Manual testing for ankle instability

Manual Therapy , 04/13/2012

Inter–rater reliability was poor for manual tests of ankle stability. Reliability may be improved by using a grading scale with fewer intervals. The cumberland ankle instability tool (CAIT) scores and manual tests correlated poorly, potentially reflecting the variety of conditions leading to ankle instability.


  • One ankle from each of 60 participants was assessed using four different manual tests (anterior drawer in supine and crook lying, talar tilt, inversion tilt).
  • Three different raters, varying in experience, tested each participant.
  • The CAIT questionnaire was also administered.
  • The study received ethics approval from the University of Sydney Human Research Ethics Committee.
  • Intraclass correlation coefficients (ICC), standard error of the mean (SEM) and percent close agreement (PCA) were used to determine reliability of the four tests.
  • Pearson's correlation coefficients were used to determine relationships between the manual tests and CAIT scores.


  • Inter–rater reliability for the four manual tests was poor regardless of therapist's experience (ICC[1,1] –0.12 to 0.33; SEM 0.93–1.69).
  • Correlations between the CAIT and manual tests were also low varying between r = –0.12 and –0.42.

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