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Original research
TENDINopathy Severity assessment–Achilles (TENDINS-A): evaluation of reliability and validity in accordance with COSMIN recommendations
  1. Myles Calder Murphy1,2,
  2. Fergus McCleary2,
  3. Dana Hince3,
  4. Ruth Chimenti4,
  5. Paola Chivers3,
  6. J Turner Vosseller5,
  7. Sophia Nimphius6,
  8. Nonhlanhla Sharon Mkumbuzi7,8,9,10,
  9. Peter Malliaras11,
  10. Nicola Maffulli12,13,
  11. Robert-Jan de Vos14,
  12. Ebonie Kendra Rio15,16,17
  1. 1Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
  2. 2School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
  3. 3Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
  4. 4Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
  5. 5Jacksonville Orthopaedic Institute, Jacksonville, Florida, USA
  6. 6School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
  7. 7Ntombi Sport, Cape Town, South Africa
  8. 8Department of Sports, Exercise, and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
  9. 9Department of Rehabilitation, Midlands State University, Gweru, Zimbabwe
  10. 10Department of Human Movement Science, Nelson Mandela University, Summerstrand, Gqeberha, South Africa
  11. 11School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria, Australia
  12. 12Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
  13. 13Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
  14. 14Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
  15. 15La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
  16. 16Victorian Institute of Sport, Melbourne, Victoria, Australia
  17. 17The Australian Ballet, Melbourne, Victoria, Australia
  1. Correspondence to Dr Myles Calder Murphy, Edith Cowan University, Joondalup, WA 6027, Australia; m.murphy{at}ecu.edu.au

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 α=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.

  • Reliability
  • Validity
  • Achilles

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/bjsports-2023-107741

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @myles_physio, @docsoph, @DrNoeMkumbuzi, @DrPeteMalliaras, @rj_devos, @tendonpain

    • Contributors MCM, DH and EKR conceived the study and designed the methods. FM collected all data. MCM, DH, PC and SN performed all analysis. All authors contributed to interpretation and manuscript preparation. MCM is the guarantor for the overall study.

    • Funding MCM is supported by a Western Australian Department of Health Innovation Fellowship (G1006615) and a Near-Miss Award (G1006605).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.