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  • ICON 2020—International Scientific Tendinopathy Symposium Consensus: the development of a core outcome set for gluteal tendinopathy

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ICON 2020—International Scientific Tendinopathy Symposium Consensus: the development of a core outcome set for gluteal tendinopathy
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  • Published on: 7 May 2024
    Letter to the editor: response to patient-reported outcome measures for gluteal tendinopathy – more empirical evidence is needed?
    • Angela M Fearon, Physiotherapist University of Canberra; Trauma and Orthopaedic Research Unit at Canberra Hospital
    • Other Contributors:
      • Alison Grimaldi, Physiotherapist
      • Rebecca Mellor, Physiotherapist
      • Anthony Nasser, Physiotherapist
      • Jane Fitzpatrick, Sports physician
      • Andreas Ladurner, Orthopaedic surgeon
      • Bill Vicenzino, Physiotherapist

    In responding to the comments raised in the letter to the editor regarding the recommendation of the VISA-G questionnaire for gluteal tendinopathy, we first want to acknowledge qualified agreement with the points raised while also emphasising the practical considerations and guidelines that informed our recommendation.

    1. A key conclusion of our recent publication was that we were not able to form a Core Outcome Set as no outcome measure had sufficient clinimetric properties (1). For a measure to be selected for a Core Outcome Set, it should have at least high-quality evidence of good content validity (2 3). As part of the COS-GT consensus process, we completed a systematic review that collected and evaluated measurement properties of all outcome measures used to evaluate patients with gluteal tendinopathy. (4) No outcome measures met this threshold. Of the ICON disability domain outcome measures that had been validated in people with gluteal tendinopathy (the VISA-G and the two HOS outcome measures), the VISA-G had, albeit low, the best available evidence for content validity (low-quality evidence of sufficient comprehensibility and very low-quality evidence of sufficient comprehensiveness and relevance). (4) After much consideration the final recommendation for interim use was based on consideration of the impact of not providing a recommendation and the COSMIN systematic review guidelines for formulating recommendations. (p45, 4.2 Step 9) (5)

    2. We ackno...

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    Conflict of Interest:

    Dr Fearon is the lead author on the development of the VISA-G, and a co-author two translations and one utility paper of the same
  • Published on: 8 April 2024
    Letter to Editor: Patient-reported outcome measures for gluteal tendinopathy – more empirical evidence is needed?
    • Kristian Thorborg, PT, Professor Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amage
    • Other Contributors:
      • Karl B Christensen, Biostatistician, Professor
      • Signe Kierkegaard-Brøchner, PT, Senior Researcher
      • Jeppe Lange, MD, Associate Professor
      • Marie B Bohn, MD, Senior Researcher

    Dear Editor,
    First, we commend the efforts of the International Scientific Tendinopathy Symposium Consensus (ICON) group in defining health-related core domains for tendinopathy treatment outcomes. However, in this rapid response, we want to share our concern with the conclusion from the ICON 2020 statement concerning the development of a core outcome set for gluteal tendinopathy, written by Fearon et al. and published in the British Journal of Sports Medicine.(1)

    Our primary concern relates to the suggestion that the Victorian Institute of Sport Assessment-Greater trochanteric pain syndrome (VISA-G) questionnaire, as the only condition/region-specific patient-reported outcome measure (PROM), should be considered in clinical trials - and that this measure currently is the best measure of relevant tendinopathy domains. Presently, we do not find any evidence from the literature(2,3,4) or the ICON consensus process(1) that supports such a strong statement, and we would like to support our claim in three main points:

    1. The development of the VISA questionnaires has not sufficiently included patients, and the content validity of the VISA questionnaires is therefore questionable.(2,3,4) The Delphi process from the ICON paper by Fearon et al. also seems to question the content validity of the VISA-G questionnaire, as only 14% of patients (1 in 7 patients) considered the VISA-G an appropriate measure concerning gluteal tendinopathy core-domains.(1) As content...

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    Conflict of Interest:
    Professor Kristian Thorborg is Deputy Editor of the British Journal of Sports Medicine and is also the developer of the Copenhagen Hip And Groin Outcome Score (HAGOS) and the revised HAGOS scoring format.

    Karl Bang Christensen is developer of the revised HAGOS scoring format.

    Signe Kierkegaard-Brøchner is Associate Editor of the British Journal of Sports Medicine.