Achilles Tendinopathy Toolkit: Section B - Outcome Measures

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Introduction

An outcome measure is a tool used to assess a patient’s current status. Outcome measures may provide a score, an interpretation of results and at times a risk categorization of the patient. Prior to providing any intervention, an outcome measure provides baseline data. The initial results may help determine the course of treatment intervention. Once treatment has commenced, the same tool may be used in serial assessments to determine whether the patient has demonstrated change. With the move towards Evidence Based Practice (EBP) in health care, outcome measures provide credible and reliable justification for treatment on an individual patient level.

The following patient-reported and performance-based outcome measures should be selected and used in the management of Achilles tendinopathy.

Patient-Reported Outcome Measures (PROMs)

PROMs are an important tool in today's physiotherapy practise. They provide feedback on a patient's health condition that comes directly from the patient and does not take into account any interpretation of the patient's response by a health professional. PROMs can take the form of questionnaires (in paper or electronic form) that include instructions and can be completed independently by the patient.

There are four commonly used PROMs for achilles tendinopathy - the Victorian Institute of Sports-Achilles (VISA-A) [ref 1] and the VISA-A (Sedentary) [ref 5], both of these are population specific and have been designed and validated for achilles tendinopathy, and the Numeric Pain Reporting Scale (NPRS 0-10) and the Lower Extremity Functional Scale (LEFS) both of which are generic outcome measures that have not been specifically designed for achilles tendinopathy.

• Victorian Institute of Sports-Achilles (VISA-A) Scale - This is the only questionnaire validated specifically for mid-portion Achilles tendinopathy. Recommended as the primary outcome measure in clinic and research setting for mid-portion Achilles tendinopathy[ref 3]
  • 8-item scale. Max score= 100
  • 3 domains: pain, function, activity.
  • Clinically, scores >90 suggest full recovery.[ref 2]
  • Minimal Clinically Important Difference (MCID) = 15.4
  • No Minimal Detectable Change (MDC) to report for mid-portion Achilles tendinopathy.[ref 3]
  • VISA-A (Sedentary) [ref 5] Available here (Click on ‘view questionnaire’) - Currently patients with Achilles tendon disorders complete an internationally recognised patient reported outcome measure (VISA A questionnaire). The original VISA-A questionnaire was designed for sports men/women and does not suit inactive individuals with Achilles tendon problems. As such it is difficult for doctors and Physiotherapists to measure change in symptoms and function in this group of patients, they often score badly on the questions despite a high level of functional improvement. This means that the results make it difficult to determine the effectiveness of treatment.
    • Developed to evaluate response to treatment in a sedentary population. It has been estimated that up to 33% if mid-portion Achilles tendinopathy cases occur in non-active individuals.[ref 6]
    • No MCID or MDC available to report specific to this population.[ref 5]

• Generic Outcome Measures - They are not designed specifically for Achilles Tendinopathy. Such as:
  • Numeric Pain Reporting Scale - NPRS (0-10) - Used to measure pain intensity only and it has been considered as a useful tool to measure immediate response to functional testing or post treatment response for mid-portion Achilles tendinoapthy. Available here
  • Lower Extremity Functional Scale - LEFS. Available here
    

Performance-Based Outcome Measures: (Clinician-Reported)

1. Heel-Rise test (10-14) It is suggested as the main impairment measure for Achilles tendinopathy. It measures a combination of load tolerance and calf muscle endurance. Click here to see a video of how to correctly perform the Heel-Rise test.

2. Single Leg Hop Test Assesses energy storage-release function of tendon, and the stretch-storage cycle (SSC) required for cyclic weight bearing activities such as running. Available here

• Click to go back to the Main Achilles Tendinopathy Toolkit page
• Click to go back to Section A - Clinical Evaluation
• Click to continue to Section C - Summary of Evidence and Recommendations for Interventions
• Click to continue to Section D - Exercise Programs
• Click to continue to Section E - Low Level Laser Therapy Dosage Calculation
• Click to continue to Section F - Medical and Surgical Interventions