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Translational Cross-cultural Adaptation and Validation of the VISA-A Questionnaire for Arabic-Speaking Patients With
Nabeel Hamdan Alghamdi1, Mohammad ALMohiza2, Rana Abdullah Alghamdi3
1Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
Background:
Achilles tendinopathy is a prevalent musculoskeletal condition that limits activity and performance. The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is the gold-standard patient-reported outcome measure for symptom severity, but no comprehensive Arabic validation has been available.
Purpose:
To translate, culturally adapt, and validate the VISA-A into Arabic (VISA-A-Arabic) and to examine its psychometric properties in a broad population.
Study Design:
Cohort study (diagnosis); Level of evidence, 3.
Methods:
The VISA-A was translated and culturally adapted following international guidelines. A total of 139 participants were recruited: 60 healthy participants, 47 healthy at-risk participants, and 32 patients with Achilles tendinopathy. All participants completed the VISA-A-Arabic and the 36-item Short Form Health Survey (SF-36) at baseline; the VISA-A-Arabic was re-administered after 1 to 3 days. Internal consistency, test-retest reliability, construct validity, measurement error, and known-group validity were evaluated.
Results:
The VISA-A-Arabic demonstrated acceptable internal consistency (Cronbach α = 0.73 [95% CI, 0.65-0.80]) at baseline and good test-retest reliability (intraclass correlation coefficient = 0.76 [95% CI, 0.68-0.83]). Construct validity was confirmed by a strong correlation with the SF-36 Physical Component Summary (r = 0.63; P < .001) and a weak correlation with the SF-36 Mental Component Summary (r = 0.33; P = .02). Known-group validity showed significantly lower VISA-A-Arabic scores at baseline in patients with Achilles tendinopathy (54.8 ± 20.9) compared with healthy (85.9 ± 10.6) and healthy at-risk (92.7 ± 8.0) participants (F(2,136) = 87.6; P < .001; η2 = 0.56). The standard error of measurement was 10.3, and the smallest detectable change at the individual level was 28.4. No floor effects were observed, and ceiling effects were minimal in the Achilles tendinopathy group.
Conclusion:
Our study showed that the VISA-A-Arabic is a reliable and valid instrument for assessing Achilles tendon-related symptoms and function. Unlike earlier Arabic validation efforts limited to patients, this study included a larger and more diverse cohort and incorporated additional psychometric analyses (standard error of measurement, smallest detectable change, Bland-Altman plot). These findings provide stronger evidence for the clinical and research application of the VISA-A-Arabic across Arabic-speaking populations.
