Key facts
- Score direction
- Higher is better
- Meaningful change
- A minimal clinically important difference (MCID) of around 6.5 to 20 points has been reported for the VISA-A depending on the population. Because VISA-A (normalised) calculates the total score in the same direction as VISA-A, the same thresholds can be used for interpreting meaningful change.
- Scoring
- The form comprises eight questions with a maximum total score of 100 points. Questions 1-5 are presented in a patient-friendly normalised direction, where 0 represents the best state and 10 represents the worst pain or l…
- Time to complete
- 5 min
- Questions
- 8
- Licensing
- Available free of charge; Patient Watch charges only for platform services
About the VISA-A (normalised)
VISA-A (normalised) is an improved presentation of the Victorian Institute of Sport Assessment-Achilles questionnaire, designed for patient ease of use. It keeps the same clinical content and score interpretation as VISA-A, but presents pain and stiffness questions (1 to 5) with conventional pain-scale direction where 0/10 is best and 10/10 is worst. This matches typical VAS and NRS pain scoring that patients already understand. Question 1 uses clear minute labels from 0 mins to 100+ mins. Question 6 keeps the natural hop-count scale from 0 to 10+. The calculated total remains equivalent to the original VISA-A, so clinicians can compare results and apply the same thresholds.
Medical Specialties
Anatomic Areas
Clinical Indications
Developer Information
Based on the Victorian Institute of Sport Assessment-Achilles questionnaire developed by Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, Taunton JE, and Khan KM. Normalised presentation adapted for patient ease of use while preserving score equivalence.
Copyright & Licensing
The VISA-A questionnaire is freely available for use in clinical practice and research settings without licensing fees or restrictions. It may be reproduced and used without permission from the developers, though proper citation of the original validation study is encouraged.
Administration Instructions
In this questionnaire, the term "pain" refers specifically to pain in the Achilles tendon region. For questions 1 to 5, 0/10 is best and 10/10 is worst - the same direction most people use when rating pain. Question 6 asks how many hops you can do (0 to 10+). The final score is calculated in the same direction as the original VISA-A.
Scoring Methodology
The form comprises eight questions with a maximum total score of 100 points. Questions 1-5 are presented in a patient-friendly normalised direction, where 0 represents the best state and 10 represents the worst pain or limitation, then reverse-transformed using 10 minus the selected response. Question 1 labels stiffness duration as 0 mins, 10 mins, 20 mins, through to 100+ mins. Question 6 (hop count) keeps the original direction (0 hops = 0 points, 10+ hops = 10 points). Question 7 retains the original VISA-A categorical options (0, 4, 7, 10). Question 8 is completed as either A, B or C only, with duration bands 0 mins, 1-10 mins, 11-20 mins, 21-30 mins and >30 mins scored as A: 0/7/14/21/30, B: 0/4/10/14/20, or C: 0/2/5/7/10. Item scores are summed to produce a total score ranging from 0 (worst symptoms) to 100 (asymptomatic). Higher scores indicate better function and fewer symptoms.
Meaningful Change Threshold
A minimal clinically important difference (MCID) of around 6.5 to 20 points has been reported for the VISA-A depending on the population. Because VISA-A (normalised) calculates the total score in the same direction as VISA-A, the same thresholds can be used for interpreting meaningful change.
Score Interpretation
Understanding what your score means
severe
0 - 49Severe symptoms with major functional impairment. Patient has substantial limitations in daily activities and sports participation, with persistent pain affecting quality of life.
moderate
50 - 69Moderate symptoms with significant functional limitations. Patient experiences regular pain during activities and may need to reduce training intensity or frequency.
mild
70 - 89Mild symptoms with some functional limitations. Patient may experience occasional pain during or after activity but can generally maintain sports participation with minor modifications.
asymptomatic
90 - 100Excellent function with minimal or no symptoms. Patient is able to participate fully in sports and daily activities without limitation.
Clinical Limitations & Considerations
VISA-A (normalised) improves patient ease of use by changing the response direction for pain and stiffness questions (1 to 5), but keeps the calculated score equivalent to VISA-A. Question 6 hop count retains the original 0 to 10+ direction. Clinicians should avoid mixing raw item responses from the original and normalised forms without accounting for display-direction differences on questions 1 to 5.
Frequently asked questions
What does a mild VISA-A (normalised) score mean?
A VISA-A (normalised) score of 70 to 89 is classified as mild. Mild symptoms with some functional limitations. Patient may experience occasional pain during or after activity but can generally maintain sports participation with minor modifications.
What does a severe VISA-A (normalised) score mean?
A VISA-A (normalised) score of 0 to 49 is classified as severe. Severe symptoms with major functional impairment. Patient has substantial limitations in daily activities and sports participation, with persistent pain affecting quality of life.
What does a moderate VISA-A (normalised) score mean?
A VISA-A (normalised) score of 50 to 69 is classified as moderate. Moderate symptoms with significant functional limitations. Patient experiences regular pain during activities and may need to reduce training intensity or frequency.
What does a asymptomatic VISA-A (normalised) score mean?
A VISA-A (normalised) score of 90 to 100 is classified as asymptomatic. Excellent function with minimal or no symptoms. Patient is able to participate fully in sports and daily activities without limitation.
Related Outcome Measures
Other clinical questionnaires for similar specialties and conditions
VISA-A
An index assessing the severity of Achilles tendinopathy. Evaluates pain, function, and ability to participate in activities and sports. Scoring Breakdown: Questions 1-7 are scored out of 10 each (total 70). Question 8 (activity/pain) is scored out of 30. Total Score: 0-100.
VISA-A (Sedentary)
A modified version of the VISA-A questionnaire designed specifically for sedentary/non-sporting patients with Achilles tendinopathy. Replaces sport-specific questions (hopping, sporting activity) with daily functional activity questions. Two dimensions: Symptoms (Q1-5, 0-50) and Activity (Q6-8, 0-50). Total Score: 0-100.
Foot and Ankle Ability Measure (FAAM)
A patient-reported outcome measure assessing physical function in foot and ankle disorders. Includes two subscales: activities of daily living and sports.
Achilles Tendon Total Rupture Score (ATRS)
A validated 10-item patient-reported outcome measure evaluating symptoms and physical activity limitations following Achilles tendon rupture.
Cumberland Ankle Instability Tool
A validated 9-item questionnaire designed to measure the severity of functional ankle instability in individuals with chronic ankle instability.
FAOS - Foot and Ankle Outcome Score
A comprehensive questionnaire assessing foot and ankle function across five domains: pain, symptoms, activities of daily living, sport/recreation, and quality of life.
This questionnaire is provided free of charge. Patient Watch charges only for platform services (data storage, automated reminders, analytics) - not for use of clinical instruments. This non-commercial model supports academic and clinical use.View full licensing disclosure