Abstract
PurposeThe Victorian Institute of Sport Assessment (Achilles tendon—VISA-A, greater trochanteric pain syndrome—VISA-G, proximal hamstring tendinopathy—VISA-H, patellar tendon—VISA-P) questionnaires are widely used in research and clinical practice; however, no systematic reviews have formally evaluated their content, structural, and cross-cultural validity evidence. The measurement properties referring to content, structural and cross-cultural validity of the VISA questionnaires were appraised and synthesized.MethodsThe systematic review was conducted according to Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. PubMed, Cochrane, CINAHL, EMBASE, Web of Science, SportsDiscus, grey literature, and reference lists were searched. Development studies and cross-cultural adaptations (12 languages) assessing content or structural validity of the VISA questionnaires were included and two reviewers assessed their methodological quality. Evidence for content (relevance, comprehensiveness, and comprehensibility), structural, and cross-cultural validity was synthesized. A modified Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was applied to evidence synthesis.ResultsThe VISA-A presented very-low-quality evidence of sufficient relevance, insufficient comprehensiveness, and inconsistent comprehensibility. VISA-G displayed moderate-quality evidence for sufficient comprehensibility and very-low-quality evidence of sufficient relevance and comprehensiveness. The VISA-P presented very-low-quality evidence of sufficient relevance, insufficient comprehensiveness, and inconsistent comprehensibility, while VISA-H presented very-low evidence of insufficient content validity. VISA-A displayed low-quality evidence for structural validity concerning unidimensionality and internal structure, while VISA-H presented low-quality evidence of insufficient unidimensionality. The structural validity of VISA-G and VISA-P were indeterminate and inconsistent, respectively. Internal consistency for VISA-G, VISA-H, and VISA-P was indeterminate. No studies evaluated cross-cultural validity, while measurement invariance across sexes was assessed in one study.ConclusionsOnly very-low-quality evidence exists for the content and structural validity of VISA questionnaires when assessing the severity of symptoms and disability in patients with lower limb tendinopathies.Level of evidenceIV.RegistrationPROSPERO reference—CRD42019126595.
Highlights
According to the International Scientific Tendinopathy Symposium Consensus from 2020, the impact of lower limb tendinopathies on the patient should be measured using validated outcome measures that can capture the core domains of the condition such as: functional testing, participation in life activities, psychological factors, physical function capacity, and most importantly disability via condition-specific patient-rated outcome measures (PROMs) [44, 78]
The Victorian Institute of Sport Assessment (VISA) questionnaires [6, 20, 69, 80] have been recommended by the 2020 consensus statement [78] and are the most used conditionspecific lower limb questionnaires in the literature [8, 11, 37, 44, 52, 57, 76, 77]
Four self-administered VISA questionnaires exist which assess the severity of symptoms in patients with Achilles tendinopathy (VISA-A), greater trochanteric pain syndrome (VISA-G), proximal hamstring tendinopathy (VISA-H), and patellar tendinopathy (VISA-P) [6, 20, 69, 80]
Summary
According to the International Scientific Tendinopathy Symposium Consensus from 2020, the impact of lower limb tendinopathies on the patient should be measured using validated outcome measures that can capture the core domains of the condition such as: functional testing, participation in life activities, psychological factors, physical function capacity, and most importantly disability via condition-specific patient-rated outcome measures (PROMs) [44, 78]. The Victorian Institute of Sport Assessment (VISA) questionnaires [6, 20, 69, 80] have been recommended by the 2020 consensus statement [78] and are the most used conditionspecific lower limb questionnaires in the literature [8, 11, 37, 44, 52, 57, 76, 77]. The strength of a PROM can be evaluated by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) [64]. COSMIN evaluates validity, reliability, and responsiveness of outcome measurement instruments like the patient-reported VISA questionnaires [6, 20, 69, 80]. Irrelevant items decrease internal consistency and structural validity, and missing concepts decrease validity and responsiveness [74]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call