Results of a survey of client satisfaction with outpatient physiotherapy care

Patients Satisfied with Care Report Better Quality of Life and Self-Rated Health-Cross-Sectional Findings Based on Hospital Quality Data

BACKGROUND

Satisfaction with care is an important indicator of health care quality. However, if this process measure is associated with patients' outcomes in real-world data is largely unknown. We, therefore, aimed to evaluate if satisfaction with physician- and nurse-related care is associated with quality of life and self-rated health among inpatients at the University Hospital Hamburg-Eppendorf in Germany.

METHOD

We used standard hospital quality survey data of 4925 patients treated at various departments. We used multiple linear regressions to examine an association between satisfaction with staff-related care and quality of life as well as self-rated health, adjusted for age, gender, mother tongue, and treating ward. Patients rated their satisfaction with physician- and nurse-related care from 0 "not at all" to 9 "very much". The outcomes regarding quality of life and self-rated health were evaluated on five-point Likert scales ranking from 1 "bad" to 5 "excellent".

RESULTS

We found that satisfaction with physician-related care was positively associated with quality of life (ß = 0.16; p < 0.001) as well as with self-rated health (ß = 0.16; p < 0.001). Similar findings were observed for satisfaction with nurse-related care and the two outcomes (ß = 0.13; p < 0.001 and ß = 0.14; p < 0.001, respectively).

CONCLUSION

We show that patients who are more satisfied with staff-related care report better quality of life and self-rated health than patients less satisfied with care. Thus, patient satisfaction with care, is not only a process measure indicating the quality of care but is also positively associated with patient-reported outcomes.

The Impact of COVID-19 on the Prevalence and Perception of Telehealth Use in the Middle East and North Africa Region: Survey Study

BACKGROUND

Due to the COVID-19 pandemic, telehealth has become a safer way to access health care. The telehealth industry has rapidly expanded over the last decade as a modality to provide patient-centered care. However, the prevalence of its use and patient acceptability remains unclear in the Middle East and North Africa (MENA) region.

OBJECTIVE

The primary aim was to assess the prevalence of telehealth use before and during the pandemic by using social media (Instagram) as an online platform for survey administration across different countries simultaneously. Our secondary aim was to assess the perceptions regarding telehealth among those using it.

METHODS

An Instagram account that reaches 130,000 subjects daily was used to administer a questionnaire that assessed the current prevalence of telehealth use and public attitudes and acceptability toward this modality of health care delivery during the COVID-19 pandemic.

RESULTS

A total of 1524 respondents participated in the survey (n=1356, 89% female; median age 31 years), of whom 97.6% (n=1487) lived in the Gulf Cooperation Council (GCC) region. Prior to COVID-19, 1350 (88.6%) had no exposure to telehealth. Following the COVID-19 pandemic, telehealth use increased by 251% to a total of 611 users (40% of all users). About 89% (571/640) of telehealth users used virtual visits for specialist visits. Of the 642 participants who reported using telehealth, 236 (36.8%) reported their willingness to continue using telehealth, 241 (37.5%) were unsure, and 164 (25.5%) did not wish to continue to use telehealth after the COVID-19 pandemic. An inverse trend, although not statistically significant, was seen between willingness to continue telehealth use and the number of medical comorbidities (odds ratio [OR] 0.81, 95% CI 0.64-1.03; P=.09). Compared to the respondents who chose only messaging as the modality they used for telehealth, respondents who chose both messaging and phone calls were significantly less likely to recommend telehealth (OR 0.42, 95% CI 0.22-0.80; P=.009). Overall, there was general satisfaction with telehealth, and respondents reported that telehealth consultations made them feel safer and saved both time and money.

CONCLUSIONS

Telehealth use increased dramatically after the COVID-19 pandemic, and telehealth was found to be acceptable among some young adult groups on Instagram. However, further innovation is warranted to increase acceptability and willingness to continue telehealth use for the delivery of health care.

