• Amy Pui Pui Ng, John King Yiu Cheng, Joyce Sau Mei Lam, WongCarlos King HoCKH0000-0002-6895-6071Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong; Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medic, Will Ho Gi Cheng, Emily Tsui Yee Tse, David Vai Kiong Chao, Edmond Pui Hang Choi, Rosa Sze Man Wong, and LamCindy Lo KuenCLK0000-0001-7536-8481Department of Family Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Ho.
• Department of Family Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
• Br J Gen Pract. 2023 Nov 1; 73 (736): e867e875e867-e875.

BackgroundChronic back and knee pain impairs health- related quality of life (HRQoL) and patient enablement can improve HRQoL.AimTo determine whether enablement was a moderator of the effect of chronic back and knee pain on HRQoL.Design And SettingA cross-sectional study of Chinese patients with chronic back and knee problems in public primary care clinics in Hong Kong.MethodEach 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).ResultsValid 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).ConclusionPatient 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.© The Authors.

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