Document Type
Journal Article
Publication Title
British Journal of Sports Medicine
Publisher
BMJ Publishing Group
School
Nutrition and Health Innovation Research Institute / School of Medical and Health Sciences
RAS ID
69813
Funders
Western Australian Department of Health Innovation Fellowship / Near-Miss Award
Abstract
Objective To evaluate the construct validity (structural validity and hypothesis testing), reliability (test–retest reliability, measurement error and internal consistency) and minimal important change (MIC) of the 13-item TENDINopathy Severity assessment–Achilles (TENDINS-A). Methods Participants with Achilles pain completed an online survey including: demographics, TENDINS-A, Foot and Ankle Outcome Score (FAOS) and Victorian Institute of Sport Assessment–Achilles (VISA-A). Exploratory factor analysis (EFA) assessed dimensionality. Confirmatory factor analysis (CFA) assessed structural validity (root mean square error of approximation (RMSEA); Comparative Fit Index (CFI); Tucker-Lewis Index (TLI); standardised root measure square (SRMS)). Correlations between TENDINS-A and the FAOS or VISA-A assessed hypothesis testing. Intraclass correlation (ICC) assessed test–retest reliability. Cronbach’s alpha assessed internal consistency. SE of the measurement (SEM) assessed measurement error. A distribution-based approach assessed MIC. Results 79 participants (51% female) with a mean (SD) age=42.6 (13.0) years, height=175.0 (11.7) cm and body mass=82.0 (19.1) kg were included. EFA identified three meaningful factors, proposed as pain, symptoms and function. The best model identified using CFA for TENDINS-A had structural validity (RMSEA=0.101, CFI=0.959, TLI=0.947, SRMS=0.068), which included three factors (pain, symptoms and function), but excluded three items from the original TENDINS-A. TENDINS-A exhibited moderate positive correlation with FAOS (r=0.598, p < 0.001) and a moderate negative correlation with VISA-A (r=−0.639, p < 0.001). Reliability of the TENDINS-A was excellent (ICC=0.930; Cronbach’s =0.808; SEM=6.54 units), with an MIC of 12 units. Conclusions Our evaluation of the revised 10-item TENDINS-A determined it has construct validity and excellent reliability, compared with the VISA-A and FAOS which lack content and construct validity. The TENDINS-A is recommended as the preferred patient-reported outcome measure to assess disability in people with Achilles tendinopathy.
DOI
10.1136/bjsports-2023-107741
Comments
This article has been accepted for publication in British Journal of Sports Medicine, 2024, following peer review, and the Version of Record can be accessed online at https://doi.org/10.1136/bjsports-2023-107741.
Murphy, M. C., McCleary, F., Hince, D., Chimenti, R., Chivers, P., Vosseller, J. T., . . . Rio, E. K. (2024). TENDINopathy severity assessment–achilles (TENDINS-A): Evaluation of reliability and validity in accordance with COSMIN recommendations. British Journal of Sports Medicine. Advance online publication. https://doi.org/10.1136/bjsports-2023-107741