Validação de dois instrumentos para avaliação do complexo do tornozelo: habilidade funcional autorrelatada e posição de primeira resistência detectável

Abstract

Background: The mechanical properties of the ankle and foot joint complex are directly related to important actions for human functionality. Functional changes and changes in the physiological state of joint stiffness influence the characteristics of gait, running and jumping. Such changes are related to the emergence of conditions such as Achilles tendinopathy (AT) and impact on the reduction of sports, work and social participation with an aggregate economic loss. Objectives: This dissertation aimed to present valid strategies to improve the assessment of patients with ankle disorders. Therefore, the first objective was to validate the patient-measured outcome for ankle and foot changes using the Foot and Ankle Ability Measure (FAAM) questionnaire for AT participants; the second objective was to validate the digital inclinometer as an instrument to measure the position of the first detectable ankle resistance. Methods: Two clinimetric studies were conducted. The FAAM validation study had a sample of 101 symptomatic AT participants. We performed the analysis of the instrument measurement properties, such as internal consistency, test-retest reliability, construct validity, and ceiling and floor effect. VISA-A and LEFS were used for construct validation. The second study had a sample of 50 participants, of which 24 were symptomatic for AT. The position of first detectable ankle resistance measurement was performed with the digital inclinometer (Diconna) and validated concurrently with the manual goniometer. Assessments were performed by two physical therapists to test interrater reproducibility. For intrarater reproducibility, one of them performed two measurements on different occasions. To test validity, comparative measures were correlated between the two instruments evaluated. Descriptive analysis, intraclass correlation coefficient (ICC), standard error of measurement and smallest detectable change intrarater and interrater for both instruments were evaluated. Results: Regarding the FAAM validation for AT participants, we obtained the results of good internal consistency (Cronbach's α = 0.84 and 0.89), good test-retest reproducibility (ICC FAAM ADL 0.81, 95%CI = 0.73 to 0.87 and FAAM Sport 0.85, 95%CI = 0.78 to 0.90), and strong correlation when compared to VISA-A (rho = 0.67) and LEFS (rho = 0.68). We did not observe ceiling effect and floor effect. In the second study, the inclinometer showed good intrarater (ICC = 0.96, 95%CI = 0.94 to 0.98) and interrater (ICC = 0.94, 95%CI = 0.87 to 0.97) reproducibility as well as a strong correlation with the goniometer (reference) in the measurement of the position of first detectable ankle resistance (r=0.95; p=0.001). Conclusion: The FAAM instruments used to assess the activity and participation has satisfactory to excellent reproducibility, proving to be a viable questionnaire to be used in AT. The digital inclinometer also has high reproducibility and strong correlation with the reference instrument in measuring the position of the first detectable ankle resistance, and can be used in clinical settings and in scientific research.