The Reliability and Validity of the Physical Therapy Outpatient Satisfaction Survey

12 Pages·2017·0.15 MB·English

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Physical Therapy Faculty Publications Physical Therapy
8-2007
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Susan E. Roush
University of Rhode Island, [email protected]
Cynthia Scott
Margaret Drake
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Scott C, Roush SE, Drake D. (2007). The reliability and validity of the Physical Therapy Outpatient
Satisfaction Survey: A replication study. HPA Journal, 7(2): 1-10.
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a supplement to HPA Resource, Vol.7 No.2
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THE RELIABILITY AND VALIDITY OF THE PHYSICAL
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THERAPY OUTPATIENT SATISFACTION SURVEY: A

& REPLICATION STUDY

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Abstract
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Objective: The study re-examined the validity and reliability of the Physical Therapy
I Outpatient Satisfaction Survey (PTOPS) using a geographically different and larger patient
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population, random sampling, and mail survey methodology. Background: Measurement of
O patient satisfaction in physical therapy is in its infancy. Development and refinement of theory
and measurement methodology are imperative. Replication of reliability and validity is an
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important component of questionnaire development. Design: This study used a methodological
design with descriptive elements. It employed a survey of a random sampling of subjects from
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20 outpatient clinics throughout the Gulf South United States. Method: 2,039 patients 21
years of age or older who lived in Mississippi, Alabama, Florida, and Louisiana were mailed
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the PTOPS questionnaire, yielding 1,175 usable responses and a 60% usable response rate.
L Principal components analysis explored the dimensions of satisfaction, and Cronbach alpha
A scores investigated inter-item reliability. Regression analysis investigated predictive validity.
Results: The construct of four original dimensions found in the PTOPS (Enhancers,
E
Detractors, Costs, Location) remained consistent with this sample and methodology. Cronbach
H alpha scores indicated high levels of inter-item reliability. Regression analysis suggested that
all four dimensions were predictive of overall patient satisfaction. Conclusion: The PTOPS

retained excellent reliability and validity when used in a different locale, with a mail survey
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methodology, and when using retrospective study techniques. [Scott C, Roush S, Drake M.
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The Reliability and Validity of the Physical Therapy Outpatient Satisfaction Survey: A
Replication Study. HPA Resource/HPA Journal 2007; 7(2): J1 – J10.]

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A KEY WORDS: patient satisfaction, physical therapy, survey methodology
N Cynthia Scott, Susan Roush, and Margaret Drake
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A Peer-Reviewed Publication of the Section on Health Policy & Administration
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Measurement of patient satisfaction with services is a long and validity. Replication is an important step in the survey de-
standing concept in health care. Bond and Thomas1 identified velopment process. No validity and reliability tests of the in-
patient satisfaction as the most widely used nonspecific mea- struments used in the studies noted above have been replicated.
sure of health care outcome. In independent reviews of the lit-
erature, Mahon2 and Minick3 identified Abdellah and Levine’s4 Our study was designed to replicate the work of Roush and
study of patient satisfaction with nursing care, which was pub- Sonstroem17 who developed the PTOPS. Using a broader sam-
lished in the late 1950s, as among the earliest studies. Multiple pling frame, random sampling, and a mail survey methodology,
studies in a variety of settings and by numerous professionals we posed three research questions: (1) Do the dimensions of
characterize treatment of the topic over the past fifty years. In a patient satisfaction outlined by Roush and Sonstroem17 remain
series of meta-analyses, Hall and Dornan5-7 identified 221 stud- consistent when using a different patient sample, retrospective
ies of patient satisfaction with medical care. Bond and Thomas data collection techniques, and a mail survey methodology? (2)
summarized 19 studies of patient satisfaction with nursing care Does the PTOPS17 demonstrate acceptable inter-item reliability
in the United Kingdom between 1981 and 1994.1, 8 in this new patient sample? (3) Does the PTOPS17 display con-
current validity with a patient satisfaction index criterion col-
Patient satisfaction studies in physical therapy are less common lected from this new patient sample?
than in other health professions. Many physical therapy clinics
use survey instruments that are self developed and lack validity METHOD
and reliability studies.9 In 1998, Keith10 identified eight studies
Instrumentation
that focus on measuring patient satisfaction in both inpatient As stated above, the instrument used in this study was the
and outpatient rehabilitation populations. In 2002, Scott found Physical Therapy Outpatient Satisfaction Instrument
only eight studies specific to outpatient physical therapy that (PTOPS).17 In addition, we collected basic demographic data
also provided psychometric analysis of the measurement instru- and responses to three new items related to overall satisfaction.
