RehabMeasures Instrument
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  2. Foot and Ankle Disability Index

Foot and Ankle Disability Index

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Purpose

The FADI is designed to assess functional limitations related to foot and ankle conditions. The FADI is a region-specific self-report of function with two components. The FADI was first described in 1999 by Martin et al: It assesses activities of daily living, and the FADI Sport assesses more difficult tasks that are essential to sports.

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Instrument Details

Acronym FADI

Area of Assessment

Activities of Daily Living
Functional Mobility
Gait
Occupational Performance
Pain
Sleep
Strength

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Pain Management

Populations

Non-Specific Patient Population

Key Descriptions

  • It is a region-specific self-report outcome measure related to activities of daily living.
  • There is also a FADI Sport that is intended to address the needs of the high-performing athletic population.
  • The FADI has 26 items. Each item is scored from 0 (unable to do) to 4 (no difficulty at all). The 4 pain items of the FADI are scored 0 (unbearable) to 4 (none).
  • The FADI has a total point value of 104 points, whereas the FADI Sport has a total point value of 32 points.
  • The FADI and FADI Sport are scored separately as percentages, with 100% representing no dysfunction.

Number of Items

FADI: 26
FADI Sport: 8

Time to Administer

5 minutes

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Instrument Reviewers

Initial review completed by: Marian Thomas Sudano, Annemarie Erich, Abbie Marrale, Rob Sykes, Andrew Kohler, Korre Scott, Krissy Ayers, Sean O’Kelley, Emily Paul, and Chelsea Parker. Update completed by:  Molly Miller, SPT; Mackenzie Owens, SPT; Lauren Kozar, SPT; Anthony Pastore, SPT; Tyler Shelton, SPT; Honorée McGraw, SPT

Body Part

Lower Extremity

ICF Domain

Body Function
Activity

Measurement Domain

Activities of Daily Living
Motor
Sensory

Professional Association Recommendation

Recommended to determine change in activity limitations, participation restrictions, and body impairments with those who have chronic ankle instability by the Orthopedic Section of the APTA. 

Considerations

  • These studies primarily tested active individuals in their 20s. Therefore, this measure may not be appropriate for those in different populations, such as geriatric or pediatric patients.
  • More research needs to be conducted to evaluate the FADI in various populations, to determine the sensitivity and specificity of the FADI, to determine its MDC and MCID, and other important statistical analyses.
  • Must consider the possibility of a placebo effect when examining improvements in the FADI, a self-report measure on function.
  • Must examine clinical importance of anterior fibular position in comparison to other potential contributors to CAI to identify the minimum amount of positional fault needed to cause ankle joint dysfunction.

  • Perception-based outcomes demonstrated the greatest potential to be accurate predictors of the development of CAI after an initial lateral ankle sprain, but long-term prospective investigations are needed to confirm these findings.

  • A systematic literature review identified the FADI as one of four patient-assessed instruments for measuring chronic ankle instability. The FADI and the FAAM (Foot and Ankle Ability Measure) were considered the most appropriate patient-assessed tools to quantify functional disabilities in patients with chronic ankle instability.

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Non-Specific Patient Population

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Standard Error of Measurement (SEM)

Healthy subjects and subjects with CAI who were recreationally active Hale and Hertel (2005):

  • FADI:

    • 1 week Interval: SEM= 2.61

    • 6 week Interval: SEM= 1.31

  • FADI Sport:

    • 1 week Interval: SEM= 5.32

    • 6 week Interval: SEM= 4.43

Minimal Detectable Change (MDC)

Healthy subjects and subjects with CAI who were recreationally active Hale and Hertel (2005):

  • FADI at 6 weeks on the involved side: MDC= 3.0 (90%CI)/ 3.6 (95%CI)

  • FADI Sport at 6 weeks on the involved side: MDC= 10.3 (90%CI) and 12.3 (95% CI)

Eechaute et al., 2007:

  • FADI: MDC= ± 4.48 points

  • FADI Sport: MDC= ± 6.39 points

Normative Data

Healthy subjects and subjects with CAI who were recreationally active Hale and Hertel (2005):

Group

FADI, % (Mean ± SD)

FADI Sport, % (Mean ± SD)

Chronic ankle instability (CAI)

89.6 ± 9.1

79.5 ± 12.7

Control

99.9 ± 0.3

99.8 ± 0.7

CAI rehabilitation group, at baseline

87.1 ± 12.1

78.4 ± 12.9

CAI rehabilitation group, after rehab

94.4 ± 6.1

89.5 ± 11.3

Normative values for subjects with CAI in respect to their involved limb.

 

Healthy subjects and subjects with unilateral chronic ankle instability (Gribble and Robinson, 2009):

Group

FADI, % (Mean ± SD)

FADI Sport, % (Mean ± SD)

Chronic ankle instability (CAI)

89.3 ± 2.03

 

74.8 ± 4.1

 

Control

100.0 ± 0.00

100.0 ± 0.00

 

Healthy subjects and subjects with unilateral chronic ankle instability (Hubbard et al., 2006):

Fibular Position and FAI

Group

FADI, % (Mean ± SD)

FADI Sport, % (Mean ± SD)

Chronic ankle instability (CAI)

90.0 ± 5.1

80.3 ± 13.0

Control

99.9 ± 0.2

99.7 ± 1.3

 

Young adults with self-reported CAI (McKeon, 2008):

Group

FADI, % (Mean ± SD)

 

FADI Sport, % (Mean ± SD)

Chronic ankle instability (CAI)

