A Reliability Generalization Meta-Analysis of the Victorian Institute of Sport Assessment Scale for Achilles Tendinopathy (VISA-A)

Foot Ankle Int. 2019 Apr;40(4):430-438. doi: 10.1177/1071100718816953. Epub 2018 Dec 20.


Background:: A reliability generalization study of a questionnaire is necessary to provide higher-level evidence for its reliability. This has not been performed for the Victorian Institute of Sport Assessment-Achilles tendinopathy (VISA-A) questionnaire. The VISA-A has been a commonly used questionnaire to evaluate the symptoms of Achilles tendon disorders and their impact on physical activity, one of the most common disorders among athletes and sports persons (9%-40%). Furthermore, this questionnaire has been translated to several languages and due to its simplicity is one of the most widely used questionnaires for patients with this type of disorder. Therefore, we performed a reliability generalization study of the VISA-A using MEDLINE (through PubMed) and Scopus as data sources.

Methods:: We selected studies that analyzed the reliability of the VISA-A by evaluating Cronbach's alpha, the intraclass correlation coefficient (ICC), and the Spearman correlation coefficients to compare VISA-A with similar scales. The data were analyzed using fixed- and random-effects models. We assessed sensitivity through the leave-one-out method. Quality analysis was performed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

Results:: Of a total of 263 studies (eliminating duplicates), 7 fulfilled inclusion criteria. The mean reliability was (1) Cronbach's alpha, 0.75 (95% CI, 0.70-0.79); (2) ICC, 0.91 (95% CI, 0.82-0.96); (3) correlation coefficient with the Curwin and Stanish grading system, -0.82 (95% CI, -0.93 to -0.56); and (4) correlation coefficient with the Percy and Conochie classification, 0.91 (95% CI, 0.87-0.93). We were unable to perform the funnel plot analysis and estimate meta-regression models. The Spearman correlation coefficients for both comparative scales showed influential studies (sensitivity analysis).

Conclusion:: Internal consistency and reproducibility were found to be good, but the parallel-forms reliability could not be supported. Therefore, more scientific evidence is needed to generalize the reliability of the VISA-A.

Level of evidence:: Level I, meta-analysis of literature.

Keywords: Achilles tendon; VISA-A; meta-analysis; reliability generalization; sports physiotherapy.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Achilles Tendon / physiopathology*
  • Athletic Injuries / diagnosis*
  • Disability Evaluation*
  • Exercise*
  • Humans
  • Reproducibility of Results
  • Tendinopathy / diagnosis*
  • Tendinopathy / physiopathology