Patient Satisfaction With Physiotherapy Services in Libya: A Cross-Sectional Study

Patient satisfaction (PS) is an essential indicator of the quality of physiotherapy services. However, regarding Libya, there has been a dearth of research on PS. This cross-sectional study aimed to measure PS with outpatient physiotherapy services and to examine the sociodemographic factors that influence the levels of satisfaction in Libya. Patient satisfaction with physiotherapy services was assessed using a reliable, valid, and structured questionnaire. Data were collected from 501 patients, and the participants’ ages ranged from 18 to 79 (mean ± standard deviation = 47.19 ± 12.8), with more females (n = 312) than males (n = 189). Participants were satisfied or very satisfied with the physiotherapy they received in the domains that measure PS. The highest percentage of satisfaction was in the physiotherapists’ attributes and ability to provide detailed explanations to their patients. Patient satisfaction was also associated with gender and occupation, with females and unemployed patients reporting higher satisfaction rates. This highlights the value of surveys administered to patients during treatments, as well as the value of strategies to address the influential factors for the improvement of PS in public physiotherapy clinics in Libya.

Content Validity of Patient-Reported Outcome Measures of Satisfaction With Primary Care for Musculoskeletal Complaints: A Systematic Review

OBJECTIVE

To evaluate the content validity of patient-reported outcome measures (PROMs) used to assess satisfaction in patients with musculoskeletal complaints who are treated in primary care.

DESIGN

Systematic review of clinimetric measurement.

LITERATURE SEARCH

A literature search in MEDLINE, Embase, and CINAHL was undertaken (up to January 2020) to identify studies of the development or evaluation of content validity of a PROM that aimed to assess patient satisfaction.

STUDY SELECTION CRITERIA

A PROM was considered eligible if it aimed to measure satisfaction with care in patients with musculoskeletal complaints. Two independent reviewers performed study selection, quality assessment, and data extraction.

DATA SYNTHESIS

Evaluation of content validity of the included PROMs was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance, which includes an evaluation of PROM development, content validity studies, PROM content, and quality of evidence using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

Seven PROMs were identified. Their quality of development was inadequate. No studies evaluating the content validity of the satisfaction PROMs were retrieved. The content validity of the patient satisfaction PROMs was insufficient and supported by very low- quality evidence.

CONCLUSION

In measuring satisfaction among patients with musculoskeletal complaints treated in primary care, none of the identified PROMs had adequate content validity. Future studies should address the relevance, comprehensiveness, and comprehensibility of PROMs used to measure patient satisfaction and emphasize patient involvement during the development of new instruments. J Orthop Sports Phys Ther 2021;51(3):94-102. Epub 12 Nov 2020. doi:10.2519/jospt.2021.9788.

Construction, Factor Structure, and Internal Consistency Reliability of the Hospital Physical Therapy Perceived Satisfaction Questionnaire (H-PTPS)

Patient satisfaction is a crucial aspect in the evaluation of the quality of health care provided by health services and units, especially in patients that require physical rehabilitation. This study aims to design and analyze the factor structure and internal consistency reliability of the Hospital Physical Therapy Perceived Satisfaction Questionnaire (H-PTPS) measuring the level of physical therapy patient satisfaction in hospital rehabilitation services. This study has a multicenter cross-sectional survey design. This study used the structural validity and internal consistency domains from COSMIN (consensus-based standards for the selection of health status measurement instruments) guideline. The H-PTPS questionnaire consists of 20 closed questions. A sample of 384 adult patients from physical therapy units from three Spanish public hospitals completed this questionnaire. A factor structure and internal consistency reliability analysis were performed. The factor analysis including the 20 items of the H-PTPS showed an adequacy index of 0.922 according to the Kaiser–Meyer–Olkin measure and the Barlett test allowed us to reject the null hypothesis (p < 0.001). In the rotated component matrix, four specific factors were obtained, explaining 66.75% of the accumulated variance. All factors present satisfactory internal reliability, achieving Cronbach’s alpha indices and Omega coefficients higher than 0.74. The H-PTPS questionnaire has shown a four-factor solution with satisfactory reliability evaluating the satisfaction of Spanish patients treated in physical therapy units in the hospital rehabilitation services.