ment.11,12 Physical therapists are still in the early stages of un- These new items addressed intent to return, intent to recom-
derstanding the ways in which patient satisfaction manifests mend, and overall satisfaction with services.
itself. We believe that physical therapists, as integral players in
the health care arena, should seek accurate input from patients The PTOPS instrument consists of thirty-four items that mea-
in order to gain and maintain credibility in an increasingly sure four dimensions of satisfaction. Each item is rated by the
competitive market. patient using a 5-point Likert-type scale anchored by Strongly
Agree and Strongly Disagree. Using factor analysis, Roush and
The eight studies identified by Scott that focus specifically on Sonstroem17 identified four dimensions of patient satisfaction:
outpatient physical therapy13-20 are summarized in Table 1. Enhancers, Detractors, Cost, and Location. These factors ac-
These studies demonstrate considerable diversity of construct counted for 46.7% of the variability in response.17 The authors
and method. When compared to studies with other health care defined Enhancers as factors that add value above and beyond
practitioners, those instruments reporting reliability and valid- basic satisfaction with therapy services, while Detractors were
ity predominantly used convenience sampling strategies with a defined as basic expectations that may lead to disappointment
variety of constructs. With the exception of two studies,16,19 in the encounter if they were not met. The Cost factor ad-
sample sizes were modest at best. The need exists for further dressed the ease of paying for services, and the Location factor
development and refinement of both theoretical construct and focused on the ease of getting to and from the clinic setting.
measurement methodology of a patient satisfaction instrument
used in outpatient physical therapy practice. A three-stage development model, each with its own sample,
was used in the Roush and Sonstroem17 study. Their subjects
Precision by replication is defined as “the stability of psycho- included three separate samples of 177, 257, and 173 outpa-
metric estimates for instrument reliability and validity over tients from 21 different outpatient facilities. All facilities were
multiple studies”.21(p 170) This concept is particularly applicable located in the southeastern New England area, and subjects
to survey research where instrument testing occurs in field con- were asked to complete the PTOPS at point of service before
ditions that may limit testing and interpretation of reliability leaving the clinic at the close of treatment.
CScott, PT, PhD, MBA is Professor of Physical Therapy at the University of Mississippi Medical Center School of Health Related
Professions in Jackson, MS. Address all correspondence to Dr Scott at [email protected].
SRoush, PT, PhD is Associate Professor and Associate Dean of Physical Therapy at the University of Rhode Island in Kingston, RI.
MDrake, OTR, PhD is retired Professor of Occupational Therapy at the University of Mississippi Medical Center in Jackson, MS.
This study was approved by the Institutional Review Board at the University of Mississippi Medical Center.
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While the Roush and Sonstroem17 study was methodologically lored Design Methodology27, 28 to enhance the number of sur-
sound, its sampling frame included a small geographic area, veys returned. Use of this method, which is based on social ex-
and they used a convenience sample of outpatient physical change theory, has garnered average response rates between
therapy clients. Thus, generalization to other geographic areas fifty and eighty-five percent.29, 30 Social exchange theory is
is compromised. In addition, they made little effort to question based on increasing rewards for responding, decreasing the
non-participants, some of whom may have been dissatisfied costs of responding, and encouraging trust on the part of the
with services. It is possible that those who were disenchanted participants. In this study, the methodology was accomplished
with physical therapy services may have had a different con- by personalizing all communications, minimizing numbers of
struct for expressing their opinions. Finally, the Roush and survey items, and sending the survey out from a reputable
Sonstroem17 study used a concurrent survey with direct inter- source.27,28 Also, in accordance with this methodology, up to
view of patients actively participating in treatment. Research five contacts with each participant were made. An introductory
shows that direct interview methods at point of service may letter was sent initially, with the survey, cover letter, and pre-
result in positive response bias.22-24 Our study was designed to paid return envelope mailed approximately one week later. One
address these limitations by enlarging the sampling frame, ran- week after the survey was mailed, a follow-up post card was
domly selecting the participants, surveying patients many days sent encouraging participation. Three weeks after the initial
after their therapy sessions had been completed, and using survey was mailed, a second copy of the survey was sent to
multiple follow-up techniques for non-respondents. In addition, those who had not responded. This was followed a week later
we added 3 new items to examine concurrent validity. These by a phone call to encourage response. In addition, a small in-
items included intent to return for further services, intent to centive, a post-it note® pad with physical therapy insignia, was
recommend to others, and an overall satisfaction rating. All of mailed in the initial survey packet. Participants were informed
these items were rated on a five-point Likert-type scale, with in the cover letter that return of the questionnaire constituted
choices ranging from Excellent to Poor. All three items are consent for participation.
