Sergio Hernández-Sánchez

Cross-cultural Adaptation of VISA-P Score for Patellar Tendinopathy in Spanish Population

STUDY DESIGN Clinical measurement. OBJECTIVES To adapt the VISA-P questionnaire into Spanish and to assess its psychometric properties. BACKGROUND Health status questionnaires and scales to report outcomes are increasingly used in medical research and clinical practice. Validated versions of these tools are necessary to avoid bias during use in different languages and cultures. METHODS We followed international recommendations to perform cross-cultural adaptation. The Spanish VISA-P (VISA-P-Sp) questionnaire and the Short Form (36) Health Survey (SF-36) were administered to 150 individuals: 40 healthy students, 40 professional players in sports requiring jumping, 40 athletes with patellar tendinopathy, and 30 athletes with knee injuries other than patellar tendinopathy. Participants were assessed at baseline and after 1 week. Athletes with tendinopathy also completed questionnaires and other knee measures (the Kujala Scoring Questionnaire and the Cincinnati Knee Rating Scale) after physiotherapy treatment, which consisted of rest, ice, eccentric exercise, electrotherapy, and manual therapy. RESULTS The VISA-P-Sp showed high reliability for both temporal stability (intraclass correlation coefficient [ICC] = 0.994; 95% CI: 0.992, 0.996) and internal consistency (Cronbach α = 0.885). Based on a factor analysis, a 2-factor solution explained 76.1% of the variance. The VISA-P-Sp score in the tendinopathy group was significantly correlated with scores on other knee scales (Kujala score [Spearman rho = 0.897; P<.001] and Cincinnati scale [Spearman rho = 0.782, P<.001]) and with SF-36 physical components score (Spearman rho>0.6, P<.001). The standardized size effect was 1.14, and the standardized response mean was 1.17. CONCLUSION The VISA-P-Sp questionnaire proved to be a valid and reliable instrument, sensitive to clinical changes and comparable to the original English-language version.

Responsiveness of the VISA-P scale for patellar tendinopathy in athletes

Background Patient-reported outcome measures are increasingly used in sports medicine to assess results after treatment, but interpretability of change for many instruments remains unclear. Objective To define the minimum clinically important difference (MCID) for the Victorian Institute of Sport Assessment scale (VISA-P) in athletes with patellar tendinopathy (PT) who underwent conservative treatment. Methods Ninety-eight athletes with PT were enrolled in the study. Each participant completed the VISA-P at admission, after 1 week, and at the final visit. Athletes also assessed their clinical change at discharge on a 15-point Likert scale. We equated important change with a score of ≥3 (somewhat better). Receiver-operating characteristic (ROC) curve analysis and mean change score were used to determine MCID. Minimal detectable change was calculated. The effect of baseline scores on MCID and different criteria used to define important change were investigated. A Bayesian analysis was used to establish the posterior probability of reporting clinical changes related to MCID value. Results Athletes with PT who showed an absolute change greater than 13 points in the VISA-P score or 15.4–27% of relative change achieved a minimal important change in their clinical status. This value depended on baseline scores. The probability of a clinical change in a patient was 98% when this threshold was achieved and 45% when MCID was not achieved. Conclusions Definition of the MCID will enhance the interpretability of changes in the VISA-P score in the athletes with PT, but caution is required when these values are used.

Training Effects of the FIFA 11+ Kids on Physical Performance in Youth Football Players: A Randomized Control Trial

