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      Translation, cross-cultural adaptation and factor analysis of the Persian version of ankle instability instrument

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          Abstract

          Background: Ankle Instability Instrument (AII) is a questionnaire for determination of ankle stability status. The aim of this study is to cross-culturally translate and investigate the reliability and validity of AII in a sample of Persian-speaking Iranians, suffering from ankle sprain.

          Methods: One hundred twenty persons with a history of ankle sprain were recruited in the study. All participants completed the Persian version of Ankle Instability Instrument, Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM) and Foot and Ankle Outcome Score (FAOS) at the baseline. Out of them, 60 randomly selected subjects completed the questionnaires once more, one week later. Face validity, Test–retest reliability, internal consistency, standard error of measurement, minimal metric detectable change, spearman’s correlation coefficient and confirmatory factor analysis of AII measured. We used Lisrel v 8.80 software with significant level of p<0.05.

          Results: Persian version of AII is clear and unambiguous and its qualitative face validity was confirmed in the pilot study on the 20 subjects with a lateral ankle sprain. The interclass correlation coefficient, Cronbach’s alpha, standard error of measurement and minimal metric detectable change were 0.93, 0.87, 0.81 and 2.25 (95% confidence interval, 0.85-0.96). The Spearman correlations coefficients between AII, and CAIT, FAAM and FAOS measures were 0.91, 0.71 and 0.69 respectively. The original three factor structure of AII was replicated based on the confirmatory factor analysis. Which showed an adequate fit of the model to the data and goodness-of-various fit indices.

          Conclusion: The Ankle Instability Instrument Persian Version (AII-PV) is a reliable and valid measure for assessing the ankle stability status.

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          The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies.

          Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist. Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity. We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields. One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with high-quality studies (0.54 vs 11.55 per 1,000 exposures). Ankle sprain prevalence period estimates were similar across sub-groups. Lateral ankle sprain was the most commonly observed type of ankle sprain. Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity. Studies at a greater risk of bias were more likely to underestimate the risk of ankle sprain. Participants were at a significantly higher risk of sustaining a lateral ankle sprain compared with syndesmotic and medial ankle sprains.
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            The Cumberland ankle instability tool: a report of validity and reliability testing.

            To test the Cumberland Ankle Instability Tool (CAIT), a 9-item 30-point scale, for measuring severity of functional ankle instability. Cross-sectional study. General community. Volunteer sample of 236 subjects. Not applicable. Concurrent validity by comparison with the Lower Extremity Functional Scale (LEFS) and a visual analog scale (VAS) of global perception of ankle instability by using the Spearman rho. Construct validity and internal reliability with Rasch analysis using goodness-of-fit statistics for items and subjects, separation of subjects, correlation of items to the total scale, and a Cronbach alpha equivalent. Discrimination score for functional ankle instability by maximizing the Youden index and tested for sensitivity and specificity. Test-retest reliability by intraclass correlation coefficient, model 2,1 (ICC(2,1)). There were significant correlations between the CAIT and LEFS (rho=.50, P 0.5; item reliability index, .99). The threshold CAIT score was 27.5 (Youden index, 68.1); sensitivity was 82.9% and specificity was 74.7%. Test-retest reliability was excellent (ICC(2,1)=.96). CAIT is a simple, valid, and reliable tool to measure severity of functional ankle instability.
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              Psychometric Properties of the Spanish Version of the Tampa Scale for Kinesiophobia (TSK).

              The Tampa Scale for Kinesiophobia (TSK) is one of the most frequently employed measures for assessing pain-related fear in pain patients. Although the TSK has been translated into different languages, a Spanish version of the TSK has not been available, up to now. Thus, the aim of this study was to validate the Spanish version of the TSK in 2 different pain samples: A heterogeneous chronic pain sample (n = 125) and a musculoskeletal acute pain sample (n = 86). Factor analysis revealed a 2-factor model of 11 items replicated on both samples, named TSK-11. The instrument obtained shows good reliability (internal consistency and stability) and validity (convergent and predictive), with the advantage of brevity. Evidence is provided on discriminant validity between both TSK factors (called Activity Avoidance and Harm). The Harm factor shows the best predictive validity, as it predicts pain persistence, catastrophizing, depression, and pain intensity scores after 6 months. Changes in the Activity Avoidance factor are positively correlated with changes in catastrophizing and anxiety, and negatively associated with changes in functional status. The results of this study point to the relative contribution of both components of pain-related fear to pain adjustment. This article presents the Spanish version of the TSK. Factor analysis revealed a 2-factor model (called Activity Avoidance and Harm). The version obtained shows good reliability and validity. Results provide clinicians with access to a measure of pain-related fear for Spanish-speaking pain patients, offering the advantage of brevity. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Med J Islam Repub Iran
                Med J Islam Repub Iran
                MJIRI
                Med J Islam Repub Iran
                Medical Journal of the Islamic Republic of Iran
                Iran University of Medical Sciences
                1016-1430
                2251-6840
                2018
                01 September 2018
                : 32
                : 79
                Affiliations
                1 Department of Physiotherapy, Iran University of Medical Sciences, Tehran, Iran.
                2 Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
                3 Department of Statistical Research and Information Technology, Institute for Research and Planning in Higher Education, Tehran, Iran.
                4 Department of Orthopedic Surgery, Iran University of Medical Sciences, Tehran, Iran.
                Author notes
                Corresponding author: Dr Ismail Ebrahimi, ebrahimitakamjani.e@ 123456iums.ac.ir
                Article
                10.14196/mjiri.32.79
                6325292
                7223aba9-3cd1-4afd-8f71-54c17b6bf4d7
                © 2018 Iran University of Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0), which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                : 28 November 2017
                Page count
                Figures: 1, Tables: 4, References: 21, Pages: 6
                Categories
                Original Article

                ankle sprain,instability,psychometric,questionnaire,persian,confirmatory factor analysis

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