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Cross-cultural Adaptation and Measurement Properties of the Brazilian Portuguese Version of the Victorian Institute of Sport. Assessment-Patella (VISA-P) Scale ...
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BRUNA BORGES WAGECK, PT1 • MARCOS AMARAL DE NORONHA, PT, PhD1,2 • ALEXANDRE DIAS LOPES, PT, PhD3 RONALDO ALVES DA CUNHA, PT4 • RICARDO HISAYOSHI TAKAHASHI, PT5 • LEONARDO OLIVEIRA PENA COSTA, PT, PhD3

Cross-cultural Adaptation and Measurement Properties of the Brazilian Portuguese Version of the Victorian Institute of Sport Assessment-Patella (VISA-P) Scale

P

atellar tendinopathy is an injury related to structural damage in the distal and proximal regions of the patellar tendon.22 This injury generally occurs in individuals who engage in sports and recreational activities that require sudden

TTSTUDY DESIGN: Clinical measurement.

TTOBJECTIVES: To translate, adapt, and test the measurement properties of the Brazilian Portuguese version of the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire.

TTBACKGROUND: It is important to objectively

measure symptoms and functional limitations related to patellar tendinopathy using outcome measures that have been validated in the language of the target population. Cross-cultural adaptations are also useful to enhance the understanding of the measurement properties of an assessment tool, regardless of the target language.

TTMETHODS: The VISA-P questionnaire was

translated into Brazilian Portuguese, culturally adapted, and titled VISA-P Brazil. It was then administered on 2 occasions with a 24- to 48-hour interval between them, and a third time after a month of physical therapy treatment. The following measurement properties were analyzed: internal consistency, test-retest reliability, agreement, construct validity, floor and ceiling effects, and responsiveness.

TTRESULTS: The VISA-P Brazil had high internal

consistency (Cronbach α = .76; if item deleted, Cronbach α = .69-.78), excellent reliability and agreement (intraclass correlation coefficient = 0.91; 95% confidence interval: 0.85, 0.95; standard error of measurement, 5.2 points; minimal detectable change at the 90% confidence level, 12.2 points), and good construct validity (Pearson r = 0.60 compared to Lysholm). No ceiling and floor effects were detected for the VISA-P Brazil, and the responsiveness, based on 32 patients receiving physical therapy intervention for 1 month, demonstrated a large effect size of 0.97 (95% confidence interval: 0.68, 1.25).

TTCONCLUSION: The VISA-P Brazil is a

reproducible and responsive tool and can be used in clinical practice and research to assess the severity of pain and disability of patients with patellar tendinopathy. J Orthop Sports Phys Ther 2013;43(3):163-171. Epub 14 January 2013. doi:10.2519/jospt.2013.4287

TTKEY WORDS: Brazil, knee, patellar tendinopathy, questionnaire, tendinopathy

acceleration and deceleration, and in athletes who perform repetitive movements such as jumping, climbing, and kicking. These activities are known to have the potential to overload the extensor apparatus of the knee.7,22 Lian et al,13 in a study that included 612 athletes from different sports, reported a prevalence of patellar tendinopathy of 14.2%. This injury is twice as prevalent in men as it is in women11 and keeps 33% of athletes away from their sports activities for more than 6 months, forcing 50% of these athletes into early retirement.2 Furthermore, it affects approximately 45% of volleyball athletes, as this is a sport with actions that involve several risk factors for patellar tendinopathy.11 Due to the high prevalence of patellar tendinopathy in athletes, early diagnosis and treatment are essential to avoid extended periods away from sports activities. Clinical instruments to determine the severity and the level of disability resulting from patellar tendinopathy are highly useful because they can assess the evolution of the condition and serve as

Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil. 2La Trobe Rural Health School, Bendigo, Victoria, Australia. 3Universidade da Cidade de São Paulo, São Paulo, Brazil. 4Physical Therapy Department, Sports Orthopaedic Trauma Center, Universidade Federal de São Paulo, São Paulo, Brazil. 5Saúde Plena, São Paulo, Brazil. The protocol for this study was approved by the Institutional Review Board at Universidade do Estado de Santa Catarina. The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the manuscript. Address correspondence to Dr Marcos Amaral de Noronha, La Trobe University, PO Box 199, Bendigo, Victoria, Australia 3552. E-mail: [email protected] t Copyright ©2013 Journal of Orthopaedic & Sports Physical Therapy 1

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[ TABLE 1

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Participant Characteristics* Patellar Pain at the Time of Assessment (n = 52)

Subgroup Receiving Treatment for Patellar Pain (n = 32)

Age, y

23.4  6.8

22.0  6.1

Gender (female), n (%)

14 (26.9%)

11 (34.4%)

VISA-P First occasion

59.1 17.5

55.2  15.6

Second occasion

60.9  19.0

58.2  19.2

...

70.3  19.7

First occasion

72.0  15.9

70.0  15.3

Second occasion

74.4  17.0

71.7  16.9

...

76.7  17.1

Third occasion Lysholm questionnaire

Third occasion

Abbreviation: VISA-P, Victorian Institute of Sport Assessment-Patella. *Values are mean  SD unless otherwise indicated.

an important parameter for decisions on return to activities and sports.6 Imaging tests, such as magnetic resonance imaging and ultrasound, are useful in the diagnosis of patellar tendinopathy; however, although imaging technology can help to determine the severity of the injury, it must be conducted in specialized clinics11,19,24 and is not capable of assessing pain and disability associated with the condition. The Victorian Institute of Sport Assessment-Patella (VISAP)3 is designed to quantify the severity of pain and disability in people with patellar tendinopathy and is a useful tool to evaluate and monitor changes related to this injury over time. The VISA-P was originally developed in Australia, which has limited its application to culturally similar English-speaking countries.15 To be useful in other languages, this questionnaire must be translated and cross-culturally adapted to the language and culture of interest, and its measurement properties must be verified to allow future comparisons and inclusions with different populations.1 Given that the VISA-P is not available to the Brazilian population, its cross-cultural adaptation will provide clinical and research professionals in Brazil and other Portuguesespeaking countries a valuable, low-cost tool for quantifying the severity of pain

and disability in people with patellar tendinopathy.7 Furthermore, the information from this study, along with the data from previous German,14 Swedish,7 Spanish,9 and Dutch25 cross-cultural adaptations of the VISA-P, may also contribute to a better understanding of the measurement properties of the VISA-P, regardless of the language version. Therefore, the objective of the present study was to translate and cross-culturally adapt the VISA-P questionnaire to Brazilian Portuguese and assess its measurement properties.

METHODS

T

he study was approved by the Human Research Ethics Committee of Universidade do Estado de Santa Catarina (approval number 07/2010).

VISA-P Questionnaire The VISA-P scale is an 8-item questionnaire related to the symptoms and disabilities of individuals with patellar tendinopathy (APPENDIX). Six of the 8 questions are scored on a Likert scale, with scores ranging from 0 to 10, with 10 representing no pain or disability and 0 representing maximum severity of the disease. Question number 7 is a Likerttype question with 4 possible answers (0,

] 4, 7, or 10). The eighth and final question is divided into 3 response categories, only 1 of which may be answered (8A, 8B, or 8C), depending on the perception of pain during sports activities, with scores ranging from 0 to 30 points. The total score on the VISA-P, which represents the severity of the respondent’s condition in numerical terms, ranges from 0 to 100 points, with a maximum score indicating the absence of symptoms and disability.23

