Reliability and Validity of the Lower Extremity Motor Activity Log in Persian People with Ankle Sprain
,
Abstract
Background: Ankle sprains are among the most common injuries and affect functional mobility, lower extremity function and health status. Accessing to a reliable measurement tool to assess diverse real-world lower extremity use in patients following ankle sprain seems essential. Researchers have developed number of measurements to determine rehabilitation goals and also measure the effects of therapeutic interventions. This study was conducted to translate the original English Lower Extremity Motor Activity Log (LE-MAL) to Persian and to investigate the psychometric properties of the Persian version.
Material and Methods: The LE-MAL was translated to Persian and adapted to the Persian culture. Then a total of 140 patients with ankle sprain filled out the Persian LE-MAL, Lower Extremity Functional Scale (LEFS) and Life Space Questionnaire (LSQ). The Persian LE-MAL was re-completed by participants with an interval of two weeks and internal consistency, test-retest reliability and construct validity were investigated.
Results: The Persian LE-MAL had good internal consistency (Cronbach's α =0.95) and test-retest reliability (ICC=0.76). The construct validity of the Persian LE-MAL was demonstrated to be acceptable as a result of its significantly strong correlations with LEFS and LSQ (0.74<r<0.77). Standard error of measurement was less than 10% of the total instrument score (SEM=0.43) and minimal detectable change was 1.2. No ceiling and floor effect observed.
Conclusion: Persian version of LE-MAL is a valid and reliable measurement to assess lower extremity function in people with ankle sprain.
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2. Nabian MH, Zadegan SA, Zanjani LO, Mehrpour SR. Epidemiology of joint dislocations and ligamentous/tendinous injuries among 2,700 patients: five-year trend of a tertiary center in Iran. Archives of bone and joint surgery. 2017;5(6):426.
3. McCann RS, Johnson K, Suttmiller AMB. Lumbopelvic Stability and Trunk Muscle Contractility of Individuals with Chronic Ankle Instability. Int J Sports Phys Ther. 2021;16(3):741-8.
4. Fong DT-P, Hong Y, Chan L-K, Yung PS-H, Chan K-M. A systematic review on ankle injury and ankle sprain in sports. Sports medicine. 2007;37:73-94.
5. Sekkehchi S, Tajali SB, Ashnagar Z, Majdi F. Investigating the Effects of Intrinsic Foot Muscle Exercises on Dynamic Balance after Sub-Acute Ankle Sprain. Journal of Modern Rehabilitation. 2024;18(4):443-52.
6. Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of Ankle Sprains and Chronic Ankle Instability. J Athl Train. 2019;54(6):603-10.
7. Miklovic TM, Donovan L, Protzuk OA, Kang MS, Feger MA. Acute lateral ankle sprain to chronic ankle instability: a pathway of dysfunction. The Physician and sportsmedicine. 2018;46(1):116-22.
8. Samudra AD, Purwanto B, Utomo DN. Differences in Limb Muscle Strength Affecting Vertical Jump Heights in Soccer Players after Chronic Ankle Injury. Journal of Modern Rehabilitation. 2024.
9. Hertel J, Corbett RO. An Updated Model of Chronic Ankle Instability. Journal of Athletic Training. 2019;54(6):572-88.
10. Martin RL, Irrgang JJ. A survey of self-reported outcome instruments for the foot and ankle. J Orthop Sports Phys Ther. 2007;37(2):72-84.
11. Azadinia F, Saeedi H, Poorpooneh M, Mouloodi N, Jalali M. The translation, cultural adaptation and psychometric evaluation of the Manchester Foot Pain and Disability Index in Persian-speaking Iranians with foot disorder. Foot and Ankle Surgery. 2021;27(6):688-92.
12. Wadhokar O, Tandon V, Yede S, Bhardwaj J, Saini S, Palekar T. Current Notion on Virtual Reality Rehabilitation Approach on Post Operative Lower Extremity Conditions: A Narrative Review. Journal of Modern Rehabilitation. 2025.
13. Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999;79(4):371-83.
14. Riegle L, Taft J, Morris D, Uswatte G, Taub E. The validity and reliability of the lower extremity motor activity log. J Neurol Phys Ther. 2003;27:172.
15. Dos Anjos SM, Mark VW, Rodriguez CM, Morris DM, Crago JE, King DK, et al. Reliability and Validity of the Lower Extremity Motor Activity Log for Measuring Real-World Leg Use in Adults With Multiple Sclerosis. Arch Phys Med Rehabil. 2021;102(4):626-32.
16. Bullinger M, Alonso J, Apolone G, Leplège A, Sullivan M, Wood-Dauphinee S, et al. Translating health status questionnaires and evaluating their quality: the IQOLA project approach. Journal of clinical epidemiology. 1998;51(11):913-23.
17. Uswatte G, Taub E. Implications of the learned nonuse formulation for measuring rehabilitation outcomes: Lessons from constraint-induced movement therapy. Rehabilitation psychology. 2005;50(1):34.
18. Menezes-Oliveira E, Cecconi ME, Oliveira CBd, Vegas M, Alouche SR, Arida RM, et al. Measurement properties of the Brazilian Portuguese version of the Lower-Extremity Motor Activity Log for chronic hemiparetic poststroke patients. Arquivos de Neuro-Psiquiatria. 2023;81:369-76.
19. Cristine de Faria L, Barbosa Marques D, Hellen dos Santos Cerqueira Gomes L, Dos Anjos S, Pereira ND. Self-reported use of the paretic lower extremity of people with stroke: A reliability and validity study of the Lower-Extremity Motor Activity Log (LE-MAL)–Brazil. Physiotherapy Theory and Practice. 2023;39(8):1727-35.
20. de Lima A, Pereira ND, Foschi CVS, Ilha J. Identifying the content of the Lower Extremity Motor Activity Log based on the International Classification of Functioning, Disability and Health. Disability and Rehabilitation. 2024:1-7.
21. de Lima A, Foschi CVS, Pereira ND, Ilha J. DOES THE LOWER EXTREMITY MOTOR ACTIVITY LOG FIT THE BIOPSYCHOSOCIAL FUNCTIONING MODEL? Brazilian Journal of Physical Therapy. 2024;28:100606.
22. Mark VW, Woods AJ, Mennemeier M, Abbas S, Taub E. Cognitive assessment for CI therapy in the outpatient clinic. NeuroRehabilitation. 2006;21(2):139-46.
23. Mark VW, Taub E, Uswatte G, Bashir K, Cutter GR, Bryson CC, et al. Constraint-induced movement therapy for the lower extremities in multiple sclerosis: case series with 4-year follow-up. Archives of Physical Medicine and Rehabilitation. 2013;94(4):753-60.
24. Abdullahi A, Truijen S, Umar NA, Useh U, Egwuonwu VA, Van Criekinge T, et al. Effects of Lower Limb Constraint Induced Movement Therapy in People With Stroke: A Systematic Review and Meta-Analysis. Frontiers in neurology. 2021;12:343.
25. Dos Anjos S, Morris D, Taub E. Constraint-induced movement therapy for lower extremity function: describing the LE-CIMT protocol. Physical therapy. 2020;100(4):698-707.
26. Menezes-Oliveira E, da Silva Matuti G, de Oliveira CB, de Freitas SF, Kawamura CM, Lopes JAF, et al. Effects of lower extremity constraint-induced movement therapy on gait and balance of chronic hemiparetic patients after stroke: description of a study protocol for a randomized controlled clinical trial. Trials. 2021;22(1):1-12.
27. Mark VW, Lee RDA, Taub E, Uswatte G. Perspectives from Persons with Multiple Sclerosis for a Comprehensive Real-World Change Therapy for Mobility. Archives of Rehabilitation Research and Clinical Translation. 2021:100166.
