VISA-G Gluteal Tendinopathy

VISA-Gluteal Tendinopathy

The Victorian Institute of Sport Assessment (VISA-) Patella (P) Questionnaire is a self-report clinical outcome measure used in patients with gluteal 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:

1. How bad is your usual hip pain?

Rows	0 No Pain	1	2	3	4	5	6	7	8	9	10 worst pain
Usual Hip Pain

2. I can lie on my sore hip
3. Walking up or down one flight of stairs
4. Walking up or down a ramp or slope
5. After sitting for 30 minutes, moving to standing and then walking is...
6. Work about the house or garden (or similar activity)
7. Are you currently taking part in regular exercise, physical activity or sport?
Please complete only one of the folowing: 8A, 8B, or 8C.
Does your current hip pain affect your ability to undertake weight bearingactivities? (e.g. walking, shopping, running, squats, lunges).
8A.My hip pain is so severe that it will stop me from walking, shopping, running or other weight bearing exercise. If this is so, how much of this activity do you do each day?
8B. My hip pain is present with exercise, but it does not stop me from walking, shopping, running or other weight bearing type exercise.If this is so, how much of this activity do you do each day?
8C. If you have no pain while you undertake walking, shopping, running or other weight bearing type exercise. If this is so, how much of this activity do you do each day?
VISA-G Score
Office use only:

8A: 0, 2, 5, 7, 10
8B: 0, 5, 10, 15, 20
8C: 6, 12, 18, 24, 30
Should be Empty:

VISA-Gluteal Tendinopathy