Translation Procedure The translation of the VISA-P questionnaire for patellar tendinopathy followed the methods described by Beaton et al.1 This procedure has been frequently used in other cross-cultural adaptations of questionnaires into Portuguese.2,4,16 First, 2 translators translated the VISA-P independently from English into Brazilian Portuguese. The separate translations were later compared and consolidated into a consensus version of the questionnaire. A back-translation from Brazilian Portuguese into English was then performed independently by 2 different translators, who compared their work and reached consensus on an English version of the VISA-P. A specialist committee audited all of the translations, compared them, and discussed them with the translators to resolve any discrepancies and to develop a final version of the VISA-P to be tested in Brazil, titled VISA-P Brazil (APPENDIX). After consideration, the specialist committee decided to include an illustration of the lunge exercise, as the term lunge is not used often among health professionals in Brazil and a lack of understanding of the term could affect scores on the questionnaire. The inclusion of the illustration was intended to ensure that respondents fully understood the question. The committee also initially decided to include the option “not applicable” to question 7, to account for those respondents who did not perform regular physical activity, which was scored as 0 points, as was the option “no.” The option “not applicable” was then later removed from the VISA-P Brazil.

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Participants The VISA-P Brazil was administered to 52 participants (38 males and 14 females; mean  SD age, 23.4  6.8 years) with patellar tendinopathy, who were recruited through rehabilitation clinics and sports clubs (TABLE 1). Patellar tendinopathy was defined by the presence of patellar pain during palpation and during the squat test,8,13 regardless of whether the individual was undergoing treatment for this condition. To take part in the study, the participant had to be between 16 and 50 years of age and able to read and write in Portuguese.

Measurement Properties The individuals or legal guardians who agreed to participate in the study and met the inclusion criteria signed a consent form after receiving an explanation of the study’s objectives and procedures. Six physical therapists assisted in data collection. After the participants received a brief explanation of the questionnaire, the questionnaire was self-administered on 2 occasions, with a 24- to 48-hour interval between them. Participants were free to ask questions, if necessary, when completing the questionnaire. The 24to 48-hour interval was chosen because significant changes in clinical status that could have influenced responses were unlikely to occur in this short a time. A subgroup undergoing treatment for patellar tendinopathy completed the questionnaire on a third occasion 30 days later. We recorded the score for the VISA-P Brazil and for the Portuguese version of the Lysholm questionnaire for later analysis. The Lysholm questionnaire18 was selected to assess construct validity because it has been validated in Brazil and assesses the symptoms and function of the knee joint; however, it is not specific for detecting or monitoring patellar tendinopathy. We found no validated instruments in the Portuguese language that were designed to evaluate patellar tendinopathy. The Lysholm questionnaire18 is composed of 8 closed-ended questions, and the final result is expressed in nominal and ordinal

scores (excellent, 95 to 100 points; good, 84 to 94 points; regular, 65 to 83 points; poor, 64 or fewer points). This questionnaire was translated into Portuguese and validated in 2006.18 Internal Consistency Internal consistency was assessed using the Cronbach alpha. This test indicates the level of homogeneity between items within an instrument (or its subscales). We used the test “Cronbach alpha if item deleted” to verify Cronbach alpha with the exclusion of each of the questions, 1 at a time. This process is useful to determine whether a specific question affects the consistency of the instrument. A low Cronbach alpha indicates low correlation between items designed to measure the same construct, whereas a very high Cronbach alpha indicates redundancy between 1 or more items. The recommended value for Cronbach alpha is between .70 and .95.21 Test-Retest Reliability Reliability can be defined as the instrument’s ability to distinguish variation in measurements between testing occasions under stable conditions. For this analysis, all participants completed the questionnaire on 2 occasions, with a 24- to 48-hour interval between them. Test-retest reliability was assessed using intraclass correlation coefficients (ICC2,1). The minimum value recommended for this measurement property is 0.70.20,21 Agreement This property was assessed using both the standard error of measurement (SEM) and minimal detectable change at the 90% confidence level (MDC90). The SEM reflects the error of the instrument itself and is calculated by using the standard deviation of the difference between the first and the second measurements, divided by the square root of 2 (SD difference/√2). The MDC90 was calculated using the formula 1.645 × √2 × SEM. MDC90 refers to the minimal amount of change in score between 2 testing occasions necessary to exceed error margins with a predefined level of confidence (the level of confidence chosen for this study was 90%). Both the SEM and MDC90 are expressed in the

