Patient Enablement Moderates the Effect of Pain on Health-related Quality of Life of Primary Care Patients with Chronic Back and Knee Problems-a cross-sectional study

Abstract

<p>Purpose: To determine whether enablement was a moderator of the effect of chronic back and knee pain on health-related quality of life (HRQOL). <br></p><p>Methods: This was a cross-sectional study of 1319 Chinese primary care patients with chronic back and knee problems who completed the Chinese Patient Enablement Instrument-2 (PEI-2), the Chinese Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the Pain Rating Scale (PRS). Multivariable regression examined the effect of disease characteristics, PRS score and PEI-2 score on WOMAC total score. Moderation was evaluated by whether the interaction between enablement (PEI-2 score) and pain (PRS score) had a significant effect on HRQOL (WOMAC total score) in the moderation regression model and by simple slope analysis. <br></p><p>Results: Valid data from 1306 participants were analyzed. PRS score was associated with WOMAC total score (β = 0.326, p<0.001), while PEI-2 score was associated inversely (β = -0.260, p<0.001). There was an inverse relationship between PRS and PEI-2 scores. The effect of the interaction between PRS and PEI-2 (PRS*PEI-2) scores on the WOMAC total score was significant (β = -0.191, p<0.001) suggesting PEI-2 was a moderator. Simple slope analyses showed 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).<br></p><p>Conclusions: 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.<br></p>