To establish the minimal detectable change (MDC) and minimal clinically important difference (MCID) for the Cumberland Ankle Instability Tool (CAIT) in a population with chronic ankle instability (CAI).
A convenience sample of individuals with CAI (N=50; 12 men; 38 women; episodes of giving way, 5.84±12.54mo). CAI inclusion criteria included a history of an ankle sprain, recurrent episodes of giving way, and a CAIT score ≤25.
Participants completed demographic information, an injury history questionnaire, and the CAIT. Participants then either participated in 4 weeks of wobble board balance training, resistance tubing strength training, or no intervention. After 4 weeks, participants recompleted the CAIT and recorded their global rating of change (GRC).
Main Outcome Measures
Dependent variables were pre- and postintervention scores on the CAIT and postintervention GRC. The MDC with 95% confidence interval was calculated. A receiver operating characteristic (ROC) curve identified the optimal CAIT cut point (MCID) between improved and unimproved individuals on the basis of their GRC. The area under the curve was used to identify a significant ROC curve (α=.05).
The average CAIT score preintervention was 16.8±5.6, and postintervention, it was 20.0±5.2. Thirty-one participants (62%) rated themselves as improved on the GRC scale, whereas 19 (38%) were not improved. The ROC curve was significant (area under the curve, .797; P=.001), indicating that the CAIT change score significantly predicted clinical status. The MDC was 3.08, and the MCID was ≥3 points.
The CAIT has an MDC and MCID of ≥3 points. When CAIT scores are used to assess patient change over time, these scores should be used as a minimum threshold to indicate detectable and clinically meaningful improvement.
List of abbreviations:AUC (area under the curve), CAI (chronic ankle instability), CAIT (Cumberland Ankle Instability Tool), GRC (global rating of change), ICC (intraclass correlation coefficient), MCID (minimal clinically important difference), MDC (minimal detectable change), ROC (receiver operating characteristic)
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- The Cumberland Ankle Instability Tool: a report of validity and reliability testing.Arch Phys Med Rehabil. 2006; 87: 1235-1241
- Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability.J Athl Train. 2002; 37: 364-375
- The etiology and prevention of functional instability of the foot.J Bone Joint Surg Br. 1965; 47: 678-685
- Instability of the foot after injuries to the lateral ligament of the ankle.J Bone Joint Surg Br. 1965; 47: 669-677
- Effects of ankle sprain in a general clinic population 6 to 18 months after medical evaluation.Arch Fam Med. 1999; 8: 143-148
- Seven years follow-up after ankle inversion trauma.Scand J Med Sci Sports. 2002; 12: 129-135
- Long term outcomes of inversion ankle injuries.Br J Sports Med. 2005; 39: 14-17
- Functional ankle instability and health-related quality of life.J Athl Train. 2011; 46: 634-641
- Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium.J Athl Train. 2014; 49: 121-127
- Effects of 6 weeks of balance training on chronic ankle instability in athletes: a randomized controlled trial.Int J Sports Med. 2015; 36: 754-760
- Which treatment is more effective for functional ankle instability: strengthening or combined muscle strengthening and proprioceptive exercises?.J Phys Ther Sci. 2014; 26: 385-388
Wright CJ, Linens SW, Cain MS. A randomized controlled trial comparing rehabilitation efficacy in chronic ankle instability. J Sport Rehabil; in press.
- Recalibration and validation of the Cumberland Ankle Instability Tool cutoff score for individuals with chronic ankle instability.Arch Phys Med Rehabil. 2014; 95: 1853-1859
- Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change.Health Qual Life Outcomes. 2006; 4: 54
- Clinimetrics corner: a closer look at the minimal clinically important difference (MCID).J Man Manip Ther. 2012; 20: 160-166
- Evidence of validity for the Foot and Ankle Ability Measure (FAAM).Foot Ankle Int. 2005; 26: 968-983
- Force sense deficits in functionally unstable ankles.J Orthop Res. 2008; 26: 1489-1493
- Global rating of change scales: a review of strengths and weaknesses and considerations for design.J Man Manip Ther. 2009; 17: 163-170
- Index for rating diagnostic tests.Cancer. 1950; 3: 32-35
- Minimal clinically important difference of the Disabilities of the Arm, Shoulder and Hand outcome measure (DASH) and its shortened version (QuickDASH).J Orthop Sports Phys Ther. 2014; 44: 30-39
- Clinimetrics corner: the minimally clinically important change score (MCID): a necessary pretense.J Man Manip Ther. 2008; 16: E82-E83
- The meaning and use of the area under a receiver operating characteristic (ROC) curve.Radiology. 1982; 143: 29-36
- Sample size estimation in diagnostic test studies of biomedical informatics.J Biomed Inform. 2014; 48: 193-204
Published online: January 27, 2017
Current affiliation for Linens, University of Oregon, Eugene, OR.
Supported in part by the Pennsylvania Athletic Trainers' Society.
© 2017 by the American Congress of Rehabilitation Medicine