units of measurement.5,21 Construct Validity Construct validity refers to “the extent to which scores on a particular instrument relate to other measures in a manner that is consistent with theoretically derived hypotheses concerning the concepts that are being measured.”21 The relationship between the VISA-P Brazil and the Brazilian version of the Lysholm questionnaire was analyzed using the Pearson correlation. Because these questionnaires assess similar (but not identical) constructs, a positive correlation of at least moderate strength was expected (r0.5).12,21 We used only the results from the initial assessment for this analysis. Ceiling and Floor Effects Ceiling and floor effects are limitations of an instrument’s ability to assess the entire spectrum of a condition’s severity with the items it contains. For example, the VISAP questionnaire would be considered to have a floor effect if more than 15% of respondents scored the minimum possible score, meaning that these participants (over 15%) would have the most severe form of patellar tendinopathy, leading to absolute maximum pain and disability. Because it is unlikely that more than 15% of participants in a study would have the worst possible score, it is more likely that this represents a limitation of the questionnaire to detect the entire spectrum of severity of the condition in question.15,21 The ceiling effect follows the same rationale: if more than 15% of respondents with patellar tendinopathy had a maximum score of 100, it would suggest that they had no pain and disability, despite their clinical condition. Responsiveness This measurement determines whether the instrument can detect clinical changes, however slight, over time. It was assessed through the response of a subgroup of 32 participants diagnosed with patellar tendinopathy who underwent varied physical therapy treatments that were not controlled by the researchers. This subgroup answered the questionnaires a third time, 4 weeks after the initial testing. Effect sizes were

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[ determined by calculating the differences in the means of baseline and follow-up data, divided by the standard deviation at baseline.10 Effect sizes are expressed as units of standard deviation at baseline. A value of 0.20 or less represents a change of approximately 20% of the baseline standard deviation and is considered small. A value of 0.50 is considered moderate, whereas a value of 0.80 or greater is viewed as large.10

RESULTS

A

total of 52 participants with patellar tendinopathy completed the VISA-P Brazil questionnaire on the first and second occasions (24 to 48 hours apart). Of these, 32 were receiving treatment for patellar tendinopathy and also completed the questionnaire 1 month after the first assessment.

research report TABLE 2

]

Summary of Measurement Properties   of the VISA-P Brazil Questionnaire

Measurement Property

Result

Internal consistency Cronbach alpha

0.76

Alpha if item deleted (range)

0.69-0.78

Test-retest reliability ICC2,1

0.91 (0.85, 0.95)*

Construct validity Pearson r, using Lysholm as comparison

0.60

Agreement Standard error of measurement

5.2 points

Minimal detectable change at 90% confidence level

12.2 points

Ceiling and floor effects Percent of patients with maximum or minimum scores

4% with minimum, 4% with maximum score

Responsiveness Effect size, VISA-P

0.97 (0.68, 1.25)*

Effect size, Lysholm

0.44 (0.14, 0.73)*

Abbreviations: ICC, intraclass correlation coefficient; VISA-P, Victorian Institute of Sport Assessment-Patella. *95% confidence interval.

Internal Consistency The Cronbach alpha for internal consistency was .76, and the Cronbach alpha if item deleted (for each question) varied from .69 to .78.

Test-Retest Reliability The ICC2,1 was 0.91, with a 95% confidence interval (CI) of 0.85 to 0.95 (TABLE 2).

Agreement The SEM was 5.2 points and the MDC90 was 12.2 points.

Construct Validity The level of association between the VISA-P Brazil and Lysholm questionnaires was 0.60 (TABLE 2).