Patient satisfaction: Concept analysis in the healthcare context

OBJECTIVE

Patient satisfaction had been the focus of many scientific studies worldwide. However, very few studies published had addressed the definition of the concept of patient satisfaction. Therefore this present concept analysis is to explore the attributes of the concept in the broader healthcare context.

METHODS

The Rodgers method, an inductive method of concept analysis, was selected to guide this concept analysis.

RESULTS

The attributes of patient satisfaction in the healthcare context identified were provider attitude, technical competence, accessibility, and efficacy. Perception in relation to expectation, patient demographics and personality, and market competition were regarded as prerequisites of patient satisfaction. Consequences of patient satisfaction identified in this analysis were: patient compliance, clinical outcomes, loyalty and referrals.

CONCLUSION

As healthcare is becoming an increasingly competitive marketplace, studying patient experience could certainly help practitioners to better encompass patient perspectives in service delivery and improve patient satisfaction.

PRACTICE IMPLICATIONS

To ensure the validity of patient satisfaction measurement and subsequently improve healthcare quality, practitioners should involve patients in identifying important factors relevant to each attributes of patient satisfaction.

Factors Influencing the Overall Satisfaction in Patients With Severe Brain Injury With Physiotherapy Services During Inpatient Rehabilitation

OBJECTIVE

To determine what influences the satisfaction of rehabilitation inpatients and their relatives with physiotherapy after severe traumatic brain injury.

DESIGN

A prospective purpose-designed survey of consecutive eligible patients discharged from a metropolitan brain injury unit.

PARTICIPANTS

A total of 65 patients with severe traumatic brain injury and 32 relatives.

RESULTS

The vast majority of patients (99%) and relatives (97%) reported being "satisfied" or "highly satisfied" with the service. Patients' overall satisfaction was influenced by the extent of actual and perceived improvement, satisfaction with certain aspects of service delivery, and quality of interaction with physiotherapy staff. Satisfaction with the amount of therapy was the key determinant for patients' overall satisfaction, whereas relatives' overall satisfaction was influenced primarily by how well they felt they were listened to by physiotherapy staff.

CONCLUSION

The high satisfaction of the patients and relatives suggests that our brain injury unit provides physiotherapy that meets their expectations. Promoting recovery, providing high-quality care, and ensuring good interaction are ways to maintain high satisfaction of patients and relatives with the service. In addition, staff may have to pay particular attention to patients' satisfaction with the amount of therapy and ensure that relatives' needs are listened to.

Erognomic education on housework for women with upper limb repetitive strain injury (RSI): a conceptual representation of therapists' clinical reasoning

BACKGROUND

Ergonomic education in housework that aims to facilitate behavior change is important for women with upper limb repetitive strain injury. Therapists usually conduct such programs based on implicit reasoning. Making this reasoning explicit is important in contributing to the profession's knowledge.

AIM

To construct a conceptual representation of how occupational therapists make clinical decisions for such program.

METHOD

Based on a constructivist-grounded theory methodology, data were collected through in-depth interviewing with 14 occupational therapists from a major hospital in Singapore. Interviews were audiotaped and transcribed. Data was analyzed with line by line, focused and axial coding with constant data comparison throughout data collection.

RESULTS

Therapists made clinical decisions based on their perceptions of their clients' behavior change in three stages: (i) listen; (ii) try; and (iii) persevere, bearing significant similarities to the transtheoretical theory of change. The study also showed that therapists may not have considered the full range of meanings that their clients attach to housework when interacting with them, a gap that needs to be addressed.

CONCLUSIONS

The present study indicates the importance of therapists' understanding of the meanings that their clients attach to housework. Further research needs to address how to achieve this in a time-pressured clinical environment. Implications for Rehabilitation This study used qualitative research to demonstrate the process of translating therapists' tacit knowledge into an explicit form. It elucidates the following major implications for practice when therapists conduct ergonomic education to facilitate behavior change in housework for female homemakers with upper limb RSI:The conceptual framework of clinical reasoning constructed from the results can be used to increase therapists' awareness of how they make clinical decisions during an intervention. This framework can also be used for training new therapists. It is important for therapists to actively listen to their clients. Active listening will enable the therapists to understand and consider the personal meanings that these women attach to housework in order to facilitate a behavior change. Client-therapist interactions to facilitate clients' willingness to change should become a major focus in such a program. Similar research should be conducted in other clinical areas to develop explicit clinical reasoning frameworks to facilitate learning of novice therapists and reflection of experienced therapists to address any gap in their clinical reasoning.

