Cumberland Ankle Instability Tool

Original Editor - Carina Therese Magtibay

Top Contributors - Carina Therese Magtibay  

Objective[edit | edit source]

The Cumberland Ankle Instability Tool (CAIT) is a 9-item 30-point scale that measures the severity of functional ankle instability.[1] Using a numeric value, the CAIT has the ability to discriminate between stable and unstable ankles.[2]

Intended Population[edit | edit source]

Individuals with chronic ankle instability are identified and monitored with this valid and reliable tool.[1]

Cross-cultural Adaptations[edit | edit source]

Originally designed by Hiller et al (2006)[1] in English, CAIT has been translated and validated in other languages:

Method of Use[edit | edit source]

This self-report questionnaire allows patients to rate their perceived degree of difficulty in performing different physical activities. The CAIT is filled out for both the left and right ankle, making it possible to assess both ankles individually.[2] The patient simply has to check one statement in each item that best describes the affected ankle/s.

Scoring[edit | edit source]

The nine items of CAIT generate a total score of 30.

  • 0 points: extreme functional ankle instability
  • 30 points: stable ankle


The original study established a cutoff score of ≤ 27[1], however, recent literature suggests that a cutoff score of ≤25 results in improved test characteristics, thus, enhancing the accuracy of the tool in differentiating individuals with and without chronic ankle instability.[10]

Evidence[edit | edit source]

Psychometric Property CAIT
Test-retest reliability ICC2,1=.96[1]
Sensitivity 82.9%[1]
Specificity 74.7%[1]
Minimal Detectable Change (MDC) 3.08[11]
Minimal Clinically Important Difference (MCID) ≥3 [11]

Resources[edit | edit source]

Online Cumberland Ankle Instability Tool

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Hiller CE, Refshauge KM, Bundy AC, Herbert RD, Kilbreath SL. The Cumberland ankle instability tool: a report of validity and reliability testing. Archives of physical medicine and rehabilitation. 2006 Sep 1;87(9):1235-41.
  2. 2.0 2.1 2.2 Vuurberg G, Kluit L, van Dijk CN. The Cumberland Ankle Instability Tool (CAIT) in the Dutch population with and without complaints of ankle instability. Knee Surgery, Sports Traumatology, Arthroscopy. 2018 Mar;26:882-91.
  3. De Noronha M, Refshauge KM, Kilbreath SL, Figueiredo VG. Cross-cultural adaptation of the Brazilian-Portuguese version of the Cumberland Ankle Instability Tool (CAIT). Disability and rehabilitation. 2008 Jan 1;30(26):1959-65.
  4. Wang W, Liao D, Kang X, Zheng W, Xu W, Chen S, Xie Q. Development of a valid Chinese version of the Cumberland Ankle Instability Tool in Chinese-speaking patients with chronic ankle instability disorders. Scientific Reports. 2021 May 7;11(1):1-8.
  5. Geerinck A, Beaudart C, Salvan Q, Van Beveren J, D’Hooghe P, Bruyère O, Kaux JF. French translation and validation of the Cumberland Ankle Instability Tool, an instrument for measuring functional ankle instability. Foot and Ankle Surgery. 2020 Jun 1;26(4):391-7.
  6. Kunugi S, Masunari A, Noh B, Mori T, Yoshida N, Miyakawa S. Cross-cultural adaptation, reliability, and validity of the Japanese version of the Cumberland ankle instability tool. Disability and rehabilitation. 2017 Jan 2;39(1):50-8.
  7. Ko J, Rosen AB, Brown CN. Cross‐cultural adaptation and validation of the Korean version of the Cumberland Ankle Instability Tool. International Journal of Sports Physical Therapy. 2015 Dec;10(7):1007.
  8. Hadadi M, Ebrahimi Takamjani I, Ebrahim Mosavi M, Aminian G, Fardipour S, Abbasi F. Cross-cultural adaptation, reliability, and validity of the Persian version of the Cumberland Ankle Instability Tool. Disability and rehabilitation. 2017 Jul 31;39(16):1644-9.
  9. Cruz-Díaz D, Hita-Contreras F, Lomas-Vega R, Osuna-Pérez MC, Martínez-Amat A. Cross-cultural adaptation and validation of the Spanish version of the Cumberland Ankle Instability Tool (CAIT): an instrument to assess unilateral chronic ankle instability. Clinical rheumatology. 2013 Jan;32:91-8.
  10. Wright CJ, Arnold BL, Ross SE, Linens SW. Recalibration and validation of the Cumberland Ankle Instability Tool cutoff score for individuals with chronic ankle instability. Archives of physical medicine and rehabilitation. 2014 Oct 1;95(10):1853-9.
  11. 11.0 11.1 Wright CJ, Linens SW, Cain MS. Establishing the minimal clinical important difference and minimal detectable change for the Cumberland Ankle Instability Tool. Archives of physical medicine and rehabilitation. 2017 Sep 1;98(9):1806-11.