28. García-Salazar LF, Pacheco MM, Alcantara CC, Russo TL, Pereira ND. Lower extremity constraint-induced movement therapy increase variability in the intra-limb coordination during walking in chronic post-stroke. Ecological Psychology. 2022;34(3):109-31.
29. Matuti G, de Oliveira EM. Which Are the Variables That Better Explain Results of Lower Extremity Constraint Induced Movement Therapy? Archives of Physical Medicine and Rehabilitation. 2025;106(4):e45.
30. Menezes-Oliveira E, da Silva Matuti G, de Oliveira CB, de Freitas SF, Miyuki Kawamura C, Fernandes Lopes JA, et al. Improvement of gait and balance function in chronic post-stroke patients induced by Lower Extremity–Constraint Induced Movement Therapy: a randomized controlled clinical trial. Brain Injury. 2024;38(7):559-68.
31. Tanabe H, Tanabe H, Moita Y, editors. Efficacy of lower Extremity LE CI Therapy using a spasticity reduction device for hemiplegia in stroke patients. 2024 24th International Conference on Control, Automation and Systems (ICCAS); 2024: IEEE.
32. Brown S, Scott C, Duncanson M, Lewis A, Burns K, Luke M, et al. Investigating the Inclusion of the Pediatric Quality of Life Inventory E-Application Within Pediatric Outpatient Rehabilitation. Archives of Physical Medicine and Rehabilitation. 2025;106(4):e45.
33. Okuda S, Tanabe H, Tanabe H, Ryoya S, Sakurai Y, Takata Y. Effects of Constraint-induced Movement Therapy on Patients with Post-cerebrovascular Disease Hemiplegia in the Maintenance Phase: Evaluation of Gait Improving Effects by Biomechanical Analysis. British Journal of Healthcare and Medical Research-Vol. 2025;12(1).
34. Sit W. Three-dimensional Printing in Clinical Education and Practice. Archives of Physical Medicine and Rehabilitation. 2025;106(4):e45-e6.
35. Silveira AF, Uliam NR, Feltrin MC, Araujo PN, Roscani MG, Takahashi ACM, et al. Moderate-vigorous multimodal circuit training to boost steps and reduce seated time in post-stroke survivors: Protocol for a randomized clinical trial. 2024.
36. Negahban H, Hessam M, Tabatabaei S, Salehi R, Sohani SM, Mehravar M. Reliability and validity of the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower limb musculoskeletal disorders. Disabil Rehabil. 2014;36(1):10-5.
37. Stalvey BT, Owsley C, Sloane ME, Ball K. The life space questionnaire: a measure of the extent of mobility of older adults. Journal of Applied Gerontology. 1999;18(4):460-78.
38. Youdan Jr GA, Chihuri ST, Wong CK. Preliminary analysis of reliability and validity of the Life Space Questionnaire as a real-world mobility measure for people with lower limb loss: A technical note. Prosthetics and orthotics international. 2022;46(5):491-5.
39. Rovira E, McLaughlin AC, Pak R, High L. Looking for age differences in self-driving vehicles: examining the effects of automation reliability, driving risk, and physical impairment on trust. Frontiers in Psychology. 2019;10:800.
40. Satariano WA, Guralnik JM, Jackson RJ, Marottoli RA, Phelan EA, Prohaska TR. Mobility and aging: new directions for public health action. American journal of public health. 2012;102(8):1508-15.
41. Baker PS, Bodner EV, Allman RM. Measuring life‐space mobility in community‐dwelling older adults. Journal of the American Geriatrics Society. 2003;51(11):1610-4.
42. McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Quality of life research. 1995;4(4):293-307.
43. Cronbach LJ. Coefficient alpha and the internal structure of tests. psychometrika. 1951;16(3):297-334.
44. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychological bulletin. 1979;86(2):420.
45. Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. The Journal of Strength & Conditioning Research. 2005;19(1):231-40.
46. Seamon BA, Kautz SA, Bowden MG, Velozo CA. Revisiting the concept of minimal detectable change for patient-reported outcome measures. Physical Therapy. 2022;102(8):pzac068.
47. Hiengkaew V, Jitaree K, Chaiyawat P. Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Archives of physical medicine and rehabilitation. 2012;93(7):1201-8.
48. Taylor R. Interpretation of the correlation coefficient: a basic review. Journal of diagnostic medical sonography. 1990;6(1):35-9.
2. Nabian MH, Zadegan SA, Zanjani LO, Mehrpour SR. Epidemiology of joint dislocations and ligamentous/tendinous injuries among 2,700 patients: five-year trend of a tertiary center in Iran. Archives of bone and joint surgery. 2017;5(6):426.
3. McCann RS, Johnson K, Suttmiller AMB. Lumbopelvic Stability and Trunk Muscle Contractility of Individuals with Chronic Ankle Instability. Int J Sports Phys Ther. 2021;16(3):741-8.
4. Fong DT-P, Hong Y, Chan L-K, Yung PS-H, Chan K-M. A systematic review on ankle injury and ankle sprain in sports. Sports medicine. 2007;37:73-94.
5. Sekkehchi S, Tajali SB, Ashnagar Z, Majdi F. Investigating the Effects of Intrinsic Foot Muscle Exercises on Dynamic Balance after Sub-Acute Ankle Sprain. Journal of Modern Rehabilitation. 2024;18(4):443-52.
6. Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of Ankle Sprains and Chronic Ankle Instability. J Athl Train. 2019;54(6):603-10.
7. Miklovic TM, Donovan L, Protzuk OA, Kang MS, Feger MA. Acute lateral ankle sprain to chronic ankle instability: a pathway of dysfunction. The Physician and sportsmedicine. 2018;46(1):116-22.
8. Samudra AD, Purwanto B, Utomo DN. Differences in Limb Muscle Strength Affecting Vertical Jump Heights in Soccer Players after Chronic Ankle Injury. Journal of Modern Rehabilitation. 2024.
9. Hertel J, Corbett RO. An Updated Model of Chronic Ankle Instability. Journal of Athletic Training. 2019;54(6):572-88.
10. Martin RL, Irrgang JJ. A survey of self-reported outcome instruments for the foot and ankle. J Orthop Sports Phys Ther. 2007;37(2):72-84.
11. Azadinia F, Saeedi H, Poorpooneh M, Mouloodi N, Jalali M. The translation, cultural adaptation and psychometric evaluation of the Manchester Foot Pain and Disability Index in Persian-speaking Iranians with foot disorder. Foot and Ankle Surgery. 2021;27(6):688-92.
12. Wadhokar O, Tandon V, Yede S, Bhardwaj J, Saini S, Palekar T. Current Notion on Virtual Reality Rehabilitation Approach on Post Operative Lower Extremity Conditions: A Narrative Review. Journal of Modern Rehabilitation. 2025.
13. Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999;79(4):371-83.
14. Riegle L, Taft J, Morris D, Uswatte G, Taub E. The validity and reliability of the lower extremity motor activity log. J Neurol Phys Ther. 2003;27:172.
15. Dos Anjos SM, Mark VW, Rodriguez CM, Morris DM, Crago JE, King DK, et al. Reliability and Validity of the Lower Extremity Motor Activity Log for Measuring Real-World Leg Use in Adults With Multiple Sclerosis. Arch Phys Med Rehabil. 2021;102(4):626-32.
16. Bullinger M, Alonso J, Apolone G, Leplège A, Sullivan M, Wood-Dauphinee S, et al. Translating health status questionnaires and evaluating their quality: the IQOLA project approach. Journal of clinical epidemiology. 1998;51(11):913-23.
