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de Vos RJ, Gravare Silbernagel K, Malliaras P, Visser TS, Alfredson H, Akker-Scheek IVD, van Ark M, Brorsson A, Chimenti R, Docking S, Eliasson P, Farnqvist K, Haleem Z, Hanlon SL, Kaux JF, Kearney RS, Kirwan PD, Kulig K, Kumar B, Lewis T, Longo UG, Lui TH, Maffulli N, Mallows AJ, Masci L, McGonagle D, Morrissey D, Murphy MC, Newsham-West R, Nilsson-Helander KM, Norris R, Oliva F, O'Neill S, Peers K, Rio EK, Sancho I, Scott A, Seymore KD, Soh SE, Vallance P, Verhaar JAN, van der Vlist AC, Weir A, Zellers JA, Vicenzino B. ICON 2023: International Scientific Tendinopathy Symposium Consensus - the core outcome set for Achilles tendinopathy (COS-AT) using a systematic review and a Delphi study of professional participants and patients. Br J Sports Med 2024:bjsports-2024-108263. [PMID: 39271248 DOI: 10.1136/bjsports-2024-108263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/15/2024]
Abstract
To develop a core outcome set for Achilles tendinopathy (COS-AT) for use in clinical trials we performed a five-step process including (1) a systematic review of available outcome measurement instruments, (2) an online survey on truth and feasibility of the available measurement instruments, (3) an assessment of the methodological quality of the selected outcome measurement instruments, (4) an online survey on the outcome measurement instruments as COS and (5) a consensus in-person meeting. Both surveys were completed by healthcare professionals and patients. The Outcome Measures in Rheumatology guidelines with a 70% threshold for consensus were followed. We identified 233 different outcome measurement instruments from 307 included studies; 177 were mapped within the International Scientific Tendinopathy Symposium Consensus core domains. 31 participants (12 patients) completed the first online survey (response rate 94%). 22/177 (12%) outcome measurement instruments were deemed truthful and feasible and their measurement properties were evaluated. 29 participants (12 patients) completed the second online survey (response rate 88%) and three outcome measurement instruments were endorsed: the Victorian Institute of Sports Assessment-Achilles questionnaire, the single-leg heel rise test and evaluating pain after activity using a Visual Analogue Scale (VAS, 0-10). 12 participants (1 patient) attended the final consensus meeting, and 1 additional outcome measurement instrument was endorsed: evaluating pain during activity/loading using a VAS (0-10). It is recommended that the identified COS-AT will be used in future clinical trials evaluating the effectiveness of an intervention. This will facilitate comparing outcomes of intervention strategies, data pooling and further progression of knowledge about AT. As COS-AT is implemented, further evidence on measurement properties of included measures and new outcome measurement instruments should lead to its review and refinement.
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Affiliation(s)
- Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Peter Malliaras
- Physiotherapy Department, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Tjerk Sleeswijk Visser
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Sports Medicine, HMC Antoniushove Stichting Haaglanden Medisch Centrum, Leidschendam, The Netherlands
| | - Hakan Alfredson
- Department of Community Medicine and Rehabilitation, Sports Medicine, Umea University Faculty of Medicine, Umea, Sweden
| | | | - Mathijs van Ark
- Physiotherapy Department, School of Health Care Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Annelie Brorsson
- Department of Orthopedics, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Ruth Chimenti
- Department of Physical Therapy and Rehabilitation Sciences, The University of Iowa, Iowa City, Iowa, USA
| | - Sean Docking
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Pernilla Eliasson
- Department of Orthopedics, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Kenneth Farnqvist
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Zubair Haleem
- Sports and Exercise Medicine, Queen Mary University, London, UK
- Arsenal Football Club, London, UK
| | - Shawn L Hanlon
- Department of Kinesiology, California State University Fullerton, Fullerton, California, USA
| | - Jean-Francois Kaux
- Physical Medicine and Sport Traumatology Department, University of Liege, Liege, Belgium
- FIMS Collaborative Centre of Sports Medicine, FIFA Medical Centre of Excellence, Dubai, UAE
| | | | - Paul D Kirwan
- Discipline of Physiotherapy, School Of Medicine, Trinity College Dublin, Dublin, Ireland
- Physiotherapy Dept, Connolly Hospital Blanchardstown, Blanchardstown, Ireland
| | - Kornelia Kulig
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | | | - Trevor Lewis
- Liverpool Foundation Trust, Aintree University Hospital, Liverpool, UK
| | | | - Tun Hing Lui
