Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction.

This guideline was developed to inform clinical practice on rehabilitation after anterior cruciate ligament reconstruction (ACLR) and was performed in accordance with the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A Guideline Development Group systematically searched and reviewed evidence using randomised clinical trials and systematic reviews to evaluate the effectiveness of rehabilitation interventions and guide clinicians and patients on the content of the optimal rehabilitation protocol after ACLR.The guideline targets patients during rehabilitation after ACLR and investigates the effectiveness of the available interventions to the physiotherapist, alone or in combination (eg, exercise, modalities, objective progression criteria). Exercise interventions should be considered the mainstay of ACLR rehabilitation. However, there is little evidence on the dose-response relationship between volume and/or intensity of exercise and outcomes. Physical therapy modalities can be helpful as an adjunct in the early phase of rehabilitation when pain, swelling and limitations in range of motion are present. Adding modalities in the early phase may allow earlier pain-free commencement of exercise rehabilitation. Return to running and return to training/activity are key milestones for rehabilitation after ACLR. However, there is no evidence on which progression or discharge criteria should be used.While there is a very low level of certainty for most components of rehabilitation, most of the recommendations provided in this guideline were agreed to by expert clinicians. This guideline also highlights several new elements of ACLR management not reported previously.

Rotational head acceleration and traumatic brain injury in combat sports: a systematic review.

BACKGROUND: Traumatic brain injury (TBI) in combat sports is relatively common, and rotational acceleration (RA) is a strong biomechanical predictor of TBI. This review summarizes RA values generated from head impacts in combat sport and puts them in the context of present evidence regarding TBI thresholds. SOURCES OF DATA: PubMed, EMBASE, Web of Science, Cochrane Library and Scopus were searched from inception to 31st December 2021. Twenty-two studies presenting RA data from head impacts across boxing, taekwondo, judo, wrestling and MMA were included. The AXIS tool was used to assess the quality of studies. AREAS OF AGREEMENT: RA was greater following direct head strikes compared to being thrown or taken down. RA from throws and takedowns was mostly below reported injury thresholds. Injury thresholds must not be used in the absence of clinical assessment when TBI is suspected. Athletes displaying signs or symptoms of TBI must be removed from play and medically evaluated immediately. AREAS OF CONTROVERSY: Methodological heterogeneity made it difficult to develop sport-specific conclusions. The role of headgear in certain striking sports remains contentious. GROWING POINTS: RA can be used to suggest and assess the effect of safety changes in combat sports. Gradual loading of training activities based on RA may be considered when planning sessions. Governing bodies must continue to work to minimize RA generated from head impacts. AREAS TIMELY FOR DEVELOPING RESEARCH: Prospective research collecting real-time RA data is required to further understanding of TBI in combat sports.

Single leg vertical jump performance identifies knee function deficits at return to sport after ACL reconstruction in male athletes.

OBJECTIVES: Vertical jump performance (height) is a more representative metric for knee function than horizontal hop performance (distance) in healthy individuals. It is not known what the biomechanical status of athletes after anterior cruciate ligament (ACL) reconstruction (ACLR) is at the time they are cleared to return to sport (RTS) or whether vertical performance metrics better evaluate knee function. METHODS: Standard marker-based motion capture and electromyography (EMG) were collected from 26 male athletes cleared to RTS after ACLR and 22 control healthy subjects during single leg vertical jumps (SLJ) and single leg drop jumps (SLDJ). Performance outcomes, jump height and the Reactive Strength Index, were calculated. Sagittal plane kinematics, joint moments and joint work were obtained using inverse dynamics and lower limb muscle forces were computed using an EMG-constrained musculoskeletal model. Muscle contribution was calculated as a percentage of the impulse of all muscle forces in the model. Between-limb and between-group differences were explored using mixed models analyses. RESULTS: Jump performance, assessed by jump height and Reactive Strength Index, was significantly lower in the involved than the uninvolved limb and controls, with large effect sizes. For the ACLR group, jump height limb symmetry index was 83% and 77% during the SLJ and SLDJ, respectively. Work generation was significantly less in the involved knee compared to uninvolved limb and controls during the SLJ (p<0.001; d=1.19; p=0.003, d=0.91, respectively) and during the SLDJ (p<0.001; d=1.54; p=0.002, d=1.05, respectively). Hamstrings muscle contribution was greater in the involved compared to the uninvolved limb and controls, whereas soleus contribution was lower in the involved limb compared to controls. CONCLUSIONS: During vertical jumps, male athletes after ACLR at RTS still exhibit knee biomechanical deficits, despite symmetry in horizontal functional performance and strength tests. Vertical performance metrics like jump height and RSI can better identify interlimb asymmetries than the more commonly used hop distance and should be included in the testing battery for the RTS.

