Validation of “Victorian institute of sports assessment for patellar tendons” in patellofemoral pain: Reliability, interpretability and feasibility study

doi:10.5312/wjo.v16.i6.105068

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World Journal of Orthopedics

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World J Orthop. Jun 18, 2025; 16(6): 105068
Published online Jun 18, 2025. doi: 10.5312/wjo.v16.i6.105068

Validation of “Victorian institute of sports assessment for patellar tendons” in patellofemoral pain: Reliability, interpretability and feasibility study

Gema Chamorro-Moriana, Fernando Espuny-Ruiz, Carmen Ridao-Fernandez, Eleonora Magni

Gema Chamorro-Moriana, Fernando Espuny-Ruiz, Carmen Ridao-Fernandez, Department of Physiotherapy, University of Seville, Sevilla 41009, Andalusia, Spain

Eleonora Magni, Department of Nursing, University of Seville, Sevilla 41009, Andalusia, Spain

Author contributions: Chamorro-Moriana G conceptualized the idea; Espuny-Ruiz F and Magni E participated in the study design; Espuny-Ruiz F and Ridao-Fernandez C acquired data; Chamorro-Moriana G, Ridao-Fernandez C and Magni E analysed and interpreted the results; all authors provided contribution to drafting and critically revising the manuscript; all authors have read and approved the final submitted manuscript.

Institutional review board statement: The study was reviewed and approved by the Virgen Macarena-Virgen del Rocío Hospitals of the Andalusian Public Health System Institutional Review Board (C.I.0162-N-21).

Informed consent statement: Informed consent statement: All study participants provided informed written consent regarding personal and medical data collection prior to study enrolment.

Conflict-of-interest statement: The authors confirm that there are no conflicts of interest with any financial organization concerning the content discussed in the manuscript.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at mridao@us.es.

Corresponding author: Carmen Ridao-Fernandez, PhD, Department of Physiotherapy, University of Seville, Avicena St., Sevilla 41009, Andalusia, Spain. mridao@us.es

Received: January 27, 2025
Revised: April 21, 2025
Accepted: May 21, 2025
Published online: June 18, 2025
Processing time: 142 Days and 15.2 Hours

Abstract

BACKGROUND

The Victorian institute of sports assessment for patellar tendons questionnaire (VISA-P), a valid tool for patellar tendinopathy, has been used for patellofemoral pain (PFP).

AIM

To validate VISA-P in PFP.

METHODS

Study of validity, responsiveness and feasibility following COSMIN. Inclusion criteria: Subjects with PFP, aged 18 to 55. Agreement among 10 experts on the relevance and clarity of each item using Aiken's V coefficient determined content validity. An exploratory factorial analysis established structural validity. The correlation of VISA-P with knee injury and osteoarthritis outcome score for PFP and Osteoarthritis (KOOS-PF) and Kujala patellofemoral score (KPS; specific for PFP) analyzed the construct validity. Internal consistency was calculated with Cronbach's α and test-retest reliability with the intraclass correlation coefficient (ICC). Feasibility considered the subjects' self-completion time.

RESULTS

The sample consisted of 103 knees from 73 subjects (47 female/26 male; aged 34.9 ± 13 SD). The items were relevant and clear, with the exception of item-8, which didn't reach an acceptable level of agreement on clarity. Exploratory factorial analysis found a 2-factor solution, which explained 63.48% of the variance. VISA-P achieved a strong and significant correlation with KOOS-PF (Spearman rho = 0.826; P < 0.001) and KPS (Spearman rho = 0.771; P < 0.001). The questionnaire showed adequate reliability (Cronbach's α: 0.752; ICC: 0.934; P < 0.0001; 95%CI: 0.902-0.955). The mean self-completion time was 232 ± 0.52 SD seconds.

CONCLUSION

VISA-P proved to be valid and reliable to functionally assess PFP and/or chondromalacia patella. VISA-P is a feasible tool in the clinical and research environment, quick and easy to complete.

Keywords: Patellofemoral pain; Patellar chondromalacia; Validity; Reliability; Outcome measures

Core Tip: Victorian institute of sports assessment for patellar tendons questionnaire (VISA-P) is an appropriate tool for the evaluation of patellofemoral pain and/or chondromalacia patella. This scale is useful for users who are physically active or involved in sports. VISA-P, recommended for assessing the progression of pathology in a subject, has been translated, cross-culturally adapted and validated in Spanish.