widely used as overall satisfaction survey items, and, in a pilot
study that preceded the current study, had demonstrated high Data Analysis
correlation with the PTOPS factor scores and with each other. Like the Roush and Sonstroem17 study, principal components
analysis was used to explore the dimensions of patient satisfac-
Participants tion in our sample. This type of factor analysis is used to iden-
Using a cluster sampling technique, twenty outpatient clinics tify underlying, unobservable relationships between a group of
were recruited from a randomized list of clinics participating variables.31 For purposes of replication, a confirmatory factor
in the clinical education program at a physical therapist educa- analysis using an a priori criterion of four factors was the first
tional program. Clinics were randomized by state to insure ad- analysis employed.31 This is consistent with the four factors
equate geographic distribution. Only adult outpatient clinics demonstrated in the Roush and Sonstroem17 study. However,
located in the Gulf South region of the United States (MS, AL, the criterion for inclusion of a factor based on factor loading
LA, FL) were used for purposes of this study. A list of up to scores was lowered from 0.4 to a 0.3 or greater factor loading.
125 randomly selected patients was obtained from each clinic. This lower criterion is considered an appropriate significance
To participate in this study, patients had to be 21 years of age level for sample sizes numbering 350 or greater, or those with
or older and discharged (or became inactive) within the past 90 a large number of individual items.31 Items that loaded on more
days. In consultation with the principal investigator, each than one factor were allocated to the factor with the larger
clinic also selected patients randomly who met the criteria. In loading value. Similar to Roush and Sontroem,17 we used Ob-
many instances, the sample included all of the patients seen by lique rotation methods for final factor analysis. This type of
a clinic within the designated time period. analysis is recommended for developing theoretically meaning-
ful constructs. It is accomplished by rotating factor scores
The participating clinics were provided with extensive patient about a non-rigid axis to determine more meaningful factor
privacy procedures during the recruitment phase. These proce- relationships.31 After completing the a priori analysis, an ex-
dures included coding the surveys with unique identifiers to ploratory analysis was performed to identify alternate factor
protect personal information and destroying all contact infor- structures that may have additional explanatory value in this
mation at the conclusion of data collection. Data collection was sample. An exploratory analysis does not specify the number of
complete by June 2002, prior to the October 2002 deadline for factors to be extracted.
implementation of patient privacy standards under the Health
Insurance Privacy and Accountability Act of 1996 (Public Law Cronbach alpha inter-item reliability coefficients were calcu-
104-191).25 lated to examine the internal reliability properties of the instru-
ment. This type of reliability analysis is derived from the aver-
Procedure age correlations of the items on the scale. Scores range from 0
All participants received the PTOPS survey in the mail. Since to 1, with higher scores indicating higher reliability.31
mail surveys are often plagued with low response rates, which
has implications for sampling error and may result in question- Finally, ordinal logistic regression was used to compare factor
able validity of the study,26 we used elements of Dillman’s Tai- scores with an overall patient satisfaction index. This outcome
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h h h h
Reliability Analysis None ChronbacAlpha ChronbacAlpha None ChronbacAlpha ChronbacAlpha
s
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ysis sis sis sis Anal sis sis
alidity Anal actor Analy actor Analy actor Analy egression actor Analy actor Analy
V F F F R F F
10,11y Scott Significant Dimensions Cost Expectations Exposure Art of care Quality of care Perceived empathy Information giving Competence Information x gender Information x importance Date of onset x empathy Personal attention Continuity of care Clinician knowledge Amount of patient input Enhancers Detractors Location Cost Unidimensional construct
b
ed e
hometric Data as IdentifiDimensions Studied Accessibility Scheduling Miles traveled Transportation expense Waiting times Art of care Technical competence Effectiveness of care Art of care Quality of care Cognitive Affective Behavioral Overall satisfaction Therapist interaction Center operations Facility Billing Provider conduct Accessibility/conveniencCost Physical environment Expectations Treatment Privacy Convenience
c
y
s
h P ce ce ce
