Impact of chronic Achilles tendinopathy on health-related quality of life, work performance, healthcare utilisation and costs

Tjerk S O Sleeswijk Visser, Arco C van der Vlist, Robert F van Oosterom, Peter van Veldhoven, Jan A N Verhaar, Robert-Jan de Vos, Tjerk S O Sleeswijk Visser, Arco C van der Vlist, Robert F van Oosterom, Peter van Veldhoven, Jan A N Verhaar, Robert-Jan de Vos

Abstract

Objectives: To evaluate the impact of Achilles tendinopathy (AT) on quality of life (QoL), work performance, healthcare utilisation and costs in adults with conservatively treated chronic midportion AT.

Methods: This cross-sectional survey-based study included 80 patients and took place in a sports medicine department of a large regional hospital in the Netherlands. Data were collected before any intervention was given. Primary outcome was the EuroQol questionnaire (EQ-5D). The EQ-5D expresses the percentage of moderate/major problems on the domains self-care, anxiety/depression, mobility, usual activities and pain/discomfort. Secondary outcomes were the number of previous healthcare visits, work performance during the period of symptoms and estimated annual direct medical and indirect costs per patient as a result of AT.

Results: All 80 patients completed the questionnaires. The EQ-5D scores were low for the domains self-care (1%) and anxiety/depression (20%), and high for the domains mobility (66%), usual activities (50%) and pain/discomfort (89%). Patients with AT mainly reported an impact on work productivity (38%). Work absenteeism due to AT was present in 9%. The total median (IQR) number of annual healthcare visits was 9 (3-11). The total mean (SD) estimated annual costs were €840 (1420) per patient with AT (mean (SD) US$991 (1675)).

Conclusions: This study shows the large impact of AT on QoL and work productivity. This study also provides new information about the socioeconomic impact of AT, which emphasises that this common and longstanding disease causes substantial costs. These findings stress the need for optimised treatment and improved preventive interventions for AT.

Trial registration number: NCT02996409.

Keywords: Achilles; economics; quality of life; sociology; tendinosis.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
The EQ-5D scores for persons with musculoskeletal diseases per domain. DMC3 study. Displayed values are percent with any (moderate and severe) problems (SE). EQ-5D: EuroQoL five-item questionnaire for measuring health-related quality of life. General population: EQ-5D score in a large sample of the general population (no target on specific diseases) aged ≥25 years (n=3664), weighted for age and sex in the Dutch population of 1998. DMC3 study, Dutch population-based musculoskeletal complaints and consequences cohort study.

