8 149 Impact of Socioeconomic Status in Patients with Achilles Tendinopathy more extensively. Previous research shows a strong association between low SES and worse treatment outcomes in individuals with other musculoskeletal conditions such as rheumatoid arthritis and osteoarthritis.42,43 These studies align with the outcomes of the present study, which revealed an association between low SES and increased pain and disability after 24 weeks of treatment in individuals with AT as measured with the VISA-A questionnaire. Clinical implications The present study has demonstrated that AT patients belonging to low socioeconomic status may experience inferior treatment outcomes compared to AT patients with higher SES when treated according to current guidelines. This observation has important clinical implications that require careful consideration by healthcare providers. Specifically, healthcare providers should be mindful of the SES of their patients while administering treatment. A potential reason for the lower treatment effect in people with lower SES is a lack of understanding of their condition and suggested treatment and trust in their physician,44 which may be addressed through improved patient education. Patient education has emerged as an important factor for improving treatment outcomes in general45,46, and also plays a crucial role in improving treatment outcomes through knowledge gain in AT patients.47 Patients belonging to lower SES groups may possess limited health literacy, which could impede their understanding of treatment recommendations and hinder their ability to adhere to the prescribed treatment plan.9,48 Recognizing this, healthcare providers must take a proactive approach in providing comprehensive education and support to AT patients with lower SES. By ensuring that these patients possess a clear understanding of their treatment plan and the necessary steps required to achieve the best possible outcome, healthcare providers can empower them to actively participate in their own care. In addition, it is crucial to recognize that individuals from lower SES groups often face multiple barriers in accessing healthcare services, such as access to physiotherapy or consultations with medical specialists.8,49 Financial constraints and lack of insurance coverage can hinder their ability to seek and afford the recommended treatment.7,8,49 Variations in physical activity engagement and adherence to exercise therapy could also affect AT recovery. Notably, in our study, the disparity between high and low SES groups primarily emerged between 12 and 24 weeks. This timing may reflect the challenges lower SES groups face in accessing continued physiotherapy support due to potential increased costs associated with prolonged rehabilitation. Consequently, healthcare providers may need to offer additional support to assist patients with lower SES in accessing affordable healthcare resources.
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