The VISA – A: Indexing the Severity of Achilles Tendinopathy

shutterstock_243796033Given that over the last 4 years I have published at least 3 article based on achilles tendinopathy I am surprized I haven’t discussed this topic earlier. The VISA-A questionnaire was developed by some of the greatest names in tendon research. It aims to provide a measurable outcome to determine the severity of achilles tendinopathy within an individual and can be revisited post intervention to monitor the success of that which has been put in place.

The VISA-A was established using a previously developed patella tendinopathy severity index as a template, with questions and scaling adapted specifically to achilles tendinopathy based on focus group analysis and input. The focus group consisted of; two physiotherapists and a primary care sports physician.

The questionnaire consists of eight questions across three categories; pain, function and activity. The first seven questions are given a score out of 10, while the eighth question is given a score out of 30. The final result is x/100, with an asymptomatic individual receiving top marks.

A free copy of the questionnaire is available from BJSM here:

In the assessment of reliability and validity the following was found:

  • Reliability was found to have a p-value 0.58; no difference of score was found during the initial test or re-test.
  • It is believed the excellent reliability is due to the uncomplicated nature of the questionnaire.
  • Validity assessment showed that achilles tendinopathy patients had significantly lower scores (p<0.001) than those within the control group.
  • Continuous numerical results are ideal for comparing patient’s progress in a clinical setting.

Additionally, the VISA-A Index has transcended cultural and linguistic barriers that sometimes inhibit the reliability and comparability of research of this nature. In 2009 an advisory committee determined an English to German translation of the VISA-A questionnaire to be Acceptable. Similar to the original study, the German base reproduction showed moderate to excellent test and re-test reliability.

A quick one for this week and more for the practitioners than the public.

Until Next Time

Jackson McCosker
Director/ Chief Editor


Lohrer, H., & Nauck, T. (2009). Cross- Cultural Adaption and Validation of the VISA-A Questionaire for German-Speaking Achilles Tendinopathy Patients. BMC Musculoskeletal Disorders, 1 – 9.

Robinson, J., Cook, J., Purdam, C., Visentini, P., Ross, J., Maffulli, . . . Khan, K. (2001). The VISA-A Questionaire: A Valid and Reliable Index of the Clinical Severity of Achilles Tendinopathy. British Journal of Sports Medicine, 335 – 341.


Categories Ankle Injuries, Management, Pain, UncategorizedTags , , ,

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