Single leg hop for distance symmetry masks lower limb biomechanics: time to discuss hop distance as decision criterion for return to sport after ACL reconstruction?

BACKGROUND: We evaluated the lower limb status of athletes after anterior cruciate ligament reconstruction (ACLR) during the propulsion and landing phases of a single leg hop for distance (SLHD) task after they had been cleared to return to sport. We wanted to evaluate the biomechanical components of the involved (operated) and uninvolved legs of athletes with ACLR and compare these legs with those of uninjured athletes (controls). METHODS: We captured standard video-based three-dimensional motion and electromyography (EMG) in 26 athletes after ACLR and 23 healthy controls during SLHD and calculated lower limb and trunk kinematics. We calculated lower limb joint moments and work using inverse dynamics and computed lower limb muscle forces using an EMG-constrained musculoskeletal modelling approach. Between-limb (within ACLR athletes) and between-group differences (between ACLR athletes and controls) were evaluated using paired and independent sample t-tests, respectively. RESULTS: Significant differences in kinematics (effect sizes ranging from 0.42 to 1.56), moments (0.39 to 1.08), and joint work contribution (0.55 to 1.04) were seen between the involved and uninvolved legs, as well as between groups. Athletes after ACLR achieved a 97%±4% limb symmetry index in hop distance but the symmetry in work done by the knee during propulsion was only 69%. During landing, the involved knee absorbed less work than the uninvolved, while the uninvolved knee absorbed more work than the control group. Athletes after ACLR compensated for lower knee work with greater hip work contribution and by landing with more hip flexion, anterior pelvis tilt, and trunk flexion. CONCLUSION: Symmetry in performance on a SLHD test does not ensure symmetry in lower limb biomechanics. The distance hopped is a poor measure of knee function, and largely reflects hip and ankle function. Male athletes after ACLR selectively unload the involved limb but outperform controls on the uninvolved knee.

Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) - A systematic review.

BACKGROUND: Reviews on the diagnostic performance of the examination tests for lateral elbow tendinopathy (LET) based on updated context-specific tools and guidelines are missing. PURPOSE: To review the diagnostic accuracy of examination tests used in LET. DESIGN: Systematic review following PRISMA-DTA guidelines. METHODS: We searched MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, and Cochrane Library databases. The QUADAS-2 checklist was used to assess the methodological quality of the eligible studies. We included diagnostic studies reporting the accuracy of physical examination tests or imaging modalities used in patients with LET. RESULTS: Twenty-four studies with 1370 participants were identified reporting the diagnostic performance of Ultrasound Imaging (USI) (18 studies), physical examination tests (2 studies) and Magnetic Resonance Imaging (MRI) (4 studies). Most studies (97%) were assessed with "unclear" or "high risk" of bias. Sonoelastography showed the highest sensitivity (75- 100%) and specificity (85- 96%). Grayscale with or without Doppler USI presented poor to excellent values (sensitivity: 53%-100%, specificity: 42%-90%). MRI performed better in the diagnosis of tendon thickening and enthesopathy (sensitivity and specificity: 81%-100%). The Cozen's test reported high sensitivity (91%) while a grip strength difference of 5%-10% between elbow flexion and extension showed high sensitivity (78%-83%) and specificity (80%-90%). CONCLUSIONS: Cozen's test and grip strength measurement present high accuracy in the diagnosis of LET but are poorly investigated. USI and MRI provide variable diagnostic accuracy depending on the entities reported and should be recommended with caution when differential diagnosis is necessary. Substantial heterogeneity was found in inclusion criteria, operator/ examiner, mode of application, type of equipment and reference standards across the studies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID CRD42020160402.

Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials.

OBJECTIVE: To evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function. DESIGN: Systematic review and meta-analysis. METHODS: We used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures. ELIGIBILITY CRITERIA: RCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET. RESULTS: 30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident. CONCLUSIONS: Low and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small. PROSPERO REGISTRATION NUMBER: CRD42018082703.

A systematic review evaluating the clinimetric properties of the Victorian Institute of Sport Assessment (VISA) questionnaires for lower limb tendinopathy shows moderate to high-quality evidence for sufficient reliability, validity and responsiveness-part II.

PURPOSE: The evaluation of measurement properties such as reliability, measurement error, construct validity, and responsiveness provides information on the quality of the scale as a whole, rather than on an item level. We aimed to synthesize the measurement properties referring to reliability, measurement error, construct validity, and responsiveness of the Victorian Institute of Sport Assessment questionnaires (Achilles tendon-VISA-A, greater trochanteric pain syndrome-VISA-G, proximal hamstring tendinopathy-VISA-H, patellar tendon-VISA-P). METHODS: A systematic review was conducted according to Consensus-based Standards for the Selection of Health Measurement Instruments methodology (COSMIN). PubMed, Cochrane, CINAHL, EMBASE, Web of Science, SportsDiscus, grey literature, and reference lists were searched. Studies assessing the measurement properties concerning reliability, validity, and responsiveness of the VISA questionnaires in patients with lower limb tendinopathies were included. Two reviewers assessed the methodological quality of studies assessing reliability, validity, and responsiveness using the COSMIN guidelines and the evidence for these measurement properties. A modified Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was applied to the evidence synthesis. RESULTS: There is moderate-quality evidence for sufficient VISA-A, VISA-G, and VISA-P reliability. There is moderate-quality evidence for sufficient VISA-G and VISA-P measurement error, and high-quality evidence for sufficient construct validity for all the VISA questionnaires. Furthermore, high-quality evidence exists with regard to VISA-A for sufficient responsiveness in patients with insertional Achilles tendinopathy following conservative interventions. CONCLUSIONS: Sufficient reliability, measurement error, construct validity and responsiveness were found for the VISA questionnaires with variable quality of evidence except for VISA-A which displayed insufficient measurement error. LEVEL OF EVIDENCE: IV. REGISTRATION DETAILS: Prospero (CRD42018107671); PROSPERO reference-CRD42019126595.

Evaluating lower limb tendinopathy with Victorian Institute of Sport Assessment (VISA) questionnaires: a systematic review shows very-low-quality evidence for their content and structural validity-part I.

