Cross-cultural adaptation and measurement properties of the Brazilian Portuguese Version of the Victorian Institute of Sport Assessment-Patella (VISA-P) scale

Effectiveness of adding Dynamic Tape® to progressive tendon-load exercise program in patients with patellar tendinopathy: A randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of adding Dynamic Tape® to a progressive load exercise program in patients with patellar tendinopathy.

DESIGN

Randomized controlled trial.

SETTING

University research.

PARTICIPANTS

Forty-eight subjects with patellar tendinopathy.

METHODS

Participants were divided into two groups: dynamic group, which received progressive load exercises and Dynamic Tape®, and sham group, which received progressive load exercises and sham taping. The intervention was conducted three times per week over 12 weeks.

MAIN OUTCOME MEASURES

The pain during decline squatting was assessed using a visual analog scale. The severity of patellar tendinopathy was measured using the Victorian Institute of Sport Assessment-Patella (VISA-P).

RESULTS

There was no effect of group-time interaction for the pain (Z = 0.844, p = 0.472) or severity (Z = 1.275, p = 0.286) of patellar tendinopathy. Reduced pain and severity were observed over time (p < 0.05), however there was no between-group differences (p > 0.05).

CONCLUSION

Dynamic Tape® does not provide additional benefits when combined with a progressive load exercise program for reducing pain and severity in patellar tendinopathy.

Translation, Cross-Cultural Adaptation, and Validation of the Traditional Chinese Version of the VISA-P Questionnaire

Background

The Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire is a widely accepted instrument for measuring the severity of symptoms and pain in patients having sustained patellar tendinopathy.

Purpose

To adapt the VISA-P questionnaire cross-culturally to a traditional Chinese version (VISA-P-Ch) and validate its psychometric properties.

Study Design

Cohort study (diagnosis); Level of evidence, 3.

Methods

The VISA-P questionnaire was adapted to a traditional Chinese version following international recommended guidelines, including translation, synthesis, back translation, revision by expert committee, pretesting, and validation. The psychometric properties were tested in 15 healthy controls and 15 participants with patellar tendinopathy. Face validity was judged by the authors and participants. Known-groups validity was tested by comparing the VISA-P-Ch scores between symptomatic and asymptomatic participants using an independent t test. Concurrent validity was determined by comparing the Blazina classification of the participants against VISA-P-Ch scores using the Spearman correlation coefficient. Test-retest reliability was assessed by calculating the intraclass correlation coefficient (ICC) following a 24- to 48-hour interval. Internal consistency was determined by the Cronbach alpha.

Results

The expert committee and participants reported good face validity of the VISA-P-Ch. Significantly higher scores were found in the control group than in the patellar tendinopathy group (98.47 ± 3.04 vs 65 ± 11.9; P < .001). Concurrent validity showed a high correlation between VISA-P-Ch and the Blazina classification system (r = -0.899; P < .01). The test-retest reliability was excellent (ICC = 0.964). Internal consistency was found to be good for both the first and second assessments (Cronbach α = 0.834 and 0.851).

Conclusion

The VISA-P-Ch was proven to be a reliable and valid questionnaire with similar psychometric properties as the original VISA-P.

Patient-reported outcome measures for patellofemoral disorders: a systematic review

INTRODUCTION

Patellofemoral conditions include, but are not limited to, anterior knee pain syndrome and patellar instability. Patients and surgeons may find it difficult to identify the specific source of the symptoms and clinical scenarios, so patient-reported outcome measures (PROMs) may be a useful diagnostic aid. There are a number of available PROMs for patellofemoral conditions, which are often used indistinctly. This systematic review explores the available PROMs for patellofemoral conditions, their use and methodological quality.

METHODS

A systematic review was conducted, searching for scientific articles relating to PROMs in patellofemoral conditions, from inception to July 2022. Scoring systems including physician-directed or imagining assessment were not included. All types of conditions in the patellofemoral joint were considered.

RESULTS

Twenty-two relevant PROMs were encountered, divided into four categories: eight PROMs for anterior knee pain syndrome, five for patellar instability, four for other patellofemoral conditions and five for non-specific PROMs.

CONCLUSIONS

While many PROMs have been found used in patellofemoral research, only few of them have showed sufficient methodological quality. In addition, PROMs employed in PF literature are often inaccurately chosen. This review may help authors to better understand the characteristics of specific patellofemoral PROMs, in order to select the more appropriate and recommended ones.

LEVEL OF EVIDENCE

Level II.

Cross-cultural adaptation, validity, reliability and responsiveness of the Japanese version of the Victorian Institute of sports assessment for patellar tendinopathy (VISA-P-J)

BACKGROUND

This study aimed to translate, adapt, and test the psychometric properties of the Japanese version of the Victorian Institute of sports assessment for patellar tendinopathy (VISA-P-J).

METHODS

This prospective cohort study registered 43 participants ≥ 18 years old with a history of painful symptoms in the inferior pole of the patella to the proximal patellar tendon lasting ≥ 1 month for patellar tendinopathy. Pain in daily life and during sports activities, symptom classification, and patient global impression of change were assessed at the baseline, 1 week, and 12 weeks. The psychometric properties, test-retest reliability, standard error of measurement, internal consistency criterion validity, construct validity, responsiveness, and interpretability, of the VISA-P-J were calculated according to the COSMIN.

