Cross-cultural Adaptation and Cut-off Score Determination of the Turkish Version of the Cumberland Ankle Instability Tool (CAIT-TR)

The foot and ankle are the most common injured body parts after the knee in the general population and athletes. Ankle sprain, which is the most common injury in the ankle, consists of more than 80% of all ankle injuries. While the rate of ankle injury among all sports injuries is 23%, according to a study, the most common sports injury seen among 33 sports is ankle sprain (76.7%). Taking into account that ankle sprains are considered insignificant by athletes and coaches and that 40-55% of individuals who experienced ankle sprains for the first time do not seek medical support and treatment from a healthcare professional, it is understood that this rate is higher than it seems. Almost half of the ankle sprains (49.3%) occur during athletic activities, and these ankle sprains that are related to athletic activity are mostly common in basketball (41.1%), football (9.3%), and soccer (7.9%). The incidence of ankle sprain is seen higher in the field (i.e. field, court) and team sports (such as rugby, soccer, volleyball, handball, basketball, American football, Australian football, Gaelic football, tennis, netball, lacrosse, and field hockey). The incidence of ankle sprains, which is quite common in athletes and also in the general population, has been seen as higher in women compared to men, in adults compared to adolescents, and in children compared to adolescents.

Despite the acute symptoms of ankle sprain disappearing very quickly, most individuals develop long-term symptoms such as pain, a feeling of instability, a perception of weakness, and crepitus, which play a role in the development of chronic ankle instability (CAI) after the injury. Seventy-four percent of individuals with an ankle sprain show at least one symptom for 1.5-4 years following the injury, and 32% of individuals with a history of ankle sprain have chronic complaints even 7 years after the injury. One of the most common of these permanent problems is CAI and the feeling of "giving way", which occurs as a result of multiple recurrences of ankle sprain. Ankle stabilization is an integral part of normal movement and minimizes the risk of ankle sprain during sports activities.

Ankle sprains have a high recurrence rate, and approximately 30% of individuals with a history of ankle sprains experience CAI. CAI is observed within 1 year after the injury in 40.5% of individuals who have had their first ankle sprain, and the incidence of CAI can reach up to 70% shortly after the sprain. The chronicity of recurrent sprains, the decrease in physical activity level and quality of life, the increase in post-traumatic ankle osteoarthritis rates, and the large financial costs cause deterioration in the athletic performance of athletes. Considering all these results, the necessity of an appropriate approach to prevent injury and comprehensive rehabilitation programs is a fact.

Although there are different definitions such as chronic ankle instability, functional ankle instability, and mechanical ankle instability. The term CAI is most frequently used when describing patients who report that their symptoms continue after their first ankle sprain, and the most reported losses associated with CAI are the number/repeat of sprains and the sensation of giving way in the ankle joint. Ankle instability is a common clinical problem in athletes, in which various complex mechanical and neuromuscular factors play a role. Two hypothetical causes of CAI are defined as mechanical instability and functional instability. Mechanical instability (MI) is defined as ankle movement beyond the physiological limits of the ankle range of motion. The term laxity is often used synonymously with mechanical instability. Functional instability (FI) is defined as ankle instability due to proprioceptive and neuromuscular deficits or the subjective feeling of recurrent and symptomatic ankle sprains (or both). As it can be understood from here, the perception of individuals is an important issue in CAI diagnoses.

Interventions by clinicians and physiotherapists are usually standard medical tests and practices and their evaluations, which initially provide key information based on various screening methods, joint range of motion, and joint and tissue stability. With these results, which do not include the perspective of the individual, in addition to the measurable characteristics of the individual, it is largely incomprehensible how the patient feels about his health status. The goal of most healthcare services is to improve patient's well-being, and patients themselves are probably the ones who can best assess their feelings. Patient-reported measures of outcome (PROM) convert qualitative entities such as anxiety, pain, or social functioning that cannot be directly observed, or that are impractical or impossible to directly observe (for example, the performance of daily activities), into quantitative scores that can be processed mathematical statements such as patient perceptions of certain aspects of their own health. PROMs can provide both valid and reliable results that directly reflect the patient's own perspective, without the interpretation of the doctor or others, in response to a series of questions asked about patients' views and priorities regarding the treatment they receive or their own health status, how they feel, their quality of life, or their functional status. They are questionnaire-like scales that were developed to measure patients' own assessments of their health and health-related quality of life. PROMs such as the Western Ontario Shoulder Instability Index (WOSI) for shoulder instability, knee injury, osteoarthritis outcome score (KOOS) for knee problems, and Victorian Sports Assessment Institute (VISA) for tendinopathies are widely used in sports health. PROMs, which are useful clinical tools to obtain information about the perceived health status of patients, are becoming increasingly popular for clinicians to measure the changes in patient's health status over time. PROMs are usually general, regional, or disease-specific. While using scales such as the SF-36 health questionnaire in the general evaluation of health status, regional scales designed to be sensitive to the characteristics of the population to assess problems and functions specific to certain regions of the musculoskeletal system, such as general shoulder, arm and hand disorders (DASH), Victorian sports institute for Achilles assessment (VISA-A) or condition-specific examples such as patellar tendinopathy (VISA-P). Disease-specific rating scales are designed to assess function, pain, and problems in specific conditions. Scales whose reliability, validity, and responsiveness have been scientifically tested are the most useful scales.