4 79 Chronic Achilles Tendinopathy: Impact on Quality of Life and Costs Strengths and limitations Our study is one of the first studies to evaluate the impact of AT on quality of life, work performance, health care utilization, and estimated direct and indirect costs. To assess the impact of AT on quality of life we used the reliable and validated EQ-5D questionnaire.20 Data was complete for our primary outcome and was retrieved from a homogenous group of clinically-diagnosed AT patients. However, there are some limitations to this study. We asked patients about the duration of their symptoms and applied treatments retrospectively, which could have induced recall bias on these specific items. This may have inaccuracy in collection of these secondary outcome measures. Secondly, loss in work productivity was measured using a binary response option (‘yes’ or ‘no’), the amount of loss of work productivity was not specified. Thirdly, the study population may not be representative of all AT patients. Most patients included in this study had longstanding symptoms (median 63 weeks) and it is likely that patients with short living AT experience less impact on QoL, work performance, and visit less healthcare providers. Another limitation was that the direct costs were mainly based on assumptions of the national mean costs of treatments. The main reason for this is that we did not register accurate data of the profession of the patients. This might have provided a less accurate estimation of the direct costs. Recommendations for future research Our main recommendation for future research is to evaluate the effect of different treatments on quality of life scores in AT patients. This will gain more insight into the impact and effectiveness of different treatments. Secondly, it would be interesting to investigate the cost-effectiveness of different treatments. To better understand the economic impact of AT, future studies could research the specific underlying cause of the decreased work productivity.
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