Scribd
Upload
33 views2 pages

Cuestionario VISA - Isquios

The document is a questionnaire for patients experiencing pain in the buttock region. It consists of 8 questions assessing the level of pain experienced during various activities like sitting, running, lunging, and lifting, as well as the ability to participate in sports. Patients are asked to rate their pain on a scale of 0 to 10 for each activity, with 0 being no pain and 10 being severe pain. They are also asked questions about current participation in physical activity and sports.

Uploaded by

carla
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
33 views2 pages

Cuestionario VISA - Isquios

The document is a questionnaire for patients experiencing pain in the buttock region. It consists of 8 questions assessing the level of pain experienced during various activities like sitting, running, lunging, and lifting, as well as the ability to participate in sports. Patients are asked to rate their pain on a scale of 0 to 10 for each activity, with 0 being no pain and 10 being severe pain. They are also asked questions about current participation in physical activity and sports.

Uploaded by

carla
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

VISA-H QUESTIONNAIRE

Patient Name: ___________________________________ Instructions: In this questionnaire, the term


Date: ____________________________________________ "pain" refers specifically to pain in the buttock
region

1. For how many minutes can you sit/can you drive a car pain free?
0 100
minutes 0 1 2 3 4 5 6 7 8 9 10 minutes

2. How much pain do you have during or immediately after stretching your posterior
thigh/hamstring (keeping knee straight)?
Strong No
severe pain 0 1 2 3 4 5 6 7 8 9 10 pain

3. How much pain do you have during or immediately after normal running?
Strong No
severe pain 0 1 2 3 4 5 6 7 8 9 10 pain

4. How much pain do you have during or immediately after sprinting?


Strong No
severe pain 0 1 2 3 4 5 6 7 8 9 10 pain

5. How much pain do you have during or immediately after a full weight-bearing lunge?
Strong No
severe pain 0 1 2 3 4 5 6 7 8 9 10 pain

6. How much pain do you have during or immediately after lifting an object from the
floor (keeping knee straight)?
Strong No
severe pain 0 1 2 3 4 5 6 7 8 9 10 pain
7. Are you currently undertaking sport or other physical activity?

0 Not at all

4 Modified training ± modified competition

7 Full training ± competition but not at same level as when symptoms began

10 Competing at the same or higher level as when symptoms began

8. Please complete EITHER A, B or C in this question.


If you have no pain while undertaking sports please complete Q8a only.
If you have pain while undertaking sports but it does not stop you from
completing the activity, please complete Q8b only.
If you have pain that stops you from completing sports, please complete Q8c
only.

A. If you have no pain while undertaking sports, for how long can you train/practise?

0-20 minutes 21-40 minutes 41-60 minutes 61-90 minutes >90 minutes

0 7 14 21 30

B. If you have some pain while undertaking sport, but it does not stop you from
completing your training/practice for how long can you train/ practise?

0-15 minutes 16-30 minutes 31-45 minutes 46-60 minutes > 60 minutes

0 4 10 14 20

C. If you have pain that stops you from completing your training/practice in sporting
activities, for how long can you train/practise?

NIL 1-10 minutes 11-20 minutes 21-30 minutes >30 minutes

0 2 5 1 1

TOTAL SCORE (______ /100) = _____%

MORE INFORMATION

You might also like