Ceiling and Floor Effects No ceiling or floor effects were found, as only 4% of the participants scored the maximum or minimum possible score (TABLE 2), which is less than the 15% threshold typically used to indicate ceiling and floor effects.

Responsiveness Data on the 32 participants who received

physical therapy treatment for 1 month indicated an effect size of 0.97 (95% CI: 0.68, 1.25) for the VISA-P and 0.44 (95% CI: 0.14, 0.73) for the Lysholm questionnaire (TABLE 2).

DISCUSSION

T

he present study aimed to translate the VISA-P questionnaire into Brazilian Portuguese, as well as to test its measurement properties. Our results showed that the VISA-P Brazil has good measurement properties, high reliability, and appropriate construct validity, and can be used in Brazil to evaluate and monitor changes over time in patients with patellar tendinopathy. The instrument showed equivalence to the English version and was more responsive than the Lysholm scale in both the English and Brazilian Portuguese versions. The internal consistency analysis using Cronbach alpha showed the VISA-P Brazil to be within the recommended range of values (.70-.95),21 meaning that the items of the questionnaire are homogeneous while nonredundant. In the analysis of

the influence of the exclusion of each of the questions (alpha if item deleted), we observed that the absence of questions 1 and 7 caused a slight increase in the value of Cronbach alpha (.78 and .77, respectively), suggesting that these questions could be reformulated to improve comprehension of the questionnaire. However, this increase was insignificant, because the value was within the recommended interval. Interestingly, the original version of the VISA-P was not assessed in terms of internal consistency, but validations of this questionnaire in other languages had high Cronbach alpha values.7,14,25 This acceptable internal consistency across different cultures may be an indication that the original VISA-P is well formulated and also has good internal consistency. The German version (Cronbach α = .88)14 and the Swedish version (Cronbach α = .83)7 had higher internal consistency than the Brazilian version; however, they are all well within the range considered acceptable. Overall, there seems to be a confirmation among the different versions that the VISA-P is well designed to address a single construct.

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Test-retest of the VISA-P Brazil questionnaire within 24 to 48 hours yielded an ICC of 0.91 (95% CI: 0.85, 0.95), which indicates the high reliability of the instrument.21 The original version23 of the VISA-P did not include this analysis; however, high reliability was found for the versions from Sweden (ICC = 0.97),7 Germany (ICC = 0.87),14 the Netherlands (ICC = 0.74),25 and Spain (ICC = 0.99; 95% CI: 0.992, 0.996).9 The level of agreement for the VISA-P Brazil may be considered excellent, with a SEM value of 5.2 points, which represents a small portion of the 0- to 100-point scale.17 Accordingly, the MDC90 was 12.2 points, which means that a change of at least 12.2 points is needed, on a scale of 100 points, to be confident that this change is not due to random measurement error. In the assessment of the correlation between the VISA-P Brazil and the Brazilian version of the Lysholm questionnaire, Pearson r was 0.60, which was expected, because these 2 questionnaires do not have the same construct. According to Terwee et al,21 the recommended level of agreement between questionnaires should be greater than 0.70 when they are of the same construct, but lower levels of agreement are allowed for questionnaires with similar but different constructs. Therefore, considering that the Lysholm questionnaire was developed as a region-specific questionnaire to assess symptoms and function for different knee conditions, and the VISA-P was developed as a condition-specific questionnaire to assess symptoms related to patellar tendinopathy, the moderate level of correlation between these 2 instruments is expected. Construct validity for the German version of the VISA-P was assessed using the Blazina classification system for patellar tendinopathy, whereas the Spanish version was assessed using 3 different tools: the Medical Outcomes Study 36-Item Short-Form Health Survey, the Kujala Scoring Questionnaire, and the Cincinnati Knee Rating System. In general, the results of the present study, combined with those of previ-