Studies witSample Strategy Purposive Convenien Not stated Random Convenien Convenien
n
atisfactioSample Size 151 81 160 19,835 177 257 173 289
S
Therapy Patient Patient population Occupational and Physical therapy patients Multiple sclerosis physical therapy and occupational therapy patients Physical therapy sports medicine patients Orthopedic physical therapy patients Physical therapy patients Orthopedic Physical therapy
cal e 8 5 5 7 9 0
hysiDat 198 199 199 199 199 200
P
e 1. Outpatient Author Winter and 13 Keith 14 Roush Taylor and 15 May Elliot-Burke and 16 Pothast Roush and 17 Sonstroem Goldstein and 18 Guccione
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Personal asSystem aspConvenienc Treatment sAdmission subscale Logistic sub he Roush and So 17and Sontroem 607 9.4 (Mean) 18-87 36 64 60.2 36.4 3.5
Cost Billing Ease of scheduling Scheduling Wait time Courteous staff Courteous therapist Overall satisfaction Personal aspects System aspects 24 individual items ata as Compared to t nt Study Roush 1175 5(Median) 421-86 35.4 64.6 83.2 9.6 7.1
D e 5
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Not stated Convenien emograp %) eletal scular
ant D ory (uloskromu
patients 1868 Occupation related physical therapy conditions Physical 528 Therapy patients Table 2. Particip Variable N Age Mean/Median Range Sex (%)Male Female Diagnostic CategOrthopedic/MuscNeurological/NeuOther
2 2
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able 1. conti Beattie and 19 Pinto Monin and 20 Perneger
T

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variable, developed by the authors, was a summed score of Next, an explanatory analysis was completed in which no a
three commonly used overall patient satisfaction measures: priori factors were specified. The initial solution revealed six
overall satisfaction, intent to return, and intent to recommend. factors with eigenvalues of 1.0 or greater, a standard criteria
The range of scores for each measure was 1 to 5, so the maxi- for retaining factors.31 Most of the variance (51%) is explained
mum range of the summed scores of the three measures would in the initial 4 factors, with only minor additional explanation
be between 3 and 15. Collected along with the PTOPS vari- in the remaining 2 factors. Based on this information, addi-
ables, these three outcome variables were found to be highly tional a priori analyses of three-factor and five-factor solutions
correlated and therefore suitable for use as an index. Once the were pursued.
summed scores were derived, the sample was then divided into
three categories of patients: those who rated their clinic as ex- The three-factor solution was based on the criterion to disre-
cellent or very good (summed score of 13-15), those who rated gard any factors that contributed less than 5% of the variance
their clinic as good (summed score of 9-12), and those who of the model.31 Although this solution explained less variance
rated their satisfaction levels as fair or poor (summed score of than the four-factor model (46.1%), it was thought to be more
8 or less). These divisions were relevant to the data distribution conceptually sound because all of the items measuring profes-
and intuitive in nature. All calculations were performed using sional behavior loaded on to the first factor, accounting for
version 10.1 Statistical Package for the Social Sciences.* 32.1% of the variance. The location and cost factors remained
intact. This model is conceptually more consistent with previ-
RESULTS ous literature, in which professional demeanor plays a large
role in satisfaction with nurse and physician services.33, 34
Participants
The randomized sample included 2,039 names and addresses
to which surveys were mailed. Of these, 91 were returned by The five-factor solution was also found to be adequate because
the postal service with wrong addresses, leaving 1,948 total all items loaded on one of the five factors. It was remarkably
participants receiving the questionnaire. Of those asked to par- similar to the four-factor solution, except that three items re-
ticipate, 1,199 returned the survey, resulting in a 62% total re- lated to quietness, crowdedness, and parking loaded into a
turn rate. During the data recording stage, 24 surveys were dis- separate factor. These items were previously included in the
carded because less than two thirds of the questions were an- Enhancers or Detractors factor, but had little to do with pro-
swered. The final sample size included 1,175 respondents for a vider conduct. Again, the categories were conceptually clearer
60% usable response rate. in this model, with professional behaviors aligning with En-
hancers and Detractors, and adding a separate category related
The typical respondent was Caucasian (79.8%), married to facility amenities. This model explained 54% of the total
(65.5%), and had completed 12.8 years of education. A com- variance of the data.
