The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
PLoS One. 2021 Mar 11;16(3):e0247152. doi: 10.1371/journal.pone.0247152. eCollection 2021.
A recent COSMIN review found that the Victorian Institute of Sports Assessment-Achilles tendinopathy questionnaire (VISA-A) has flawed construct validity. The objective of the current study was to assess specifically the process of how VISA-A was constructed and validated, and whether the Danish version of VISA-A is a valid patient-reported outcome measure (PROM) for measuring the perceived impact of Achilles tendinopathy. The original item generation strategy for content validity and the process for confirming the scaling properties (construct validity) were examined. In addition, construct validity was evaluated directly using several psychometric methods (Rasch analysis, confirmatory factor analysis (CFA), and multivariable linear regression) in a cohort of 318 persons with Achilles tendinopathy with symptom duration groups ranging from less than 3 months to more than 1 year of chronicity, and a group of 120 healthy persons. We found that the item generation and item reduction in the original construction of VISA-A was based on literature review and clinician consensus with little or no patient involvement. We determined that 1) VISA-A consists of ambiguous conceptual item themes and thus lacks content validity, 2) there was no thorough investigation of the psychometric properties of the original version of VISA-A, which thus lacks construct validity, and 3) rigorous direct assessment of the psychometric properties of the Danish VISA-A revealed inadequate psychometric properties. In agreement with the COSMIN study, we conclude that when used as a single score, VISA-A is not an adequate scale for measuring self-reported impact of Achilles tendinopathy.
最近的一项 COSMIN 综述发现，维多利亚运动评估-跟腱病问卷（VISA-A）在结构有效性方面存在缺陷。本研究的目的是专门评估 VISA-A 的构建和验证过程，以及丹麦版的 VISA-A 是否是一种有效的测量跟腱病患者感知影响的患者报告结局测量（PROM）。本研究检查了内容有效性的原始项目生成策略和确认定标属性（结构有效性）的过程。此外，还通过几种心理测量方法（Rasch 分析、验证性因素分析（CFA）和多变量线性回归）直接评估了结构有效性，研究对象为 318 名跟腱病患者和 120 名健康人，这些患者的症状持续时间从少于 3 个月到超过 1 年的慢性期不等。我们发现，VISA-A 的原始构建中的项目生成和项目删减是基于文献回顾和临床医生共识，几乎没有或没有患者参与。我们确定了以下几点：1）VISA-A 由模糊的概念性项目主题组成，因此缺乏内容有效性；2）VISA-A 的原始版本没有进行彻底的心理测量特性研究，因此缺乏结构有效性；3）对丹麦 VISA-A 的心理测量特性进行了严格的直接评估，发现其心理测量特性不足。与 COSMIN 研究一致，我们得出结论，当作为单一评分使用时，VISA-A 不是一种充分的测量跟腱病患者自我报告影响的量表。
