142 Chapter 8 treatment plan that could be used during the physiotherapy sessions. This is according to the Dutch multidisciplinary guideline.17 Follow-up appointments were scheduled between 6 to 12 weeks as part of routine care and further follow-up appointments were made based on individual needs. The limited value of additional conservative treatments (e.g. ESWT or orthotic devices)18 was discussed at the first appointment and considered during follow-up. Socioeconomic status We linked a neighborhood SES-indicator based on area information, which is in line with previous studies in this field.24-26 The indicator was linked using patients’ four-digit postal code. SES scores are calculated per postal code area by the Dutch Central Bureau for Statistics,27 based on household income, educational level and employment status. The most recent socioeconomic data, published in 2019, were used.27 We divided the SES scores into quintiles, based on the rank of the scores. Quintile 5 (Q5) was the quintile with the lowest SES (most deprived) and quintile 1 (Q1) was the quintile with the highest SES (least deprived, e.g. high income, high educational level and high employment rate). The Q1 and Q5 groups were used for the analyses, which has been shown to be a customary method for evaluating inequality.28 This approach follows guidelines by the World Health Organization, highlighting the importance of focusing on the most extreme SES contrasts to effectively reveal significant effects on health outcomes and ensure findings are easily interpretable.29 Outcome measures At 6-, 12- and 24-weeks patients were asked to complete a follow-up questionnaire including the VISA-A questionnaire and treatment satisfaction. The primary outcome measure was the score on the VISA-A questionnaire at 24 weeks. This questionnaire evaluates pain scores and activity level and ranges from 0 to 100 (with lower scores corresponding with more pain and decreased activity).19 The VISA-A is considered to be a reliable and responsive measure of symptom severity in people with AT.30 The secondary outcome measure of the study was the level of satisfaction with the treatment effect as reported by the patients. Treatment satisfaction was assessed using a four-point Likert scale, which consisted of the following categories: excellent, good, moderate, and poor.31 In this study, we dichotomized the satisfaction score, as done previously.31 Patients who rated their treatment satisfaction as excellent or good were considered to be satisfied, while those who rated it as moderate or poor were deemed unsatisfied. The number of additional treatments (e.g. ESWT or orthotic devices) was also recorded. Treatment adherence to the exercise therapy and guidance of a physiotherapist were not registered in this study.
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