Establishing the Minimal Clinical Important Difference and Minimal Detectable Change for the Cumberland Ankle Instability Tool

Publication date: Available online 27 January 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Cynthia J. Wright, Shelley W. Linens, M. Spencer Cain
ObjectiveThe objective was to establish the minimal detectable change (MDC) and minimal clinically important different (MCID) for the Cumberland Ankle Instability Tool (CAIT) in a population with chronic ankle instability (CAI).DesignExperimental cohort.SettingLaboratory.ParticipantsA convenience sample of fifty participants with CAI participated (12 males, 38 females, monthly giving-way=5.84±12.54). CAI inclusion criteria included a history of an ankle sprain, recurrent episodes of giving way, and a CAIT score ≤ 25.InterventionsParticipants completed an injury history and demographic data then the CAIT. Participants then either participated in 4 weeks of wobble board balance training, resistance tubing strength training, or no intervention. After 4 weeks, participants re-completed the CAIT and recorded their global rating of change (GRC).Main Outcome MeasuresDependent variables were pre- and post-intervention score on the CAIT, and post-intervention GRC. MDC with 95% confidence was calculated. A receiver operating characteristic curve (ROC) identified the optimal CAIT cut-point (MCID) between improved and unimproved individuals based on their GRC. Area under the curve (AUC) was used to identify a significant ROC curve (alpha = 0.05).ResultsThe average CAIT score pre-intervention was 16.8±5.6, and post-intervention was 20.0±5.2. Thirty-one participants (62%) rated themselves as improved on the GRC, whereas 19 (38%) were not improved. The ROC was significant (AUC = 0.797, p=0.001), indicating that CAIT change score significantly predicted clinical status. The MDC was 3.08, the MCID was ≥3 points.ConclusionsThe CAIT has a MDC and MCID of ≥3 points. When CAIT scores are utilized to assess patient change over time, these scores should be used as a minimum threshold to indicate detectable and clinically meaningful improvement.



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