About the VISA-H
The Victorian Institute of Sport Assessment - Hamstring (VISA-H) is a patient-reported outcome measure specifically designed to assess the severity of symptoms, functional limitations, and ability to participate in sports for individuals with proximal hamstring tendinopathy. This self-administered questionnaire comprises eight questions that systematically evaluate pain intensity and frequency in the buttock region, impact on daily activities and physical function, and capacity for sports participation. The VISA-H has been validated across multiple languages and clinical settings, making it a valuable tool for monitoring treatment progress and outcomes in patients with hamstring tendon pathology.
Medical Specialties
Anatomic Areas
Clinical Indications
Developer Information
Developed by Angelo Cacchio and colleagues in 2014 at the University of L'Aquila, Italy. Published in the British Journal of Sports Medicine (BJSM). The VISA-H was developed following the methodology of other VISA questionnaires (VISA-A for Achilles, VISA-P for patella) to provide a condition-specific outcome measure for proximal hamstring tendinopathy.
Copyright & Licensing
Copyright © 2014 Cacchio et al. Published in British Journal of Sports Medicine. The VISA-H questionnaire is freely available for clinical and research use without licensing fees. Users are encouraged to cite the original validation study: Cacchio A, et al. Development and validation of a new visa questionnaire (VISA-H) for patients with proximal hamstring tendinopathy. Br J Sports Med. 2014;48(6):448-452.
Administration Instructions
Answer each question about pain in your buttock region. Select the one response that most closely describes your condition. If you have never had pain, you will score 100.
Scoring Methodology
The VISA-H consists of 8 questions with a total possible score ranging from 0 to 100, where higher scores indicate better function and less pain. Questions 1-6 use a Visual Analogue Scale (VAS) where patients mark their response on a 10cm line, with 0 representing the worst possible outcome and 10 representing optimal health (each question worth up to 10 points). Question 7 assesses sports participation and contains four categorical responses scored as 0, 4, 7, or 10 points depending on the level of participation and pain experienced. Question 8 evaluates training duration despite pain, scored based on the number of minutes patients can train (0-10 points for 0 minutes, up to 30 points for >100 minutes). The maximum score of 100 represents an asymptomatic individual with no functional limitations, while a score of 0 indicates severe symptoms and complete inability to participate in activities.
Meaningful Change Threshold
The minimal clinically important difference (MCID) for the VISA-H has been established at 22 points, indicating the smallest change in score that represents a meaningful improvement or deterioration in a patient's condition from their perspective. Changes of 22 points or greater are considered clinically significant.
Score Interpretation
Understanding what your score means
severe
0 - 39Severe symptoms with significant functional limitations. Patients in this range typically experience substantial pain during daily activities and are unable to participate in most sports or training activities. Immediate clinical attention and comprehensive treatment plan recommended.
moderate
40 - 69Moderate symptoms with noticeable limitations in daily activities and sports participation. Patients can perform some activities but experience regular pain and reduced performance. Active treatment and rehabilitation typically indicated.
mild
70 - 89Mild symptoms with minimal impact on daily activities. Patients can participate in most activities but may experience occasional discomfort or minor limitations during demanding tasks or sports. Conservative management often sufficient.
minimal
90 - 100Minimal to no symptoms with full or near-full participation in all activities including sports. Patients in this range have excellent function and minimal pain. May be ready for return to sport or discharge from active treatment.
Clinical Limitations & Considerations
A systematic review has identified very-low-quality evidence for the content and structural validity of VISA questionnaires, including the VISA-H, indicating the need for further validation studies. Specific limitations include: (1) The questionnaire relies on self-reported data which may be subject to recall bias and reporting bias; (2) It is specific to proximal hamstring tendinopathy and not validated for other hamstring conditions or injuries; (3) The sports-specific questions (items 7-8) may be less relevant for sedentary individuals or those not engaged in regular sporting activities; (4) Cultural and language variations may affect interpretation despite validated translations; (5) The questionnaire does not assess psychosocial factors such as fear avoidance or kinesiophobia which can influence outcomes; (6) Limited evidence exists for the questionnaire's responsiveness to change over short time periods.
Supporting Literature
Key validation and development studies for the VISA-H
- 1
Development and validation of a new visa questionnaire (VISA-H) for patients with proximal hamstring tendinopathy
Cacchio A, De Paulis F, Maffulli N
British Journal of Sports Medicine, 2014
Related Outcome Measures
Other clinical questionnaires for similar specialties and conditions
VISA-G
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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.
VISA-P
An index of the severity of patellar tendinopathy
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Oxford Hip Score
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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