The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy

J M Robinson^1,2, J L Cook^1,3, C Purdam^1,3, P J Visentini^1,4, J Ross^1,5, N Maffulli^1,5, J E Taunton^1,2 and K M Khan^1,2

¹ For The Victorian Institute Of Sport Tendon Study Group
² Department of Family Practice (Allan McGavin Sports Medicine Centre) and School of Human Kinetics, University of British Columbia, Vancouver, Canada
³ Department of Physiotherapy, LaTrobe University, Bundoora, Australia and Victorian Institute of Sport Tendon Study Group, Melbourne, Australia
⁴ Alphington Sports Medicine Clinic and School of Physiotherapy, University of Melbourne, Australia and Victorian Institute of Sport Tendon Study Group, Melbourne, Australia
⁵ Department of Orthopaedic Surgery, University of Aberdeen, Aberdeen, Scotland, UK

Correspondence to:
Correspondence to: Dr Khan, James Mather Building, 5804 Fairview Avenue, Vancouver V6T 1Z3, Canada kkhan{at}interchange.ubc.ca

Background—There is no disease specific, reliable, and valid clinical measure of Achilles tendinopathy.

Objective—To develop and test a questionnaire based instrument that would serve as an index of severity of Achilles tendinopathy.

Methods—Item generation, item reduction, item scaling, and pretesting were used to develop a questionnaire to assess the severity of Achilles tendinopathy. The final version consisted of eight questions that measured the domains of pain, function in daily living, and sporting activity. Results range from 0 to 100, where 100 represents the perfect score. Its validity and reliability were then tested in a population of non-surgical patients with Achilles tendinopathy (n = 45), presurgical patients with Achilles tendinopathy (n = 14), and two normal control populations (total n = 87).

Results—The VISA-A questionnaire had good test-retest (r = 0.93), intrarater (three tests, r = 0.90), and interrater (r = 0.90) reliability as well as good stability when compared one week apart (r = 0.81). The mean (95% confidence interval) VISA-A score in the non-surgical patients was 64 (59–69), in presurgical patients 44 (28–60), and in control subjects it exceeded 96 (94–99). Thus the VISA-A score was higher in non-surgical than presurgical patients (p = 0.02) and higher in control subjects than in both patient populations (p<0.001).

Conclusions—The VISA-A questionnaire is reliable and displayed construct validity when means were compared in patients with a range of severity of Achilles tendinopathy and control subjects. The continuous numerical result of the VISA-A questionnaire has the potential to provide utility in both the clinical setting and research. The test is not designed to be diagnostic. Further studies are needed to determine whether the VISA-A score predicts prognosis.

Key Words: Achilles; tendinopathy; tendinitis; outcome; questionnaire

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