Effectiveness of Routine Measurement of Health-Related Quality of Life (HRQOL) in Improving Patient-reported Outcomes in Primary Care Patients with Chronic Knee and Back Problems – A Cluster Randomised Controlled Trial

Chronic knee and back (knee/back) problems are common, painful, and disabling. Routine health-related quality of life (HRQOL) measurement may enhance doctor-patient communication and person-centred care by identifying unmet biopsychosocial needs, guiding personalized care, and encouraging engagement. We examined whether routine measurement and reporting of HRQOL using the electronic EuroQol 5-Dimension 5-Level (e-EQ-5D-5L) could improve HRQOL in participants allocated to the intervention (IG) or control (CG) groups. Participants were Chinese adult patients with a doctor-diagnosed knee/back problem with a scheduled follow-up visit within 12 months. The IG completed the e-EQ-5D-5L before each consultation at baseline and each scheduled follow-up visit, with reports available to their doctors during consultations. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary outcomes were Patient Enablement Instrument-version 2 (PEI-2), Pain Rating Scale (PRS), and Short-form 6-Dimension (SF-6D) health utility scores and management options. The effects of the intervention on the outcomes were assessed by generalised estimating equations (GEE) with linear function. 1200 participants were randomised to the IG (n = 595) and CG (n = 605). At 12 months, both groups reported higher (worse) WOMAC scores, with a greater increase in the IG than the CG (β = 2.43, p = 0.018). The IG reported higher (better) PEI-2 than the CG (β = 0.99, p = 0.010). There was no difference in PRS and SF-6D scores between groups. The IG received more oral medications, while the CG had more referrals to orthopaedic specialists. Routine measurement of HRQOL by the e-EQ-5D-5L did not improve HRQOL or pain, but was associated with better self-care enablement in primary care patients with chronic knee/back problems. HRQOL data may prompt primary care doctors to offer more conservative treatments before specialist referral, potentially easing the burden on secondary care.