The VISA-P is a simple, practical questionnaire-based index of severity would facilitate jumper's knee research and subsequently, clinical management.
8
3 minutes
Adult
18 - 64
yearsInitially reviewed by Amanda Doty; Brennan Ehlinger; Monica Anderson; Kristen Ignaszewski; Julianne Runey; and Elizabeth Huber.
Recommendations for use based on acuity level of the patient:
Acuity doesn’t play a huge role. This test can be performed in acute or chronic phase of injury
Recommendations based on level of care in which the assessment is taken:
Make sure they understand how to score the VISA-P properly
Recommendations based on SCI AIS Classification:
Not Established.
Recommendations based on EDSS Classification:
Not Established
Recommendations for entry-level physical therapy education and use in research:
Should probably not be used in research since validity cannot be tested. However, simple scoring scales are essential to obtain clinical data in a time-efficient manner without observer bias. Such data can then be analyzed statistically. The VISA scale is a simple, reliable instrument for measuring the severity of jumper's knee
Wilgen et al. (2011)
Scores below 80 indicate a patient with patellar tendinopathy
Time, mental status, fatigue. The VISA-P is not a diagnostic test. The test is inappropriate for individuals who cannot perform functional tests due to other limitations.
Frohm et al. (2004)
The VISA-P score has not been validated for pathological knee conditions other than patellar tendinopathy
The VISA-P score could be abbreviated to two or three items without losing significant clinical information
Zwerver et al. (2009)
A limitation of this study is that the test-retest reliability was investigated in asymptomatic students. One could argue that testing reliability in athletes with patellar tendinopathy would have been more appropriate
Hernandez-Sanchez et al. (2012)
The estimated MCID for the VISA-P is dependant on baseline scores and the interpretation of the relevant change on GROC
The MCID values vary depending on intervention type therefore further studies are needed to assess whether these values differ after surgical treatment
Hernandez-Sanchez et al. (2011)
The sample in this study consisted primarily of male participants, which may limit the generalization for the results. Further research is necessary to better establish the responsiveness of the scale
The VISA-P should not be considered a diagnostic tool, because there were no significant differences between the scores of athletes with tendinopathy and those of patients with other knee injuries
Maffulli et al. (2008)
The VISA-P-I was only validated for classic patellar tendinopathy as it is more common than tendinopathy of the main body of the patellar tendon
The VISA-P-I was not administered to any patients scheduled for surgery
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Asymptomatic University students, Sports medicine clinic patients with symptoms unrelated to knees, Sports medicine clinic patients who presented with jumper's knee, Elite basketball players who competed in the national league(current or past history of jumper's knee were not exclusion criteria), Patients before and after surgery for chronic jumper's knee.
Visentini et al (1998)
90% MDC for test-retest
All subjects = 1.39
Only tendons with VISA <80 = 1.49
Inter-tester all subjects tested = 1.49
Inter-tester for only tendons with VISA <80 = 3.33
Stability = 3.94
Athletes with patellar tendinopathy from 10 sports physiotherapy clinics across Spain
Hernandez-Sanchez et al (2012)
SEM = 4.0
Athletes with patellar tendinopathy from 10 sports physiotherapy clinics across Spain
Hernandez-Sanchez et al (2012)
MDC using a 95% CI= 11.1
Athletes with patellar tendinopathy from 10 sports physiotherapy clinics across Spain
Hernandez-Sanchez et al (2012)
> 13 point on the VISA-P score or 15.4-27% of relative change achieved MCID
Probability of clinical change 98% when threshold was achieved
Probability of clinical change 45% when MCID not achieved
Athletes with patellar tendinopathy from 10 sports physiotherapy clinics across Spain
Hernandez-Sanchez (2012)
Cut-off score of ≥3 on the Global Rating of Change scale (GROC) to define MCID level
Asymptomatic University students, Sports medicine clinic patients with symptoms unrelated to knees, Sports medicine clinic patients who presented with jumper's knee, Elite basketball players who competed in the national league(current or past history of jumper's knee were not exclusion criteria), Patients before and after surgery for chronic jumper's knee.