93.7 ± 7.4

85.0 ± 14.4

Control

81.4 ± 18.1

66.3 ± 11.8

 

Subjects with unilateral CAI (Sedory et al., 2007):

Group

FADI, % (Mean ± SD)

FADI Sport, % (Mean ± SD)

Chronic ankle instability (CAI)

90.5 ± 10.2

75.6 ± 11.8

Control

99.8 ± 0.5

99.7 ± 1.4

Test/Retest Reliability

Eechaute et al. (2007)

  • FADI involved ankles: Excellent (ICC =.89)
  • FADI uninvolved ankles: Excellent (ICC= .85)
  • FADI Sport involved ankles: Excellent (ICC= .84)
  • FADI Sport uninvolved ankles: Excellent (ICC= .94)  

 

Healthy subjects and subjects with CAI who were recreationally active (Hale and Hertel, 2005)

  • Intersession reliability in subjects with CAI during 1-week Excellent: (ICC 2,1 = 0.89) and 6-week intervals: Excellent (ICC 2,1 = 0.93)

 

Subjects with unilateral CAI that are recreationally active (Hale, Hertel, Olmstead-Kramer, 2007)

  • Strong reliability over 1 week: Excellent (ICC=0.85) and 6 weeks: Excellent (ICC=0.93)

Interrater/Intrarater Reliability

Healthy subjects and subjects with CAI who were recreationally active Hale and Hertel (2005):

  • FADI 1 week: Excellent (ICC: 0.89)
  • FADI Sport 1 week: Excellent (ICC: 0.84)
  • FADI after 6 weeks: Excellent (ICC: 0.93)
  • FADI Sport after 6 weeks: Excellent (ICC: 0.92)

Construct Validity

Healthy subjects and subjects with CAI who were recreationally active Hale and Hertel (2005):

  • Correlation between FADI; FADI Sport: Excellent (r = 0.64)

Content Validity

Eechaute et al. (2007)

  • Experts and patients were involved in item generation and reduction

Floor/Ceiling Effects

Eechaute et al. (2007)

  • The subjects with chronic ankle instability that were studied by Hale and Hertel (2005) have at baseline substantially high FADI and FADI Sport scores. This indicates that these subjects do not demonstrate much difficulty and are functioning at a high-level ability. The absence of ceiling effects for the FADI and the FADI Sport should be established.

Responsiveness

Healthy subjects and subjects with CAI who were recreationally active Hale and Hertel (2005):

FADI: Effect size = 0.52                Moderate effect size

FADI Sport: Effect size = 0.71       Moderate effect size

 

Eechaute et al. (2007)

FADI: significant difference after 6 weeks of training: pre training score= 87.1% (± 12.1) post training score= 94.4% (± 6.1) ES= 0.52 (n=16 subjects)

 

FADI Sport: significant difference after 6 weeks of training; pre training score= 78.4% (± 12.9) post training score= 89.5% (± 11.3; E= 0.71 (n=16 subjects)

 

Young adults with self-reported CAI (McKeon, 2008):

  • The effect sizes for pretest to posttest change for the balance training group:

    • FADI: Large (ES= 0.97)

    • FADI Sport: Large (ES=1.23)

  • The effect size for improvements in the FADI and FADI Sport:

  • FADI: Moderate (ES= 0.68)

  • FADI: Large (ES= 1.58)

Bibliography

Eechaute, Vaes, Aerschot, Asman, Duquet. The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: A systematic review. BMC Musculoskeletal Disorders 2007; 8(6). doi:10.1186/1471-2474-8-6  

Gribble PA, Robinson RH. Alterations in knee kinematics and dynamic stability associate with chronic ankle instability. Journal of Athletic Training. 2009; 44(4): 350-355.

Hale SA, Hertel J. Reliability and sensitivity of the foot and ankle disability index in subjects with chronic ankle instability. J Athl Train. 2005; 40(1): 35‐40.

Hale AS, Hertel J, Olmstead-Kramer LC. The Effect of a 4-Week Comprehensive Rehabilitation Program on Postural Control and Lower Extremity Function in Individuals With Chronic Ankle Instability. Journal of Orthopaedic & Sports Physical Therapy. 2007; 37(6); 303-311.

Hubbard TJ, Hertel J, Sherbondy P. Fibular Position in Individuals With Self-Reported Chronic Ankle Instability. Journal of Orthopaedic & Sports Physical Therapy. 2006; 36(1): 3-9.

Kim H, Chung E, Lee B. A comparison of the foot and ankle condition between elite athletes and non-athletes. J Phys Ther Sci. 2013; 25(10); 1269-1272.

Martin RL, Davenport TE, Paulseth S, Wukich DK, Godges JJ. Ankle stability and movement coordination impairment: ankle ligament sprains. J Orthop Sports Phys Ther. 2013; 43.

McKeon P, Ingersoll C, Karrigan C.D., Saliba E, Bennett B, Hertel J. Balance Training Improves Function and Postural Control in Those with Chronic Ankle Instability. ACSM 2008, 1810-1819.

Sedory EJ, McVey ED, Cross KM, Ingersoll CD, Hertel J. Arthrogenic muscle response of the quadriceps and hamstrings with chronic ankle instability. J Athl Train. 2007; 42(3): 355-360.

Wikstrom EA, Tillman MD, Chmielewski TL, Cauraugh JH, Naugle KE, Borsa PA. Discriminating between copers and people with chronic ankle instability. J Athl Train. 2012; 47(2): 136-42.

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