Christophe Eechaute

The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: A systematic review

BackgroundThe assessment of outcomes from the patients 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.MethodsA 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 inter-observer reliability of both the selection procedure and the clinimetric evaluation was calculated using modified kappa coefficients.ResultsThe 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.ConclusionThe 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.

Functional Performance Deficits in Patients With Cai: Validity of the Multiple Hop Test

Objectives:To investigate the reliability and validity of a functional performance test in patients with chronic ankle instability (CAI). Design:Cross-sectional study. Setting:All tests were conducted in the practice room of the physical therapy department of the Vrije Universiteit Brussel. Participants:Twenty-nine healthy subjects and 29 patients with CAI were selected. For the main outcome measurements, participants performed a multiple hop test two times, within a 1-week time interval. Subjects hopped on 10 different tape markers and had to try to avoid making any postural correction. Only when subjects stood still were they allowed to continue hopping. The time needed to complete the test and VAS scores for the perceived difficulty were assessed. Results:In unstable ankles, ICCs of time values were >0.90 (SEM = 2.3 seconds); Spearman rho values of VAS scores were >0.80. When hopping on their unstable ankles, patients (41.1 ± 12.6 seconds) needed significantly more time to complete the test than healthy subjects (31.4 ± 5.0 seconds; test: P = 0.000; retest: P = 0.002) or when compared with their unaffected contralateral ankles (38.0 ± 7.1 seconds; test: P = 0.047; retest: P = 0.009). Only with respect to the dominant ankles, patients (median = 64 mm) perceived the test as significantly more difficult than did healthy subjects (median = 37 mm; test: P = 0.018; retest: P = 0.002). VAS scores of unstable ankles in patients (median = 50 mm) were significantly higher than their contralateral, unaffected ankles (median = 30 mm; test: P = 0.001; retest: P = 0.002). Conclusions:The multiple hop test is a reliable test demonstrating functional performance deficits in patients with CAI.

Reliability and discriminative validity of sudden ankle inversion measurements in patients with chronic ankle instability.

BACKGROUND Studies investigating peroneal muscle reaction times in chronically unstable ankle joints present conflicting results. The degree of reliability and accuracy of these measurements is unknown in patients with chronic ankle instability (CAI). METHODS 40 patients with CAI and 30 healthy subjects were tested using a sudden ankle inversion of 50 degrees while standing on a trapdoor device. Sudden ankle inversion measurements were registered using electromyography, accelerometry and electrogoniometry. For reliability testing, intra-class coefficients (ICCs; model 3,1) and standard errors of measurements of the latency time, motor response time and electromechanical delay of the peroneus longus muscle, the time and angular position of onset of decelerations, the mean and maximum inversion speed and the total inversion time were calculated in 15 patients with CAI. To assess between-group differences, t-tests for independent samples (p<.05) were used. RESULTS ICCs ranged from .20 (angular position of onset of the second deceleration) to .98 (electromechanical delay of the peroneus longus muscle). Significant between-group differences were observed in only 2 of the 12 variables (for the electromechanical delay of the peroneus longus muscle, p=.001; time of onset of the second deceleration, p=.040). CONCLUSIONS The latency time and motor response time of the peroneus longus muscle, the total inversion time and the mean inversion speed demonstrate acceptable reliability in healthy subjects and patients. The latency time and motor response time of the peroneus longus muscle are not delayed in patients with CAI. Ankle inversion measurements are not discriminative for CAI.

The dynamic postural control is impaired in patients with chronic ankle instability: reliability and validity of the multiple hop test.

