8 139 Impact of Socioeconomic Status in Patients with Achilles Tendinopathy INTRODUCTION Achilles tendinopathy (AT) is characterized by localized pain in the Achilles tendon that results from mechanical loading.1 AT is frequently occurring and often longstanding with substantial impact on quality of life.2-5 The role of psychosocial factors In tendinopathy is scarcely studied, but believed to be important by experts.6 Examples of socioeconomic factors include income, place of residence, age, sex, education, and ethnicity. Individuals with lower socioeconomic status (SES) may face barriers to accessing healthcare, leading to limited support during rehabilitation.7,8 Limited health literacy is also associated with low SES and results to misunderstanding of medical information and reduced adherence to medical instructions.9 The outcome of various diseases is associated with socioeconomic factors.10-12 Low SES leads to a higher incidence, more severe symptoms before treatment initiation and worse outcomes in several musculoskeletal conditions10,13,14 Understanding the influence of SES on treatment outcomes in Achilles tendinopathy is crucial, as it could lead to more effective, tailored interventions (e.g. health literacy education and targeted support to improve access to healthcare). This could help bridge the health disparity gap in musculoskeletal care. It is unknown whether SES influences symptom severity and treatment effectiveness in patients with Achilles tendinopathy. The primary objective of this study is to assess whether a disparity exists in the severity of symptoms at baseline between AT patients with low SES and those with high SES. The secondary aim is to investigate whether there is a difference in the effectiveness of standardized treatment after 24 weeks between AT patients with low and high SES.
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