The Cumberland ankle instability tool: a report of validity and reliability testing

Arch Phys Med Rehabil. 2006 Sep;87(9):1235-41. doi: 10.1016/j.apmr.2006.05.022.


Objective: To test the Cumberland Ankle Instability Tool (CAIT), a 9-item 30-point scale, for measuring severity of functional ankle instability.

Design: Cross-sectional study.

Setting: General community.

Participants: Volunteer sample of 236 subjects.

Interventions: Not applicable.

Main outcome measures: 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)).

Results: There were significant correlations between the CAIT and LEFS (rho=.50, P<.01) and VAS (rho=.76, P<.01). Construct validity and internal reliability were acceptable (alpha=.83; point measure correlation for all items, >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).

Conclusions: CAIT is a simple, valid, and reliable tool to measure severity of functional ankle instability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Ankle Injuries / classification*
  • Cross-Sectional Studies
  • Humans
  • Injury Severity Score
  • Joint Instability / classification*
  • ROC Curve
  • Reproducibility of Results
  • Surveys and Questionnaires