The acceptability to patients of PhysioDirect telephone assessment and advice services; a qualitative interview study

BACKGROUND

In response to long waiting lists and problems with access to primary care physiotherapy, several Primary Care Trusts (PCTs) (now Clinical Commissioning Groups CCGs) developed physiotherapy-led telephone assessment and treatment services. The Medical Research Council (MRC) funded PhysioDirect trial was a randomised control trial (RCT) in four PCTs, with a total of 2252 patients that compared this approach with usual physiotherapy care. This nested qualitative study aimed to explore the acceptability of the PhysioDirect telephone assessment and advice service to patients with musculoskeletal conditions.

METHODS

We conducted 57 semi-structured interviews with adults from 4 PCTs who were referred from general practice to physiotherapy with musculoskeletal conditions and were participating in the PhysioDirect trial. The Framework method was used to analyse the qualitative data.

RESULTS

The PhysioDirect service was largely viewed as acceptable although some saw it as a first step to subsequent face-to-face physiotherapy. Most participants found accessing the PhysioDirect service straightforward and smooth, and they valued the faster access to physiotherapy advice offered by the telephone service. Participants generally viewed both the PhysioDirect service and the physiotherapists providing the service as helpful. Participants' preferences and priorities for treatment defined the acceptable features of PhysioDirect but the acceptable features were traded off against less acceptable features. Some participants felt that the PhysioDirect service was impersonal and impaired the development of a good relationship with their physiotherapist, which made the service feel remote and less valuable.

CONCLUSION

The PhysioDirect service was broadly acceptable to participants since it provided faster access to physiotherapy advice for their musculoskeletal conditions. Participants felt that it is best placed as one method of accessing physiotherapy services, in addition to, rather than as a replacement for, more traditional face-to-face physiotherapy assessment and treatment.

Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study

OBJECTIVE

To identify elements of the physiotherapist-patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings.

DESIGN

A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach.

SETTING

Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain).

PARTICIPANTS

Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries.

RESULTS

Patients based their evaluations of quality of care on their assessment of physiotherapists' willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist-patient interaction emerged under all these themes, except for friendly and respectful communication.

CONCLUSION

This study identified which elements of the physiotherapist-patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients' experiences of the physiotherapist-patient interaction in rehabilitation services to provide empirical and quantitative evidence.

Conversion rates and perceived barriers to referral: views of extended scope physiotherapists in the primary care setting

AIMS

A questionnaire survey of primary care musculoskeletal extended-scope physiotherapists (ESPs) was undertaken to determine information about their conversion rates and referral barriers, with regard to radiological and consultant referrals.

METHOD

A sample of 200 musculoskeletal ESPs classified as having a speciality in orthopaedics and working in primary care were recruited via the 'ESP Professional Network'.

RESULTS

A total of 100 (50%) responses were received. Forty-seven per cent of primary care ESPs indicated that they recorded their conversion rates, but only 31 participants submitted conversion rate data. Overall, the average conversion rate for all participants was 74% (range 30-95%). Forty-three per cent of respondents identified that they had experienced barriers when referring for radiological investigations and 38% that they experienced barriers when referring patients to secondary care for a consultant opinion. Commissioning barriers such as poorly commissioned care pathways were the most common theme in both areas. Fifty per cent of respondents identified that they used a referral criteria when referring patients to secondary care. Commonly, these criteria had been developed in conjunction with secondary care consultants or commissioners.

CONCLUSION

ESPs in primary care have reported similar conversion rates to those working in secondary care. There is a need for further empirical conversion rate studies in primary care to validate these self-reported findings and to enable ESPs to demonstrate clinical efficiency and benchmark their performance.