RESULTS

The two-way random-effects, absolute agreement intraclass correlation coefficient for test-retest reliability of VISA-P-J was 0.87 (95% confidence interval: 0.78, 0.93), and the standard error of measurement of VISA-P-J was 0.89. The Cronbach's alpha for internal consistency of VISA-P-J was 0.81. A correlation between VISA-P-J and Roel's classification, Visual Analog Scale for pain (VAS)-Active Daily Living, and VAS-Sports (r = - 0.52, r = - 0.66, r = - 0.86, p < 0.01, respectively) was observed for criterion validity. All hypotheses of the hypothesis-testing method to evaluate construct validity and responsiveness of VISA-P-J were substantiated. The minimal clinically important difference of VISA-P-J was 7 points.

CONCLUSION

We demonstrated that the VISA-P-J was a reliable, valid, and responsive assessment method for individuals with chronic pain in the patellar tendon.

Association of Cycling Kinematics With Anterior Knee Pain in Mountain Bike Cyclists

CONTEXT

Comfort and pain in cyclists are often discussed as a result of the posture on the bike, and bike fit, including motion analysis, is advocated as a strategy to minimize these conditions. The relationship between cycling kinematics, comfort, and pain is still debatable.

OBJECTIVES

To investigate the association of ankle, knee, and trunk kinematics with the occurrence of anterior knee pain (AKP) in mountain bike cyclists.

DESIGN

Cross-sectional study.

METHODS

Fifty cross-country mountain bike cyclists (26 with AKP and 24 without AKP) had their pedaling kinematics assessed. Linear and angular data from trunk, hip, knee, ankle, and foot from cyclists with and without AKP were recorded using Retül motion analysis system.

RESULTS

The binary logistic regression model showed that kinematic variables such as peak ankle plantar flexion, peak knee flexion, and forward trunk lean were significant predictors of AKP. Both larger peak plantar flexion and knee flexion decreased the probability of reporting AKP. On the other hand, larger forward trunk lean increased the probability of reporting AKP.

CONCLUSIONS

Ankle, knee, and trunk sagittal kinematics may predict AKP in cross-country mountain bike cyclists, whereas hip, knee, and ankle alignment in the frontal plane showed no association with occurrence of AKP. In other words, cyclists with larger ankle plantar flexion and knee flexion are less likely to have AKP, whereas those with increased trunk forward lean are more likely to have AKP.

The Brazilian version of the Victorian Institute of Sport Assessment - Hamstring (VISA-H) Questionnaire: Translation, cross-cultural adaptation and measurement properties

STUDY DESIGN

Study of diagnostic accuracy/assessment scale.

BACKGROUND

Proximal hamstring tendinopathy (PHT) usually causes disability, deep pain in the proximal insertion of the tendon, and limitations in daily life and sports practice. Scales that assess PHT pain and disability may assist practitioners in their clinical decision-making processes.

OBJECTIVES

To perform a translation, cross-cultural adaptation and to evaluate the measurement properties of the Victorian Institute of Sport Assessment - Hamstring (VISA-H) questionnaire for the Brazilian population.

METHODS

The VISA-H was adapted to Brazilian Portuguese (VISA-H-Br) and applied in 2 occasions with 5-8-day intervals. The following measurement properties were evaluated: internal consistency, test-retest reliability, standard error of the measurement (SEM), smallest detectable change (SDC), structural validity, and construct validity. Ninety (n = 90) participants (40 PHT and 50 asymptomatic participants) were evaluated using the Lower Extremity Functional Scale (LEFS) and VISA-H. PHT was diagnosed via clinical examination.

RESULTS

The questionnaire was successfully translated, cross-culturally adapted, and renamed VISA-H-Br. The VISA-H-Br questionnaire demonstrated high internal consistency (Cronbach α = 0.96), excellent test-retest reliability (ICC = 0.90, CI 95% 0.83-0.93), and strong construct validity (rho = 0.692, p < 0.01 compared to LEFS). The SEM was 2.15 points, and the SDC was 5.96 points. No ceiling or floor effects were detected.

CONCLUSION

The Brazilian version of the VISA-H was consistent, reliable, and valid. Therefore, it may be used in clinical practice and research to assess the pain and disability of patients with PHT.

The Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P): A Reliability Generalization Meta-analysis

OBJECTIVE

The Victorian Institute of Sport Assessment-Patella (VISA-P) is a questionnaire to assess the severity of patellar tendinopathies. Its use requires good reliability indicators: internal consistency, test-retest and parallel forms. Several studies have been published examining this question, but to date the reliability of this questionnaire (meta-analysis) has not been generalized. The aim of this study was to perform a meta-analysis to generalize the reliability of the VISA-P.

DATA SOURCES

MEDLINE, EMBASE, and Scopus.

STUDY SELECTION

Studies included were those examining the reliability coefficients of the VISA-P: Cronbach alpha, intraclass correlation coefficient (ICC), and parallel-forms (correlation coefficients compared with other scales).

DATA EXTRACTION

All coefficients were extracted and the mean reliability was obtained using fixed- or random-effects models. Sensitivity (leave-one-out analysis) was analyzed. Quality assessment was performed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

DATA SYNTHESIS

Of 364 scientific articles, 12 fulfilled meta-analysis criteria. The summary statistic was 0.86 [95% confidence interval (CI): 0.78-0.92] for Cronbach alpha and 0.94 (95% CI: 0.89-0.97) for the ICC. Parallel forms depended on the comparative test used, ranging from -0.83 to 0.68. The sensitivity analysis found an influential study for the parallel-forms reliability in the Blazina score. We were unable to analyze the asymmetry of funnel plots and meta-regression models because of the number of studies.

CONCLUSIONS

The reliability of VISA-P for assessing the severity of patellar tendinopathies requires greater evaluation with more scientific evidence before it can be implemented in clinical practice.

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

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.

