4 69 Chronic Achilles Tendinopathy: Impact on Quality of Life and Costs INTRODUCTION The term Achilles Tendinopathy (AT) entails the clinical triad of localized Achilles tendon pain, tendon thickening and impaired load-bearing capacity.1-4 AT is frequently observed in middle-aged, physically active people.1 The incidence rate of AT is 2-3 per 1,000 Dutch general practice registered patients and has risen in the past decade, probably as a result of an increasing amount of people performing sports activities.2,5 Various treatment options are available and conservative treatment is the primary treatment of choice, but is not very effective.6 Despite treatment two-thirds of the patients with new-onset AT remain symptomatic at one year follow up.7 At 10-years follow up, still a quarter of the patients remain symptomatic.7,8 The restricting pain and impaired load-bearing capacity associated with AT is assumed to decrease quality of life (QoL).1,4,9 Indeed, recent qualitative studies showed that some patients with AT describe profound impact on their life (e.g. their identity, social activities, and perceived levels of fitness). 10-12 One of these exploratory studies showed that AT is associated with a lower QoL score compared to normative data.11 In this study – however – patients were included online without verifying the diagnosis of AT and the QoL scores were not compared to other musculoskeletal diseases. Additionally, a significant number of patients did not have AT at the time of inclusion, but experienced symptoms suggestive for AT in the past. This could have resulted in recall bias. Other musculoskeletal conditions also affect quality of life13-16, with the magnitude of this impact varying among the conditions.13-18 It is important to be informed about the magnitude of the impact on quality of life of specific diseases to be aware of the urgency on scientific agendas and it also aids in designing management plans when there is knowledge of the specific domains affected. This information is unknown in AT. Knowledge of the impact of AT on work performance, health care utilization and costs is currently also lacking. The primary aim of this study is to evaluate the impact on QoL in conservatively treated patients with chronic midportion AT. The secondary aims are to assess the effect of AT on 1) work performance, 2) health care utilization and 3) estimated direct and indirect costs. We hypothesized the impact and socio-economic consequences of AT on QoL to be similar to other musculoskeletal conditions (such as lateral epicondylar tendinopathy, knee osteoarthritis, rheumatoid arthritis and chronic back pain). METHODS Study design The study was designed at the Erasmus MC University Medical Centre (Rotterdam, the Netherlands) in collaboration with Haaglanden Medical Centre (Leidschendam, The
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