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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



                            6
              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)




                                      7
              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




                                     8
                                         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




                                                                    9
                  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



                                               10
                Limitations

• No ultrasound images available for some
  participants
• Randomisation not achieved
• At-risk population mostly female




                      11
                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



                       13
             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




                          14

				
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posted:1/26/2013
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