Healthy students, Members of Swedish male national basketball team (at-risk population), Non-surgically treated patients with clinically diagnosed patellar tendinopathy
Frohm et al (2004)
Asymptomatic male and female volleyball players, Athletes with symptomatic patellar tendinopathy who specifically had activity-related anterior knee pain and palpation tenderness, Participants completed the Dutch VISA-P
Wilgen et al (2011)
(“Athletes without knee complaints score the maximal score of 100, whereas athletes with PT usually score 50-75”)
Healthy students, Competitive volleyball players (at-risk population), Patients with patellar tendinopathy, Patients who had surgery for patellar tendinopathy, Patients with knee injuries other than patellar tendinopathy, Patients with symptoms unrelated to their knees, Participants completed the Dutch VISA-P
Zwerver et al (2009)
|
|
VISA-P Score |
|
Healthy Students |
95.3 (SD = 8.8) |
|
At-risk population |
88.6 (SD = 11.1) |
|
Injury other than knee |
76.6 (SD = 24.3) |
|
Knee Injury |
61.9 (SD = 24.1) |
|
Patellar Tendinopathy |
58.2 (SD = 18.9) |
|
Surgery for patellar tendinopathy |
56.0 (SD = 20.9) |
Healthy students, Athletes who participated in sports such as volleyball, basketball, and handball (at-risk population for patellar tendinopathy), Athletes diagnosed with patellar tendinopathy who played for professional sports clubs in Spain, Patients with knee injuries other than patellar tendinopathy
Hernandez-Sanchez et al (2011)
25 male athletes with diagnosis of classic patellar tendinopathy between ages 18-32, Participants completed the Italian VISA-P
Maffulli et al (2008)
Asymptomatic University students, Sports medicine clinic patients with symptoms unrelated to knees, Sports medicine clinic patients who presented with jumper's knee, Elite basketball players who competed in the national league(current or past history of jumper's knee were not exclusion criteria), Patients before and after surgery for chronic jumper's knee.
Visentini et al (1998)
Excellent test-retest reliability (r > 0.95)
Healthy students, Members of Swedish male national basketball team (at-risk population), Non-surgically treated patients with clinically diagnosed patellar tendinopathy
Frohm et al (2004)
Excellent test-retest reliability (ICC = 0.97)
Healthy students, Competitive volleyball players (at-risk population), Patients with patellar tendinopathy, Patients who had surgery for patellar tendinopathy, Patients with knee injuries other than patellar tendinopathy, Patients with symptoms unrelated to their knees, Participants completed the Dutch VISA-P
Zwerver et al (2009)
Adequate to excellent test-retest reliability (ICC = 0.74, p < 0.001)
Asymptomatic male and female volleyball players, Athletes with symptomatic patellar tendinopathy who specifically had activity-related anterior knee pain and palpation tenderness, Participants completed the Dutch VISA-P
Wilgen et al (2011)
Adequate to excellent test-retest reliability (ICC = 0.74)
Healthy students, Athletes who participated in sports such as volleyball, basketball, and handball (at-risk population for patellar tendinopathy), Athletes diagnosed with patellar tendinopathy who played for professional sports clubs in Spain, Patients with knee injuries other than patellar tendinopathy
Hernandez-Sanchez et al (2011)
Excellent test-retest reliability ICC = 0.994
Asymptomatic University students, Sports medicine clinic patients with symptoms unrelated to knees, Sports medicine clinic patients who presented with jumper's knee, Elite basketball players who competed in the national league(current or past history of jumper's knee were not exclusion criteria), Patients before and after surgery for chronic jumper's knee.
Visentini et al (1998)
Interrater Reliability (same as Test-retest Reliability)
Excellent interrater reliability (r > 0.95)
Healthy students, Members of Swedish male national basketball team (at-risk population), Non-surgically treated patients with clinically diagnosed patellar tendinopathy
Frohm et al (2004)
1st assessment:
Excellent internal consistency (Cronbach's alpha = 0.83)
2nd assessment
Excellent internal consistency (Cronbach's alpha = 0.82)
Healthy students, Competitive volleyball players (at-risk population), Patients with patellar tendinopathy, Patients who had surgery for patellar tendinopathy, Patients with knee injuries other than patellar tendinopathy, Patients with symptoms unrelated to their knees, Participants completed the Dutch VISA-P
Zwerver et al (2009)
1st assessment
Adequate internal consistency (Cronbach's alpha = 0.73)
2nd assessment
Adequate internal consistency (Cronbach's alpha = 0.71)
Healthy students, Athletes who participated in sports such as volleyball, basketball, and handball (at-risk population for patellar tendinopathy), Athletes diagnosed with patellar tendinopathy who played for professional sports clubs in Spain, Patients with knee injuries other than patellar tendinopathy
Hernandez-Sanchez et al (2011)
1st assessment
Excellent internal consistency (Cronbach's alpha = 0.885)
2nd assessment
Excellent internal consistency (Cronbach's alpha = 0.880)
25 male athletes with diagnosis of classic patellar tendinopathy between ages 18-32, Participants completed the Italian VISA-P