Evaluating lower limb tendinopathy with Victorian Institute of Sport Assessment (VISA) questionnaires: a systematic review shows very-low-quality evidence for their content and structural validity-part I

PURPOSE

The 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.

METHODS

The 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.

RESULTS

The 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.

CONCLUSIONS

Only 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 EVIDENCE

IV.

REGISTRATION

PROSPERO reference-CRD42019126595.

The adaptation of sport assessment-patella questionnaire into simplified Chinese version: cross-cultural adaptation, reliability and validity

Background

The original version of Victorian Institute of Sport Assessment-Patella Questionnaire (VISA-P) is developed in English, and aimed to assess the severity of patellar tendinopathy symptoms. Before used in China, it should be translated to Chinese version.

Objectives

Our aim is to make a translation/cross-culturally adaption for the VISA-P into simplified Chinese version (VISA-PC). And primarily validate the VISA-PC in Chinese speaking population.

Methods

The translation process of VISA-P questionnaire into simplified Chinese version (VISP-PC) followed the International recognized guideline. Cross-cultural adaptation was carried out with a clinical measurement study. A total of 128 projects which consisted 33 healthy students, 39 patients with patellar tendinopathy and 56 military students (receive military training as at-risk population) were included into this study. Internal consistency was evaluated with Cronbach’s alpha, and test-retest reliability was assessed with intraclass correlation coefficients (ICCs). Construct validity and floor and ceiling effects were also tested.

Results

The scores were 95.84 ± 5.97 of healthy group, 91.87 ± 9.03 of at-risk group, 62.49 ± 11.39 of pathological group. There is no ceiling and floor effect of VISA-PC. The Cronbach’s alpha (0.895) and ICC (0.986) values showed good internal consistency and reliability. There were high correlations between VISA-PC and Kujala patellofemoral score (r = 0.721). VISA-PC score also had good correlation with the relevant SF-36 items.

Conclusion

The VISA-PC was well translated into simplified Chinese version (VISA-PC), which is reliable and valid for Chinese-speaking patients with patellar tendinopathy.

Level of evidence

II.

Translation and Cross-cultural Adaptation of the "Thumb Disability Exam - TDX" questionnaire into Brazilian Portuguese

Objective  To perform the translation, cultural adaptation and validation of the Thumb Disability Exam (TDX) questionnaire into Brazilian Portuguese. Method  The questionnaire was translated, with reverse translation. The translations were evaluated and synthesized by a committee, resulting in the THUMB DISABILITY EXAM - BRASIL (TDX-BR). A total of 31 patients diagnosed with rhizarthrosis were selected and answered the questionnaire. Quality parameters were evaluated, such as internal consistency, reproducibility and ceiling and floor effect. Results  The questionnaires were translated and adapted according to defined protocols. Internal consistency, through the Cronbach α coefficient for the TDX-BR, was 0.962. The reliability of the questionnaire, through intraclass correlation coefficient (ICC )also proved to be quite high, with κ = 0.953 (0.947-0.959). Agreement, measured using the standard error of measurement, remained with standard values < 5%. There was no ceiling and floor effect. Conclusion  Through specific methodology, we consider TDX-BR as translated and valid for the Portuguese language of Brazil.

The factor structure of the posttraumatic growth inventory in cancer patients in Turkey

Posttraumatic growth is a positive psychological change that occurs as a result of tackling vital crises. Although cancer is perceived as a fatal disease, the individual's struggle with many negative conditions during diagnosis and treatment can provide positive change and development. The aim of this study was to examine the factor structure of the posttraumatic growth inventory (PTGI) in Turkish cancer patients. This study included 265 cancer patients receiving treatment at the chemotherapy unit of two university hospitals located in northern Turkey. Percentages, frequencies, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to analyse the data, and Cronbach's α measured internal consistency. EFA yielded a five-factor structure: Spiritual and existential change, change in perception of life and selfness, relating to others, personal strength and new possibilities. Fit indices for CFA were root mean square error of approximation (RMSEA), 0.06; non-normed fit index (NNFI), 0.92; comparative fit index (CFI), 0.90; root mean residuals (RMR), 0.06; and goodness-of-fit index (GFI), 0.90. The overall Cronbach's α of the scale was 0.93. PTGI was determined as a reliable and valid tool for Turkish cancer patients. PTGI, which has a determined validity and reliability rate, can be used by healthcare professionals working with oncology patients to evaluate the positive psychological growth and changes in cancer patients and determine their adoption rate.

Cross-cultural adaptation, reliability and validity of the Persian version of the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A)

PURPOSE

Achilles tendinopathy is a prevalent overuse injury among athletes and in those with a sedentary lifestyle. Current evidence indicates that the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a valid, reliable and disease-specific outcome measure for assessing the clinical symptoms in patients with Achilles tendinopathy. The objective of this study was to translate and cross-culturally adapt the VISA-A questionnaire into Persian (VISA-A-P) and evaluating its psychometric properties.

MATERIALS AND METHODS

Cultural adaptation of VISA-A-P was conducted according to Beaton's guideline. The final version of VISA-A-P was handed to 61 patients for analysis of psychometric properties. Test-retest reliability, internal consistency, concurrent validity, item-total correlation, and floor/ceiling effect were evaluated in patients with Achilles tendinopathy. To assess test-retest reliability, 35 patients refilled the VISA-A-P twice within 5-7 days. Known-group validity was evaluated using 50 healthy individuals.

RESULTS

VISA-A-P showed excellent test-retest reliability (ICC = 0.90), excellent internal consistency (Cronbach's alpha = 0.95), strong correlation with FAAM, and moderate to strong correlation with FAOS questionnaires. There was a significant difference between the average score of patients (34.55 ± 18.24) and the healthy group (73.1 ± 20.10). VISA-A-P showed neither ceiling nor floor effect.

