Eechaute Christophe, Vaes Peter, Van Aerschot Lieve, Asman Sara, Duquet William
The Physical Therapy Department, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium.
BMC Musculoskelet Disord. 2007 Jan 18;8:6. doi: 10.1186/1471-2474-8-6.
BACKGROUND: The assessment of outcomes from the patient's perspective becomes more recognized in health care. Also in patients with chronic ankle instability, the degree of present impairments, disabilities and participation problems should be documented from the perspective of the patient. The decision about which patient-assessed instrument is most appropriate for clinical practice should be based upon systematic reviews. Only rating scales constructed for patients with acute ligament injuries were systematically reviewed in the past. The aim of this study was to review systematically the clinimetric qualities of patient-assessed instruments designed for patients with chronic ankle instability. METHODS: A computerized literature search of Medline, Embase, Cinahl, Web of Science, Sport Discus and the Cochrane Controlled Trial Register was performed to identify eligible instruments. Two reviewers independently evaluated the clinimetric qualities of the selected instruments using a criteria list. The inter-observer reliability of both the selection procedure and the clinimetric evaluation was calculated using modified kappa coefficients. RESULTS: The inter-observer reliability of the selection procedure was excellent (k = .86). Four instruments met the eligibility criteria: the Ankle Joint Functional Assessment Tool (AJFAT), the Functional Ankle Outcome Score (FAOS), the Foot and Ankle Disability Index (FADI) and the Functional Ankle Ability Measure (FAAM). The inter-observer reliability of the quality assessment was substantial to excellent (k between .64 and .88). Test-retest reliability was demonstrated for the FAOS, the FADI and the FAAM but not for the AJFAT. The FAOS and the FAAM met the criteria for content validity and construct validity. For none of the studied instruments, the internal consistency was sufficiently demonstrated. The presence of floor- and ceiling effects was assessed for the FAOS but ceiling effects were present for all subscales. Responsiveness was demonstrated for the AJFAT, FADI and the FAAM. Only for the FAAM, a minimal clinical important difference (MCID) was presented. CONCLUSION: The FADI and the FAAM can be considered as the most appropriate, patient-assessed tools to quantify functional disabilities in patients with chronic ankle instability. The clinimetric qualities of the FAAM need to be further demonstrated in a specific population of patients with chronic ankle instability.
背景：在医疗保健领域，从患者角度对治疗结果进行评估越来越受到认可。对于慢性踝关节不稳患者，也应从患者角度记录当前损伤、残疾和参与问题的程度。关于哪种患者评估工具最适合临床实践的决策应基于系统评价。过去仅对为急性韧带损伤患者构建的评定量表进行了系统评价。本研究的目的是系统评价为慢性踝关节不稳患者设计的患者评估工具的测量学质量。 方法：通过计算机检索Medline、Embase、Cinahl、Web of Science、Sport Discus和Cochrane对照试验注册库，以确定符合条件的工具。两名研究者使用标准列表独立评估所选工具的测量学质量。使用修正的kappa系数计算选择过程和测量学评估的观察者间信度。 结果：选择过程的观察者间信度极佳（k = 0.86）。四种工具符合纳入标准：踝关节功能评估工具（AJFAT）、踝关节功能结局评分（FAOS）、足踝残疾指数（FADI）和踝关节功能能力测量（FAAM）。质量评估的观察者间信度为中等至极佳（k在0.64至0.88之间）。FAOS、FADI和FAAM显示出重测信度，而AJFAT未显示。FAOS和FAAM符合内容效度和结构效度标准。对于所有研究工具，均未充分证明其内部一致性。对FAOS评估了地板效应和天花板效应，但所有子量表均存在天花板效应。AJFAT、FADI和FAAM显示出反应度。仅FAAM给出了最小临床重要差异（MCID）。 结论：FADI和FAAM可被视为最适合的、由患者评估的工具，用于量化慢性踝关节不稳患者的功能残疾。FAAM的测量学质量需要在特定的慢性踝关节不稳患者群体中进一步验证。
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