3 ± 3.1	p = 0.55
CAIT-TW	16.4 ± 4.1	25.6 ± 4.4	p < 0.001^a
LEFS-TW	76.2 ± 4.8	78.7 ± 2.9	p < 0.001^a
NRS	4.9 ± 1.8	1.7 ± 1.9	p < 0.001^a

CAI: group of Chronic ankle instability; CON: control group; CAIT-TW: Taiwan-Chinese version of Cumberland Ankle Instability Tool; LEFS-TW: Taiwan-Chinese version of Lower Extremity Function Scale; NRS: Numeric Rating Scale.

^ap < 0.05.

Table 3. Participants’ characteristics in evaluating test-retest reliability, internal consistency, and discriminating ability.

	CAI	CON	Homogeneity
N (Men/Women)	75 (47/28)	47 (40/7)
Age (year)	20.5 ± 1.5	20.1 ± 1.4	p = 0.11
Height (cm)	171.4 ± 9.5	173.0 ± 9.0	p = 0.26
Weight (kg)	66.9 ± 14.1	66.0 ± 15.5	p = 0.82
Training hours per week	19.2 ± 7.0	18.9 ± 5.6	p = 0.79
Training experience (year)	9.7 ± 3.6	9.4 ± 3.2	P = 0.89
CAIT-TW score	16.6 ± 4.3	26.1 ± 4.0	p < 0.001^a
CAIT-TW retest score	17.2 ± 5.2	26.6 ± 4.3	p < 0.001^a
LEFS-TW	76.3 ± 4.8	78.8 ± 3.0	p < 0.001^a
NRS	5.0 ± 1.8	1.5 ± 1.9	p < 0.001^a

CAI: group of Chronic ankle instability; CON: control group; CAIT-TW: Taiwan-Chinese version of Cumberland Ankle Instability Tool; LEFS-TW: Taiwan-Chinese version of Lower Extremity Function Scale; NRS: Numeric Rating Scale.

^ap < 0.05.

Table 4. Test-retest of Taiwan-Chinese version of Cumberland Ankle Instability Tool.

Items	ICC2.1	95%CI	p value
Item 1	0.82	0.75–0.88	<0.001
Item 2	0.60	0.43–0.73	<0.001
Item 3	0.71	0.59–0.80	<0.001
Item 4	0.68	0.58–0.78	<0.001
Item 5	0.73	0.62–0.81	<0.001
Item 6	0.71	0.59–0.80	<0.001
Item 7	0.83	0.76–0.88	<0.001
Item 8	0.82	0.74–0.87	<0.001
Item 9	0.85	0.78–0.89	<0.001
Total score	0.91	0.87–0.94	<0.001

Table 5. Internal consistency of Taiwan-Chinese version of Cumberland Ankle Instability Tool.

	Corrected item: total correlation	Cronbach’s α if item was deleted
Item 1	0.67	0.85
Item 2	0.58	0.85
Item 3	0.64	0.85
Item 4	0.63	0.85
Item 5	0.48	0.86
Item 6	0.65	0.85
Item 7	0.68	0.84
Item 8	0.59	0.85
Item 9	0.65	0.85

No improvement was observed if any item was deleted.

Figure 2. The receiver operating characteristic (ROC) curve of Taiwan-Chinese version of Cumberland Ankle Instability Tool. The area under the curve was 0.94.

Table 6. Sensitivity, specificity and Youden index of Taiwan-Chinese version of Cumberland Ankle Instability Tool.

CAIT score	Sensitivity	Specificity	Youden index
3.0	1.00	0.00	0.00
5.5	1.00	0.01	0.01
7.5	1.00	0.03	0.03
8.5	1.00	0.07	0.07
9.5	1.00	0.08	0.08
10.5	1.00	0.11	0.11
11.5	1.00	0.12	0.12
12.5	1.00	0.15	0.15
13.5	1.00	0.17	0.17
14.5	1.00	0.29	0.29
15.5	1.00	0.39	0.39
16.5	0.98	0.45	0.43
17.5	0.96	0.57	0.53
18.5	0.94	0.68	0.62
19.5	0.91	0.73	0.65
20.5	0.91	0.77	0.69
21.5	0.87	0.85	0.73
22.5	0.83	0.89	0.72
23.5	0.72	1.00	0.72
24.5	0.66	1.00	0.66
25.5	0.57	1.00	0.57
26.5	0.55	1.00	0.55
27.5	0.49	1.00	0.49
28.5	0.43	1.00	0.43
29.5	0.32	1.00	0.32
31.0	0.00	1.00	0.00

ROC showed that the cutoff score of CAIT-TW was 21.5 according to the maximum Youden index (0.73).