CONCLUSIONS

The VISA-A-P is a reliable and valid instrument for measuring the symptoms in Persian speaking populations with Achilles tendinopathy.Implications for rehabilitationAchilles tendinopathy is a debilitating overuse injury that insidiously affects tendoAchilles.VISA-A-P revealed acceptable validity and reliability and it could be used by Persian speaking clinicians and researchers to assess pain and function in people with Achilles tendinopathy.

Rotational flywheel training in youth female team sport athletes: could inter-repetition movement variability be beneficial?

BACKGROUND

The aim of this study was to analyze the effects of an inter-repetition variable rotational flywheel training program (variable) over standard rotational flywheel training (Standard).

METHODS

Twenty-four youth female team-sports players were randomly assigned to both training groups (variable, N.=12; standard, N.=12), which consisted of 1 set of 3 rotational flywheel exercises ×10-12 repetitions, biweekly for a period of 6-weeks. The participants included in variable group were instructed to perform the movement randomly in one of the three directions (0°, 45° right, and 45° left). Measurements included reactive strength, jumping, change of direction, and sprinting tests; patellar tendon condition was also assessed.

RESULTS

Substantial improvements were found in vertical jump with left leg (16.9%), lateral jump with right leg (13.6%), and patellar condition in left leg (4.1%) for standard group, but also in reactive strength index in right leg landing (33.9%), vertical jump with right (10.1%) and left leg (12.0%) for variable group. A significant interaction effect (group × time) was observed on patellar condition in right leg (F=10.02, P<0.01, η²=0.37), favoring variable group.

CONCLUSIONS

Rotational flywheel training programs were beneficial for youth-female team-sports athletes, although the movement variability may play a key role to develop different and specific physical adaptations.

Translation, cross-cultural adaptation and validation of the Finnish Diabetes Risk Score (FINDRISC) for use in Brazilian Portuguese: questionnaire validity study

BACKGROUND

The Finnish Diabetes Risk Score (FINDRISC) is a questionnaire that was developed by Finnish researchers to track the risk of diabetes.

OBJECTIVE

To translate, cross-culturally adapt and validate the FINDRISC for use in Brazilian Portuguese.

DESIGN AND SETTING

Questionnaire validity study conducted at a private university.

METHODS

The Brazilian version of the FINDRISC was developed through the processes of translation, back-translation, committee review and pre-testing. Test-retest reliability was measured using the intraclass correlation coefficient (ICC), kappa coefficient, standard error of measurement (SEM) and minimum detectable change (MDC). Internal consistency was measured using Cronbach's alpha. For construct validity, the total score of the FINDRISC was correlated with the Diabetes Knowledge Scale (DKN-A) and Diabetes Mellitus Risk Questionnaire (QRDM). Ceiling and floor effects were also evaluated in the present study.

RESULTS

For construct validity and floor and ceiling effect measurements, a total sample of 107 participants was used. For reliability, a subsample of 51 participants out of the total sample was used. We identified adequate values for reliability (kappa ≥ 0.79 and ICC = 0.98) and internal consistency (Cronbach's alpha = 0.84). Regarding the error inherent in the FINDRISC, we found SEM = 8.02% and MDC = 22.44%. There were significant correlations between the FINDRISC and the QRDM (r = 0.686) and DKN-A (r = -0.216). No ceiling or floor effects were found.

CONCLUSION

The Brazilian version of the FINDRISC has adequate psychometric properties that are in accordance with the best international recommendations.

High-energy dose of therapeutic ultrasound in the treatment of patellar tendinopathy: protocol of a randomized placebo-controlled clinical trial

BACKGROUND

Patellar tendinopathy is an extremely debilitating condition and its treatment usually requires a combination of clinical approaches. Therapeutic ultrasound (TUS) is one of the most available electrophysical agent in rehabilitation settings; however, there is also a lack of high-quality studies that test different dosimetric aspects of TUS. Thus, the purpose of this study is to evaluate the short-, medium-, and long-term effects of the combination of high-energy TUS with a rehabilitation program for patellar tendinopathy.

METHODS

This will be a randomized, placebo-controlled trial with blinding of patients, assessors, and therapist. The setting is an outpatient physical therapy clinic. We will recruit 66 participants (male and female) aged between 18 and 40 years and presenting with patellar tendinopathy. A treatment combining high-energy dose TUS and a rehabilitation program for patellar tendinopathy will be delivered twice a week for 8 weeks. The control group will receive the same treatment, but with a placebo TUS. The effectiveness of the intervention will be measured at the beginning (baseline), midpoint (4 weeks), and end of treatment (8 weeks), as well as at 3- and 6-months post-treatment. Primary outcomes will be pain intensity (visual analogue scale, VAS), and VISA-P questionnaire and primary time points will be baseline (T0) and the end of the program (T2). Also, IPAQ-short form questionnaire, muscle strength (manual dynamometry), 2D kinematics, pain pressure threshold (PPT) algometry, thermography, and magnetic resonance imaging (MRI) will be collected.

DISCUSSION

TUS will be applied in an attempt to enhance the results obtained with the rehabilitation program proposed in this study, as well as stimulate some repair responses in individuals undergoing treatment for patellar tendinopathy, which in turn may optimize and improve treatment programs for patellar tendinopathy as well as to establish new guidelines for the application of TUS.

TRIAL REGISTRATION

This study was prospectively registered at April-3rd-2018 and updated at September-1st-2019 in the Brazilian Registry of Clinical Trials (REBEC) under the registration number: RBR-658n6w.

