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Assessment of the Visa-A questionnaire for Achilles tendinopathy and its correlation with imaging

University of British Columbia

Background: Because Achilles tendon disorders, which are common, have a significant morbidity among athletes, further research into efficacious treatments is necessary. Yet there is a lack of objective or quantifiable outcome measurement tools. Purpose: The purpose of this thesis was to investigate outcome measurement tools used in Achilles tendinopathy research. In particular clinical measures that quantify the severity of the patient's condition and ultrasound and magnetic resonance imaging were examined. Methods: A 3-month prospective study was done. Participants: Forty five consecutive patients (27 men, 18 women; mean age 42 years, range 20-66 years) with 57 symptomatic and 33 asymptomatic Achilles tendons (mean duration 21 months, range 0.5 - 120 months) were admitted to the study. Results: The VISA-A questionnaire had construct validity. The VISA-A scores of the 45 subjects correlated significantly (p<0.01) with their scores on two other clinical severity grading systems. There was also a significant difference in scores among the 45 symptomatic subjects (mean 63.75 ± 16.81) compared to the VISA-A scores of 66 asymptomatic University students (mean 95.95 ± 7.41) (p<0.01). The test-retest reliability was 0.930, the interrater reliability was 0.903, the intrarater reliability was 0.903 and the short term reliability was 0.805. Ultrasound had a sensitivity of 0.65 and specificity of 0.67 and an overall accuracy of 0.66. The addition of colour and power doppler interrogation did not enhance the accuracy of US. MRI had a sensitivity of 0.56, a specificity of 0.94 and an overall accuracy of 0.68. At 3 month follow up 7 of the 45 patients had improved, 37 remained the same and 1 had worsened. Only the baseline VISA-A score correlated with the 3 month results (p<0.01) neither US nor MRI was able to differentiate between cases that would improve and those that would worsen. Conclusion: The VISA-A index of severity for Achilles tendon disorders offers a valid, reliable and quantifiable outcome measurement tool useful clinically and in research. Imaging lacked sensitivity and therefore not suitable as an outcome measure. Neither imaging modality proved more accurate but because of the cost and accessibility US would be preferred when imaging is required.

Thesis/Dissertation

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2009-07-13

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http://hdl.handle.net/2429/10746

Human Kinetics

University of British Columbia

UBCV

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