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

Amy Pui Pui NG, John King Yiu CHENG, Joyce Sau Mei LAM, Carlos King Ho WONG, Will Ho Gi CHENG, Emily Tsui Yee TSE, David Vai Kiong CHAO, Edmond Pui Hang CHOI, Rosa Sze Man WONG, Cindy Lo Kuen LAM

Research output: Contribution to journalArticlespeer-review

Abstract

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. Copyright © 2023 The Authors.

Original languageEnglish
Pages (from-to)e867-e875
JournalBritish Journal of General Practice
Volume73
Issue number736
Early online dateOct 2023
DOIs
Publication statusPublished - Nov 2023

Citation

Ng, A. P. P., Cheng, J. K. Y., Lam, J. S. M., Wong, C. K. H., Cheng, W. H. G., Tse, E. T. Y., Chao, D. V. K., Choi, E. P. H., Wong, R. S. M., & Lam, C. L. K. (2023). Patient enablement and health-related quality of life for patients with chronic back and knee pain: A cross-sectional study in primary care. British Journal of General Practice, 73(736), e867-e875. https://doi.org/10.3399/BJGP.2022.0546

Keywords

  • Back pain
  • Chronic pain
  • Knee
  • Health-related quality of life
  • Musculoskeletal pain
  • Primary care

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