title: Recalibration and validation of the Cumberland Ankle Instability Tool cutoff score for individuals with chronic ankle instability.
abstract: OBJECTIVE
  To independently recalibrate and revalidate the Cumberland Ankle Instability Tool (CAIT) cutoff score for discriminating individuals with and without chronic ankle instability (CAI). There are concerns the original cutoff score (≤27) may be suboptimal for use in the CAI population.
  
  
  METHODS
  Case control.
  
  
  METHODS
  Research laboratory.
  
  
  METHODS
  Two independent datasets were used (total N=200). Dataset 1 included 61 individuals with a history of ≥1 ankle sprain and ≥2 episodes of giving way in the last year (CAI group) and 57 participants with no history of ankle sprain or instability in their lifetime (uninjured group). Dataset 2 included 27 uninjured participants, 29 participants with CAI, and 26 individuals with a history of a single ankle sprain and no subsequent instability (copers).
  
  
  METHODS
  All participants completed the CAIT during a single session. In dataset 1, a receiver operating characteristic (ROC) curve was calculated using the CAIT score and group membership as test variables. The ideal cutoff score was identified using the Youden index. The recalibrated cutoff score was validated in dataset 2 using the ROC analysis and clinimetric characteristics.
  
  
  METHODS
  CAIT cutoff score and clinimetrics.
  
  
  RESULTS
  In dataset 1, the optimal cutoff score was ≤25, which is lower than previously reported. In dataset 2, the recalibrated cutoff score demonstrated a sensitivity of 96.6%, specificity of 86.8%, positive likelihood ratio of 7.318, and negative likelihood ratio of .039. There were 7 false positives and 1 false negative.
  
  
  CONCLUSIONS
  The recalibrated CAIT score demonstrated very good clinimetric properties; all properties improved compared with the original cutoff score. Clinicians using the CAIT should use the recalibrated cutoff score to maximize test characteristics. Caution should be taken with copers, who had a high rate of false positives.
authors.affiliation: Department of Health and Human Performance, Virginia Commonwealth University, Richmond, VA. Electronic address: cwright@whitworth.edu.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Wright
authors.affiliation: Department of Health and Human Performance, Virginia Commonwealth University, Richmond, VA.
authors.forename: Brent L
authors.initials: BL
authors.lastname: Arnold
authors.affiliation: Department of Health and Human Performance, Virginia Commonwealth University, Richmond, VA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Ross
authors.affiliation: Department of Health and Human Performance, Virginia Commonwealth University, Richmond, VA.
authors.forename: Shelley W
authors.initials: SW
authors.lastname: Linens
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000150:complications*; D019540:Area Under Curve; D002138:Calibration; D016022:Case-Control Studies; D002908:Chronic Disease; D003661:Decision Support Techniques; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D012372:ROC Curve; D012720:Severity of Illness Index; D013180:Sprains and Strains / Q000150:complications*; D055815:Young Adult
keywords: Rehabilitation