8 141 Impact of Socioeconomic Status in Patients with Achilles Tendinopathy a broad spectrum of patients from across the country, encompassing both underserved and well-served populations. The inclusion period was between September 2018 and March 2023. Patients were included if: 1) the clinical diagnosis of Achilles tendinopathy was established by the physician, 2) informed consent was provided and 3) the baseline digital questionnaire was completed. Procedures Patients who were referred by a healthcare provider (general practitioner or medical specialist) because of pain in the Achilles tendon region were asked to complete a digital questionnaire before their appointment at the outpatient department. This questionnaire was sent within one week before the appointment to patients using GemsTracker (GEneric Medical Survey Tracker), a software package designed for clinical research assuring secure distribution of questionnaires. This baseline questionnaire consisted of questions on demographics (age, sex, postal code), lifestyle, comorbidities, work, injury characteristics and (sports) activity. Sports activity was rated using the Ankle Activity Score (range 0-10) (AAS).20 The VISA-A questionnaire was also completed. A single senior sports physician (RJDV) performed complete history taking, physical examination and ultrasound examination on all patients. The scheduled duration of the consultation was one hour for all patients. Patients were specifically asked if their symptoms were associated with (sports) activities. Physical examination included the assessment of recognizable pain on palpation21 and the presence/absence of localized tendon thickening. The clinical diagnosis was made based on physical examination and patient history. The physician established the clinical diagnosis of Achilles tendinopathy if 1) pain located in the Achilles tendon region in association with Achilles tendon-loading activities AND 2) localized pain upon Achilles tendon palpation that was consistent with their injury pain (e.g. experienced during loading activities) were present. This could be with or without Achilles tendon thickening. The imaging findings were discussed with the patients. All included patients received treatment advice based on the best available evidence and standard practices for Achilles tendinopathy at the time of inclusion. This approach was aligned with the prevailing recommendations in existing (inter)national guidelines, which included education, load management, and exercise therapy.17,22,23 If patients already received (part of) this treatment advice, the sports physician aimed to optimize this cornerstone of treatment based on the context of the individual (e.g. changes in the exercise therapy program or education about the longstanding nature of tendinopathy and need for prolonged rehabilitation). All patients received a folder (see Supplementary Files 3 and 4 for the folders ‘insertional Achilles tendinopathy’ and ‘midportion Achilles tendinopathy’) which provided an overview of education, load management advice and progression of exercise therapy. The patient could voluntarily consult a physiotherapist for guidance if he or she desired. If so, the physician also instructed that the folder was a guide of the
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