Cross-cultural adaptation and measurement properties of the Brazilian-Portuguese version of the Cincinnati Knee Rating System

Purpose: To translate, culturally adapt, evaluate the measurement properties, and propose a new scoring system of the Cincinnati Knee Rating System for the Brazilian population.Materials and Methods: One hundred fifty people with anterior cruciate ligament injury completed Cincinnati Knee Rating System and Lysholm Knee Scoring Scale on three occasions: 1-week prior to surgery, 90-days after and 95-days after reconstruction. The measurement properties of the Brazilian-Portuguese Cincinnati Knee Rating System, internal consistency, construct validity, reproducibility, ceiling and floor effect and responsiveness, were tested.Results: Using the original scoring system (multiple scores), the internal consistency (Cronbach's α) varied between 0.54-0.79 (if item deleted = 0.07-0.73); the construct validity (Pearson's r) varied between 0.19-0.82 (related to Lysholm); the reliability (intraclass correlation coefficient) varied between 0.96-0.99; the standard error of measurement varied between 0.2-1.3 points; the minimum detectable change varied between 0.4-3.5 points; no ceiling or floor effect was detected, and responsiveness (effect size) varied between -0.3-2.7. Using the new proposed scoring system (single score), Cronbach's α was 0.78 (if item deleted = 0.65-0.71); the Pearson's r was 0.79 (related to Lysholm); the intraclass correlation coefficient was 0.99; the standard error of measurement was 0.5 points, the minimum detectable change was 1.3 points; no ceiling or floor effect was detected, and effect size was 1.4.Conclusions: The Brazilian-Portuguese Cincinnati Knee Rating System has adequate property measurement and can be used in a Brazilian population. The new proposed scoring system is appropriate.Implications for rehabilitationThe Brazilian-Portuguese Cincinnati Knee Rating System is a valid and reliable instrument which can identify consistent clinical changes over the time.The Brazilian-Portuguese Cincinnati Knee Rating System can be used to evaluate and to follow-up a Brazilian population with anterior cruciate ligament injuries and postoperative reconstruction.The new proposed score for Cincinnati Knee Rating System is appropriate and did not compromise the quality of the measurement properties.The new scoring system generates a unique score, creating a potentially simpler and faster clinical understanding of the patient's condition.

Ultrasound examination and patellar tendinopathy scores in asymptomatic college jumpers

OBJECTIVE

To investigate the prevalence of hypoechoic areas by US and its' association with VISA-P scores among asymptomatic jumpers while highlighting sex comparisons.

DESIGN

Cross-sectional study.

SETTING

Pre-participation exam at a National Collegiate Athletic Association (NCAA) division I college.

PARTICIPANTS

Thirty-one college athletes who engage in jumping sports.

MAIN OUTCOME MEASURES

Hypoechoic images of patellar tendon captured by ultrasound examination were compared to a self-reported knee functional survey, the Victorian Institute of Sport Assessment for patellar tendinopathy (VISA-P) scale (0-100).

RESULTS

With a total of 31 athletes (13 males and 18 females), prevalence rate of the hypoechoic areas of patellar tendon was 19.4% (6/31) in the right knee and 29.0% (9/31) in the left knee. There was no proportional difference in a comparison of prevalence rate of hypoechoic area [(+) or (-)] by sex in either right or left knee. The VISA-P scores were significantly lower in US (+) than US (-) in the right knee (p = 0.003, Cohen's d = 1.675), but not the left knee (p = 0.250, Cohen's d = 0.512). The receiver operating characteristics curve analysis indicated the most sensitive and specific VISA-P values based on status [(+) or (-)] of hypoechoic area was 89.5 with 86.4% and 77.7% of sensitivity and specificity.

CONCLUSION

In short, hypoechoic areas were detected by US examination among self-reported asymptomatic jumpers. There was an association between hypoechoic areas and VISA-P scores in the right knee, but not in left knee. VISA-P scores may be used as a screening tool for the presence of hypoechoic areas.

The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction

OBJECTIVE

To evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT).

DESIGN

Systematic review.

ELIGIBILITY CRITERIA

Randomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included. Risk of bias and quality of studies were evaluated.

RESULTS

Moderate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT. Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT. Regarding the rest of the results, there was only very low or no level of evidence. 13 studies showed high risk of bias largely due to methodology, blinding and reporting.

CONCLUSION

Low level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation.

Confirmatory factor analysis of VISA-P scale and measurement invariance across sexes in athletes with patellar tendinopathy

BACKGROUND

The Victorian Institute of Sport Assessment-Patella (VISA-P) scale is the most condition-specific patient-reported outcome measure used to assess symptom severity in athletes with patellar tendinopathy. Previous exploratory factor analyses have been conducted to evaluate the scale's dimensionality, with inconsistent results, and the factor structure of the scale remains unclear. The aims of the present study were to determine the factorial structure of the VISA-P scale using confirmatory factor analysis (CFA) and test measurement invariance across sexes.

METHODS

The study included a convenience sample of 249 Spanish athletes with patellar tendinopathy. CFA was performed to assess factorial validity. Hypothesized 1- and 2-factor models were tested. Measurement invariance across sexes was evaluated via multi-group CFA with several fit indices using EQS 6.1 software.

RESULTS

The internal consistency coefficient was 0.74. Several CFA models were examined and the 1-factor model in which errors for Items 7 and 8 were correlated showed acceptable fit in terms of comparative fit index (CFI) and goodness-of-fit index (GFI) statistics (CFI = 0.93; GFI = 0.94; standardized root mean square residual = 0.06; root mean square error of approximation = 0.10; 90% confidence interval: 0.08-0.13). This model was invariant across sexes.

