Victorian Institute of Sport Assessment—Achilles thresholds for minimal important change and return to presymptom activity level in active soldiers with mid-portion Achilles tendinopathy

Abstract

IntroductionMid-portion Achilles tendinopathy (mid-AT) is common in soldiers, significantly impacting activity levels and operational readiness. Currently, Victorian Institute of Sport Assessment—Achilles (VISA-A) represents the gold standard to evaluate pain and function in mid-AT. Our objective was to estimate VISA-A thresholds for minimal important change (MIC) and patient-acceptable symptom state for return to the presymptom activity level (PASS-RTA), in soldiers treated with a conservative programme for mid-AT.MethodsA total of 40 soldiers (40 unilateral symptomatic Achilles tendons) were included in this prospective cohort study. Pain and function were evaluated using VISA-A. Self-perceived recovery was assessed with the Global Perceived Effect scale. The predictive modelling method (MIC-predict) was used to estimate MIC VISA-A post-treatment (after 26 weeks) and after 1 year of follow-up. The post-treatment PASS-RTA VISA-A was estimated using receiver operating characteristic statistics. The PASS-RTA was determined by calculating Youden’s index value closest to 1.ResultsThe adjusted MIC-predict was 6.97 points (95% CI 4.18 to 9.76) after 26 weeks and 7.37 points (95% CI 4.58 to 10.2) after 1 year of follow-up post-treatment.The post-treatment PASS-RTA was 95.5 points (95% CI 92.2 to 97.8).ConclusionsA VISA-A change score of 7 points, post-treatment and at 1 year of follow-up, can be considered a minimal within-person change over time, above which soldiers with mid-AT perceive themselves importantly changed. Soldiers consider their symptoms to be acceptable for return to their presymptom activity level at a post-treatment VISA-A score of 96 points or higher.Trial registration numberNL69527.028.19.

Low socioeconomic status is associated with worse treatment outcomes in patients with Achilles tendinopathy

“…Patients with low SES reported a mean VISA-A score that was 7–11 points lower at 24 weeks compared with patients with high SES. While this difference aligns with or exceeds the minimal clinically important difference of 7 points,40 41 indicating potential clinical relevance, it is important to note that sensitivity analyses of the VISA-A scores only suggest a trend and did not demonstrate statistically significant differences between groups at all time periods, possibly due to the large dispersion of data. This highlights the need for cautious interpretation of these findings.…”

Common Painful Foot and Ankle Conditions

“…Although there was no benefit at 1 year to adding concentric exercise, the eccentric group had long-term improvement on the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire (range, 0-100; higher score indicates higher function) from a mean (SD) of 60.7 (17.1) at baseline to 89.4 (13.0) at 1 year of follow-up ( P <.001) . The MCID for the VISA-A is 7.37 (95% CI, 4.58-10.2) at 1 year …”

“…58 The MCID for the VISA-A is 7.37 (95% CI, 4.58-10.2) at 1 year. 62 In a systematic review, Scott et al 63 found that functional improvement (AOFAS hindfoot score) with ankle joint dorsiflexion night splinting or a brace with dual bladders that apply pulsatile compression to the Achilles tendon with walking was similar to eccentric training. These treatment options may be of use in patients who are unable to do eccentric training.…”

Prognostic value of ultrasound tissue characterisation for a recurrence of mid-portion Achilles tendinopathy in military service members: a prospective cohort study

“…A recurrence was determined after 1 year of follow-up posttreatment. We defined a recurrence either as: (1) the presence of AT pain and reduced function due to mid-AT symptoms (yes/ no), combined with a decrease in post-treatment VISA-A score of at least the minimal important change (MIC) of 7 points, as assessed for this particular cohort, 21 or (2) a self-reported recurrent episode in the past year, from which the participant was recovered at follow-up.…”

“…25 Finally, in defining a mid-AT recurrence, we used a population-specific VISA-A MIC of 7 points, as recently assessed for this particular cohort. 21 With regard to the definition of a mid-AT recurrence, several methodological choices made in the present study have to be taken into account. First, we cannot rule out that individuals defined as recovered in our study experienced a mid-AT recurrence beyond the 1-year follow-up period.…”