Reliability and validity of the Persian version of the Victorian Institute of Sport Assessment-Patella (VISA-P) Questionnaire

Aynollah Naderi; Hossein Shahrokhi; Hossein ChoromZadeh; Ebrahim Ebrahimi

doi:10.1186/s13018-025-06464-x

Reliability and validity of the Persian version of the Victorian Institute of Sport Assessment-Patella (VISA-P) Questionnaire

J Orthop Surg Res. 2025 Nov 28;20(1):1046. doi: 10.1186/s13018-025-06464-x.

Authors

Aynollah Naderi¹, Hossein Shahrokhi², Hossein ChoromZadeh¹, Ebrahim Ebrahimi³

Affiliations

¹ Department of Physical Education and Sport Sciences, Faculty of Physical Education, Shahrood University of Technology, Shahrood, Iran.
² Department of Sports Injury and Corrective Exercises, Faculty of Sport Sciences, Hakim Sabzevari University, Sabzevar, Iran. h.shahrokhi@hsu.ac.ir.
³ Department of Sports Injury and Corrective Exercises, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran.

Abstract

Background: Patellar tendinopathy symptoms and functional limitations should be evaluated using validated, language-specific assessment tools. Cultural adaptation of these tools can improve their psychometric properties across languages. The VISA-P questionnaire is the only condition-specific tool for measuring symptom severity, but a validated Persian version is not available.

Purpose: To translate, culturally adapt, and evaluate the psychometric properties of the VISA-P questionnaire for use among Persian-speaking athletes.

Study design: Case-control observational study with a test-retest subgroup; Level of evidence, 3.

Methods: The VISA-P was translated into Persian following international guidelines: forward translation, synthesis, back-translation, expert review, pretesting, and validation. Sixty Persian-speaking athletes (30 with patellar tendinopathy, 30 healthy controls) participated in this cross-sectional study. Psychometric evaluation followed COSMIN standards assessing structural validity (exploratory factor analysis), construct validity (Spearman correlation with the Blazina classification), known-groups validity (comparison between symptomatic and healthy athletes using the Mann-Whitney U test)), internal consistency (Cronbach's α), and test-retest reliability (ICC over 24-48 h). Face validity, feasibility, and interpretability were also assessed.

Results: The VISA-P-Pr demonstrated good face and content validity. Factor analysis revealed a two-factor structure explaining 87.1% of variance with strong item loadings. Construct validity was supported by a strong negative correlation with the Blazina classification (r_s = -0.75, p < .001), and known-groups validity showed significantly lower scores in athletes with patellar tendinopathy compared to healthy controls (median 65.0 vs 98.5, p < .001). Test-retest reliability was excellent in the tendinopathy group (ICC = 0.91) with good internal consistency across both assessments (Cronbach's α = 0.88 and 0.89).

Conclusion: The VISA-P-Pr is a reliable and valid instrument with psychometric properties comparable to the original VISA-P, suitable for clinical and research use among Persian-speaking athletes.

Keywords: Cross-cultural; Jumper’s knee; Psychometrics; Reliability; Validation.

Publication types

Observational Study
Validation Study

MeSH terms

Adolescent
Adult
Athletes*
Case-Control Studies
Cross-Sectional Studies
Female
Humans
Male
Patellar Ligament*
Persia
Psychometrics / methods
Psychometrics / standards
Reproducibility of Results
Surveys and Questionnaires / standards
Tendinopathy* / diagnosis
Translations
Young Adult