17. Uswatte G, Taub E. Implications of the learned nonuse formulation for measuring rehabilitation outcomes: Lessons from constraint-induced movement therapy. Rehabilitation psychology. 2005;50(1):34.
18. Menezes-Oliveira E, Cecconi ME, Oliveira CBd, Vegas M, Alouche SR, Arida RM, et al. Measurement properties of the Brazilian Portuguese version of the Lower-Extremity Motor Activity Log for chronic hemiparetic poststroke patients. Arquivos de Neuro-Psiquiatria. 2023;81:369-76.
19. Cristine de Faria L, Barbosa Marques D, Hellen dos Santos Cerqueira Gomes L, Dos Anjos S, Pereira ND. Self-reported use of the paretic lower extremity of people with stroke: A reliability and validity study of the Lower-Extremity Motor Activity Log (LE-MAL)–Brazil. Physiotherapy Theory and Practice. 2023;39(8):1727-35.
20. de Lima A, Pereira ND, Foschi CVS, Ilha J. Identifying the content of the Lower Extremity Motor Activity Log based on the International Classification of Functioning, Disability and Health. Disability and Rehabilitation. 2024:1-7.
21. de Lima A, Foschi CVS, Pereira ND, Ilha J. DOES THE LOWER EXTREMITY MOTOR ACTIVITY LOG FIT THE BIOPSYCHOSOCIAL FUNCTIONING MODEL? Brazilian Journal of Physical Therapy. 2024;28:100606.
22. Mark VW, Woods AJ, Mennemeier M, Abbas S, Taub E. Cognitive assessment for CI therapy in the outpatient clinic. NeuroRehabilitation. 2006;21(2):139-46.
23. Mark VW, Taub E, Uswatte G, Bashir K, Cutter GR, Bryson CC, et al. Constraint-induced movement therapy for the lower extremities in multiple sclerosis: case series with 4-year follow-up. Archives of Physical Medicine and Rehabilitation. 2013;94(4):753-60.
24. Abdullahi A, Truijen S, Umar NA, Useh U, Egwuonwu VA, Van Criekinge T, et al. Effects of Lower Limb Constraint Induced Movement Therapy in People With Stroke: A Systematic Review and Meta-Analysis. Frontiers in neurology. 2021;12:343.
25. Dos Anjos S, Morris D, Taub E. Constraint-induced movement therapy for lower extremity function: describing the LE-CIMT protocol. Physical therapy. 2020;100(4):698-707.
26. Menezes-Oliveira E, da Silva Matuti G, de Oliveira CB, de Freitas SF, Kawamura CM, Lopes JAF, et al. Effects of lower extremity constraint-induced movement therapy on gait and balance of chronic hemiparetic patients after stroke: description of a study protocol for a randomized controlled clinical trial. Trials. 2021;22(1):1-12.
27. Mark VW, Lee RDA, Taub E, Uswatte G. Perspectives from Persons with Multiple Sclerosis for a Comprehensive Real-World Change Therapy for Mobility. Archives of Rehabilitation Research and Clinical Translation. 2021:100166.
28. García-Salazar LF, Pacheco MM, Alcantara CC, Russo TL, Pereira ND. Lower extremity constraint-induced movement therapy increase variability in the intra-limb coordination during walking in chronic post-stroke. Ecological Psychology. 2022;34(3):109-31.
29. Matuti G, de Oliveira EM. Which Are the Variables That Better Explain Results of Lower Extremity Constraint Induced Movement Therapy? Archives of Physical Medicine and Rehabilitation. 2025;106(4):e45.
30. Menezes-Oliveira E, da Silva Matuti G, de Oliveira CB, de Freitas SF, Miyuki Kawamura C, Fernandes Lopes JA, et al. Improvement of gait and balance function in chronic post-stroke patients induced by Lower Extremity–Constraint Induced Movement Therapy: a randomized controlled clinical trial. Brain Injury. 2024;38(7):559-68.