- Department of Orthopaedic and Traumatology, North District Hospital, Hong Kong, Hong Kong
| | - Nicola Maffulli
- Department of Trauma and Orthopaedics, School of Medicine and Psychology, University of Rome La Sapienza, Rome, Italy
| | - Adrian James Mallows
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Lorenzo Masci
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Dennis McGonagle
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds Leeds, Leeds, UK
- Leeds Biomedical Research Centre, Leeds, UK
| | - Dylan Morrissey
- Sport and Exercise Medicine, Queen Mary University, London, UK
- Physiotherapy Department, Barts Health NHS Trust, London, UK
| | - Myles Calder Murphy
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Health Sciences, The University of Notre Dame, Fremantle, Western Australia, Australia
| | | | | | - Richard Norris
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- The Physiotherapy Centre, Liverpool, UK
| | - Francesco Oliva
- Department of Human Sciences and Promotion of the Quality of Life, University of Rome La Sapienza, Rome, Italy
| | - Seth O'Neill
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| | - Koen Peers
- Department of Development and Regeneration, KU Leuven - University, Leuven, Belgium
| | - Ebonie Kendra Rio
- La Trobe Sport and Exercise Medicine Research Centre, The Australian Ballet, The Victorian Institute of Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Igor Sancho
- Deusto Physical TherapIker, Physiotherapy Department, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Alex Scott
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kayla D Seymore
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Sze-Ee Soh
- Department of Physiotherapy and Rehabilitation, Monash University Rehabilitation Ageing and Independent Living Research Centre, Frankston, Victoria, Australia
| | - Patrick Vallance
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, Victoria, Australia
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Arco C van der Vlist
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Adam Weir
- Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
- Sport Medicine and Exercise Clinic (SBK), Haarlem, The Netherlands
| | - Jennifer Ann Zellers
- Program in Physical Therapy & Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Bill Vicenzino
- Physiotherapy, The University of Queensland School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
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Pierre-Jean L, Alexis T, Ronny L. Validation and reliability of the Simple Achille Value (SAV) in Achilles tendon disorders. Foot Ankle Surg 2024:S1268-7731(24)00179-6. [PMID: 39174355 DOI: 10.1016/j.fas.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/07/2024] [Accepted: 08/01/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Achilles tendon (AT) disorders significantly impact patient life, necessitating accurate assessment tools. Current methods are often complex and time-consuming. This study aims to validate the Simple Ankle Value (SAV) for AT disorders. METHODS A multicenter study was conducted involving 101 participants, including a surgical, a conservative, and a control group. Participants completed the SAV, VISA-A, and EFAS scores. The study assessed correlations among scores, reliability, responsiveness to change, threshold and ceiling effect and discriminative ability of the SAV. RESULTS There was a significant strong correlation with the EFAS and a significant moderate to strong correlation with the VISA-A. The score showed excellent reliability (ρ = 0.95, 95 %CI: [0.913; 0.976], p < 0.001). Responsiveness to change was significant between preoperative and postoperative SAV (37.99 ± 25.73 vs 70.86 ± 21.26). The SAV discriminated between patient and controls with no threshold or ceiling effect. CONCLUSION The SAV provides a valid, reliable, and responsive method for assessing AT disorders. It offers a simplified and effective alternative to more complex scores. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 2.
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Affiliation(s)
- Lambrey Pierre-Jean
- Service de Chirurgie orthopédique et traumatologique, CHU de Lille, 2 avenue Emile Laine, 59000 Lille, France; Université Lille-Hauts de France, 59000 Lille, France.
| | - Thiounn Alexis
- Institut Main Pied Plastique Articulations Chirurgie Traumatologie (IMPPACT), Clinique Lille Sud, Lesquin, France
| | - Lopes Ronny
- Department of Orthopaedic Surgery and Sports Medicine, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Alshewaier SA, Alotaibi RM, Alshabanat AS, Alkathiry AA. 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. Orthop J Sports Med 2024; 12:23259671241252649. [PMID: 38840792 PMCID: PMC11151768 DOI: 10.1177/23259671241252649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 06/07/2024] Open
Abstract
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.