parison of demographic characteristics with those of the Roush
and Sonstroem17 study appears in Table 2. Remarkable simi- Inter-Item Reliability
larities occurred in the age and sex categories. Diagnostic cat- In order to assess the inter-item reliability of the PTOPS di-
egories displayed only moderate congruity between the two mensions, Cronbach alpha statistics were calculated for the
studies. four-factor confirmatory solution. The coefficients for the four-
factor model were .80, .85, .89, and .89, all exceeding the stan-
dard guideline that coefficients greater than 0.70 constitute ad-
Construct Validity
Confirmatory factor analysis results, using the a priori criteria equate reliability.31 The coefficients for the three-factor explor-
of four factors, are found in Table 3. The fundamental factor atory model were .80, .85, and .88, not quite as high as the
structure found in Roush and Sonstroem’s original study17 ap- four-factor model. The five-factor exploratory model, on the
pears to hold true in our patient population. However, two mi- other hand, was abandoned since some of its factors had
nor departures are apparent in the structure. Notable is item Cronbach alpha scores below .70. These results led us to con-
#16, “I had to wait too long between appointments,” that ap- clude that the four-factor model was the superior model.
peared as an Enhancer in the original study, but loaded in the
Detractor category in this study. In addition, item #33, “My Predictive/Criterion Validity
therapist should have listened more carefully to what I told Once the four-factor structure was validated and found to have
him/her,” switched from the Detractor to the Enhancer dimen- the best inter-item reliability, the factor scores from each of the
sion. Our four-factor model explained 51% of the total variance factors were entered into an ordinal logistic regression equa-
in the data, a modest, but adequate amount.31,32 The Detractors tion to determine whether they were predictive of an ordinal
dimension was most explanatory, accounting for 32% of the outcome “Overall Satisfaction Index.” Ordinal logistic regres-
variability in the data, followed by Location (7.9%), Cost sion analysis revealed that all four dimension factor scores con-
(6.2%), and Enhancers (4.9%) . tributed significantly to the model, with an overall R2 value of
0.47. This result indicates that the four-factor scores predict
*SPSS, Inc. 444 North Michigan Avenue, Chicago, IL 60611
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approximately 47% of the variability in the overall satisfaction We found that the Detractors dimension explained the most
index, which is considered adequate explanatory value in re- variability in this data set, which suggests that patients’ views
gression models.35 Odds ratio calculations from the regression are more affected by negative therapist behaviors than all other
analysis indicated that individuals who had high factor scores factors combined. However, other factors that we did not mea-
in the Enhancers dimension were over 6 times more likely to sure, such as patient demographics, clinical, and treatment-
have overall satisfaction scores in the excellent category. Pa- related variables, may have provided additional explanatory
tients who had high scores in the Detractors scale were 65% value. In addition, we believe that item wording may have af-
less likely to have high overall satisfaction index scores. Indi- fected the results. For example, the Detractor items are worded
viduals with high factor scores in the Location dimension were predominantly negatively, while Enhancer items are worded
23% less likely to have excellent overall index scores, and pa- positively. The Cost and Location items, by contrast, have both
tients with high factor scores in the Cost dimension were 58% positive and negative wording. Further study is needed to de-
less likely to score their overall satisfaction as excellent. termine the impact of item wording on the reliability and valid-
ity of the PTOPS instrument. Finally, although the Cost dimen-
DISCUSSION sion of the PTOPS has adequate statistical explanatory value, it
The PTOPS had been previously demonstrated as reliable and remains problematic because 7% of the subjects declined to an-
valid in outpatient settings in Southeastern New England using swer questions related to costs. Respondents’ written comments
concurrent data collection by direct interview.17 However, the indicated that a substantial number of the patients had not re-
methodology used in the Roush and Sonstroem study17 differed ceived adequate billing information on which to base their per-
from our study’s approach in several ways. First, we used a ceptions. This may limit the practical usefulness of the Cost
broader geographic base for its sampling frame, improving on portion of the PTOPS, especially when used in clinics with
potential generalizability. Second, we used random rather than long billing cycles.
convenience sampling to improve the rigor of the study. Third,
we made multiple attempts to contact patients who had been Reliability
discharged or discontinued from therapy and obtained a re- Inter-item reliability remained remarkably consistent in our
spectable usable response rate (60%), which resulted in nearly sample of patients when compared to the original study.17 The
twice the sample size of the Roush and Sonstroem study.17 An Cronbach alpha score for each of the four dimensions was well
additional difference was that of using mail survey, rather than above the 0.70 standard, and the four-factor model rendered
direct interview method, which potentially minimized positive the best scores among the models considered. This result pro-
response bias. Finally, our study demonstrated the concurrent vides strong evidence for the continued internal reliability of
validity of the PTOPS when compared to a patient satisfaction the PTOPS when used with a different sample and with a mail
index. survey methodology.
