About the Cumberland Ankle Instability Tool
The Cumberland Ankle Instability Tool (CAIT) is a widely-used, validated questionnaire specifically designed to assess the severity of functional ankle instability. Developed through rigorous psychometric testing, the CAIT evaluates multiple aspects of ankle function including pain, instability, and activity limitations. It is particularly valuable for identifying individuals with chronic ankle instability and monitoring their progress through rehabilitation. The questionnaire has demonstrated excellent reliability and validity in both athletic and general populations, making it a standard assessment tool in sports medicine and physiotherapy practices worldwide.
Medical Specialties
Anatomic Areas
Clinical Indications
Developer Information
The Cumberland Ankle Instability Tool was developed by Claire E. Hiller and colleagues at the University of Sydney, Australia. The questionnaire was published in 2006 following extensive validation studies with athletes and individuals experiencing chronic ankle instability. The development process included item generation, expert review, and psychometric testing to ensure comprehensive assessment of functional ankle instability.
Copyright & Licensing
The CAIT is freely available for clinical and research use without licensing fees. While the questionnaire is copyrighted by the original authors, it can be used, reproduced, and distributed without permission for non-commercial purposes. Proper citation of the original validation study (Hiller et al., 2006) is requested when using the tool in research or publications.
Administration Instructions
Answer all 9 questions about your ankle condition over the past month. Select the response that best describes your situation. Consider your most affected ankle when answering.
Scoring Methodology
The CAIT uses a variable scoring system across 9 items. Each question has different response options with associated point values. The total score ranges from 0 to 30, where higher scores indicate better ankle stability and function. Scores are calculated by summing the point values from all 9 items. A score of 27 or less (out of 30) is generally considered indicative of functional ankle instability, while a score below 24 strongly suggests chronic ankle instability. The questionnaire does not use subscales; rather, it provides a single total score representing overall ankle stability.
Meaningful Change Threshold
A change of 3 points or more in the CAIT total score is considered clinically meaningful and represents a noticeable improvement or decline in ankle stability. Changes of 5 points or greater indicate substantial functional improvement.
Score Interpretation
Understanding what your score means
severe instability
0 - 19Severe functional ankle instability with significant limitations in daily activities and high risk of recurrent sprains
moderate instability
20 - 23Moderate functional ankle instability with some activity limitations and increased injury risk
mild instability
24 - 27Mild functional ankle instability with minor limitations and occasional symptoms
stable ankle
28 - 30Stable ankle with minimal to no functional limitations or instability symptoms
Subscales
This questionnaire measures multiple dimensions
Total Ankle Stability Score (0-30)
Overall measure of ankle stability and functional capacity
Clinical Limitations & Considerations
The CAIT is a self-reported questionnaire and may be influenced by patient recall bias or subjective perception of symptoms. It focuses specifically on functional ankle instability and does not assess structural instability or ligamentous laxity. The questionnaire may not be sensitive enough to detect subtle changes in highly functional individuals. Some questions reference specific activities that may not be relevant to all populations (e.g., non-athletes). The CAIT should be used in conjunction with clinical examination and other objective measures for comprehensive ankle assessment.
Supporting Literature
Key validation and development studies for the Cumberland Ankle Instability Tool
- 1
The Cumberland Ankle Instability Tool: A Report of Validity and Reliability Testing
Hiller CE, Refshauge KM, Bundy AC, Herbert RD, Kilbreath SL
Archives of Physical Medicine and Rehabilitation, 2006
- 2
Recalibration and Validation of the Cumberland Ankle Instability Tool Cutoff Score for Individuals With Chronic Ankle Instability
Wright CJ, Arnold BL, Ross SE, Linens SW
Archives of Physical Medicine and Rehabilitation, 2014
- 3
The Cumberland Ankle Instability Tool (CAIT) in the Dutch population with and without complaints of ankle instability
Vuurberg G, Kluit L, van Dijk CN
Knee Surgery, Sports Traumatology, Arthroscopy, 2016
- 4
The Cumberland Ankle Instability Tool: A Report of Validity and Reliability Testing
Hiller CE, Refshauge KM, Bundy AC, Herbert RD, Kilbreath SL
Archives of Physical Medicine and Rehabilitation, 2006
- 5
Recalibration and Validation of the Cumberland Ankle Instability Tool Cutoff Score for Individuals With Chronic Ankle Instability
Wright CJ, Arnold BL, Ross SE, Linens SW
Archives of Physical Medicine and Rehabilitation, 2014
- 6
The Cumberland Ankle Instability Tool (CAIT) in the Dutch population with and without complaints of ankle instability
Vuurberg G, Kluit L, van Dijk CN
Knee Surgery, Sports Traumatology, Arthroscopy, 2016
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This questionnaire is provided free of charge. Patient Watch charges only for platform services (data storage, automated reminders, analytics) - not for use of clinical instruments. This non-commercial model supports academic and clinical use. View full licensing disclosure