PURPOSE: The Victorian Institute of Sport Assessment (Achilles tendon-VISA-A, greater trochanteric pain syndrome-VISA-G, proximal hamstring tendinopathy-VISA-H, patellar tendon-VISA-P) questionnaires are widely used in research and clinical practice; however, no systematic reviews have formally evaluated their content, structural, and cross-cultural validity evidence. The measurement properties referring to content, structural and cross-cultural validity of the VISA questionnaires were appraised and synthesized. METHODS: The systematic review was conducted according to Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. PubMed, Cochrane, CINAHL, EMBASE, Web of Science, SportsDiscus, grey literature, and reference lists were searched. Development studies and cross-cultural adaptations (12 languages) assessing content or structural validity of the VISA questionnaires were included and two reviewers assessed their methodological quality. Evidence for content (relevance, comprehensiveness, and comprehensibility), structural, and cross-cultural validity was synthesized. A modified Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was applied to evidence synthesis. RESULTS: The VISA-A presented very-low-quality evidence of sufficient relevance, insufficient comprehensiveness, and inconsistent comprehensibility. VISA-G displayed moderate-quality evidence for sufficient comprehensibility and very-low-quality evidence of sufficient relevance and comprehensiveness. The VISA-P presented very-low-quality evidence of sufficient relevance, insufficient comprehensiveness, and inconsistent comprehensibility, while VISA-H presented very-low evidence of insufficient content validity. VISA-A displayed low-quality evidence for structural validity concerning unidimensionality and internal structure, while VISA-H presented low-quality evidence of insufficient unidimensionality. The structural validity of VISA-G and VISA-P were indeterminate and inconsistent, respectively. Internal consistency for VISA-G, VISA-H, and VISA-P was indeterminate. No studies evaluated cross-cultural validity, while measurement invariance across sexes was assessed in one study. CONCLUSIONS: Only very-low-quality evidence exists for the content and structural validity of VISA questionnaires when assessing the severity of symptoms and disability in patients with lower limb tendinopathies. LEVEL OF EVIDENCE: IV. REGISTRATION: PROSPERO reference-CRD42019126595.

Arabic translation and cross-cultural adaptation of the Sport Concussion Assessment Tool 5 (SCAT5).

The aim was to create a Modern Standard Arabic SCAT5 version for different Arabic dialects. This translation and cross-cultural adaptation was performed in eight stages: initial translations, reconciliation of translations and cultural adaptation, back translation, appraisal of back translations, validation of the translation, review and adjustment by reconciliation committee, pretesting in 12 football players and document finalisation. As an alternative to the problematic Months In Reverse Order Test (MIROT) in Arabic, the Serial 3s test (32 Arabic and 30 English participants), the Days of the Week Backwards test (DWBT), and the 'Adding Serial 3s' test were tested (30 English and 30 Arabic participants) for accuracy, difficulty and time of completion. The Arabic SCAT5 was similar and comparable to the original English version (7-point Likert scales =< 2). Testing of the pre-final version of the Arabic SCAT5 took 20.4 (SD 3.4) and 17.7 (SD 3.0) minutes respectively to complete and was found acceptable in terms of clarity, understandability, grammatical correctness and coherence. The Arabic Serial 3s test (subtraction version) was unsuitable due to high completion time, low pass rate and high difficulty perception [time = 47.2 (SD 28.0) s; accuracy = 55.2%; difficulty = 3.2 (SD 1.1)]. The Arabic DWBT was too fast and undemanding for concentration testing [time = 4.6 (SD 1.5) s; accuracy = 90%; difficulty = 1.1 (SD 0.3)]. The Adding Serial 3s tests produced similar completion times [18.4 (SD 6.8) vs. 21.1 (SD 5.3), p = 0.088], accuracy (100%) and self-rated difficulty [English = 2.0 (SD 0.7) vs. Arabic-speaking participants = 2.1 (SD 0.8), p = 0.512] and was therefore adopted to replace the MIROT. This culturally adapted Arabic-SCAT5 questionnaire is the first concussion assessment tool available for Arabic-speaking healthcare providers and athletes. Sport Concussion Assessment Tool 5 (SCAT5). Biol Sport. 2021;38(1):129-144.

Measuring only hop distance during single leg hop testing is insufficient to detect deficits in knee function after ACL reconstruction: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the biomechanical deficits after ACL reconstruction (ACLR) during single leg hop for distance (SLHD) testing and report these differences compared with the contralateral leg and with healthy controls. DESIGN: Systematic review with meta-analysis. DATA SOURCES: A systematic search in Pubmed (Ovid), EMBASE, CINAHL, Scopus, Web of Science, PEDro, SPORTDiscus, Cochrane Library, grey literature and trial registries, was conducted from inception to 1 April 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies reporting kinematic, kinetic and/or electromyographic data of the ACLR limb during SLHD with no language limits. RESULTS: The literature review yielded 1551 articles and 19 studies met the inclusion criteria. Meta-analysis revealed strong evidence of lower peak knee flexion angle and knee flexion moments during landing compared with the uninjured leg and with controls. Also, moderate evidence (with large effect size) of lower knee power absorption during landing compared with the uninjured leg. No difference was found in peak vertical ground reaction force during landing. Subgroup analyses revealed that some kinematic variables do not restore with time and may even worsen. CONCLUSION: During SLHD several kinematic and kinetic deficits were detected between limbs after ACLR, despite adequate SLHD performance. Measuring only hop distance, even using the healthy leg as a reference, is insufficient to fully assess knee function after ACLR. PROSPERO trial registration number CRD42018087779.

