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

Background-There is no disease specific, reliable, and valid clinical measu re of Achilles tendinopathy. Objective-To develop and test a questionnaire based instrument that would s erve 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 tendinop athy. The final version consisted of eight questions that measured the doma ins of pain, function in daily living, and sporting activity. Results range from 0 to 100, where 100 represents the perfect score. Its validity and re liability were then tested in a population of non-surgical patients with Ac hilles tendinopathy (n = 45), presurgical patients with Achilles tendinopat hy (n = 14), and two normal control populations (total n = 87). Results-The VISA-A questionnaire had good test-retest (r = 0.93), intrarate r (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% conf idence 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 pop ulations (p<0.001). Conclusions-The VISA-A questionnaire is reliable and displayed construct va lidity when means were compared in patients with a range of severity of Ach illes 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. F urther studies are needed to determine whether the VISA-A score predicts pr ognosis.