A systematic review evaluating the clinimetric properties of the Victorian Institute of Sport Assessment (VISA) questionnaires for lower limb tendinopathy shows moderate to high-quality evidence for sufficient reliability, validity and responsiveness—part II

Abstract

Purpose The evaluation of measurement properties such as reliability, measurement error, construct validity, and responsiveness provides information on the quality of the scale as a whole, rather than on an item level. We aimed to synthesize the measurement properties referring to reliability, measurement error, construct validity, and responsiveness of the Victorian Institute of Sport Assessment questionnaires (Achilles tendon—VISA-A, greater trochanteric pain syndrome—VISA-G, proximal hamstring tendinopathy—VISA-H, patellar tendon—VISA-P). Methods A systematic review was conducted according to Consensus-based Standards for the Selection of Health Measurement Instruments methodology (COSMIN). PubMed, Cochrane, CINAHL, EMBASE, Web of Science, SportsDiscus, grey literature, and reference lists were searched. Studies assessing the measurement properties concerning reliability, validity, and responsiveness of the VISA questionnaires in patients with lower limb tendinopathies were included. Two reviewers assessed the methodological quality of studies assessing reliability, validity, and responsiveness using the COSMIN guidelines and the evidence for these measurement properties. A modified Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was applied to the evidence synthesis. Results There is moderate-quality evidence for sufficient VISA-A, VISA-G, and VISA-P reliability. There is moderate-quality evidence for sufficient VISA-G and VISA-P measurement error, and high-quality evidence for sufficient construct validity for all the VISA questionnaires. Furthermore, high-quality evidence exists with regard to VISA-A for sufficient responsiveness in patients with insertional Achilles tendinopathy following conservative interventions. Conclusions Sufficient reliability, measurement error, construct validity and responsiveness were found for the VISA questionnaires with variable quality of evidence except for VISA-A which displayed insufficient measurement error. Level of evidence IV. Registration details Prospero (CRD42018107671); PROSPERO reference—CRD42019126595.

Tendinopathy VISAs have expired—is it time for outcome renewals?

“…In essence, shortcomings as those highlighted in recent years concerning the VISA-A [3,11], most likely apply to all VISA questionnaires, as also indicated by our recent systematic reviews in this journal from 2021 [8,9]. Beyond the obvious evidence and the appraisal of measurement bonafides of VISA from these reviews, the questionnaires incorporate complex items with complicated scoring and thematic ambiguity [3] that needs reconsideration.…”

“…Although our systematic review revealed high-quality evidence for sufficient construct validity of all VISA questionnaires, some general limitations to their construct validity remain. None of the VISA development studies predetermined the expected direction and magnitude of the correlations with the comparator instruments [2,5,15,19], and the majority of the VISA questionnaires validation studies just modelled their methodology based upon the approach of previous studies [8,9] without any underlying theoretical concept and hypotheses testing. From an in-depth inspection of study methods assessing validity of the VISA questionnaires, 82% of these studies used comparator scales without proven reliability and/or validity, or using non condition-or region-specific PROMs [8,9].…”

“…The quality of a PROM-not its availability-is fundamental in defining its validity in research and clinical practice [6] and should be based upon its clinimetric properties (i.e., reliability, validity, and responsiveness) [13]. However, in a recent systematic review [8,9] we have highlighted the limited evidence of the VISA questionnaires' clinimetric properties and underlined important deviations and short-cuts from methodological recommendations associated with robust and sound development and validation of PROMs. Although, most likely driven by the lack of current and relevant alternatives, the development and replication of VISA study methodology to cover all tendinopathies seem to have introduced bias and affected VISA questionnaires' validity as a measure of different region-specific tendinopathies.…”

Outcome measures in the management of gluteal tendinopathy: a systematic review of their measurement properties

“…The suitability of two items in the VISA questionnaires for less active populations has come under scrutiny, due to the focus on the performance of sporting activities (item seven and eight) 31–33. For example, in item eight of VISA-G responders are asked to answer one of three sections that corresponds with their ability to perform activities for certain durations, and consider the influence on pain in the performance of the activity 21.…”

Consequences of Patellar Tendinopathy on Isokinetic Knee Strength and Jumps in Professional Volleyball Players

“…The pre-season evaluation consisted of measuring the isokinetic knee strength and performing single-leg CMJ and one-leg hop tests in random order. Moreover, the volleyball players' symptoms and their sportive activities were assessed by the Victorian Institute of Sport Assessment-Patella (VISA-P) score [20], which is a reliable and valid tool [21]. Every player received standardized information and a demonstration of the jumps.…”