Patient enablement and health-related quality of life for patients with chronic back and knee pain: a cross-sectional study in primary care

• Published in: British journal of general practice Vol. 73; no. 736; pp. e867 - e875
• Main Authors: Ng, Amy Pui Pui, Cheng, John King Yiu, Lam, Joyce Sau Mei, Wong, Carlos King Ho, Cheng, Will Ho Gi, Tse, Emily Tsui Yee, Chao, David Vai Kiong, Choi, Edmond Pui Hang, Wong, Rosa Sze Man, Lam, Cindy Lo Kuen
• Format: Journal Article
• Language: English
• Published: London Royal College of General Practitioners 01-11-2023
• Subjects: Back pain; Cross-sectional studies; Knee; Pain management; Primary care; Quality of life; Regression analysis
• ISSN: 0960-1643; 1478-5242
• DOI: 10.3399/BJGP.2022.0546

Background
Chronic back and knee pain impairs health- related quality of life (HRQoL) and patient enablement can improve HRQoL.
Aim
To determine whether enablement was a moderator of the effect of chronic back and knee pain on HRQoL.
Design and setting
A cross-sectional study of Chinese patients with chronic back and knee problems in public primary care clinics in Hong Kong.
Method
Each participant completed the Chinese Patient Enablement Instrument-2 (PEI-2), the Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Pain Rating Scale (PRS). Multivariable regression examined the effects of PRS score and PEI-2 score on WOMAC total score. A moderation regression model and simple slope analysis were used to evaluate whether the interaction between enablement (PEI-2) and pain (PRS) had a significant effect on HRQoL (WOMAC).
Results
Valid patient-reported outcome data from 1306 participants were analysed. PRS score was associated with WOMAC total score (β = 0.326,
P
<0.001), whereas PEI-2 score was associated inversely with WOMAC total score (β = −0.260,
P
<0.001) and PRS score. The effect of the interaction between PRS and PEI-2 (PRS × PEI-2) scores on WOMAC total score was significant (β = −0.191,
P
<0.001) suggesting PEI-2 was a moderator. Simple slope analyses showed that the relationship between PRS and WOMAC was stronger for participants with a low level of PEI-2 (gradient 3.056) than for those with a high level of PEI-2 (gradient 1.746).
Conclusion
Patient enablement moderated the impact of pain on HRQoL. A higher level of enablement can lessen impairment in HRQoL associated with chronic back and knee pain.