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

1. How many minutes can you sit pain free?

Rows	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

2. Do you have pain walking downstairs with a normal gait cycle?

Rows	0 no pain	1	2	3	4	5	6	7	8	9	10 strong severe pain
Walking downstairs

3. Do you have pain at the knee with full active nonweightbearing knee extension?

Rows	0 no pain	1	2	3	4	5	6	7	8	9	10 strong severe pain
Pain with knee extension

4. Do you have pain when doing a full weight bearing lunge?

Rows	0 no pain	1	2	3	4	5	6	7	8	9	10 strong severe pain
Pain with full weightbearing lunge

5. Do you have any problems squatting?

Rows	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
5. Any problem squatting?

6. Do you have pain during or immediately after doing 10 single leg hops?

Rows	No pain	1	2	3	4	5	6	7	8	9	10 severe pain, or unable to hop
5. Any problem squatting?

7. Are you currently involved in any sport or other physical activity?
Please complete only one of the folowing: 8A, 8B, or 8C
Please select only one of the following:
8A: If you have NO PAIN while doing sports, how long can you train or practice?
8B: If you have SOME PAIN while doing sports, but it does not stop you from participating, how long can you train or practice?
8C: If you have PAIN WHICH STOPS YOU while doing sports, for how long can you train or practice?
VISA-P Score
Office use only:

8A: 0, 7, 14, 21, 30
8B: 0, 4, 10, 14, 20
8C: 0, 2, 5, 7, 10
Should be Empty:

VISA-Patellar Tendon