VISA-A scale

Objective

The VISA-A aims to assess the clinical severity of patients with chronic Achilles tendinopathy. It is an easy self-administered questionnaire that assesses symptoms and effects on physical activity. It can be used to compare different populations of chronic achilles tendinopathy and facilitate comparisons between studies. It can be used to quantify the clinical severity of a patient and to provide instructions for treatments as well as to monitor treatment effects[1] The VISA-A is very user-friendly as it usually takes less than minutes five have even finished patients with chronic and severe symptoms. The questionnaire represents a valid, reliable and disease-specific questionnaire for measuring the status of the Achilles tendon but is not a diagnostic tool. The final section of the questionnaire was named the Victorian Institute of Sport Research-Achilles Questionnaire.

Intended Population

• Patients with Achilles tendinopathy.
• Patients able to give written informed consent.
• Exclusion: pregnant or lactating individuals with complete rupture of the Achilles tendon.

Method of Use

The questionnaire consists of eight questions on three important areas: 1) pain 2) functional status and 3) function (= three important indicators of functional impairment):

• Questions 1-3 relate to pain. (In this questionnaire, the term pain refers specifically to pain in the area of the Achilles tendon).
• Questions 4-6 are related to function.
• Questions 7-8 are related to activity.
• Question 8 actually consists of two questions: a) Pain during activity and b) Duration of activity.
• The first seven questions are worth 10 points, and the eighth question is worth 30 points.
• The first six questions use a VAS so that the patient can report the severity of ongoing subjective symptoms. The last two questions used a categorical rating scale[2].

The answer to question 8 is only AB or C and is relevant to the patient’s facts. The patient automatically loses at least 10 of the 20 points if he or she experiences pain during sports.

The maximum score possible for the question is 100 and would be the score of a person who has no symptoms at all. A lower score indicates more symptoms and more limited physical activity.

Recreationalists with Achilles tendinopathy will score no higher than 70 on the VISA-A scale.

Evidence

Reliability

The VISA-A questionnaire had good test-retest (r=0.93) within-rater (r=0.90 for yourtest) and between-rater (r=0.90) reliability and good stability when compared one week apart (R=0.81) 。

Scores did not differ whether the retest questionnaire was completed at the first or second visit (p=0.58). Reliability data were analyzed by Pearson’r since these data were normally distributed. [2]

It is noted that even if the average visa score of non -surgery and surgery patients has significant statistical differences, the visa score does not indicate whether the surgery is determined.

For international comparison of results, conduct multinational research or mitigate bias from minorities speaking different languages in one country, it is a unique process of back and forth translation and cultural change as well as ”verification of the scaling requirements and the implementation and establishment of criteria for the new definition’’ is necessary .

This measure has been developed and published for the Swedish Italian and Turkish versions of the VISA-A questionnaire. Multicultural adaptations to Spanish Portuguese and Flemish have been made but not reported in journals in Medline/Pubmed.[1][3][4][5][6]

Validity

VISA-A scores correlated significantly with both Percy and Conochie grade of severity (Spearman’s r =0.58; p<0.01) and Curwin and Stanish (Spearman’s r=-0.57; p<0.001).[2]

Factor analysis has provided two factors that strongly emphasize the suitability of the questionnaire for the assessment of patient symptoms and their impact on physical activity. An internal factor value of 0.77 as measured by Cronbach’s alpha indicates that no question should be omitted.[2]

The VISA-A questionnaire demonstrates construct validity when used in two populations with Achilles tendinopathy and control subjects. The mean score in nonoperative patients has been shown to be 64 (59-69) in previously operated patients aged 44 (28-60) and asymptomatic 96 people (94-99). VISA-A scores were higher in patients without surgery vs those with prior surgery (p=0.02) and higher in asymptomatic subjects vs patients with or without surgery (p<0.001).[2]

Responsiveness

The VISA-A questionnaire shows positive responses; it is susceptible to clinically significant changes over time with the treatment being easier for patients to fill and the issues easier to manage.[7]

Other Languages

The French version of this questionnaire (VISA-AF) is also available. It has recently been shown to have construct validity providing satisfactory test–retest reliability with excellent internal consistency and discriminant validity as well as the absence of floor and ceiling effects. [8] .

Miscellaneous

Because minimal researcher assistance is required the VISA-A can be self-administered and the risks for possible administrator bias are minimal.

The VISA-A questionnaire is not a diagnostic tool and the score may be reduced or influenced e.g. function of the lower limbs. Functional limitations hinder the subject’s ability to score well on question 8 even though the Achilles tendon may not be injured.

The continuous numeric results of the VISA-A questionnaire are ideal for comparing patient progress in a clinical setting. Continuous numerical results have the potential to provide utility in clinical settings and research. Further research is needed to determine whether VISA-A Score Predicts Prognosis [2]

A lower score indicates more symptoms and greater exercise restriction but there is no evidence for example that a patient with a score of 70 cures.

Reources

• VISA-A Questionnaire