Prospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2018; 9(1): 1-6
Published online Jan 18, 2018. doi: 10.5312/wjo.v9.i1.1
Dutch version of the Victorian Institute of Sports Assessment-Achilles questionnaire for Achilles tendinopathy: Reliability, validity and applicability to non-athletes
Inger Sierevelt, Maayke van Sterkenburg, Hans Tol, Bella van Dalen, Niek van Dijk, Daniel Haverkamp
Inger Sierevelt, Daniel Haverkamp, Department of Orthopaedic Surgery, Slotervaart Hospital, Amsterdam 1066 EC, The Netherlands
Maayke van Sterkenburg, Niek van Dijk, Department of Orthopedic Surgery, Academic Medical Center, Amsterdam 1105 AZ, The Netherlands
Hans Tol, Academic Center for Evidence Based Sports Medicine, Academic Medical Center Amsterdam, Amsterdam 1105 AZ, The Netherlands
Bella van Dalen, Bergmanclinics te Naarden, Naarden 1411 GE, The Netherlands
Author contributions: All the authors contributed to this manuscript.
Institutional review board statement: The local accredited ethics committee (Dutch acronym: METC) reviewed this study in an expedited manner and determined, based on the Dutch Medical Research Involving Human Subjects Act (Dutch acronym: WMO), that the research activities described meet the requirements for exemption from METC review under the WMO.
Informed consent statement: All patients received a patient information brochure.
Conflict-of-interest statement: The authors do not report a conflict of interest.
Data sharing statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Daniel Haverkamp, MD, PhD, Department of Orthopaedic Surgery, Slotervaart Hospital, Louwesweg 6, Amsterdam 1066 EC, The Netherlands.
Telephone: +31-6-45628276
Received: January 24, 2017
Peer-review started: February 2, 2017
First decision: June 26, 2017
Revised: November 30, 2017
Accepted: December 1, 2017
Article in press: December 1, 2017
Published online: January 18, 2018

To translate the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire into the Dutch language (VISA-A-NL), and to assess its reliability, validity, and applicability to non-athletes.


After translation according to a forward-backward protocol, 101 patients with complaints of Achilles tendinopathy were asked to fill out the VISA-A-NL at two time points together with visual analogue scale, the Foot and Ankle Outcome Score, and the Short Form-36 questionnaires. Reliability, internal consistency, construct validity, and content validity were tested.


The VISA-A-NL showed high reliability (0.97, 95%CI: 0.95-0.98). Cronbach’s alpha (internal consistency) was 0.80. It increased to 0.88 without activity domain. Correlation with other questionnaires was moderate or poorer.


The VISA-A-NL proved to be an excellent evaluation instrument for the Dutch physician. If applied to non-athletes, using a modified score (questions 1-6) should be considered.

Keywords: Achilles tendon, Victorian Institute of Sports Assessment-Achilles, Validity, Patient reported outcome measurement

Core tip: This manuscript shows the validity and reliability of the Dutch version of the Victorian Institute of Sports Assessment-Achilles (VISA-A) in patients with Achilles tendinopathy. The most important finding is that the athletes and non-athletes cannot be compared. The effect of treatment, when using the VISA-A score to measure outcome, is underestimated in non-athletes. If applied to non-athletes, using a modified score (questions 1-6) should be considered.