ous studies, lead to the conclusion that the VISA-P has a well-defined objective, given its acceptable construct validity. 9,14 It also gives us a good indication that the characteristics of participants in Brazil and other countries where the VISA-P has been tested are reasonably similar, as the VISA-P performed well in different countries/cultures.7,9,14,25 Additionally, it is clear that this is a questionnaire with different characteristics from others that assess changes related to other knee conditions. In the assessment of the presence of ceiling and floor effects, we found that the number of participants who scored the maximum and minimum values on the questionnaire was well below the 15% threshold. This suggests that the VISA-P Brazil is an appropriate tool for individuals with the full spectrum of severity of patellar tendinopathy. The responsiveness analysis further corroborated the absence of ceiling and floor effects. The VISA-P Brazil had an effect size of 0.97 (95% CI: 0.68, 1.25), similar to the Spanish version of the VISA-P (standardized effect size = 1.15), the only previous study that tested this property.9 These results show that the Brazilian and Spanish versions of the VISA-P are responsive to clinical changes and could potentially be used to monitor changes in symptoms over time and for specific interventions,21 providing clinicians and researchers with a quick and affordable tool for that purpose. During the translation process of the VISA-P questionnaire, we included the alternative answer “not applicable” for the seventh question. This alternative was included because, at first, we considered the possibility of using the questionnaire to assess patellar tendinopathy in individuals not engaged in regular physical activity. The present study used a sample of people who regularly practiced physical activity; therefore, the option “not applicable” was only marked 3 times for the entire sample. Although the option “not applicable” was useful during the measurement property testing of the

instrument, as it helped us to confirm that this questionnaire should be used only in a population with patellar tendinopathy, this option was not consistent with the original version. Therefore, it was not included in the instrument to be used in clinical practice.

CONCLUSION

B

ased on the results obtained in the assessments of the measurement properties of the VISA-P Brazil, we can conclude that the questionnaire is reliable and reproducible, and that it can be used in clinical practice and in research to evaluate the severity of pain and disability in people with patellar tendinopathy. t

KEY POINTS FINDINGS: This study demonstrated that

the VISA-P has high reliability, appropriate construct validity, and high responsiveness. Furthermore, the translation process and measurement properties demonstrated equivalence with the English version, suggesting that its measurement properties are very good across different languages and cultures. IMPLICATIONS: The VISA-P Brazil can be used by clinicians and researchers who need to assess severity of pain and disability in Brazilian Portuguese speakers with patellar tendinopathy. The results from these assessments can be compared to the results of the assessments performed in other languages in which the VISA-P is available (English, German, Dutch, Italian, Swedish, and Spanish). CAUTION: The VISA-P Brazil is a questionnaire designed to assess physically active people; therefore, the results of its application to other populations should be interpreted with caution. ACKNOWLEDGEMENTS: The authors would like

to acknowledge Lailah Fernandes de Noronha, Rafael Marinho, Lucíola Menezes Costa, Guilherme Silva Nunes, Aridone Borgonovo, Fabrício Biscaro, Ricardo Burigo, and Carlos Alberto Pierri for their participation in the translation and recruitment of participants.