Maffulli et al (2008)
Adequate internal consistency (Kappa = 0.78, range of 0.7 - 0.86 with p < 0.05)
Healthy students, Members of Swedish male national basketball team (at-risk population), Non-surgically treated patients with clinically diagnosed patellar tendinopathy
Frohm et al (2004)
Differences between scores of the patients, healthy students, and basketball players were statistically significant: p<0.001
Asymptomatic male and female volleyball players, Athletes with symptomatic patellar tendinopathy who specifically had activity-related anterior knee pain and palpation tenderness, Participants completed the Dutch VISA-P
Wilgen et al (2011)
Significant difference between PPT results of “symptomatic group” (with scores less than 80) and participants classified as “normal group” (scores above 80)--symptomatic group’s PPTs were lower: x² p< 0.001
Healthy students, Athletes who participated in sports such as volleyball, basketball, and handball (at-risk population for patellar tendinopathy), Athletes diagnosed with patellar tendinopathy who played for professional sports clubs in Spain, Patients with knee injuries other than patellar tendinopathy
Hernandez-Sanchez et al (2011)
Differences between the healthy and the at-risk groups were statistically significant with respect to the participants with tendinopathy (37.9 points, P<.01) and other knee injuries (36.3 points, P<.01)
However, no differences were found between scores of participants in the tendinopathy group and those in the other knee injury group (1.6 points, P>.05) or between the healthy and the at-risk groups (5.45 points, P>0.05)
Healthy students, Competitive volleyball players (at-risk population), Patients with patellar tendinopathy, Patients who had surgery for patellar tendinopathy, Patients with knee injuries other than patellar tendinopathy, Patients with symptoms unrelated to their knees, Participants completed the Dutch VISA-P
Zwerver et al (2009)
ANOVA revealed a significant difference between the six groups (F = 10.7, p < 0.001). See normative data for the six groups.
Healthy students, Athletes who participated in sports such as volleyball, basketball, and handball (at-risk population for patellar tendinopathy), Athletes diagnosed with patellar tendinopathy who played for professional sports clubs in Spain, Patients with knee injuries other than patellar tendinopathy
Hernandez-Sanchez et al (2011)
Ceiling and floor effects were not observed in this study further supporting the validity of the VISA-P
Athletes with patellar tendinopathy from 10 sports physiotherapy clinics across Spain
Hernandez-Sanchez et al (2012)
We combined anchor-based (MCS and ROC curve) and distribution-based approaches (SEM and MDC) to study responsiveness
AUC represents responsiveness, AUC between 0.7 and 0.8 were considered acceptable discrimination. Values higher than 0.8 have excellent discrimination
To interpret the VISA-P changes, alternative methods of studying responsiveness are required alongside further studies
Healthy students, Athletes who participated in sports such as volleyball, basketball, and handball (at-risk population for patellar tendinopathy), Athletes diagnosed with patellar tendinopathy who played for professional sports clubs in Spain, Patients with knee injuries other than patellar tendinopathy
Hernandez-Sanchez et al (2011)
In athletes with tendinopathy, VISA-P (spanish) score changes were observed in those who were able to return to sports participation. The mean SD change in scores for this group was 15.23 +/- 13.01 points between the first and third applications of the questionnaire
The effect size (less than 0.8) provides evidence that the VISA-P (spanish) can detect changes in symptom severity at 2 different time points in the clinical course of tendinopathy
Frohm A, Saartok T, Edman G, Renström P. Psychometric properties of a Swedish translation of the VISA-P outcome score for patellar tendinopathy. BMC Musculoskelet Disord. 2004;5:49.
Hernandez-Sanchez S, Hildalgo MD, Gomez A. Cross-cultural adaptation of VISA-P score for patellar tendinopathy in Spanish population. Journal of Orthopaedic and Sports Physical Therapy. 2011; 41(8):581-91.
Hernandez-Sanchez, S., Hidalgo, M., & Gomez, A. (2012). Responsiveness of the VISA-P scale for patellar tendinopathy in athletes. British Journal of Sports Medicine Br J Sports Med, 453-457.
Maffulli N, Longo UG, Testa V, Oliva F, Capasso G, Denaro V. VISA-P score for patellar tendinopathy in males: Adaptation to Italian. Disability and Rehabilitation. 2008;30(20-22):1621-1624.
Van wilgen P, Van der noord R, Zwerver J. Feasibility and reliability of pain pressure threshold measurements in patellar tendinopathy. J Sci Med Sport. 2011;14(6):477-81.
Visentini PJ, Khan KM, Cook JL, Kiss ZS, Harcourt PR, Wark JD. The VISA score: an index of severity of symptoms in patients with jumper's knee (patellar tendinosis). Victorian Institute of Sport Tendon Study Group. J Sci Med Sport. 1998;1(1):22-8.
Zwerver J, Kramer T, Van den akker-scheek I. Validity and reliability of the Dutch translation of the VISA-P questionnaire for patellar tendinopathy. BMC Musculoskelet Disord. 2009;10:102.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.