References

    1. d'Hooghe P, Kerkhoffs G. The ankle in football. 1 edn. Springer series Sports and Traumatology, 2014.
    1. Maffulli N, Sharma P, Luscombe KL. Achilles tendinopathy: aetiology and management. J R Soc Med 2004;97:472–6. 10.1177/0141076809701004
    1. Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy 1998;14:840–3. 10.1016/S0749-8063(98)70021-0
    1. Scott A, Squier K, Alfredson H, et al. . Icon 2019: international scientific tendinopathy symposium consensus: clinical terminology. Br J Sports Med 2020;54:260–2. 10.1136/bjsports-2019-100885
    1. de Jonge S, van den Berg C, de Vos RJ, et al. . Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med 2011;45:1026–8. 10.1136/bjsports-2011-090342
    1. van der Vlist AC, Winters M, Weir A, et al. . Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials. Br J Sports Med 2021;55:249–56. 10.1136/bjsports-2019-101872
    1. Lagas I, van Veldhoven P, Weir A. A quarter of patients with midportion Achilles tendinopathy has persisting symptoms after 10 years: a prospective cohort study. Clin Orthop Relat Res 2020.
    1. Johannsen F, Jensen S, Wetke E. 10-year follow-up after standardised treatment for Achilles tendinopathy. BMJ Open Sport Exerc Med 2018;4:e000415. 10.1136/bmjsem-2018-000415
    1. Kujala UM, Sarna S, Kaprio J. Cumulative incidence of Achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med 2005;15:133–5. 10.1097/01.jsm.0000165347.55638.23
    1. Mc Auliffe S, Synott A, Casey H, et al. . Beyond the tendon: experiences and perceptions of people with persistent Achilles tendinopathy. Musculoskelet Sci Pract 2017;29:108–14. 10.1016/j.msksp.2017.03.009
    1. Ceravolo ML, Gaida JE, Keegan RJ. Quality-of-life in Achilles tendinopathy: an exploratory study. Clin J Sport Med 2020;30:495-502. 10.1097/JSM.0000000000000636
    1. Turner J, Malliaras P, Goulis J, et al. . "It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away." A qualitative study exploring individuals' beliefs and experiences of Achilles tendinopathy. PLoS One 2020;15:e0233459. 10.1371/journal.pone.0233459
    1. Crowe M, Whitehead L, Seaton P, et al. . Qualitative meta-synthesis: the experience of chronic pain across conditions. J Adv Nurs 2017;73:1004–16. 10.1111/jan.13174
    1. Beaudart C, Biver E, Bruyère O, et al. . Quality of life assessment in musculo-skeletal health. Aging Clin Exp Res 2018;30:413–8. 10.1007/s40520-017-0794-8
    1. Salaffi F, De Angelis R, Stancati A, et al. . Health-related quality of life in multiple musculoskeletal conditions: a cross-sectional population based epidemiological study. II. The mapping study. Clin Exp Rheumatol 2005;23:829.
    1. Picavet HSJ, Hoeymans N. Health related quality of life in multiple musculoskeletal diseases: SF-36 and EQ-5D in the DMC3 study. Ann Rheum Dis 2004;63:723–9. 10.1136/ard.2003.010769
    1. Cross M, Smith E, Hoy D, et al. . The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014;73:1323–30. 10.1136/annrheumdis-2013-204763
    1. Hunter DJ, Riordan EA. The impact of arthritis on pain and quality of life: an Australian survey. Int J Rheum Dis 2014;17:149–55. 10.1111/1756-185X.12232
    1. van der Vlist AC, van Oosterom RF, van Veldhoven PLJ, et al. . Effectiveness of a high volume injection as treatment for chronic Achilles tendinopathy: randomised controlled trial. BMJ 2020;370:m3027. 10.1136/bmj.m3027
    1. EuroQol Group . EuroQol--a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199–208. 10.1016/0168-8510(90)90421-9
    1. Kind P, Dolan P, Gudex C, et al. . Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ 1998;316:736–41. 10.1136/bmj.316.7133.736
    1. IJzerman MJ. Richtlijn voor Het uitvoeren van economische evaluaties in de gezondheidszorg. In: Door Zorginstituut Nederland. in samenwerking Met Het ministerie van VWS, 2016.
    1. VdLN H-vanRL, Bouwmans C, Kanters T. Methodologie van kostenonderzoek en referentieprijzen voor economische evaluaties in de gezondheidszorg. In: Opdracht van Zorginstituut Nederland, 2015.
    1. Hagberg M, Tornqvist EW, Toomingas A. Self-reported reduced productivity due to musculoskeletal symptoms: associations with workplace and individual factors among white-collar computer users. J Occup Rehabil 2002;12:151–62. 10.1023/A:1016890527520
    1. Filardo G, Kon E, Di Matteo B, et al. . Platelet-rich plasma for the treatment of Patellar tendinopathy: clinical and imaging findings at medium-term follow-up. Int Orthop 2013;37:1583–9. 10.1007/s00264-013-1972-8
    1. Bonde JP, Mikkelsen S, Andersen JH, et al. . Prognosis of shoulder tendonitis in repetitive work: a follow up study in a cohort of Danish industrial and service workers. Occup Environ Med 2003;60:8e–8. 10.1136/oem.60.9.e8
    1. Walker-Bone K, Palmer KT, Reading I, et al. . Occupation and epicondylitis: a population-based study. Rheumatology 2012;51:305–10. 10.1093/rheumatology/ker228
    1. Sérazin C, Ha C, Bodin J, et al. . Employment and occupational outcomes of workers with musculoskeletal pain in a French region. Occup Environ Med 2013;70:143–8. 10.1136/oemed-2012-100685
    1. De Vries AJ, Koolhaas W, Zwerver J, et al. . The impact of Patellar tendinopathy on sports and work performance in active athletes. Res Sports Med 2017;25:253–65. 10.1080/15438627.2017.1314292
    1. van der Worp H, Zwerver J, Kuijer PPFM, et al. . The impact of physically demanding work of basketball and volleyball players on the risk for patellar tendinopathy and on work limitations. J Back Musculoskelet Rehabil 2011;24:49–55. 10.3233/BMR-2011-0274
    1. van den Heuvel SG, Ijmker S, Blatter BM, et al. . Loss of productivity due to neck/shoulder symptoms and hand/arm symptoms: results from the PROMO-study. J Occup Rehabil 2007;17:370–82. 10.1007/s10926-007-9095-y
    1. Martimo K-P, Shiri R, Miranda H, et al. . Self-reported productivity loss among workers with upper extremity disorders. Scand J Work Environ Health 2009;35:301–8. 10.5271/sjweh.1333
    1. Romanelli RJ, Shah SN, Ikeda L, et al. . Patient characteristics and healthcare utilization of a chronic pain population within an integrated healthcare system. Am J Manag Care 2017;23:e50–6.
    1. Sanders TL, Maradit Kremers H, Bryan AJ, et al. . Health care utilization and direct medical costs of tennis elbow: a population-based study. Sports Health 2016;8:355–8. 10.1177/1941738116650389
    1. Hermans J, Koopmanschap MA, Bierma-Zeinstra SMA, et al. . Productivity costs and medical costs among working patients with knee osteoarthritis. Arthritis Care Res 2012;64:853–61. 10.1002/acr.21617
    1. Boonen A, van den Heuvel R, van Tubergen A, et al. . Large differences in cost of illness and wellbeing between patients with fibromyalgia, chronic low back pain, or ankylosing spondylitis. Ann Rheum Dis 2005;64:396–402. 10.1136/ard.2003.019711
    1. Lagas IF, Fokkema T, Verhaar JAN, et al. . Incidence of Achilles tendinopathy and associated risk factors in recreational runners: a large prospective cohort study. J Sci Med Sport 2020;23:448–52. 10.1016/j.jsams.2019.12.013
    1. Kader D, Saxena A, Movin T, et al. . Achilles tendinopathy: some aspects of basic science and clinical management. Br J Sports Med 2002;36:239–49. 10.1136/bjsm.36.4.239
    1. Iversen JV, Bartels EM, Langberg H. The victorian institute of sports assessment - achilles questionnaire (visa-a) - a reliable tool for measuring achilles tendinopathy. Int J Sports Phys Ther 2012;7:76–84.
    1. Halasi T, Kynsburg A, Tállay A, et al. . Development of a new activity score for the evaluation of ankle instability. Am J Sports Med 2004;32:899–908. 10.1177/0363546503262181

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