• VISA-A: Achilles Tendon

    The Victorian Institute of Sport Assessment (VISA-) Achilles (A) Questionnaire is a self-report clinical outcome measure used in patients with Achilles Tendinopathy. It consists of eight questions that measure the domains of pain, function in daily living, and sports activities
  • Today's Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • If you are completing this form regarding a different date, enter it here (Month, Day, Year)
     - -
    2 digit month, 2 digit day, 4 digit year
  • Please indicate which achilles tendon this survey is about:*
  • VAS: Overall, how bad is your pain (0=no pain, 100 =maximum imaginable pain)*
  • 1. For how many minutes do you have stiffness in the Achilles area on first getting up?*
    Rows
  • Once you are warmed up for the day, please rate the amount of achilles pain you have for the following activities:*
    Rows
  • How many single leg hops can you do without pain?*
    Rows
  • 7. Are you currently involved in any sport or other physical activity?

  • Please complete only one of the folowing: 8A, 8B, or 8C

  • For sports which require Achilles tendon loading, select only one of the following:*
  • 8A: If you have NO PAIN during sports, how long can you train or practise?*
    Rows
  • 8B: If you have PAIN but it does NOT STOP YOU from doing sports, how long can you train or practise?*
    Rows
  • 8C: If PAIN STOPS YOU from completing sports, how long can you train or practice before stopped by PAIN?*
    Rows

  • Office use only:

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

     

  • Should be Empty: