Tendinopathy VISAs have expired—is it time for outcome renewals?

Over 20 years ago, clinical researchers greatly improved our understanding of the multi-faceted nature of the burden of tendinopathy when the first patient-report outcome measure (PROM) in this area was published [ 19 ]. The Victorian Institute of Sport Assessment (VISA) questionnaires—Achilles (VISA-A), patellar (VISA-P), hamstring (VISA-H), and greater trochanteric pain syndrome (VISA-G) [ 2 , 5 , 15 , 19 ] rate tendinopathy severity from 8 items (question and response/score options) on a single scale from 0 to 100 points, where 100 is the highest and best possible score, indicating no tendinopathy related disability. VISA questionnaires have since dominated the tendinopathy literature as the preferred condition-specific PROMs. This was also recently highlighted as the VISA questionnaires were suggested by the ICON 2019—International Scientific Tendinopathy Symposium Consensus [ 18 ] as appropriate and valid measures to capture one of the “core domains” in tendinopathy— disability . Ongoing cross-cultural research has already translated and adapted the VISA questionnaires into several languages, with the VISA-A for example, being available in more than 10 languages. The quality of a PROM—not its availability—is fundamental in defining its validity in research and clinical practice [ 6 ] and should be based upon its clinimetric properties (i.e., reliability, validity, and responsiveness) [ 13 ]. However, in a recent systematic review [ 8 , 9 ] we have highlighted the limited evidence of the VISA questionnaires’ clinimetric properties and underlined important deviations and short-cuts from methodological recommendations associated with robust and sound development and validation of PROMs. Although, most likely driven by the lack of current and relevant alternatives, the development and replication of VISA study methodology to cover all tendinopathies seem to have introduced bias and affected VISA questionnaires’ validity as a measure of different region-specific tendinopathies.