Proximal Hamstring Tendinopathy

VISA-H Questionnaire



International Knee Documentation Committee (IKDC)

VISA-H Questionnaire

The Victorian Institute of Sport Assessment (VISA-) Hamstring (H) Questionnaire is a self-report clinical outcome measure used in patients with Proximal Hamstring Tendinopathy (PHT). It consists of eight questions that measure the domains of pain, function in daily living, and sports activities (Cacchio et al. 2014).


Validity and Reliability

The VISA-H questionnaire has high psychometric properties, including validity, reliability, and responsiveness (Cacchio et al. 2014). The validity of the VISA-H questionnaire was established by Cacchio et al. (2013) through the use of a cross-sectional study design, which included 30 patients with PHT (20 non-surgical & 10 surgical) and 30 healthy controls. The same authors also established the reliability of the VISA-H questionnaire through the use of a test-retest design. The Cronbach’s alpha coefficient for the VISA-H questionnaire was 0.84, indicating high internal consistency. Translations of the VISA-H questionnaire into Spanish, Brazilian Portuguese, and French have shown to be consistent, reliable, and valid in clinical practice and research to assess the pain and disability of patients with PHT (De-la-Cruz-Torres et al. 2021, Lima et al. 2022, Locquet et al. 2019).

However, a recent systematic review evaluating the content and structural validity evidence of the VISA questionnaires showed very-low-quality evidence for their content and structural validity (Korakakis et al. 2021).


Scoring and Interpretation

  • Questions 1-6 receive a VAS rating of 0 to 10. (10 is optimal health)
  • The 4 categories on question 7 can be scored as 0, 4, 7, or 10.
  • Question 8 is graded according to how long the patient can train in spite of their current level of pain.

The maximum score for an asymptomatic person is 100; theoretically, the smallest score is 0.


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Cacchio A, De Paulis F, Maffulli N. Development and validation of a new visa questionnaire (VISA-H) for patients with proximal hamstring tendinopathy. Br J Sports Med. 2014;48(6):448-452. doi:10.1136/bjsports-2012-091552

De-la-Cruz-Torres, B., Maffulli, N., & Hernández-Sánchez, S. (2021). Cross-cultural adaptation of the Victorian institute of sports assessment-Hamstrings (VISA-H) questionnaire for Spanish speaking athletes with proximal hamstring tendinopathy. Physical Therapy in Sport, 51, 50-57.

Lima POP, Lourenco BM, Valentim de Freitas L, Nazareno TS, Maffulli N, de Oliveira RR. The Brazilian version of the Victorian Institute of Sport Assessment – Hamstring (VISA-H) Questionnaire: Translation, cross-cultural adaptation and measurement properties. Musculoskelet Sci Pract. 2022;58:102516. doi:10.1016/j.msksp.2022.102516

Locquet, M., Bornheim, S., Colas, L., Van Beveren, J., Bruyère, O., Reginster, J. Y., & Kaux, J. F. (2019). Traduction en langue française, adaptation transculturelle et validation du questionnaire «Victorian Institute of Sport Assessment Scale for Proximal Hamstring Tendinopathy»(VISA-H). Journal de Traumatologie du Sport36(4), 217-221.

Korakakis V, Kotsifaki A, Stefanakis M, Sotiralis Y, Whiteley R, Thorborg K. 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. Knee Surg Sports Traumatol Arthrosc. 2021;29(9):2749-2764. doi:10.1007/s00167-021-06598-5

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