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The Development of an Online
Questionnaire for Grading Patellar
Tendinopathy and Establishing the
Associated Risk Factors
Sarah Morton
Candidate Number: 110552697
Supervisor: Dr Dylan Morrissey
Presentation completed as part of the Research Project Module
Background
• Patellar tendinopathy is a chronic intratendinous
degeneration process
• Highest prevalence in basketball and volleyball players
• Evaluated using the clinician-administered VISA-P
questionnaire1
• Internet means questionnaires can be administered
online
1. Visentini PJ, Khan KM, Cook JL et al. The VISA score: an index of severity of symptoms in patients with jumper's
knee (patellar tendinosis). J Sci Med Sport. 1998;1(1):22-8.
2
Aims
• Develop online questionnaire including VISA-P
and risk factor questions
• Establish equivalence between clinician and
self-administration
• Start the development of a database on
patellar tendinopathy risk factors
3
Method
• Used Google
Document Forms
• Risk factor
questions and
scoring system
based on
literature search
4
Method
• Crossover study design used to test the two different
modes of administration of VISA-P
• 85 subjects recruited:
• 17 symptomatic, 18 “at-risk” and 50 controls
• Average follow up 5.32 days (2.70 days for
symptomatic)
5
Statistics
Statistics methods employed in this study:
• Intraclass correlation coefficients (ICC)
Reliability
• Limits of Agreement (LoA)
• Paired t-test Systemic difference in means for administration modes
• One-way ANOVA test for post-hoc Tukey Test
Difference in
means between
sub-populations
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Results and Discussion
Group Number Average age Order of administration Average
recruited (range) (clinician first: self first) VISA-P score
(male: female) (±SD)
Symptomatic 16 32.5 14:2 46.8
(15: 1) (18-55) (±20.1)
At-risk 18 24.0 11:7 82.8
(3: 15) (19-29) (±18.2)
Control 46 28.4 16:30 87.4
(23:23) (18-59) (±13.6)
Total 80 28.8 41:39 78.3
(41:39) (18-59) (±22.6)
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Results and Discussion
Variable Analysed Intraclass Correlation 95% Confidence Interval
Coefficient
Left Leg VISA-P 0.80 0.70 - 0.87
Right Leg VISA-P 0.83 0.75 - 0.89
Self-administration first 0.77 0.66 - 0.85
VISA-P
Clinician-administration 0.84 0.77 - 0.90
first VISA-P
Both Legs VISA-P 0.82 0.76 - 0.86
All ICCs are greater than 0.70
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Results and Discussion
Bland-Altman Plot for VISA-P Left Leg Bland-Altman Plot for VISA-P Right Leg
40 60
30 32.1
40
Difference of Means
Difference of Means
34.0
20
10 20
0
0
-10
-20
-20 -22.1
-22.0
-30 -40
0 20 40 60 80 100 20 40 60 80 100
Mean Mean
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Results and Discussion
Paired t-test
Mean Difference 95% CI t p value
Clinician v 4.54 2.55-6.54 4.50 <0.01*
Self
Post-Hoc Tukey Test – ANOVA value of 41.88 (p<0.01)
Mean 95% CI p value
Difference
Control v Symptomatic 41.34 30.43-52.25 <0.01*
At-risk v Symptomatic 35.99 23.11-48.87 <0.01*
• Significant difference between administration modes but not clinically significant
• Significant difference between control/symptomatic and at-risk/symptomatic
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Limitations
• No ultrasound images available for some
participants
• Randomisation not achieved
• At-risk population mostly female
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Conclusions
• Online self-administered questionnaire
developed
• VISA-P online self-administration is equivalent
to clinician-administration
• Further research to be carried out into the risk
factors associated with patellar tendinopathy
12
Summary
• VISA-P and risk factor questions included
• 85 subjects in 3 sub-population groups
• ICCs all > 0.70
• Statistical difference between two modes but
not clinically significant
• Online self-administration equivalent to clinician
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Acknowledgments
• Dr Otto Chan, Mel Pritchard and the other staff at
the London Independent Hospital
• Mr D. McEntegart for his advice regarding statistics
• Phil Hayward for his assistance in recruiting subjects
• Sheffield Hatters and UWIC Archers basketball teams
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