Is the VISA-A Still Seaworthy, or Is It in Need of Maintenance?

Abstract

Background: The Victorian Institute of Sport Assessment–Achilles (VISA-A) questionnaire is validated and widely used in Achilles tendinopathy. How well it can evaluate treatment outcomes is not well understood. Purpose: To evaluate the responsiveness of the VISA-A in midportion Achilles tendinopathy and compare it with other patient-reported outcome measures. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Enrolled were 97 participants with clinically diagnosed Achilles tendinopathy (median age, 50 years [interquartile range, 18 years]; symptom duration, 10 months [interquartile range, 28.7 months). The participants underwent a baseline evaluation and completed between 1 and 6 follow-up evaluations at 8, 16, 24, 32, 40, and/or 48 weeks. Participants completed the VISA-A, the Patient Reported Outcomes Measurement Information System short form Version 2.0 (PROMIS) Physical Function and Pain Interference subscales, and the Tampa Scale for Kinesiophobia (TSK). Three thresholds were evaluated with a receiver operating characteristic analysis (minimal clinically important difference [MCID], substantial benefit [SB], and complete recovery [CR]) using an 11-point global rating of change scale as an anchor. Thresholds were evaluated on raw scores as well as changes from baseline. Results: The VISA-A was able to detect all 3 thresholds for changes over time, with raw scores >70.5, >77.5, and >89.5 representing the MCID, SB, and CR, respectively; thresholds for changes from baseline on the VISA-A were increases of 23.5, 19.5, and 37.5 points from baseline, respectively. The PROMIS subscale raw scores had identical thresholds for SB and CR (52.45 for Physical Function and 45.6 for Pain Interference). A score <34.5 on the TSK was the threshold for SB. Conclusion: The VISA-A was the most responsive outcome measure evaluated. Raw scores had increasingly higher thresholds for the MCID, SB, and CR, which were therefore logically consistent.

Low socioeconomic status is associated with worse treatment outcomes in patients with Achilles tendinopathy

“…This is especially relevant in our study design. However, the VISA-A continues to demonstrate sufficient reliability and responsiveness 30 51. Next to this, the VISA-A has been cross-culturally adapted in numerous languages (including the Dutch version of the current study) 54.…”

“…We did not observe any difference in treatment satisfaction between patients with low and high SES which may question the robustness of the findings of the VISA-A questionnaire. Recent studies have highlighted some shortcomings of the VISA-A, particularly concerning its content validity 50–52. It is also unknown whether reduced health literacy influences the ability to complete the VISA-A, as shown in other PROMs used in musculoskeletal care 53.…”

Current practice, guideline adherence, and barriers to implementation for Achilles tendinopathy rehabilitation: a survey of physical therapists and people with Achilles tendinopathy

“… 33 The finding that therapists employ a variety of exercise types implies that the specific type of exercise or use of a specific programme is considered less important than individual tailoring and engagement with the programme. 34 39 Despite CPG recommendations and the recognised utility of the VISA-A 40 and the FAAM, 41 few PTs reported using them. We speculate that the scales may not be as widely known among PTs perhaps due to their specificity, or as widely used due to their length (and hence increased patient burden) when contrast with other scales like the LEFS, NPRS, or VAS.…”