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Affiliation(s)
- Shady A. Alshewaier
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Riyadh, Majmaah, Saudi Arabia
| | - Raed M. Alotaibi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Riyadh, Majmaah, Saudi Arabia
| | - Abdulrahman S. Alshabanat
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Riyadh, Majmaah, Saudi Arabia
| | - Abdulaziz A. Alkathiry
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Riyadh, Majmaah, Saudi Arabia
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Murphy MC, McCleary F, Hince D, Chimenti R, Chivers P, Vosseller JT, Nimphius S, Mkumbuzi NS, Malliaras P, Maffulli N, de Vos RJ, Rio EK. TENDINopathy Severity assessment-Achilles (TENDINS-A): evaluation of reliability and validity in accordance with COSMIN recommendations. Br J Sports Med 2024; 58:665-673. [PMID: 38575200 DOI: 10.1136/bjsports-2023-107741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To evaluate the construct validity (structural validity and hypothesis testing), reliability (test-retest reliability, measurement error and internal consistency) and minimal important change (MIC) of the 13-item TENDINopathy Severity assessment-Achilles (TENDINS-A). METHODS Participants with Achilles pain completed an online survey including: demographics, TENDINS-A, Foot and Ankle Outcome Score (FAOS) and Victorian Institute of Sport Assessment-Achilles (VISA-A). Exploratory factor analysis (EFA) assessed dimensionality. Confirmatory factor analysis (CFA) assessed structural validity (root mean square error of approximation (RMSEA); Comparative Fit Index (CFI); Tucker-Lewis Index (TLI); standardised root measure square (SRMS)). Correlations between TENDINS-A and the FAOS or VISA-A assessed hypothesis testing. Intraclass correlation (ICC) assessed test-retest reliability. Cronbach's alpha assessed internal consistency. SE of the measurement (SEM) assessed measurement error. A distribution-based approach assessed MIC. RESULTS 79 participants (51% female) with a mean (SD) age=42.6 (13.0) years, height=175.0 (11.7) cm and body mass=82.0 (19.1) kg were included. EFA identified three meaningful factors, proposed as pain, symptoms and function. The best model identified using CFA for TENDINS-A had structural validity (RMSEA=0.101, CFI=0.959, TLI=0.947, SRMS=0.068), which included three factors (pain, symptoms and function), but excluded three items from the original TENDINS-A. TENDINS-A exhibited moderate positive correlation with FAOS (r=0.598, p<0.001) and a moderate negative correlation with VISA-A (r=-0.639, p<0.001). Reliability of the TENDINS-A was excellent (ICC=0.930; Cronbach's α=0.808; SEM=6.54 units), with an MIC of 12 units. CONCLUSIONS Our evaluation of the revised 10-item TENDINS-A determined it has construct validity and excellent reliability, compared with the VISA-A and FAOS which lack content and construct validity. The TENDINS-A is recommended as the preferred patient-reported outcome measure to assess disability in people with Achilles tendinopathy.
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Affiliation(s)
- Myles Calder Murphy
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Fergus McCleary
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Dana Hince
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Ruth Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Paola Chivers
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | | | - Sophia Nimphius
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nonhlanhla Sharon Mkumbuzi
- Ntombi Sport, Cape Town, South Africa
- Department of Sports, Exercise, and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
- Department of Rehabilitation, Midlands State University, Gweru, Zimbabwe
- Department of Human Movement Science, Nelson Mandela University, Summerstrand, Gqeberha, South Africa
| | - Peter Malliaras
- School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria, Australia
| | - Nicola Maffulli
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ebonie Kendra Rio
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
- Victorian Institute of Sport, Melbourne, Victoria, Australia
- The Australian Ballet, Melbourne, Victoria, Australia
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Murphy MC, Green B, Sancho Amundarain I, de Vos RJ, Rio EK. Are we asking the right questions to people with Achilles tendinopathy? The best questions to distinguish mild versus severe disability to improve your clinical management. Phys Ther Sport 2024; 67:54-60. [PMID: 38593625 DOI: 10.1016/j.ptsp.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Determine the capacity of individual items on the Tendinopathy Severity Assessment - Achilles (TENDINS-A), Foot and Ankle Outcome Score (FAOS), and Victorian Institute of Sports Assessment - Achilles (VISA-A) to differentiate patients with mild and severe tendon-related disability in order to provide clinicians the best questions when they are consulting patients with Achilles tendinopathy. DESIGN Cross-sectional. PARTICIPANTS Seventy participants with Achilles tendinopathy (61.4% mid-portion only, 31.4% insertional only, 7.2% both). OUTCOME MEASURES The discrimination index was determined for each TENDINS-A, FAOS, and VISA-A item to determine if items could discriminate between mild and severe disability. A Guttman analysis for polytomous items was conducted. RESULTS All 62 tems from the TENDINS-A, FAOS, and VISA-A were ranked with the best items relating to pain with physical tendon loading, time for pain to settle following aggravating activities and time for the tendon to 'warm-up' following inactivity. CONCLUSIONS Pain with loading the Achilles tendon, time for pain to settle following aggravating activity, as well as time taken for the tendon symptoms to subside after prolonged sitting or sleeping are the best questions indicative of the severity of disability in patients with Achilles tendinopathy. These questions can assist clinicians with assessing baseline severity and monitoring treatment response.