CONCLUSION

The 1-factor model of the Spanish version of the VISA-P scale (VISA-P-Sp) in which errors for Items 7 and 8 were correlated demonstrated relative fit in CFA. Scores obtained via VISA-P-Sp can be compared between men and women without sexes bias. Further studies should examine the VISA-P scale and other single-score patient-reported outcome measures concurrently.

Impact of Patellar Tendinopathy on Knee Proprioception: A Cross-Sectional Study

OBJECTIVE

To determine whether high-level athletes with patellar tendinopathy have diminished knee proprioceptive acuity.

DESIGN

Cross-sectional study.

SETTING

University research laboratory (institutional).

PARTICIPANTS

Twenty-one basketball and volleyball players with patellar tendinopathy (13 men and 8 women; mean age 24.5 ± 3.6; body mass index = 22.5 ± 2.0 kg/m) and an equal number of athletes without symptoms of patellar tendinopathy injury were included in this study.

ASSESSMENTS

Participants underwent knee proprioception assessments on a single day. Furthermore, age, sex, height, weight, VISA-P (Victorian Institute of Sport Assessment) questionnaire sports participation, medical history, knee injuries, previous treatment, and medication were obtained.

MAIN OUTCOME MEASURES

Knee proprioception was evaluated by assessing sense of resistance, using a weight discrimination protocol, and joint position sense (JPS).

RESULTS

No significant differences were observed in JPS at 30 and 60 degrees of knee flexion between groups (P = 0.165 and 0.481, respectively). In regard to the ability to discriminate weight, significant differences between the 2 groups were found with the tendinopathy group showing a higher percentage of error (P = 0.009), namely when the set of incremental weights varied by 10% from the standard weight.

CONCLUSIONS

Athletes with patellar tendinopathy have a diminished perception of force signals required for weight discrimination, whereas JPS remains unaffected in these athletes.

Validity and reliability of the Foot Function Index (FFI) questionnaire Brazilian-Portuguese version

PURPOSE

To evaluate the validity and reliability of the Foot Function Index (FFI) in its Brazilian Portuguese version.

METHODS

The validity and reliability of the FFI were tested in 50 volunteers, with plantar fasciitis, metatarsalgia and chronic ankle sprain. The FFI validity process used the Short Form-36 (SF-36) and Foot and Ankle Outcome Score (FAOS) questionnaires. The correlation between FFI, SF-36 and FAOS was done using the Pearson's linear coefficient. The inter and intra-evaluator reliability was ascertained by means of the intraclass correlation coefficient (ICC) and the internal consistency by means of Cronbach's alpha coefficient. The scores were used to assess the standard error measurement (SEM), minimal detectable change (MDC) and ceiling floor and effects.

RESULTS

The validity process showed that there were correlations between FFI and the "pain" and "social aspects" subscales of SF-36 and all subscales of FAOS, except for "other symptoms". The Brazilian-Portuguese version of FFI showed excellent intra and interevaluator correlations, with an ICC range of 0.99-0.97 and score reliability that was considered highly satisfactory, with Cronbach's alpha range of 0.80-0.61. The SEMs for inter and intra-evaluator reliability were 1.32 and 1.08, respectively. The MDC was 2.42 (90 % confidence interval). No ceiling and floor effect were detected.

CONCLUSIONS

The Brazilian-Portuguese version of the FFI questionnaire was found to be a valid and reliable instrument for foot function evaluation, and can be used both in scientific settings and in clinical practice.

Cross-cultural adaptation of VISA-P score for patellar tendinopathy in Turkish population

INTRODUCTION AND PURPOSE

VISA-P questionnaire assesses to severity of symptoms and treatment effects in athletes with patellar tendinopathy. The purpose of this study was to translated VISA-P questionnaire into Turkish language and to determine its validity and reliability.

METHODS

The English version of VISA-P questionnaire was translated into Turkish according to the internationally recommended guidelines. Test-retest reliability was determined on 89 participants with time interval 24 h. To determine validity of Turkish VISA-P, 31 (17 male, 14 female) healthy students, 34 (20 male, 14 female) patients with patellar tendinopathy (diagnosed by physical examination and ultrasonography) and 24 (16 male, 8 female) volleyball players (at risk populations) were completed VISA-P-Tr. Internal consistency was determined with Cronbach's alpha. Intraclass correlation coefficients (ICCs) were calculated to analyse test-retest reliability. To assessment of discrimination, VISA-P-Tr scores compared all groups using the Mann-Whitney-U test.

RESULTS

The VISA-P-Tr questionnaire showed good test-retest reliability (The Cronbach's alpha was 0.79 and 0.78 respectively and ICC was 0.96). The VISA-P-Tr score (mean ± SD) were 93.7 ± 8.9 and 94.0 ± 8.1 for healthy students, 81.1 ± 13.7 and 80.7 ± 13.4 for volleyball players, 58.8 ± 12.1 and 58.5 ± 11.0 for athletes with patellar tendinopathy.

CONCLUSION

The translated Turkish version of VISA-P has good internal consistency and good reliability and validity. Therefore VISA-P-Tr is useful to evaluate symptoms and follow the treatment effect in athletes with patellar tendinopathy.