Test-Retest Reliability of Handgrip Strength in Patients with Chronic Obstructive Pulmonary Disease.

The purpose of this study was to investigate the intra-rater reliability and agreement of handgrip strength (HGS) measurement using a hydraulic hand dynamometer in patients with chronic obstructive pulmonary disease (COPD). A sample of 19 COPD patients (18 males and 1 female; mean ± SD age, 66.9 ± 6.3 years) was evaluated using a hand dynamometer by the same rater in two different testing sessions with a 7-d interval. During each session, patients were asked to exert three maximal isometric contractions on the dominant hand and the mean value of the 3 efforts (measured in kilogram-force [Kgf]) was used for data analysis. The intraclass correlation coefficient (ICC2,1), the standard error of measurement (SEM), the minimal detectable change (MDC), and Bland-Altman methods were used to estimate the degree of test-retest reliability and the measurement error, respectively. HGS in COPD patients revealed an ICC2,1 score of 0.99, suggesting excellent test-retest reliability. The calculated SEM was relatively small (0.59 Kgf), and the MDC presented a clinically acceptable value of 1.64 Kgf. These findings, in conjunction with the narrow width of the 95% limits of agreements (95% limits of agreement, -2.5-2.1 Kgf) in the Bland-Altman plot, reflected the measurement precision and the narrow variation of the differences during the 2 testing sessions. The results of this study demonstrated an excellent test-retest reliability of HGS measurement, indicating that this method is reliable for repeated monitoring of peripheral muscle strength in patients with COPD.

Validation study of the Functional Assessment Scale for Acute Hamstring injuries in Spanish professional soccer players.

OBJECTIVE:: To cross-culturally adapt and validate the Functional Assessment Scale for acute hamstring injury for professional Spanish-speaking soccer players. DESIGN:: Clinical measurement study. Cross-cultural adaptation was conducted following international recommendations. Indicators of validity, reliability and responsiveness are provided. SUBJECTS:: The Spanish version of the Functional Assessment Scale for acute hamstring injury scale was administered to 165 participants: 45 professional soccer players with acute hamstring muscle injury diagnosis, 40 healthy subjects, 40 individuals at-risk for a hamstring muscle injury and 40 patients with injuries of the lower limb other than hamstring muscle injury. MAIN MEASURES:: The Functional Assessment Scale for acute hamstring injury. REFERENCE MEASURES:: Spanish version of the Quality of Life Short-Form 36 questionnaire (SF-36) and the Lower Limb Functional Index (LLFI). RESULTS:: Cronbach's alpha (internal consistency) for the Spanish version of the Functional Assessment Scale for acute hamstring injury scale was >0.8. The intraclass correlation coefficient using the two-way random model (ICC2,1) (test-retest) was 0.993 (95% confidence interval (CI): 0.991-0.995; P < 0.05). In the exploratory factor analysis, a one-factor solution explained 85% of the variance. Subjects with hamstring muscle injury scored significantly lower than the other groups in the Spanish version of the Functional Assessment Scale for acute hamstring injury scale ( P < 0.001). The Spanish version of the Functional Assessment Scale for acute hamstring injury scale score within the hamstring muscle injury group showed moderate and significant correlations with SF-36 physical components (Spearman's rs > 0.6; P < 0.001), and LLFI score at baseline ( rs = 0.42; P < 0.01). The standard error of measurement (SEM) and minimum detectable change threshold (MDC95%) were 2.6 and 7.2 points, respectively. The responsiveness indicators have an effect size of 3.62, and the standardized response mean is 3.24. CONCLUSION:: The Spanish version of the Functional Assessment Scale for acute hamstring injury scale showed satisfactory psychometric properties. It can be considered a reliable and valid instrument to assess the functional impact of acute hamstring muscle injury in professional Spanish-speaking football players.