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Affiliation(s)
- Myles C Murphy
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
| | - Brady Green
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Igor Sancho Amundarain
- Deusto Physical TherapIker Group, Physical Therapy Department, Faculty of Health Sciences, University of Deusto, Donostia - San Sebastián, Spain
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ebonie K Rio
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia; The Australian Ballet, Southbank, Victoria, Australia; Victorian Institute of Sport, Albert Park, Victoria, Australia
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Murphy MC, Newsham-West R, Cook J, Chimenti RL, de Vos RJ, Maffulli N, Malliaras P, Mkumbuzi N, Purdam C, Vosseller JT, Rio EK. TENDINopathy Severity Assessment - Achilles (TENDINS-A): Development and Content Validity Assessment of a New Patient-Reported Outcome Measure for Achilles Tendinopathy. J Orthop Sports Phys Ther 2024; 54:70-85. [PMID: 37615161 DOI: 10.2519/jospt.2023.11964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVE: To develop a new patient-reported outcome measure (PROM) assessing TENDINopathy Severity of the Achilles (TENDINS-Achilles) and evaluate its content validity. DESIGN: Mixed-methods, modified Delphi. METHODS: We performed 1 round of semistructured one-on-one interview responses with professionals and patients, for initial item generation. This was followed by 1 round of survey responses for professionals and a final round of semistructured one-on-one interviews with patients. The work culminated in a PROM to quantify Achilles tendinopathy severity under the core health domain of disability. Participants identified 3 subdomains contributing to the severity of disability of Achilles tendinopathy: pain, symptoms, and functional capacity. RESULTS: All 8 patient participants invited to participate were enrolled. Forty professional participants (50% women, six different continents) were invited to participate and 30 were enrolled (75% response rate). Therefore, a total of 30 professionals and 8 patients were included within this study. Following 3 rounds of qualitative or quantitative feedback, this study has established the content validity of TENDINS-A (good relevance, comprehensibility, and comprehensiveness) as a new PROM to assess the severity of Achilles tendinopathy, which assesses aspects of pain, symptoms, and functional capacity. CONCLUSION: TENDINS-A has established content validity and is appropriate for use with clinical and research populations. We recommend users interpret TENDINS-A results cautiously, until further testing evaluates the most appropriate scoring scale, reliability, construct validity, criterion validity, and responsiveness of TENDINS-A. Until these psychometric properties are established, we suggest using TENDINS-A alongside existing tools. J Orthop Sports Phys Ther 2023;53(11):1-16. Epub: 24 August 2023. doi:10.2519/jospt.2023.11964.
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Shitrit E, Valentin E, Baudrier N, Bohu Y, Rauline G, Lopes R, Bauer T, Hardy A. The ALR-RSI score can be used to evaluate psychological readiness to return to sport after acute Achilles tendon tear. Knee Surg Sports Traumatol Arthrosc 2023; 31:4961-4968. [PMID: 37612477 PMCID: PMC10598148 DOI: 10.1007/s00167-023-07548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The return to sport is one of the main goals following Achilles tendon tear repair. Several psychological factors influence the return to sport after a sports injury. The traditional tools to assess the return to sport do not take into account psychological factors. The ankle ligament reconstruction-return to sport injury (ALR-RSI), validated for ankle instability, is a score to evaluate psychological readiness to return to sport. The goal of this study was to validate the ALR-RSI score for the assessment of the readiness to return to sport after Achilles tendon repair. METHODS The ALR-RSI score, adapted from the anterior cruciate ligament-return to sport injury (ACL-RSI) score used following knee ligament reconstruction, was validated according to the international COSMIN methodology. Patients operated for Achilles tendon repair responded to the questionnaire during the rehabilitation period. The EFAS, FAAM and VISA-A scores were used as reference questionnaires. RESULTS A total of 50 patients were included. The ALR-RSI score was strongly (r > 0.5) correlated to the EFAS score: r = 0.68 [0.50-0.80] the FAMM sport score: r = 0.7 [0.52-0.84] the FAAM AVQ score (r = 0.6 [0.35-0.78]), and the VISA-A score (r = 0.54 [0.26-0.76]). The discriminant validity was good with the ALR-RSI, which was significantly lower in the patients that did not return to sport: 60.7 (40-81.4) compared to those that did: 83.2 (64.3-100) p = 0.001. Reproducibility was excellent with an intra-class correlation coefficient ρ of 0.99 [097-1.00]. The internal consistency was excellent (alpha coefficient = 0.95). CONCLUSION The ALR-RSI score provides a valid, reproducible assessment of the psychological readiness to return to sport in patients who undergo surgical Achilles tendon suture repair. LEVEL OF EVIDENCE III.
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Affiliation(s)
- E Shitrit
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France
| | - E Valentin
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France
| | - N Baudrier
- Clinique Jouvenet, 6 Sq. Jouvenet, 75016, Paris, France
| | - Y Bohu
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France
| | - G Rauline
- , 34 Rue Michal, 75013, Paris, France
| | - R Lopes
- chirurgie orthopedique, Pied cheville Nantes Atlantique, sante Atlantique, avenue Claude-Bernard, 44800, Saint-Herblain, France
- Clinique Brétéché, 3, rue de la Béraudière, BP 54613, 44046, Nantes Cedex 1, France
| | - T Bauer
- Service de chirurgie orthopedique et traumatologique, hopital Ambroise Paré, universite Paris-Saclay, Assistance publique-Hôpitaux de Paris, 9, avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France
| | - A Hardy
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France.