Objective To analyze the training effects of the FIFA 11+ kids on several parameters of physical performance in male youth football players. Materials and methods Twenty-three youth players were randomized within each team into two groups (control vs. intervention). The intervention group performed the FIFA 11+ kids programme 2 times a week for 4 weeks; the control groups completed their normal warm-up routines. Thirteen physical performance measures {range of motion (hip, knee, and ankle joints), dynamic postural control (measured throughout the Y balance test), 20 m sprint time, slalom dribble with a ball, agility, vertical jumping height [counter movement jump (CMJ) and drop jump (DJ)], horizontal jump distance, accuracy when volleying a ball [measured throughout the Wall Volley test]} were assessed. All physical performance parameters were compared via magnitude-based inference analysis. Results Significant between-group differences in favor of the FIFA 11+ players were found for dynamic postural control {anterior [mean and 90% confidence intervals (CI) = 1 cm, from −1.6 to 3.5 cm] and posteromedial (mean and 90% CI = 5.1 cm, from −1.8 to 12 cm) and posterolateral (mean and 90% CI = 4.8 cm, from 0.6 to 9.0 cm) distances}, agility run (mean and 90% CI = 0.5 s, from −0.9 to 0 s), vertical jump height [CMJ (mean and 90% CI = 3.1 cm, from 0.2 to 6.1 cm) and DJ (mean and 90% CI = 1.7 cm, from −0.5 to 3.9 cm)], and horizontal jump distance (mean and 90% CI = 2.5 cm, from −8 to 15 cm). The control groups showed better performance in 20 m sprint time (mean and 90% CI = −0.05 s, from −0.11 to 0.07) and wall volley tests (mean and 90% CI = 0.2, from −0.2 to 0.6) compared to the intervention group. Conclusion The main findings of this study suggest that just 4 weeks of implementation of the FIFA 11+ kids produces improved physical performance compared with traditional warm-up routines in youth soccer players.

Acute effects of three neuromuscular warm-up strategies on several physical performance measures in football players

No studies have analysed the acute effects of the FIFA 11+ and Harmoknee warm-up programmes on major physical performance measures. The aim of this study was to analyse the acute (post-exercise) effects of the FIFA 11+, Harmoknee and dynamic warm-up routines on several physical performance measures in amateur football players. A randomized, crossover and counterbalanced study design was used to address the purpose of this study. A total of sixteen amateur football players completed the following protocols in a randomized order on separate days: a) FIFA 11+; b) Harmoknee; and c) dynamic warm-up (DWU). In each experimental session, 19 physical performance measures (joint range of motion, hamstring to quadriceps [H/Q] strength ratios, dynamic postural control, 10 and 20 m sprint times, jump height and reactive strength index) were assessed. Measures were compared via a magnitude-based inference analysis. The results of this study showed no main effects between paired comparisons (FIFA 11+ vs. DWU, Harmoknee vs. DWU and Harmoknee vs. FIFA 11+) for joint range of motions, dynamic postural control, H/Q ratios, jumping height and reactive strength index measures. However, significant main effects (likely effects with a probability of >75–99%) were found for 10 (1.7%) and 20 (2.4%) m sprint times, demonstrating that both the FIFA 11+ and Harmoknee resulted in slower sprint times in comparison with the DWU. Therefore, neither the FIFA 11+ nor the Harmoknee routines appear to be preferable to dynamic warm-up routines currently performed by most football players prior to training sessions and matches.

Changes in Postural Sway After a Single Global Postural Reeducation Session in University Students: A Randomized Controlled Trial

Objective The purpose of this study was to assess the effectiveness of a single session of global postural reeducation (GPR) in postural sway in young adult university students who use data visualization screens. Methods A randomized controlled trial with 2 parallel groups was performed. Sixty‐four subjects were randomized in the experimental group (12 men and 20 women) who underwent the GPR session, and a control group (13 men and 19 women) that did not receive any intervention was included. Center of pressure (COP) was assessed using a stabilometric platform, with eyes open and eyes closed before, immediately after, 48 hours after, and 7 days after intervention in both groups. Results In the interaction of time and gender, statistically significant differences were found for the area covered by COP (P = .020) and for the standard deviation (SD) in the mediolateral axis (P = .035). Considering the complete interaction time, gender, and group, statistically significant differences were found (P = .015) for the anteroposterior rate covered by COP and the SD in the anteroposterior axis (P = .033). In eyes closed condition, the intersubject analysis showed statistically significant differences for the interaction between group and gender for the variable mediolateral SD (P = .043). Considering the interaction of time with group, statistically significant differences were found for full length covered by COP (P = .017). Conclusions Changes in postural sway were observed after a single GPR session, mainly at 48 hours, with different behaviors between men and women.

