148 Chapter 8 There was no significant difference in treatment satisfaction between Q1 and Q5 at any of the follow-up time points (Table 4). Table 4. Percentage satisfied with treatment results and the difference in treatment satisfaction between Q1 and Q5 at each time point.* The estimated difference is reported using risk ratio (RR). The RRs were derived using modified Poisson regression analysis. Group Q1 Q5 RR (95% CI) P value 6 weeks 58.3% (21/36) 63.3% (19/30) 0.94 (0.64 – 1.37) 0.75 12 weeks 56.3% (18/32) 53.6% (15/28) 1.07 (0.65 – 1.73) 0.80 24 weeks 77.4% (24/31) 69.2% (18/26) 1.10 (0.80 – 1.51) 0.56 *Adjusted for sex, BMI, age, symptom duration and AAS. Abbreviations: BMI: Body Mass Index (kg/m2), AAS: Ankle Activity Score. CI: confidence interval The results of the sensitivity analyses for the comparison of VISA-A scores between Q1 and Q5 are displayed in Supplementary File 2. Mean (Standard Error; SE) VISA-A scores at baseline were similar for Q1 and Q5 (43.3 (2.6) and 43.6 (2.8)). At 24-weeks, there was a mean (SE) difference of 7.4 (5.3) points on the VISA-A in favor of Q1, but this difference was not statistically significant (p = 0.17) (Supplementary File 2, Table 1). The sensitivity analyses yielded similar results to the primary analysis for the comparison of treatment satisfaction (Supplementary File 2, Table 2). DISCUSSION To our knowledge, this is the first study to examine the effect of socioeconomic status in patients with tendinopathy. We found that AT patients with low SES have worse outcomes at 24-weeks follow-up when treated according to the current guidelines. Patients with low SES reported a mean VISA-A score that was 7 to 11 points lower at 24-weeks compared to patients with high SES. While this difference aligns with or exceeds the Minimal Clinically Important Difference (MCID) of 7 points 40,41, indicating potential clinical relevance, it is important to note that sensitivity analyses of the VISA-A scores only suggests a trend and did not demonstrate statistically significant differences between groups at all time periods, possibly due to the large dispersion of data. This highlights the need for cautious interpretation of these findings. Comparison of current findings with the literature The impact of SES on patients with Achilles tendinopathy has not been described before, but the relationship between SES and other musculoskeletal diseases has been studied
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