Urdu translation and cross-cultural validation of Cumberland Ankle Instability Tool (CAIT)

The Cumberland Ankle Instability Tool (CAIT) is a self-assessment tool for people with chronic ankle instability (CAI). This tool had been translated and validated in many languages but there is no Urdu version of CAIT available.

The aim was to translate the CAIT into the Urdu Language and determine its validity and reliability.

A standardized step-wise forward and backward translation process was followed. Content, construct, convergent validity, internal consistency, and test-retest reliability were determined. A pilot study was done on 10 patients with CAI. The final version was investigated in 120 patients (mean age 26.6 ± 4.8 yrs) with CAI for validity and test-retest reliability in which 105 participants filled the questionnaire in the second week. Internal consistency was calculated by Cronbach's alpha. Intraclass correlation (ICC_2,1) was calculated to assess test-retest reliability between two weeks. Standard error of measurement (SEM) and smallest detectable change (SDC) were calculated. Convergent validity was determined by correlating Urdu CAIT with the Foot and Ankle Outcome Score (FAOS) using Spearman's correlation co-efficient. Factor analysis describes the structure of underlying factors.

Content validity index was > 0.80 of each question. Internal consistency was acceptable (Cronbach's alpha > 0.75). Convergent validity with FAOS total score showed a moderate negative correlation (r = -0.68) with U-CAIT and negatively correlated with subscales of FAOS. Test-retest reliability was excellent ICC_2,1 > 0.80. Scree plot showed 3 factors > 1eigen value.

The Urdu version of CAIT is a valid and reliable assessment tool for patients with chronic ankle instability. It has good content validity, construct validity and reliability.