Training Effects of the FIFA 11+ and Harmoknee on Several Neuromuscular Parameters of Physical Performance Measures

The main purpose of this study was to analyse the training effects of the FIFA 11+ and Harmoknee on several parameters of physical performance measures in youth amateur football players. 41 adolescent players were randomised within each team into 2 groups (team 1: control vs. FIFA 11+; team 2: control vs. Harmoknee). The FIFA 11+ and Harmoknee groups performed the program 3 times a week for 4 weeks; the control groups completed their usual warm-up routines. 13 physical performance measures (joint range of motion, dynamic postural control, single legged hop limb symmetry, sprint time, jumping height and agility) were assessed. All physical performance parameters were compared via a magnitude-based inference analysis. Significant between-group differences (in favour of the FIFA 11+ players) were found for dynamic postural control (anterior [2.5%] and posteromedial [7.2%] distances), single legged hop limb symmetry (side-to-side symmetry during a triple hop test [8.3%]), 10 (8.4%) and 20 (1.8%) m sprint times and jumping height (9.1%) neuromuscular outcomes. For the Harmoknee, significant differences (in comparison to its paired control group) were found only for 10 (2.7%) and 20 (2.9%) m sprint times and jumping height (9.7%). Therefore, the main findings of this study suggest exchanging traditional warm-up programmes for the FIFA 11+ in male youth soccer players based on its superior effects on some neuromuscular parameters (sprinting, jumping and stability) of physical performance.

Cross-cultural Adaptation of the Victorian Institute of Sport Assessment-Achilles (VISA-A) Questionnaire for Spanish Athletes With Achilles Tendinopathy

• STUDY DESIGN: Clinical measurement study. • BACKGROUND: Achilles tendinopathy is a prevalent sport‐related injury. The Victorian Institute of Sport Assessment‐Achilles (VISA‐A) questionnaire is a widely used patient‐reported outcome to assess the severity of symptoms for this injury. • OBJECTIVE: To adapt the VISA‐A questionnaire into Spanish and to assess its psychometric properties. • METHODS: Cross‐cultural adaptation was conducted according to recommended guidelines. The Spanish VISA‐A (VISA‐A‐Sp) questionnaire was administered to 210 subjects: 70 healthy students, 70 active at‐risk subjects (participating in running and jumping), and 70 patients diagnosed with Achilles tendinopathy. Participants were assessed at baseline and after 3 to 5 days. The injured subjects were also evaluated with a quality‐of‐life questionnaire (Medical Outcomes Study 36‐Item Short‐Form Health Survey [SF‐36]) and at discharge. The final VISA‐A‐Sp was evaluated for reliability, validity, and responsiveness. • RESULTS: Cronbach alpha for the VISA‐A‐Sp was greater than .8. The intraclass correlation coefficient (model 2,1) was 0.993 (95% confidence interval: 0.991, 0.995; P<.05). In the confirmatory factor analysis, a 1‐factor solution obtained a relatively good fit. Subjects with Achilles tendinopathy scored significantly lower than the other 2 groups (P<.001). The VISA‐A‐Sp score within the Achilles tendinopathy group showed significant correlations with SF‐36 physical components (Spearman rho>0.5, P<.001). The standard error of the measurement was 2.53, and the minimal detectable change at the 95% confidence level was 7 points. The responsiveness indicators included an effect size of 2.16 and a standardized response mean of 1.92. • CONCLUSION: The VISA‐A‐Sp showed satisfactory psychometric properties that were comparable to the original English‐language version. Therefore, it can be recommended for use in clinical practice and research for assessing the severity of symptoms in Spanish‐speaking athletes who suffer from Achilles tendinopathy.