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Norris R, Cook JL, Gaida JE, Maddox T, Raju J, O'Neill S. The VISA-A (sedentary) should be used for sedentary patients with Achilles tendinopathy: a modified version of the VISA-A developed and evaluated in accordance with the COSMIN checklist. Br J Sports Med 2023; 57:1311-1316. [PMID: 36927742 DOI: 10.1136/bjsports-2022-105547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To develop and evaluate a modified version of the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire, for use in sedentary patients with Achilles tendinopathy, using the Consensus-based Standards for the selection of health Measurement Instruments recommendations. METHODS Twenty-two sedentary patients with Achilles tendinopathy completed the VISA-A and provided feedback regarding the relevance, comprehensiveness and comprehensibility of each item, response options and instructions. Patient and professional feedback was used to develop the VISA-A (sedentary) questionnaire. Reliability, validity and responsiveness of the VISA-A (sedentary) was evaluated in 51 sedentary patients with Achilles tendinopathy: 47.1% women, mean age 64.8 (SD 11.24). RESULTS Factor analysis identified two dimensions (symptoms and activity) for the VISA-A (sedentary). Test-retest reliability was excellent for symptoms (intraclass correlation coefficient, ICC=0.991) and activity (ICC=0.999). Repeatability was 1.647 for symptoms and 0.549 for activity. There was a significant difference between the VISA-A and VISA-A (sedentary) scores both pretreatment and post-treatment. There was stronger correlation between the pretreatment to post-treatment change in the VISA-A (sedentary) scores (r=0.420 for symptoms, r=0.407 for activity) and the global rating of change than the VISA-A scores (r=0.253 for symptoms, r=0.186 for activity). CONCLUSION The VISA-A (sedentary) demonstrates adequate reliability, validity and responsiveness in sedentary patients with Achilles tendinopathy. The VISA-A (sedentary) is a more appropriate measure than the VISA-A for this cohort and is recommended for clinical and research purposes.
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Affiliation(s)
- Richard Norris
- Department of Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jill L Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Jamie E Gaida
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Thomas Maddox
- University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Jaya Raju
- University of Leicester, Leicester, UK
| | - Seth O'Neill
- School of Healthcare, Life Sciences, University of Leicester, Leicester, UK
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9
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Agergaard AS, Comins JD, Siersma V, Malmgaard-Clausen NM, Couppe C, Hjortshoej MH, Olesen JL, Magnusson SP. Assessment of the Psychometric Properties of the Danish VISA-P. TRANSLATIONAL SPORTS MEDICINE 2023; 2023:5291949. [PMID: 38654908 PMCID: PMC11022774 DOI: 10.1155/2023/5291949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/15/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2024]
Abstract
Purpose The objective of the current study was to conduct a rigorous assessment of the psychometric properties of the Victorian Institute of Sports Assessment-patellar tendinopathy (VISA-P). Methods Rasch analysis, confirmatory factor analysis (CFA), and multivariable linear regression were used to assess the psychometric properties of the VISA-P questionnaire in 184 Danish patients with patellar tendinopathy who had symptoms ranging from under 3 months to over 1 year. A group of 100 healthy Danish persons was included as a reference for known-group validation. Results The analyses revealed that the 8-item VISA-P did not fit a unidimensional model, yielded at best a 3-factor model, and exhibited differential item functioning (DIF) across healthy subjects versus people with patellar tendinopathy. Conclusion VISA-P in its present form does not satisfy a measurement model and is not a robust scale for measuring patellar tendinopathy. A new PROM for patellar tendinopathy should be developed and appropriately validated, and meanwhile, simple pain scoring (e.g., numeric rating scales) and functional tests are suggested as more appropriate outcome measures for studies of patellar tendinopathy.