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[ REFERENCES 1. B  eaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25:3186-3191. 2. Cook C, Richardson JK, Braga L, et al. Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Neck Disability Index and Neck Pain and Disability Scale. Spine (Phila Pa 1976). 2006;31:1621-1627. http://dx.doi. org/10.1097/01.brs.0000221989.53069.16 3. Cook JL, Khan KM, Harcourt PR, Grant M, Young DA, Bonar SF. A cross sectional study of 100 athletes with jumper’s knee managed conservatively and surgically. The Victorian Institute of Sport Tendon Study Group. Br J Sports Med. 1997;31:332-336. 4. de Noronha M, Refshauge KM, Kilbreath SL, Figueiredo VG. Cross-cultural adaptation of the Brazilian-Portuguese version of the Cumberland Ankle Instability Tool (CAIT). Disabil Rehabil. 2008;30:1959-1965. http://dx.doi. org/10.1080/09638280701809872 5. de Vet HC, Terwee CB, Knol DL, Bouter LM. When to use agreement versus reliability measures. J Clin Epidemiol. 2006;59:1033-1039. http://dx.doi.org/10.1016/j.jclinepi.2005.10.015 6. Filardo G, Kon E, Della Villa S, Vincentelli F, Fornasari PM, Marcacci M. Use of platelet-rich plasma for the treatment of refractory jumper’s knee. Int Orthop. 2010;34:909-915. http:// dx.doi.org/10.1007/s00264-009-0845-7 7. Frohm A, Saartok T, Edman G, Renström P. Psychometric properties of a Swedish translation of the VISA-P outcome score for patellar tendinopathy. BMC Musculoskelet Disord. 2004;5:49. http://dx.doi.org/10.1186/1471-2474-5-49 8. Gisslén K, Gyulai C, Nordström P, Alfredson H. Normal clinical and ultrasound findings indicate a low risk to sustain jumper’s knee patellar tendinopathy: a longitudinal study on Swedish elite junior volleyball players. Br J Sports Med.

research report

9.

10.

11.

12.

13.

14.

15.

16.

17.

2007;41:253-258. http://dx.doi.org/10.1136/ bjsm.2006.029488 Hernandez-Sanchez S, Hidalgo MD, Gomez A. Cross-cultural adaptation of VISA-P score for patellar tendinopathy in Spanish population. J Orthop Sports Phys Ther. 2011;41:581-591. http://dx.doi.org/10.2519/jospt.2011.3613 Husted JA, Cook RJ, Farewell VT, Gladman DD. Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol. 2000;53:459-468. Hyman GS. Jumper’s knee in volleyball athletes: advancements in diagnosis and treatment. Curr Sports Med Rep. 2008;7:296-302. http://dx.doi. org/10.1249/JSR.0b013e31818709a5 Kirshner B, Guyatt G. A methodological framework for assessing health indices. J Chronic Dis. 1985;38:27-36. Lian OB, Engebretsen L, Bahr R. Prevalence of jumper’s knee among elite athletes from different sports: a cross-sectional study. Am J Sports Med. 2005;33:561-567. http://dx.doi. org/10.1177/0363546504270454 Lohrer H, Nauck T. Cross-cultural adaptation and validation of the VISA-P questionnaire for German-speaking patients with patellar tendinopathy. J Orthop Sports Phys Ther. 2011;41:180-190. http://dx.doi.org/10.2519/jospt.2011.3354 McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res. 1995;4:293-307. Menezes Costa Lda C, Maher CG, McAuley JH, et al. The Brazilian-Portuguese versions of the McGill Pain Questionnaire were reproducible, valid, and responsive in patients with musculoskeletal pain. J Clin Epidemiol. 2011;64:903-912. http:// dx.doi.org/10.1016/j.jclinepi.2010.12.009 Ostelo RW, de Vet HC, Knol DL, van den Brandt PA. 24-item Roland-Morris Disability Questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery. J Clin Epidemiol. 2004;57:268-276. http://dx.doi. org/10.1016/j.jclinepi.2003.09.005

