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163 Patient reported outcome measures for ankle instability – quality assessments of 17 existing questionnaires
  1. Christian Fugl Hansen1,
  2. Kenneth Chukwuemeka Obionu2,
  3. Jonathan David Comins1,
  4. Michael Krogsgaard1
  1. 1Section for Sports Traumatology M51, Bispebjerg and Frederiksberg University Hospital, Denmark
  2. 2Section for Foot and Ankle Surgery, Department of Orthopedic Surgery M, Bispebjerg and Frederiksberg University Hospital, Denmark


Introduction The aim was to evaluate content validity and measurement properties of patient reported outcome measures (PROMs) to assess patients with chronic ankle instability (CAI).

Materials and Methods Potential PROMs for CAI and validity studies of these were identified in PubMed and SCOPUS. Development and validation methods for all PROMs were analyzed.

Results Seventeen PROMs were relevant for CAI, and 56 validity studies were identified for the quality assessment. Only three PROMs had been developed with inputs from patients and were potentially adequate: the Cumberland Ankle Instability Tool (CAIT), the Lower-Extremity Functional Scale (LEFS) and the Foot and Ankle Ability Measure (FAAM).

Measurement properties of CAIT has never been validated by modern test theory models (MTT), which are optimal for this purpose. In addition, CAIT is used to identify the presence of instability and not to evaluate the condition. Four analyses of LEFS with MTT methods for patients with an CAI have shown inadequate fit to the statistical model. For FAAM one study including CAI patients found adequate fit to the statistical model.

Conclusion Fourteen (of seventeen) PROMs had been developed without involvement of patients and must be considered as inadequate measurement instruments. Of the three PROMs developed with patient involvement, only FAAM exhibited fit to the statistical model for patients with CAI. However, for other conditions evidence for construct validity for FAAM is inconsistent.

No existing PROM possesses adequate content and construct validity for patients with CAI, but FAAM is suggested to be the best choice.

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