31. Tanabe H, Tanabe H, Moita Y, editors. Efficacy of lower Extremity LE CI Therapy using a spasticity reduction device for hemiplegia in stroke patients. 2024 24th International Conference on Control, Automation and Systems (ICCAS); 2024: IEEE.
32. Brown S, Scott C, Duncanson M, Lewis A, Burns K, Luke M, et al. Investigating the Inclusion of the Pediatric Quality of Life Inventory E-Application Within Pediatric Outpatient Rehabilitation. Archives of Physical Medicine and Rehabilitation. 2025;106(4):e45.
33. Okuda S, Tanabe H, Tanabe H, Ryoya S, Sakurai Y, Takata Y. Effects of Constraint-induced Movement Therapy on Patients with Post-cerebrovascular Disease Hemiplegia in the Maintenance Phase: Evaluation of Gait Improving Effects by Biomechanical Analysis. British Journal of Healthcare and Medical Research-Vol. 2025;12(1).
34. Sit W. Three-dimensional Printing in Clinical Education and Practice. Archives of Physical Medicine and Rehabilitation. 2025;106(4):e45-e6.
35. Silveira AF, Uliam NR, Feltrin MC, Araujo PN, Roscani MG, Takahashi ACM, et al. Moderate-vigorous multimodal circuit training to boost steps and reduce seated time in post-stroke survivors: Protocol for a randomized clinical trial. 2024.
36. Negahban H, Hessam M, Tabatabaei S, Salehi R, Sohani SM, Mehravar M. Reliability and validity of the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower limb musculoskeletal disorders. Disabil Rehabil. 2014;36(1):10-5.
37. Stalvey BT, Owsley C, Sloane ME, Ball K. The life space questionnaire: a measure of the extent of mobility of older adults. Journal of Applied Gerontology. 1999;18(4):460-78.
38. Youdan Jr GA, Chihuri ST, Wong CK. Preliminary analysis of reliability and validity of the Life Space Questionnaire as a real-world mobility measure for people with lower limb loss: A technical note. Prosthetics and orthotics international. 2022;46(5):491-5.
39. Rovira E, McLaughlin AC, Pak R, High L. Looking for age differences in self-driving vehicles: examining the effects of automation reliability, driving risk, and physical impairment on trust. Frontiers in Psychology. 2019;10:800.
40. Satariano WA, Guralnik JM, Jackson RJ, Marottoli RA, Phelan EA, Prohaska TR. Mobility and aging: new directions for public health action. American journal of public health. 2012;102(8):1508-15.
41. Baker PS, Bodner EV, Allman RM. Measuring life‐space mobility in community‐dwelling older adults. Journal of the American Geriatrics Society. 2003;51(11):1610-4.
42. McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Quality of life research. 1995;4(4):293-307.
43. Cronbach LJ. Coefficient alpha and the internal structure of tests. psychometrika. 1951;16(3):297-334.
44. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychological bulletin. 1979;86(2):420.
45. Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. The Journal of Strength & Conditioning Research. 2005;19(1):231-40.
46. Seamon BA, Kautz SA, Bowden MG, Velozo CA. Revisiting the concept of minimal detectable change for patient-reported outcome measures. Physical Therapy. 2022;102(8):pzac068.
47. Hiengkaew V, Jitaree K, Chaiyawat P. Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Archives of physical medicine and rehabilitation. 2012;93(7):1201-8.
48. Taylor R. Interpretation of the correlation coefficient: a basic review. Journal of diagnostic medical sonography. 1990;6(1):35-9.
| Issue | Articles in Press | |
| Section | Research Article(s) | |
| Keywords | ||
| Reliability; validity; ankle injuries; self report; outcomes assessment | ||
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How to Cite
1.
Seyed Ahmadi A, Lajevardi L, Taghizadeh G, Azad A. Reliability and Validity of the Lower Extremity Motor Activity Log in Persian People with Ankle Sprain. jmr. 2025;(-).