The Accuracy of the VISA-P Questionnaire, Single-Leg Decline Squat, and Tendon Pain History to Identify Patellar Tendon Abnormalities in Adult Athletes

Study Design Cross-sectional clinical assessment. Background Patellar tendinopathy is not always accompanied by patellar tendon abnormalities (PTAs). Thus, clinical screening tools to help identify patients with patellar tendon pain who have PTAs could enhance clinical decision making and patient prognosis. Objectives To test the diagnostic accuracy of the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire, a single-leg decline squat (SLDS), tendon pain history, age, and years of sports participation to identify athletes with symptomatic patellar tendons who have PTAs confirmed on imaging. Methods Data provided by ultrasound examination, the VISA-P questionnaire, the SLDS, tendon pain history, age, and years of sport participation were collected in 43 athletes. A classification and regression tree (CART) model was developed to verify variables associated with PTA occurrence. Likelihood ratios (LRs) were computed for positive and negative tests. Results The SLDS, VISA-P questionnaire, and tendon pain history were associated with PTA occurrence. Athletes with negative results on all 3 tests (CART model) had a lower likelihood of having PTAs (negative LR = 0.3; 95% confidence interval [CI]: 0.2, 0.5). The isolated use of the SLDS or tendon pain history (positive LR = 4.2; 95% CI: 2.3, 7.14 and 4.5; 95% CI: 1.8, 11.1, respectively) had similar influence on probability of PTA presence compared to the CART model (positive LR = 4.1; 95% CI: 2.5, 6.3). Conclusion Although the objective was to investigate a clinical test to identify PTAs, the combined use of the tests had greater accuracy to identify individuals without PTAs. Level of Evidence Diagnosis, level 3b. J Orthop Sports Phys Ther 2016;46(8):673-680. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6192.

Cross-cultural Adaptation and Validation of the Victorian Institute of Sport Assessment-Patella Questionnaire for French-Speaking Patients With Patellar Tendinopathy

Study Design Clinical measurement study. Background The Victorian Institute of Sport Assessment-Patella (VISA-P), originally developed in English, assesses the severity of patellar tendinopathy symptoms. To date, no French version of the questionnaire exists. Objectives The aim of our study was to translate the VISA-P into French and verify its psychometric properties. Methods The translation and cultural adaptation were performed according to international recommendations in 6 steps: initial translation, translation merging, back translation to the original language, use of an expert committee to reach a prefinal version, test of the prefinal version, and expert committee appraisal of a final version. Afterward, the psychometric properties of the final French version (VISA-PF) were assessed in 92 subjects, divided into 3 groups: pathological subjects (n = 28), asymptomatic subjects (n = 22), and sports-risk subjects (n = 42). Results All members of the expert committee agreed with the final version. On a scale ranging from 0 to 100, with 100 representing an asymptomatic subject, the average ± SD scores on the VISA-PF were 53 ± 17 for the pathological group, 99 ± 2 for the healthy group, and 86 ± 14 for the sports-risk group. The test-retest reliability of the VISA-PF was excellent, with good internal consistency. Correlations between the VISA-PF and divergent validity of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were low, and the correlation coefficient values measured between the VISA-PF scores and converged items of the SF-36 were higher. Conclusion The VISA-PF is understandable, valid, and suitable for French-speaking patients with patellar tendinopathy. J Orthop Sports Phys Ther 2016;46(5):384-390. Epub 21 Mar 2016. doi:10.2519/jospt.2016.5937.

Lower limb strength and flexibility in athletes with and without patellar tendinopathy

OBJECTIVES

To compare the hip, knee and ankle torques, as well as knee and ankle flexibility between athletes with patellar tendinopathy and asymptomatic controls.

DESIGN

Cross-sectional study.

SETTING

Laboratory setting.

PARTICIPANTS

Fourteen male volleyball, basketball or handball athletes, divided into 2 groups, patellar tendinopathy group (TG; n = 7) and asymptomatic control group (CG; n = 7).

MAIN OUTCOME MEASURES

Hip, knee and ankle isometric torques were measured with a handheld dynamometer. Weight-bearing ankle dorsiflexion, hamstring and quadriceps flexibility were measured with a gravity inclinometer.

RESULTS

The TG had 27% lower hip extensor torque when compared to the CG (P = 0.031), with no group differences in knee and ankle torques (P > 0.05). Also, the TG had smaller weight-bearing ankle dorsiflexion (P = 0.038) and hamstring flexibility (P = 0.006) when compared to the CG. Regarding quadriceps flexibility, no group differences were found (P = 0.828).

CONCLUSIONS

Strength and flexibility deficits might contribute to a greater overload on the knee extensor mechanism, possibly contributing to the origin/perpetuation of patellar tendinopathy. Interventions aiming at increasing hip extensors strength as well as ankle and knee flexibility might be important for the rehabilitation of athletes with patellar tendinopathy.

Patellar tendinopathy: late-stage results from surgical treatment

Objective

To evaluate the late-stage results from surgical treatment of patellar tendinopathy (PT), using the Visa score (Victorian Institute of Sport Tendon Study Group) and the Verheyden method.

Methods

This was a retrospective study in which the postoperative results from 12 patients (14 knees) who were operated between July 2002 and February 2011 were evaluated. The patients included in the study presented patellar tendinopathy that was refractory to conservative treatment, without any other concomitant lesions. Patients who were not properly followed up during the postoperative period were excluded.

Results

Using the Verheyden method, nine patients were considered to have very good results, two had good results and one had poor results. In relation to Visa, the mean was 92.4 points and only two patients had scores less than 70 points (66 and 55 points).

Conclusion

When surgical treatment for patellar tendinopathy is correctly indicated, it has good long-term results.

