140 Chapter 8 METHODS Study design This prospective cohort study was conducted at the Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Center (Rotterdam, the Netherlands). The local Medical Ethics Committee (Southwest-Holland, the Netherlands) approved the study protocol (MEC-2021-0033). All participants provided digital informed consent for this study. We adhered to the minimum reporting standards for tendinopathy studies as determined by the international consensus statement15 and the CHecklist for statistical Assessment of Medical Papers (CHAMP) statement for the design, analysis and reporting of cohort studies.16 Patient and Public involvement Prior to the start of the study, an electronic survey was performed, as part of the development of the Dutch multidisciplinary guideline on Achilles tendinopathy.17 AT patients were asked about their treatment goals. Patients mainly described treatment goals to be: return to (pain free) participation in sports and (pain free) participation in activities of daily living (ADL).18 Based on these treatment goals established by the patients we chose our outcome measures. As the Victorian Institute of Sports AssessmentAchilles (VISA-A) questionnaire evaluates pain during daily living and sports activities, and return to participation in sports, we selected the VISA-A Score as primary outcome.19 To complement this and address aspects not covered by VISA-A we included an assessment of patient satisfaction, reflecting individual treatment needs and experiences, as a secondary outcome. Equity, diversion and inclusion statement Our study, conducted in a single high income country, specifically investigated the effect of SES on the selected outcome measures. However, we acknowledge we did not evaluate the effects of race/ethnicity and marginalized groups as we did not obtain these data. The author team includes both junior and senior researchers and both men and women. Patients All adult patients who visited the outpatient department of Orthopaedics and Sports medicine of the Erasmus MC University Medical Center with symptoms in the Achilles tendon region were eligible to participate. These patients were referred by general practitioners or medical specialists. As per Dutch healthcare regulations the referral process is free for patients who have already met their deductible; otherwise, they are responsible for costs up to €385 (this amount is including costs for treatment and follow-up by the sports physician). The Erasmus MC, situated in an below average SES area, attracts
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