Original ResearchTranslation, cross-cultural adaptation, and measurement properties of the Brazilian version of the Identification of Functional Ankle Instability (IdFAI) questionnaire
Introduction
Ankle sprains are among the most common musculoskeletal injuries in sports, as well as in daily life (Fong, Hong, Chan, Yung, & Chan, 2007). They account for 77%–83% of all sprain conditions (Fong et al., 2007, Hertel, 2002, Yeung et al., 1994). The main consequence is the high rate of recidivism, which can affect approximately 8% of the general population (Hiller et al., 2012, Yeung et al., 1994). The persistence of spraining, after an initial episode, is called chronical ankle instability (CAI), and is characterized by a multifactorial condition involving mechanical and/or functional instabilities (Delahunt, 2007, Hertel, 2002).
Studies have shown that mechanical instability cannot independently explain the residual symptoms after an ankle sprain (Delahunt, 2007, Hertel, 2002). Thus, the persistence of these symptoms has been defined as functional ankle instability (FAI), which consists of recurring faults after an initial sprain (Freeman, 1965). The residual symptoms associated with FAI include ankle muscle strength decreases, proprioception and postural control impairment, a delay in the fibular muscle reaction time, and a functionality decrease in the ankle, with or without ligament laxity and pain (Delahunt, 2007, Delahunt et al., 2010, Hertel, 2002).
Freeman (1965) was the first author to establish criteria for determining and classifying FAI (Freeman, 1965). However, a recent systematic review has shown that other criteria are also being used to determine ankle instability (Delahunt et al., 2010). That review indicated an inconsistency between the studies, suggesting the need for a universal definition of ankle instability, related to standardization criteria, measurement methods, and ways of quantifying the severity (Delahunt et al., 2010). In order to minimize the heterogeneity of the population with ankle instability, a statement was created by the International Ankle Consortium to identify the criteria to select patients with chronic ankle instability in controlled research (Gribble et al., 2013). However, this consensus did not indicate a specific FAI classification tool (Gribble et al., 2013).
In the literature, seven self-report measures have been used to assess FAI: Ankle Instability Instrument (AII) (Docherty, Gansneder, Arnold, & Hurwitz, 2006), Ankle Joint Functional Assessment Tool (AJFAT) (Rozzi, Lephart, Sterner, & Kuligowski, 1999), Chronic Ankle Instability Scale (CAIS) (Eechaute, Vaes, & Duquet, 2008), Cumberland Ankle Instability Tool (CAIT) (Hiller, Refshauge, Bundy, Herbert, & Kilbreath, 2006), Foot and Ankle Ability Measure (FAAM) (Carcia, Martin, & Drouin, 2008), Foot and Ankle Instability Questionnaire (FAIQ) (Hubbard & Kaminski, 2002) and Foot and Ankle Outcome Score (FAOS) (Roos, Brandsson, & Karlsson, 2001). However, none of these tools was able to accurately indicate its presence using the Freeman criteria (Donahue, Simon, & Docherty, 2011). Moreover, the association of the Cumberland Ankle Instability Tool (CAIT) and Ankle Instability Instrument (AII) questionnaires found better results in the specificity, sensitivity, and 84% precision in determining FAI (Donahue et al., 2011).
The Identification of Functional Ankle Instability (IdFAI) is a simple and effective questionnaire to determine the ankle stability status (Simon, Donahue, & Docherty, 2012). It is the result of an adaptation and combination of the main elements of the CAIT and AII questionnaires (Donahue et al., 2013, Simon et al., 2012). When compared to the other seven self-report measures that evaluate FAI, the IdFAI is the only questionnaire that showed 95% confidence in predicting the FAI status (Simon, Donahue, & Docherty, 2014). Moreover, the IdFAI is the only one that has the definition built into its structure, which allows the patients to answer the questions with better precision (Donahue et al., 2013, Simon et al., 2012). Although the IdFAI is a valid and reliable patient-rated outcome (PRO) measure, it was developed in English (Donahue et al., 2013, Simon et al., 2012). In order to use it as an FAI outcome measure in other languages, it is necessary to do a cross-cultural adaptation and test the measurement properties.
The hypothesis of the present study was that, after the translation and cultural adaptation of the IdFAI to the Portuguese language of Brazil, and testing the measurement properties (validity and reliability) of this questionnaire, the Brazilian version of the IdFAI would be valid and reliable to determine the functional instability of the ankle. Therefore, the aims of this study were to describe the translation and cultural adaptation, and to test the validity and reliability of the Brazilian version of the IdFAI.
Section snippets
Methods
This study was approved by the Research Ethics Committee of the Federal University of Sao Paulo in Brazil (reference number 691.518), and all of the participants signed the free and informed consent statement prior participation.
Translation and cultural adaptation
The process of translation and cultural adaptation resulted in the first pre-test version (V6) of the IdFAI. The V6 was given to 30 participants, resulting in six items with over 10% “non-understanding” from the participants, as follows: the “instability sensation description” (13.34%), Item 1 (13.34%), Items 6, 9, and 10 (13.34%), and Item 7 (26.67%). Based on these “non-understanding” items, two subsequent cultural adaptations were made in the translation, and applied in the other twenty
Discussion
The aim of this study was to translate and culturally adapt the IdFAI questionnaire into Brazilian Portuguese, as well as to test its measurement properties. The results indicated that the Brazilian version of the IdFAI is a valid and reliable measure, and it can be used in Brazil in patients with FAI.
The IdFAI questionnaire has recently been recommended as the best self-reported instrument to use when identifying a patient's ankle stability status (Simon et al., 2014). This questionnaire was
Conclusion
The Brazilian version of the IdFAI Questionnaire is a valid and reliable instrument that can be used in patients with FAI, as well as in clinical practice and research settings.
Ethical approval
The study protocol was approved by the Research Ethics Committee of the Federal University of Sao Paulo, Brazil (reference number 691.518), and all the participants signed the free and informed consent statement.
Funding
None declared.
Conflict of interest
None declared.
References (27)
Neuromuscular contributions to functional instability of the ankle joint
Journal of Bodywork and Movement Therapies
(2007)- et al.
The chronic ankle instability scale: Clinimetric properties of a multidimensional, patient-assessed instrument
Physical Therapy in Sport
(2008) - et al.
Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines
Journal of Clinical Épidemiology
(1993) - et al.
Prevalence and impact of chronic musculoskeletal ankle disorders in the community
Archives of Physical Medicine and Rehabilitation
(2012) - et al.
The Cumberland ankle instability tool: A report of validity and reliability testing
Archives of Physical Medicine and Rehabilitation
(2006) - et al.
Critical review of self-reported functional ankle instability measures: A follow up
Physical Therapy in Sport
(2014) - et al.
Guidelines for the process of cross-cultural adaptation of self-report measures
Spine
(2000) - et al.
The lower extremity functional scale (LEFS): Scale development, measurement properties, and clinical application
Physical Therapy
(1999) - et al.
Validity of the foot and ankle ability measure in athletes with chronic ankle instability
Journal of Athletic Training
(2008) - et al.
Cross-cultural adaptation of the Brazilian-Portuguese version of the Cumberland ankle instability tool (CAIT)
Disability and Rehabilitation
(2008)