Objective:To investigate the reliability and validity of a clinical evaluation method for the assessment of the dynamic postural control in patients with chronic ankle instability (CAI). Design:Cross-sectional study. Setting:All tests were conducted at the practice room of the Physical Therapy Department. Participants:Twenty-nine healthy subjects and 29 patients with CAI were selected. Interventions:Participants performed twice a multiple hop test within a 1-week time interval. Subjects hopped on 10 different tape markers while trying to avoid any postural correction. Main Outcome Measures:The number and type of balance errors were documented by analyzing the digital video images. Results:Test-retest reliability of the number of balance errors was excellent in patients (intraclass correlation coefficient, ICC = 0.83; standard errors of measurement = 2.6) and moderate in healthy subjects (ICC = 0.64; standard errors of measurement = 2.8). The intra-observer and inter-observer reliability was excellent (ICC > 0.90). Both for the test (P = 0.000) and for the retest (P = 0.000), the number of balance errors in patients was significantly higher (17.9 ± 6.6) when compared with healthy subjects (10.9 ± 4.6). On both test occasions, patients with CAI used significantly more a change-in-support strategy (test: P = 0.000; retest: P = 0.000). The number of balance errors was significantly correlated with the time needed to perform the test (r = 0.60; P = 0.000) and the perceived difficulty of the hop test as rated on a visual analogue scale (r = 0.44; P = 0.014). Conclusions:The multiple hop test is a reliable and valid test for detecting an impaired dynamic postural control in patients with CAI.

The multiple hop test: a discriminative or evaluative instrument for chronic ankle instability?

Objective:To determine whether the multiple hop test should be used as an evaluative or a discriminative instrument for chronic ankle instability (CAI). Design:Blinded case–control study. Setting:University research laboratory. Participants:Twenty-nine healthy subjects (21 men, 8 women, mean age 21.8 years) and 29 patients with CAI (17 men, 12 women, mean age 24.9 years) were selected. Interventions:Subjects performed a multiple hop test and hopped on 10 different tape markers while trying to avoid any postural correction. Main Outcome Measures:Minimal detectable changes (MDC) of the number of balance errors, the time value, and the visual analog scale (VAS) score (perceived difficulty) were calculated as evaluative measures. For the discriminative properties, a receiver operating characteristic curve was determined and the area under curve (AUC), the sensitivity, specificity, diagnostic accuracy (DA), and likelihood ratios (LR) were calculated whether 1, 2, or 3 outcomes were positive. Results:Based on their MDC, outcomes should, respectively, change by more than 7 errors (41%), 6 seconds (15%), and 27 mm (55%, VAS score) before considering it as a real change. Area under curves were, respectively, 79% (errors), 77% (time value), and 65% (VAS score). The most optimal cutoff point was, respectively, 13.5 errors, 35 seconds, and 32.5 mm. When 2 of 3 outcomes were positive, the sensitivity was 86%, the specificity was 79%, the DA was 83%, the positive LR was 4.2, and the negative LR was 0.17. Conclusions:The multiple hop test seems to be more a discriminative instrument for CAI, and its responsiveness needs to be demonstrated.

Evidence of a different landing strategy in subjects with chronic ankle instability

The purpose of the study is to evaluate the discriminative validity of the multiple hop test (MHT) for chronic ankle instability (CAI). The dynamic postural control of 51 CAI subjects and 52 uninjured controls was assessed using the MHT. To evaluate dynamic postural control, the type and number of balance errors were analysed and the time to complete the MHT was measured. Between-group differences of time scores and balance errors, identified as being change-in-support strategy errors (CSS) or fixed-support strategy errors (FSS), were assessed. The area under curve of the outcomes was determined and likelihood ratios (LRs) were calculated based upon their most optimal cut off point. When compared to uninjured controls, CAI subjects needed significantly more time to perform the test (p<0.001) and made significantly more CSS errors (p<0.001). When 1 positive outcome (time score or CSS errors) was considered as a criterion, the LR+ was 2 and the LR- 0.08. In the case of 2 positive outcomes (time score and CSS errors), the LR+ was 7.1 and the LR- 0.49. CAI subjects have an impaired dynamic postural control and rely on a different postural strategy to restore balance. The MHT has good discriminative validity for CAI.