Keywords: outcome measure, tendon pain, symptoms

This blog summarises recent research published in the British Journal of Sports Medicine: TENDINopathy Severity assessment–Achilles (TENDINS-A): evaluation of reliability and validity in accordance with COSMIN recommendations.

What we did

The newly developed TENDINopathy Severity assessment – Achilles (TENDINS-A) assesses the severity of the tendon-related disability, and consists of questions covering sub-domains of pain, symptoms, and physical function related to Achilles tendinopathy (1). The TENDINS-A has adequate content validity (including relevance, comprehensiveness and comprehensibility), being co-designed by people with Achilles tendinopathy, expert clinicians and researchers (1) Whilst the TENDINS-A has sufficient content validity, the structural validity and other measurement properties were unknown. Therefore, we investigated the measurement properties of the TENDINS-A. 

What we found 

Our evaluation of the TENDINS-A, which concluded there are 10-scoreable items across three sub-domains of pain, symptoms and physical function that have adequate construct validity and reliability (2) These findings, and the previously established content validity, ensure that the TENDINS-A can be recommended for immediate use in both research and clinical practice, being the preferred tool over other outcome measures to assess disability in individuals with Achilles tendinopathy.

Where to find it

To download a copy of the TENDINS-A to use with your patients in clinical practice or for your research, please visit www.tendinopathyseverityassessment.com where you can access the TENDINS-A for free. Also keep an eye on this page as the TENDINS-A is now being translated into over 10 different languages and they will be uploaded as they become available. 

The figure below is part of the TENDINS-A questionnaire that relates to the Physical Function section.

Figure 1: Physical Function section of TENDINS-A

Why we did it 

In 2018, people with tendinopathy, expert clinicians and researchers reported there are several core health domains that are important in tendinopathy, with one being tendon-related disability.3 A group of research experts synthesised the literature and discovered many different self-reported outcome measures to assess disability, with little consistency between studies.4

Our research found that physical therapists and sports and exercise medicine doctors rarely used any of the self-reported outcome measures as they felt they were burdensome and irrelevant to their practice.5 Relevance to clinicians and patients is one of the core requirements for an outcome measure having content validity. The most commonly used outcome measure to assess the severity of disability in Achilles tendinopathy4 is the Victorian Institute of Sport Assessment – Achilles (VISA-A).6  However, a group of researchers reported poor content validity for this assessment tool and called for the development of a new tool.7          

REFERENCES 

1. Murphy MC, Newsham-West R, Cook J, et al. TENDINopathy Severity Assessment – Achilles (TENDINS-A): Development and Content Validity Assessment of a New Patient-Reported Outcome Measure for Achilles Tendinopathy. The Journal of orthopaedic and sports physical therapy 2024;54(1):70-85. doi: 10.2519/jospt.2023.11964
2. Murphy MC, McCleary F, Hince D, et al. TENDINopathy Severity assessment-Achilles (TENDINS-A): evaluation of reliability and validity in accordance with COSMIN recommendations. British journal of sports medicine 2024;58(12):665-73. doi: 10.1136/bjsports-2023-107741 [published Online First: 20240531]
3. Vicenzino B, de Vos R-J, Alfredson H, et al. ICON 2019—International Scientific Tendinopathy Symposium Consensus: There are nine core health-related domains for tendinopathy (CORE DOMAINS): Delphi study of healthcare professionals and patients. British journal of sports medicine 2019;54(8):444-51. doi: 10.1136/bjsports-2019-100894
4. Grävare Silbernagel K, Malliaras P, de Vos R-J, et al. ICON 2020—International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy. Sports medicine (Auckland, NZ) 2021 doi: 10.1007/s40279-021-01588-6
5. Murphy M, Debenham J, Bulsara C, et al. Assessment and monitoring of Achilles Tendinopathy in clinical practice: A qualitative descriptive exploration of the barrier’s clinicians face. BMJ Open Sport Exerc Med 2022;ePub ahead of print
6. Robinson JM, Cook JL, Purdam C, et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. British journal of sports medicine 2001;35(5):335-41. [published Online First: 2001/10/02]
7. Comins J, Siersma V, Couppe C, et al. Assessment of content validity and psychometric properties of VISA-A for Achilles tendinopathy. PloS one 2021;16(3):e0247152. doi: 10.1371/journal.pone.0247152 [published Online First: 20210311]

AUTHORS OF BLOG:

Myles Murphy 1, Ebonie Rio 2

1 Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia  

2 La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia