Cross-cultural adaptation and measurement properties of the VISA-A questionnaire for Chinese patients with Achilles Tendinopathy

Cross-Cultural Adaptation, Translation, and Validation of the Victorian Institute of Sport Assessment-Achilles Questionnaire (VISA-A) for Use With Arabic-Speaking Patients With Achilles Tendinopathy

Background

The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a validated instrument for assessing symptoms of Achilles tendinopathy (AT). However, there is a need to validate the Arabic version of the VISA-A (VISA-A-AR) in Arabic-speaking patients with AT.

Purpose

To validate the VISA-A-AR in Arabic patients with AT and evaluate its reliability and validity.

Study Design

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

Methods

The translation and cultural adaptation of the VISA-A questionnaire into Arabic followed international guidelines. A total of 81 participants were recruited, including 45 patients diagnosed with AT and 36 healthy individuals. The AT group comprised male and female native Arabic speakers aged ≥18 years who were diagnosed with and had symptoms of AT. The inclusion criteria for the healthy group were the same, except that they must not have had AT at the time of the study or previously. The exclusion criteria were individuals with a partial or complete Achilles tendon rupture or prior Achilles tendon surgery. The internal consistency of the VISA-A-AR was assessed using the Cronbach α coefficient. Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC[3,1]). Construct validity was assessed through correlation analysis between VISA-A-AR scores and the Arabic versions of the Short Form-36 Health Survey (SF-36-AR) and the Numeric Pain Rating Scale (ANPRS). Differences in VISA-A-AR scores between patients with AT and healthy controls were analyzed using appropriate statistical tests.

Results

The VISA-A-AR demonstrated a high level of internal consistency (Cronbach α = 0.935) and excellent test-retest reliability (ICC[3,1] = 0.985). Significant positive correlations were observed between VISA-A-AR scores and SF-36-AR (r(43) = 0.838, P < .001), indicating good construct validity. In addition, VISA-A-AR scores showed a significant negative correlation with ANPRS (rS(43) = -0.835, P < .001). Furthermore, VISA-A-AR scores exhibited a significant difference between patients with AT (mean, 45.82 ± 16.65) and healthy controls (mean, 99.94 ± 0.33) (P < .001).

Conclusion

The findings of this study validate the VISA-A-AR as a reliable and valid tool for assessing symptoms of AT in Arabic-speaking patients.

The Victorian Sports Assessment Institute-Achilles Tendinopathy Questionnaire (VISA-A): Chinese cross-cultural adaptation and psychometric validation

Purpose

We aimed to create a standardized cross-cultural adaptation of the simplified Chinese version of VISA-A, test its reliability and validity and conduct exploratory factor analysis on the correlation between items.

Methods

According to international recommendations for the cross-cultural adaptation of questionnaires, after considering the opinions of patients, we translated and revised the English version to create a simplified Chinese version of the questionnaire. We recruited healthy subjects in the general specialty of one university (n = 90) and the physical education specialty of another university (n = 89), and we recruited patients with Achilles tendinopathy in a third group (n = 85). Reliability was evaluated by calculating test–retest reliability and internal consistency, validity was evaluated by exploring structural and criterion validity (correlation with the physical function and body pain items of the SF-36), and responsiveness was evaluated by calculating area under the receiver operating characteristic curve (AUC).

Results

The simplified Chinese version of the VISA-A had no ceiling or floor effects. Four common factors were extracted and explained by the exploratory factor analysis. The test–retest reliability (ICC = 0.97) and internal consistency (Cronbach’s alpha = 0.84) were adequate. The questionnaire had moderate correlations with the physical function and body pain items of the SF-36. The AUC was 0.9407.

Conclusion

The simplified Chinese version of the VISA-A had good reliability and validity and excellent responsiveness, but the factorial structure is not inconsistent with the dimensions of the original version. It can be used to assess and manage patients with Achilles tendinitis in the Chinese culture.