Development and Validation of a New Visa Questionnaire (VISA-H) for Patients with Proximal Hamstring Tendinopathy

Background: There is a need for a patient-reported outcome (PRO) questionnaire to evaluate patients with proximal hamstring tendinopathy (PHT).

Objective: To develop a PRO questionnaire based on VISA questionnaire forms for patients with PHT.

Methods: Item generation, item reduction, item scaling and evaluation of the psychometric properties were used to develop a questionnaire to assess the severity of symptoms, function and ability to play sports in patients with PHT and healthy subjects. The final version, named Victorian Institute of Sport Assessment-Proximal Hamstring Tendons (VISA-H), consisted of eight questions that measured the domains of pain, function and sporting activity. The psychometric properties of a questionnaire were estimated in a population of non-surgical (n=20) and surgical (n=10) patients, as well as in healthy subjects (n=30).

Results: The VISA-H questionnaire displayed a high degree of internal consistency, with a Cronbach α of 0.84. (The test-retest reliability was high for all groups of participants with an intraclass correlation coefficient ranging from 0.90 to 0.95.) The VISA-H exhibited a high correlation with the Nirschl phase rating scale (r ranging from -0.75 to -0.89) and a generic tendon grading system proposed by Curwin and Stanish (r ranging from -0.70 to -0.88). Also, the responsiveness was higher for the VISA-H questionnaire with an area under the curve of 0.90 and a minimum clinically important difference of 22 points.

Conclusions: The VISA-H is a PRO questionnaire with high psychometric properties for measuring pain, function and sporting activity in patients with PHT.