Sigurðsson Haraldur B, Grävare Silbernagel Karin
School of Health Sciences, University of Iceland, Reykjavík, Iceland.
Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
Orthop J Sports Med. 2022 Aug 12;10(8):23259671221108950. doi: 10.1177/23259671221108950. eCollection 2022 Aug.
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.
To evaluate the responsiveness of the VISA-A in midportion Achilles tendinopathy and compare it with other patient-reported outcome measures.
Cohort study (diagnosis); Level of evidence, 2.
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.
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.
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.
维多利亚运动学院跟腱评估问卷（VISA-A）已得到验证，并在跟腱病中广泛应用。但对于其评估治疗效果的能力了解尚少。
评估VISA-A在中部跟腱病中的反应度，并将其与其他患者报告的结局指标进行比较。
队列研究（诊断）；证据等级，2级。
纳入97例临床诊断为跟腱病的参与者（中位年龄50岁[四分位间距18岁]；症状持续时间10个月[四分位间距28.7个月]）。参与者接受了基线评估，并在8、16、24、32、40和/或48周进行了1至6次随访评估。参与者完成了VISA-A、患者报告结局测量信息系统简表2.0版（PROMIS）身体功能和疼痛干扰分量表，以及坦帕运动恐惧量表（TSK）。使用11分的整体变化评分量表作为锚点，通过受试者工作特征分析评估了三个阈值（最小临床重要差异[MCID]、显著获益[SB]和完全恢复[CR]）。对原始分数以及相对于基线的变化进行了阈值评估。
VISA-A能够检测出随时间变化的所有三个阈值，原始分数>70.5、>77.5和>89.5分别代表MCID、SB和CR；VISA-A相对于基线变化的阈值分别是较基线增加23.5、19.5和37.5分。PROMIS分量表原始分数的SB和CR阈值相同（身体功能为52.45，疼痛干扰为45.6）。TSK评分<34.5是SB的阈值。
VISA-A是所评估的反应度最高的结局指标。原始分数对于MCID、SB和CR的阈值越来越高，因此在逻辑上是一致的。