] 18. P  eccin MS, Ciconelli R, Cohen M. Questionário específico para sintomas do joelho “Lysholm Knee Scoring Scale” – tradução e validação para a língua portuguesa. Acta Ortop Bras. 2006;14:268-272. http://dx.doi.org/10.1590/ S1413-78522006000500008 19. Peers KH, Lysens RJ. Patellar tendinopathy in athletes: current diagnostic and therapeutic recommendations. Sports Med. 2005;35:71-87. 20. Stratford P. Reliability: consistency or differentiating among subjects? Phys Ther. 1989;69:299-300. 21. Terwee CB, Bot SD, de Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60:34-42. http://dx.doi. org/10.1016/j.jclinepi.2006.03.012 22. Tiemessen IJ, Kuijer PP, Hulshof CT, FringsDresen MH. Risk factors for developing jumper’s knee in sport and occupation: a review. BMC Res Notes. 2009;2:127. http://dx.doi. org/10.1186/1756-0500-2-127 23. Visentini PJ, Khan KM, Cook JL, Kiss ZS, Harcourt PR, Wark JD. The VISA score: an index of severity of symptoms in patients with jumper’s knee (patellar tendinosis). Victorian Institute of Sport Tendon Study Group. J Sci Med Sport. 1998;1:22-28. 24. Warden SJ, Kiss ZS, Malara FA, Ooi AB, Cook JL, Crossley KM. Comparative accuracy of magnetic resonance imaging and ultrasonography in confirming clinically diagnosed patellar tendinopathy. Am J Sports Med. 2007;35:427-436. http:// dx.doi.org/10.1177/0363546506294858 25. Zwerver J, Kramer T, van den Akker-Scheek I. Validity and reliability of the Dutch translation of the VISA-P questionnaire for patellar tendinopathy. BMC Musculoskelet Disord. 2009;10:102. http://dx.doi.org/10.1186/1471-2474-10-102

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APPENDIX

VISA-P BRAZIL 1. Por quantos minutos você consegue ficar sentado sem dor? 0 minuto

100 minutos 0

1

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Pontos ____

2. Você sente dor ao descer escadas num ritmo de marcha normal? dor forte ou severa

sem dor 0

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Pontos ____

3. Você sente dor no joelho quando o estende totalmente de forma ativa e com apoio de peso? dor forte ou severa

sem dor 0

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Pontos ____

4. Você sente dor quando faz o exercício afundo* com apoio de peso total? dor forte ou severa

sem dor 0

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Pontos ____

exercício afundo 5. Você tem problemas ao agachar? incapaz

sem problemas 0



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9

10 Pontos ____

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[

]

research report APPENDIX

6. Você sente dor durante ou imediatamente após saltitar 10 vezes em uma perna só? dor forte ou severa/incapaz

sem dor 0

1

2

3

4

5

6

7

8

9

10



Pontos ____

7. Atualmente, você está praticando algum esporte ou outro tipo de atividade física? 0

Não

4

treinamento e/ou competição com restrições

7

treinamento sem restrição mas não competindo no mesmo nível anterior ao início dos sintomas

10

competindo no mesmo nível ou nível mais alto do que quando os sintomas começaram



Pontos ____

8. P  or favor, complete somente uma das questões, A, B ou C, conforme a explicação abaixo. • Se você não sente dor ao praticar esportes, por favor, responda somente a questão 8A. • Se você sente dor ao praticar algum esporte, mas esta dor não o impede de praticar a atividade esportiva, por favor, responda somente a questão 8B. • Se você sente dor que o impede de praticar atividades esportivas, responda somente a questão 8C. 8A. Se você não sente dor ao praticar esporte, por quanto tempo você consegue treinar/praticar? Não consigo treinar/praticar

0-5 minutos

6-10 minutos

11-15 minutos

mais de 15 minutos

0

7

14

21

30



Pontos ____

OU 8B. S  e você sente dor ao praticar esporte, mas a dor não o impede de completar/praticar a atividade esportiva, por quanto tempo você consegue treinar/praticar? Não consigo treinar/ praticar

0-5 minutos

6-10 minutos

11-15 minutos

mais de 15 minutos

0

4

10

14

20



Pontos ____

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APPENDIX OU 8C. Se você sente dor que o impede de completar o seu treinamento/prática esportiva, por quanto tempo você consegue treinar/praticar? Não consigo treinar/ praticar

0-5 minutos

6-10 minutos

11-15 minutos

mais de 15 minutos

0

2

5

7

10



Pontos ____ PONTUAÇÃO FINAL VISA-P Brasil

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