VISA-P Patellar Tendon

VISA-Patellar Tendon

The Victorian Institute of Sport Assessment (VISA-) Patella (P) Questionnaire is a self-report clinical outcome measure used in patients with Patellar Tendinopathy. It consists of eight questions that measure the domains of pain, function in daily living, and sports activities
Name*

First NameLast Name
Email*
example@example.com
Today's Date*

MonthDayYear
Date
If you are completing this form regarding a different date, enter it here (Month, Day, Year)

MonthDayYear
Date
Please indicate which knee this survey is about:*

LeftRight
VAS: Overall, how bad is your pain (0=no pain, 100 =maximum imaginable pain)*

How many minutes can you sit pain free?*

	0 minutes	10 minutes	20 minutes	30 min	40 min	50 min	60 min	70 min	80 min	90 min	100 minutes or more
1. Sit pain free

Pain: Please rate the amount of knee pain you have for the following activities:*

	0 (no pain at all)	1	2	3	4	5	6	7	8	9	10 (strong, severe pain)
2. Pain walking downstairs
3. Pain with full straightening of the knee, without weight.
4. Pain with a full weight bearing lunge
5. Pain during or immediately after doing 10 single leg hops

Do you have any problems squatting?*

	No problem squatting	1	2	3 mild problem squatting	4	5 some problems squatting	6	7 moderate problem squatting	8	9	10 unable to squat
6. Any problem squatting?

7. Are you currently involved in any sport or other physical activity?

Not at allModified training ± modified competitionFull training ± competition but not at same level as when symptoms beganCompeting at the same or higher level as when symptoms began
Please select only one of the following:

I have NO PAIN during sports or activities ->go to 8AI have PAIN during sports or activities, but it does not stop me from completing the activity -> go to 8BI have PAIN THAT STOPS ME from completing sports or activities -> go to 8C
Please complete only one of the folowing: 8A, 8B, or 8C

8A: If you have NO PAIN during sports, how long can you train or practise?*

	0 min	1-5 mins	6-10 mins	7-15 mins	>15 mins
8A: If you have NO PAIN during sports, how long can you train or practise?

8B: If you have PAIN but it does NOT STOP YOU from doing sports, how long can you train or practise?*

	0 min	1-5 mins	6-10 mins	7-15 mins	>15 mins
8B: If you have PAIN but it does NOT STOP YOU from doing sports, how long can you train or practise?

8C: If PAIN STOPS YOU from completing sports, how long can you train or practice before stopped by PAIN?*

	0 min	1-5 mins	6-10 mins	7-15 mins	>15 mins
8C: If PAIN STOPS YOU from completing sports, how long can you train or practice before stopped by PAIN?

VISA-Patellar Tendon