The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction.

OBJECTIVE: To evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT). DESIGN: Systematic review. ELIGIBILITY CRITERIA: Randomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included. Risk of bias and quality of studies were evaluated. RESULTS: Moderate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT. Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT. Regarding the rest of the results, there was only very low or no level of evidence. 13 studies showed high risk of bias largely due to methodology, blinding and reporting. CONCLUSION: Low level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation.

Individualised radial extracorporeal shock wave therapy (rESWT) for symptomatic calcific shoulder tendinopathy: a retrospective clinical study.

BACKGROUND: A retrospective single centre cohort analysis was performed to evaluate an individualised radial extracorporeal shock wave therapy (rESWT) protocol for treatment of symptomatic calcific shoulder tendinopathy. METHODS: 67 patients (79 Shoulders) were identified with 76 shoulders included for analysis. rESWT treatment protocol was adapted according to individual response to treatment. Variables included number of sessions, shockwave impulses, pressure and frequency. Success rate was estimated as the percentage of patients having ≥60% visual analogue score (VAS) pain decrease at follow-up. Recurrence at 1 year was recorded. RESULTS: Using this individualised symptom guided protocol, patients underwent a mean of 7 ± 1.5 rESWT sessions, with mean pressure of 1.7 ± 0.2 bar, mean frequency of 5 ± 0.3 Hz and 2175 ± 266 impulses. The mean pre-treatment VAS score of 6.7 ± 1.1 was significantly decreased to 3.2 ± 0.8 immediately post-treatment, 2.6 ± 0.9 at 1 month, 1.7 ± 1.0 at 3 months and 0.8 ± 1.0 at 1 year follow up (α = 0.05). One-year success rate was estimated at 92% and 1-year recurrence rate was 7%. CONCLUSIONS: We conclude that in this retrospective study an individualised rESWT protocol resulted in a high success rate with low number of recurrences. Randomised controlled trials to support these findings are recommended.

Cross-cultural adaptation of the VISA-P questionnaire for Greek-speaking patients with patellar tendinopathy.

OBJECTIVES: To cross-culturally adapt the VISA-P questionnaire for Greek-speaking patients and evaluate its psychometric properties. BACKGROUND: The VISA-P was developed in the English language to evaluate patients with patellar tendinopathy. The validity and use of self-administered questionnaires in different language and cultural populations require a specific procedure in order to maintain their content validity. METHODS: The VISA-P questionnaire was translated and cross-culturally adapted according to specific guidelines. The validity and reliability were tested in 61 healthy recreational athletes, 64 athletes at risk from different sports, 32 patellar tendinopathy patients and 30 patients with other knee injuries. Participants completed the questionnaire at baseline and after 15-17 days. RESULTS: The questionnaire's face and content validity were judged as good by the expert committee, and the participants. Concurrent validity was almost perfect (ρ=-0.839, p<0.001). Also, factorial validity testing revealed a two-factor solution, which explained 85.6% of the total variance. A one-factor solution explained 80.8% of the variance when the other knee injury group was excluded. Known group validity was demonstrated by significant differences between patients compared with the asymptomatic groups (p<0.001). The VISA-P-GR exhibited very good test-retest reliability (ICC=0.818, p<0.001; 95% CI 0.758 to 0.864) and internal consistency since Cronbach's α analysis ranged from α=0.785 to 0.784 following a 15-17 days interval. CONCLUSIONS: The translated VISA-P-GR is a valid and reliable questionnaire and its psychometric properties are comparable with the original and adapted versions.