Rehabilitation of Patellar Tendinopathy Using Hip Extensor Strengthening and Landing-Strategy Modification: Case Report With 6-Month Follow-up

Study Design Case report. Background Although eccentric exercises have been a cornerstone of the rehabilitation of athletes with patellar tendinopathy, the effectiveness of this intervention is sometimes less than ideal. Athletes with patellar tendinopathy have been shown to have different jump-landing patterns and lower hip extensor strength compared to asymptomatic athletes. To our knowledge, the effectiveness of an intervention addressing these impairments has not yet been investigated. Case Description The patient was a 21-year-old male volleyball athlete with a 9-month history of patellar tendon pain. Pain was measured with a visual analog scale. Disability was measured with the Victorian Institute of Sport Assessment-patella questionnaire. These assessments were conducted before and after an 8-week intervention, as well as at 6 months after the intervention. Hip and knee kinematics and kinetics during drop vertical jump and isometric strength were also measured before and after the 8-week intervention. The intervention consisted of hip extensor muscle strengthening and jump landing strategy modification training. The patient did not interrupt volleyball practice/competition during rehabilitation. Outcomes After the 8-week intervention and at 6 months postintervention, the athlete was completely asymptomatic during sports participation. This favorable clinical outcome was accompanied by a 50% increase in hip extensor moment, a 21% decrease in knee extensor moment, and a 26% decrease in patellar tendon force during jump landing measured at 8 weeks. Discussion This case report provides an example of how an 8-week intervention of hip muscle strengthening and jump-landing modification decreased pain and disability and improved jump-landing biomechanics in an athlete with patellar tendinopathy. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2015;45(11):899-909. Epub 21 Sep 2015. doi:10.2519/jospt.2015.6242.

Outcome Evaluation in Tendinopathy: Foundations of Assessment and a Summary of Selected Measures

Synopsis Clinical measurement studies that address outcome evaluation for patients with tendinopathy should consider conceptual, clinical, practical, and measurement issues to guide the selection of valid measures. Clinical outcomes reported in research studies can provide benchmarks that assist with interpretation of scores during clinical decision making. Given the pathophysiology and functional impacts of tendinopathy, there is a need for outcome measures that assess physical impairments, activity performance, and patient-reported symptoms and function. Tendinopathy-specific patient-reported outcome measures have been shown to be superior to more generic tools for some conditions, such as lateral epicondyle tendinopathy (Patient-Rated Tennis Elbow Evaluation) and Achilles tendinopathy (Victorian Institute of Sport Assessment-Achilles), whereas both generic shoulder outcome measures and disease-specific measures perform similarly in individuals with rotator cuff tendinopathy. A patient-reported outcome measure that captures pain and limitation in function should be fundamental to outcome evaluation in patients with tendinopathy. The current measurement literature does not yet provide comprehensive empirical data to define optimal outcome measures for all types of tendinopathy. This article reviews concepts, instruments, and measurement properties that should provide clinicians with a foundation for assessment of condition severity and treatment outcomes in patients with tendinopathy. J Orthop Sports Phys Ther 2015;45(11):950-964. Epub 15 Oct 2015. doi:10.2519/jospt.2015.6054.

Development and validation of a VISA tendinopathy questionnaire for greater trochanteric pain syndrome, the VISA-G

BACKGROUND

Greater trochanteric pain syndrome (GTPS) is common, resulting in significant pain and disability. There is no condition specific outcome score to evaluate the degree of severity of disability associated with GTPS in patients with this condition.

OBJECTIVE

To develop a reliable and valid outcome measurement capable of evaluating the severity of disability associated with GTPS.

METHODS

A phenomenological framework using in-depth semi structured interviews of patients and medical experts, and focus groups of physiotherapists was used in the item generation. Item and format clarification was undertaken via piloting. Multivariate analysis provided the basis for item reduction. The resultant VISA-G was tested for reliability with the inter class co-efficient (ICC), internal consistency (Cronbach's Alpha), and construct validity (correlation co-efficient) on 52 naïve participants with GTPS and 31 asymptomatic participants.

RESULTS

The resultant outcome measurement tool is consistent in style with existing tendinopathy outcome measurement tools, namely the suite of VISA scores. The VISA-G was found to be have a test-retest reliability of ICC2,1 (95% CI) of 0.827 (0.638-0.923). Internal consistency was high with a Cronbach's Alpha of 0.809. Construct validity was demonstrated: the VISA-G measures different constructs than tools previously used in assessing GTPS, the Harris Hip Score and the Oswestry Disability Index (Spearman Rho:0.020 and 0.0205 respectively). The VISA-G did not demonstrate any floor or ceiling effect in symptomatic participants.

CONCLUSION

The VISA-G is a reliable and valid score for measuring the severity of disability associated GTPS.

Translation into Portuguese of questionnaires to assess knee injuries

The aim of this systematic review was to review the quality of the translation and the measurement properties from questionnaires that assess injuries of the knee. We included questionnaires that were developed in foreign language and have been translated and validated into Portuguese. The databases used were CINAHL, SPORTDiscus, LILACS, PUBMED and SCIELO and the final search resulted in a total of 868 studies included, from which 16 were eligible. Most included questionnaires presented all steps expected in a translation process; however there were some deficiencies in measurement properties among the questionnaires. The VISA-P Brazil was the best questionnaire when analyzing translation process and measurement properties tested. It was the only questionnaire that tested all measurement properties investigated and presented adequate values for all of them. KOS-ADLS was the best questionnaire translated to Portuguese from Portugal. Among all, the VISA-P Brazil is the best questionnaire to be used with Brazilian Portuguese speakers when the condition is related to patellar tendinopathy and the LEFS is the best questionnaire for other general conditions of the knee. For Portuguese from Portugal, the best questionnaire is the KOS-ADLS, and like the LEFS it does not target any specific injury.