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Affiliation(s)
- Anne-Sofie Agergaard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Jonathan D. Comins
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
- Novo Nordisk A/S, Søborg, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nikolaj M. Malmgaard-Clausen
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Couppe
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Mikkel H. Hjortshoej
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Jens L. Olesen
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - S. Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
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10
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Radovanović G, Bohm S, Peper KK, Arampatzis A, Legerlotz K. Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial. SPORTS MEDICINE - OPEN 2022; 8:149. [PMID: 36538166 PMCID: PMC9768072 DOI: 10.1186/s40798-022-00545-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Assuming that the mechanisms inducing adaptation in healthy tendons yield similar responses in tendinopathic tendons, we hypothesized that a high-loading exercise protocol that increases tendon stiffness and cross-sectional area in male healthy Achilles tendons may also induce comparable beneficial adaptations in male tendinopathic Achilles tendons in addition to improving pain and function. OBJECTIVES We investigated the effectiveness of high-loading exercise in Achilles tendinopathy in terms of inducing mechanical (tendon stiffness, maximum strain), material (Young's modulus), morphological (tendon cross-sectional area (CSA)), maximum voluntary isometric plantar flexor strength (MVC) as well as clinical adaptations (Victorian Institute of Sports Assessment-Achilles (VISA-A) score and pain (numerical rating scale (NRS))) as the primary outcomes. As secondary outcomes, drop (DJ) and counter-movement jump (CMJ) height and intratendinous vascularity were assessed. METHODS We conducted a controlled clinical trial with a 3-month intervention phase. Eligibility criteria were assessed by researchers and medical doctors. Inclusion criteria were male sex, aged between 20 and 55 years, chronic Achilles tendinopathy confirmed by a medical doctor via ultrasound-assisted assessment, and a severity level of less than 80 points on the VISA-A score. Thirty-nine patients were assigned by sequential allocation to one of three parallel arms: a high-loading intervention (training at ~ 90% of the MVC) (n = 15), eccentric exercise (according to the Alfredson protocol) as the standard therapy (n = 15) and passive therapy (n = 14). Parameters were assessed pre- and-post-intervention. Data analysis was blinded. RESULTS Primary outcomes: Plantar flexor MVC, tendon stiffness, mean CSA and maximum tendon strain improved only in the high-loading intervention group by 7.2 ± 9.9% (p = 0.045), 20.1 ± 20.5% (p = 0.049), 8.98 ± 5.8% (p < 0.001) and -12.4 ± 10.3% (p = 0.001), respectively. Stiffness decreased in the passive therapy group (-7.7 ± 21.2%; p = 0.042). There was no change in Young's modulus in either group (p > 0.05). The VISA-A score increased in all groups on average by 19.8 ± 15.3 points (p < 0.001), while pain (NRS) dropped by -0.55 ± 0.9 points (p < 0.001). SECONDARY OUTCOMES CMJ height decreased for all groups (-0.63 ± 4.07 cm; p = 0.005). There was no change in DJ height and vascularity (p > 0.05) in either group. CONCLUSION Despite an overall clinical improvement, it was exclusively the high-loading intervention that induced significant mechanical and morphological adaptations of the plantar flexor muscle-tendon unit. This might contribute to protecting the tendon from strain-induced injury. Thus, we recommend the high-loading intervention as an effective (alternative) therapeutic protocol in Achilles tendinopathy rehabilitation management in males. CLINICAL TRIALS REGISTRATION NUMBER NCT02732782.
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Affiliation(s)
- Goran Radovanović
- grid.7468.d0000 0001 2248 7639Institute of Sports Sciences, Movement Biomechanics, Humboldt-Universität zu Berlin, Philippstr. 13, 10115 Berlin, Germany ,grid.11500.350000 0000 8919 8412Department Performance, Neuroscience, Therapy and Health, Medical School Hamburg, Faculty of Health Sciences, University of Applied Sciences and Medical University, 20457 Hamburg, Germany ,grid.11500.350000 0000 8919 8412Institute of Interdisciplinary Exercise Science and Sports Medicine, Medical School Hamburg, University of Applied Sciences and Medical University, 20457 Hamburg, Germany
| | - Sebastian Bohm
- grid.7468.d0000 0001 2248 7639Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Kim Kristin Peper
- grid.6936.a0000000123222966Munich Institute of Robotics and Machine Intelligence, Technische Universität München, 80992 Munich, Germany
| | - Adamantios Arampatzis
- grid.7468.d0000 0001 2248 7639Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Kirsten Legerlotz
- grid.7468.d0000 0001 2248 7639Institute of Sports Sciences, Movement Biomechanics, Humboldt-Universität zu Berlin, Philippstr. 13, 10115 Berlin, Germany
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11
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Malliaras P. Physiotherapy management of Achilles tendinopathy. J Physiother 2022; 68:221-237. [PMID: 36274038 DOI: 10.1016/j.jphys.2022.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 02/15/2023] Open
Affiliation(s)
- Peter Malliaras
- Department of Physiotherapy Monash University, Melbourne, Australia.
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12
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Data driven model of midportion achilles tendinopathy health created with factor analysis. BMC Musculoskelet Disord 2022; 23:744. [PMID: 35922770 PMCID: PMC9347128 DOI: 10.1186/s12891-022-05702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Achilles tendinopathy is a complex injury and the clinical presentation spans multiple different domains: physical and psychological symptoms, lower extremity function and tendon structure. A conceptual model of Achilles tendon health comprising these domains has been proposed in the literature. The aim of the study was to fit a model of Achilles tendinopathy using factor analysis and compare that to the conceptual model. An inclusive approach using a wide range of variables spanning multiple potential domains were included. Methods Participants (N = 99) with midportion Achilles tendinopathy were assessed with variables representing symptoms, physical function, tendon structure, metabolic syndrome, and psychologic symptoms. A Kaiser-Mayer-Olkin index was used to determine suitable variables for a subsequent exploratory factor analysis. Results A model emerged with an acceptable fit to the data (standardized root mean square of residuals = 0.078). Five uncorrelated factors emerged from the model and were labelled as biopsychosocial, lower extremity function, body size, load tolerance, and tendon structure. The total explained variance was 0.51 with the five factors explaining 0.14, 0.12, 0.10, 0.08, and 0.07 respectively. The results differed from the conceptual model as the factors of psychological variables and metabolic variables did not emerge from the analysis. Conclusion A data driven model of Achilles tendon health supports assessment of the clinical presentation over multiple domains. As the factors are uncorrelated, the results of assessment of, for example, tendon structure should not be expected to be associated with lower extremity function or biopsychosocial limitations. The results suggest that the Patient Reported Outcomes Measurement Information System, counter-movement jump height, body mass index, pain with hopping, and the tendon cross-sectional area can evaluate the five factors, respectively. Trial registration Registered on clinicaltrials.gov (Medicine NL of. ClinicalTrials.gov [Internet], 2018), ID number NCT03523325. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05702-1.
