Victorian Institute of Sport Assessment-Achilles (VISA-A) Questionnaire—Minimal Clinically Important Difference for Active People With Midportion Achilles Tendinopathy: A Prospective Cohort Study

Lagas, Iris F.; Vlist, Arco C van der; Oosterom, R.; Veldhoven, Peter L J van; Reijman, Max; Verhaar, Jan A N; Vos, Robert‐Jan de

doi:10.2519/jospt.2021.10040

Cited by 21 publications

(20 citation statements)

References 18 publications

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“…We can compare our MIC of 6.97 points post-treatment with a recent non-military study by Lagas et al 5 in mid-AT patients that reported a comparable MIC value of 7 points (95% CI −10 to 28) after 24 weeks of treatment. In the latter study, the MIC was found to be higher after 12 weeks of follow-up, as the authors reported a value of 14 points (95% CI 3 to 19).…”

Section: Discussionsupporting

confidence: 51%

“…Mid-AT is most common between the ages of 30 and 50 years 3. Symptoms can be long lasting despite state-of-the-art treatment 4 5. In the general population, up to 60% reports pain after 5 years of follow-up,6 and 37% still experiences some level of pain and reduced function after 10 years of follow-up 4.…”

Section: Introductionmentioning

confidence: 99%

“…No studies so far have estimated the MIC for VISA-A in soldiers with mid-AT. Moreover, no MIC for mid-AT has been reported beyond a 24-week follow-up period,5 12 13 hampering the current interpretation of long-term follow-up VISA-A change scores.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2023

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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.

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Section: Discussionsupporting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

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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

et al. 2023

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“…In Achilles tendinopathy, a MID of 6.5 points was previously determined by McCormack et al (2015) for insertional tendinopathy [ 29 ]. For mid-portion Achilles tendinopathy, Lagas et al (2021) used similar anchor-based methods in 64 patients and calculated a VISA-A MID of 14 points at 12 weeks and 7 points at 24 weeks [ 30 ]. A recent review article by Murphy et al (2018) found that, among 46 included studies (randomised and non-randomised), the most commonly used MID for VISA-A was 10 points ( n = 6), which is in agreement with our findings ( n = 7) [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…For patellar tendinopathy, Hernandez-Sanchez et al (2014) used a similar approach to McCormack et al (2015) and Lagas et al (2021) to determine a MID for VISA-P [ 29 , 30 , 35 ]. They administered a VISA-P questionnaire to 98 athletes with patellar tendinopathy along with a 15-point Likert scale; important change was defined as a change of 3 points or more on the Likert scale.…”

Section: Discussionmentioning

confidence: 99%

Determining minimal important differences for patient-reported outcome measures in shoulder, lateral elbow, patellar and Achilles tendinopathies using distribution-based methods

Challoumas

Zouvani

Creavin

et al. 2023

BMC Musculoskelet Disord

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Background Minimal important difference (MID) is a concept used inconsistently and arbitrarily in tendinopathy research. Our aim was to determine the MIDs for the most commonly used tendinopathy outcome measures using data-driven approaches. Methods Recently published systematic reviews of randomised controlled trials (RCTs) on tendinopathy management were identified and used for extraction of eligible studies through a literature search. Each eligible RCT was used to obtain information on MID where this was used and it also contributed data for the calculation of the baseline pooled standard deviation (SD) for each tendinopathy (shoulder, lateral elbow, patellar and Achilles). The rule of “half SD” was used for the computation of MIDs for patient-reported pain (visual analogue scale, VAS 0–10, single-item questionnaire) and function (multi-item questionnaires) and the rule of “one standard error of measurement (SEM)” was additionally used for the multi-item functional outcome measures. Results A total of 119 RCTs were included for the 4 tendinopathies. MID was defined and used by 58 studies (49%) and there were significant inconsistencies amongst studies where the same outcome measure was used as MID. From our data-driven methods the following suggested MIDs were obtained: a) Shoulder tendinopathy, pain VAS (combined) 1.3 points, Constant-Murley score 6.9 (half SD) and 7.0 (one SEM) points; b) lateral elbow tendinopathy, pain VAS (combined) 1.0 point, Disabilities of Arm, Shoulder and Hand questionnaire 8.9 (half SD) and 4.1 (one SEM) points; c) Patellar tendinopathy, pain VAS (combined) 1.2 points, Victorian Institute of Sport Assessment – Patella (VISA-P) 7.3 (half SD) and 6.6 points (one SEM); d) Achilles tendinopathy, pain VAS (combined) 1.1 points, VISA-Achilles (VISA-A) 8.2 (half SD) and 7.8 points (one SEM). The rules of half SD and one SEM produced very similar MIDs except for DASH due to its very high internal consistency. MIDs were also calculated for different pain settings for each tendinopathy. Conclusions Our computed MIDs can be used in tendinopathy research to increase consistency. Clearly defined MIDs should be used with consistency in tendinopathy management studies in the future.

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Efficacy of heel lifts for lower limb musculoskeletal conditions: A systematic review

Bourke,

Munteanu,

Merza

et al. 2024

Journal of Foot and Ankle Research

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IntroductionThe objective of this systematic review is to determine the benefits and harms of heel lifts to any comparator for lower limb musculoskeletal conditions.MethodsOvid MEDLINE, Ovid AMED, Ovid EMCARE, CINAHL Plus and SPORTDiscus were searched from inception to the end of May 2024. Randomised, quasi‐randomised or non‐randomised trials comparing heel lifts to any other intervention or no‐treatment were eligible for inclusion. Data was extracted for the outcomes of pain, disability/function, participation, participant rating of overall condition, quality of life, composite measures and adverse events. Two authors independently assessed risk of bias and certainty of evidence using the GRADE approach at the primary time point 12 weeks (or next closest).ResultsEight trials (n = 903), investigating mid‐portion Achilles tendinopathy, calcaneal apophysitis and plantar heel pain were included. Heel lifts were compared to exercise, ultrasound, cryotherapy orthotics, stretching, footwear, activity modification, felt pads and analgesic medication. No outcome was at low risk of bias and few effects (2 out of 47) were clinically important. Low‐certainty evidence (1 trial, n = 199) indicates improved pain relief (55.7 points [95% CI: 50.3–61.1], on a 100 mm visual analogue scale) with custom orthotics compared to heel lifts at 12 weeks for calcaneal apophysitis. Very low‐certainty evidence (1 trial, n = 62) indicates improved pain and function with heel lifts over indomethacin (35.5 points [95% CI: 21.1–49.9], Foot Function Index) at 12 months for plantar heel pain.ConclusionsFew trials have assessed the benefits and harms of heel lifts for lower limb musculoskeletal conditions. Only two outcomes out of 47 showed clinically meaningful between group differences. However, due to very low to low certainty evidence we are unable to be confident in the results and the true effect may be substantially different.RegistrationPROSPERO registration number CRD42022309644.

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Victorian Institute of Sport Assessment-Achilles (VISA-A) Questionnaire—Minimal Clinically Important Difference for Active People With Midportion Achilles Tendinopathy: A Prospective Cohort Study

Cited by 21 publications

References 18 publications

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

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

Determining minimal important differences for patient-reported outcome measures in shoulder, lateral elbow, patellar and Achilles tendinopathies using distribution-based methods

Efficacy of heel lifts for lower limb musculoskeletal conditions: A systematic review

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