Applied Evidence

Cross cultural adaptation of the TENDINopathy severity assessment - Achilles (TENDINS-A) for Spanish speaking populations.

Musculoskeletal science & practice · 2026 · Other · PT

Timothy R Fleagle, Elizabeth G Castillo, Zahra Amerian and 10 others

PMID 42526178

A Spanish version of the TENDINS-A Achilles tendinopathy questionnaire shows good reliability and validity in 90 Spanish-speaking adults, but the Pain sub-score is less reliable and it failed to distinguish patients who consider their symptoms acceptable from those who do not.

Key findings

1The Spanish TENDINS-A showed good to excellent test-retest reliability (ICC 0.839 to 0.942 across sub-scores) and Rasch analysis supported the intended 3-factor structure of Pain, Symptoms, and Physical Function.

2The questionnaire discriminated between Achilles tendinopathy, non-Achilles foot pain, and pain-free controls (F=20.28, p<0.001, adjusted r²=0.46), but did not differentiate between patients who considered their symptoms acceptable versus unacceptable (all p-values ≥0.07), contrary to the authors' hypothesis.

3The Pain sub-score had notably lower internal consistency than the other sub-scales, with a standardized person reliability of 0.45, compared to 0.76 for Symptoms and 0.87 for Function.

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What it does not show

Only 37% of the sample were actively seeking care for Achilles tendinopathy; the rest were recruited online, so the sample may not reflect patients in a clinical setting. All data were collected via online surveys; the authors note the questionnaire may perform differently when administered in person. The Pain sub-score had notably lower internal consistency (person reliability 0.45) than the other sub-scores, limiting confidence in that specific score. The questionnaire failed to discriminate between patients with acceptable versus unacceptable symptoms, which was a stated hypothesis and is a practical limitation for tracking treatment response. The Function sub-score correlated moderately with age (r=0.4), so age differences may partly drive score differences rather than true disability differences. Control groups were small (19 foot pain, 17 pain-free), limiting how well the discrimination findings generalise. The translation represents North American and European Spanish; the authors acknowledge it may not fully capture the linguistic diversity of all 30+ Spanish-speaking countries.

Declared interests

All authors declare no competing interests. No funding source is named in the text provided.

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