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13
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Sigurðsson HB, Grävare Silbernagel K. Is the VISA-A Still Seaworthy, or Is It in Need of Maintenance? Orthop J Sports Med 2022; 10:23259671221108950. [PMID: 35982828 PMCID: PMC9380230 DOI: 10.1177/23259671221108950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background 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. Purpose To evaluate the responsiveness of the VISA-A in midportion Achilles tendinopathy and compare it with other patient-reported outcome measures. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods 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. Results 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. Conclusion 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.
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14
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Johannsen F, Olesen JL, Øhlenschläger TF, Lundgaard-Nielsen M, Cullum CK, Jakobsen AS, Rathleff MS, Magnusson PS, Kjær M. Effect of Ultrasonography-Guided Corticosteroid Injection vs Placebo Added to Exercise Therapy for Achilles Tendinopathy: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2219661. [PMID: 35816306 PMCID: PMC9274322 DOI: 10.1001/jamanetworkopen.2022.19661] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022] Open
Abstract
Importance Corticosteroid injections and exercise therapy are commonly used to treat chronic midportion Achilles tendinopathy, but the evidence for this combination is limited. Objective To investigate the effect of corticosteroid injection and exercise therapy compared with placebo injection and exercise therapy for patients with Achilles tendinopathy. Design, Setting, and Participants This was a participant-blinded, physician-blinded, and assessor-blinded randomized clinical trial of patients with Achilles tendinopathy verified by ultrasonography. Assessment of pain and function were conducted at baseline and at 1, 2, 3, 6, 12, and 24 months. Patients were recruited from a university medical clinic and a private rheumatology clinic in Denmark between April 2016 and September 2018. Data analysis was performed from June to September 2021. Interventions Corticosteroid injection and placebo injection were performed with ultrasonography guidance. Exercise therapy was based on previous trials and consisted of 3 exercises done every second day. Main Outcomes and Measures The primary outcome was the Victorian Institute of Sports Assessment-Achilles (VISA-A) score (range, 1-100, with 100 representing no symptoms) at 6 months. Secondary outcomes included pain measured using a 100-mm Visual Analog Scale for morning pain and pain during exercise (with higher scores indicating worse pain), global assessment (Likert scale), and tendon thickness. Results A total of 100 patients were included, with 52 randomized to placebo (mean age, 46 years [95% CI, 44-48 years]; 32 men [62%]) and 48 randomized to corticosteroid injection (mean age, 47 years [95% CI, 45-49 years]; 28 men [58%]). Patients in the 2 groups had similar height (mean [SD], 177 [8] cm), weight (mean [SD], 79 [12] kg), and VISA-A score (mean [SD], 46 [18]) at baseline. The group receiving exercise therapy combined with corticosteroid injections had a 17.7-point (95% CI, 8.4-27.0 points; P < .001) larger improvement in VISA-A score compared with patients receiving exercise therapy combined with placebo injections at 6 months. No severe adverse events were observed in either group, and there was no deterioration in the long term (2-year follow-up). Conclusions and Relevance Corticosteroid injections combined with exercise therapy were associated with better outcomes in the treatment of Achilles tendinopathy compared with placebo injections and exercise therapy. A combination of exercise therapy and corticosteroid injection should be considered in the management of long-standing Achilles tendinopathy. Trial Registration ClinicalTrials.gov Identifier: NCT02580630.
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Affiliation(s)
- Finn Johannsen
- Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jens Lykkegaard Olesen
- Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
- Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
| | | | | | - Camilla Kjaer Cullum
- Department of Occupational Therapy and Physiotherapy, Bispebjerg Hospital, Copenhagen, Denmark
| | - Anna Svarre Jakobsen
- Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Peter Stig Magnusson
- Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Michael Kjær
- Institute of Sports Medicine, Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
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15
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Ghai V, Subramanian V, Jan H, Doumouchtsis SK. A systematic review highlighting poor-quality of evidence for Content Validity of Quality of Life (QoL) Instruments in Female Chronic Pelvic Pain (CPP). J Clin Epidemiol 2022; 149:1-11. [PMID: 35452795 DOI: 10.1016/j.jclinepi.2022.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the content validity of 19 Patient Reported Outcome Measures (PROMs) used to measure QoL in women with CPP DESIGN AND SETTING: We searched EMBASE, MEDLINE, PsycINFO databases and Google Scholar from inception to August 2020. We included records describing the development or studies assessing content validity of PROMs. Two reviewers independently assessed the methodological quality of PROMs using the COSMIN checklist. Evidence was synthesised for relevance, comprehensiveness and comprehensibility. Quality of evidence was rated using a modified GRADE approach. MAIN RESULTS PROM development was inadequate for all instruments included in this review. No high-quality evidence ratings were found for relevance, comprehensiveness and comprehensibility. QoL was measured using generic instruments (68.42%, 13/19) rather than those specific to chronic pain (21.04%, 4/19) or pelvic pain (10.53%, 2/19). Quality of concept elicitation was inadequate for 90% of PROMs. Half of PROMs did not include patients in their development and only 40% were devised using a sample representative of the target population for which the PROM was developed. Cognitive interviews were conducted in one-fifth of PROMs and were mostly of inadequate/doubtful quality. CONCLUSION There is poor-quality of evidence for content validity of PROMs used to measure QoL in women with CPP.
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Affiliation(s)
- Vishalli Ghai
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, KT18 7EG, United Kingdom; St George's University of London, Crammer Terrace, London, SW17 0RE, United Kingdom.
| | - Venkatesh Subramanian
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, KT18 7EG, United Kingdom
| | - Haider Jan
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, KT18 7EG, United Kingdom
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, KT18 7EG, United Kingdom; St George's University of London, Crammer Terrace, London, SW17 0RE, United Kingdom; Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece; American University of the Caribbean, School of Medicine; Ross University, School of Medicine
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16
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Nasser AM, Fearon AM, Grimaldi A, Vicenzino B, Mellor R, Spencer T, Semciw AI. Outcome measures in the management of gluteal tendinopathy: a systematic review of their measurement properties. Br J Sports Med 2022; 56:877-887. [PMID: 35396205 DOI: 10.1136/bjsports-2021-104548] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Evaluate properties of outcome measures for gluteal tendinopathy. DESIGN Multistage scoping/systematic review. DATA SOURCES Cochrane, PubMed, Embase, Scopus, Web of Science, PEDro, CINAHL, SPORTDISCUS were searched (December 2021) to identify measures used to evaluate gluteal tendinopathy. Measures were mapped to the core health domains for tendinopathy. Medline, CINAHL, Embase and PubMed were searched (December 2021) for studies evaluating measurement properties of gluteal tendinopathy outcome measures captured in the initial search. Both reviews included studies that evaluated a treatment in participants with gluteal tendinopathy, diagnosed by a professional. Consensus-based-Standards for the Selection of Health Instruments methodology were followed-including bias assessment and synthesis of findings. RESULTS Six studies reported on the Victorian Institute of Sport Assessment-Gluteal Tendinopathy (VISA-G). One study reported on the Hip Outcome Score (HOS)-activities of daily living (ADL) and Sport.The VISA-G had moderate-quality evidence of sufficient construct validity (known group) and responsiveness (pre-post intervention), low-quality evidence of sufficient reliability, measurement error, comprehensibility and insufficient construct validity (convergent), and very low-quality evidence of sufficient comprehensiveness, relevance and responsiveness (comparison with other outcome measures).Both the HOS(ADL) and HOS(Sport) had very low-quality evidence of sufficient reliability, relevance and insufficient construct validity and comprehensiveness. The HOS(ADL) had very low-quality evidence of sufficient comprehensibility and insufficient measurement error. The HOS(Sport) had very low quality evidence of inconsistent comprehensibility and sufficient measurement error. CONCLUSION Rigorously validated outcome measures for gluteal tendinopathy are lacking. The VISA-G is the preferred available option to capture the disability associated with gluteal tendinopathy.
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Affiliation(s)
- Anthony M Nasser
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia .,Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Angela M Fearon
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.,Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Alison Grimaldi
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca Mellor
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Spencer
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.,Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Adam Ivan Semciw
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.,Allied Health, Northern Health, Melbourne, Victoria, Australia
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17
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Korakakis V, Whiteley R, Kotsifaki A, Thorborg K. Tendinopathy VISAs have expired-is it time for outcome renewals? Knee Surg Sports Traumatol Arthrosc 2021; 29:2745-2748. [PMID: 33970294 PMCID: PMC8384781 DOI: 10.1007/s00167-021-06596-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022]
Affiliation(s)
| | - Rod Whiteley
- grid.415515.10000 0004 0368 4372Aspetar Orthopaedic and Sports Medicine Hospital, PO 29222, Doha, Qatar
| | - Argyro Kotsifaki
- grid.415515.10000 0004 0368 4372Aspetar Orthopaedic and Sports Medicine Hospital, PO 29222, Doha, Qatar
| | - Kristian Thorborg
- grid.5254.60000 0001 0674 042XDepartment of Orthopaedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Amager-Hvidovre Hospital, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark
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