Construct Validity Predictive/Criterion Validity
This study provides strong support for the construct validity of The results of the ordinal logistic regression analysis indicate
the PTOPS. The four dimensions of the instrument remained that the factor scores from the principal component analysis
essentially true with our patient population and with our retro- may predict up to 47% of a patient’s overall satisfaction with
spective methodology. The minor departures seen with two of outpatient therapy services. This result is considered an “ad-
the items may be attributable to the imprecise nature of inter- equate” or “better” explanatory value in studies using regres-
preting the principal components analysis. Alternatively, the sion techniques. In addition, each factor contributed signifi-
patients’ views on those items may have legitimately differed in cantly to the predictive value of the instrument. The results of
this study. the regression analysis suggest that the Enhancers dimension
has the most predictive value, followed by Detractors, then
The ability of the instrument dimensions to explain 51% of the Cost, and finally Location. This result is consistent with the
variance in this sample provides additional strength to the con- idea that therapist behaviors, both positive and negative, are
struct validity of the PTOPS. This variance is considered an more predictive of patient satisfaction than cost or location and
adequate amount of explanatory ability35 and is slightly higher convenience. The attentiveness to the patient, the willingness
than in the Roush and Sonstroem17 study. Although basic sci- of the practitioner to listen to patient concerns, and personal
ence experiments, which are often performed under more con- interactions in general appear to have the greatest influence in
trolled conditions, traditionally garner higher explanatory val- improving patient satisfaction with physical therapy services.
ues, explanatory values of less than 60% are not uncommon in Physical therapy practice managers may be able coach practice
social and behavioral experimentation.35 The variability is also associates to improve interpersonal relationships with patients
consistent with other studies of physical therapy patient satis- and each other to increase patient satisfaction with their ser-
faction in outpatient settings, which ranged from 51% to 57% vices.
in other studies where this type of analysis was used.17, 19, 20 Our
results suggest that clinicians should feel confident using the Limitations
PTOPS to measure patient satisfaction in outpatient settings. Limitations to this study are consistent with limitations of gen-
eral survey research. The sampling frame potentially limits the
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s
nent Analysi oush and 17onstroem esignation etractor etractor etractor etractor etractor nhancer etractor etractor etractor etractor ocation ocation ocation ocation ocation ocation ocation ost ost ost ost
po RSD D D D D D EDDDD LL LL L L L C CCC
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Prin actEnh
y F(
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o
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ed f )
ms Deriv Factor 2 (Location .816 .763 .753 -.746 .738 -.717 -.612
e
on It )
nt Satisfacti Factor 1 (Detractor .605 .581 .553 .545 .524 .490 .443 .434 .433 .382
actor Loading Values of Physical Therapy Outpatie Questionnaire Item My therapist could have communicated with me more. My therapist acted like he/she was doing me a big favor by treating me. I expected my therapist to spend more time with me than he/she did. My therapist didn’t give me a chance to say what is on my mind. My therapist could have been more thorough in my treatment. I had to wait too long between appointments. I didn’t really enjoy talking to my therapist. I expected the facility to be quieter than it was. The facility was too crowded. It was difficult for me to get into the facility from the parking lot. I had to travel too far to receive my treatment. This facility could have been more conveniently located for me. I should not have to travel this far for therapy. The physical therapy facility was conveniently located for me. It was somewhat difficult for me to reach this PT facility. The distance required for me to get to this facility was acceptable to me. The facility was in a desirable location. I was charged a reasonable amount for my therapy. I felt my therapist overcharged me. The cost of treatment was more than I expected. The quality of care I received was not compatible with the cost
3. F S er
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Tabl PTNu 15 13 6 27 31 16 23 3 20 8 21 10 28 32 19 5 14 9 11 1 17
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ability of this research to be generalized to other patient popu-
lations. The willingness of the subjects to respond at all, or re-
spond in a forthright manner, can affect the results of the study

in the form of non-response and response bias. In addition, al-

though the methodology allowed individuals who had voluntar-
ily discontinued physical therapy due to dissatisfaction to be
er er er er er er or er er er included, there was no measurement to identify patients who
ncnc nc ncncncct ncncnc might fall into this category. Finally, the self-report format of
ost ost ost nhanha nha nhanhanhaetra nhanhanha tthoe v qaluiedsattieo nthnea iirnef oprrmesaetniotsn ap rliemseintatteido nb.y N thoe o rpepsoprotnudneitnyt se xbiysted
CC C EE E EEED EEE

chart reviews or other methods.
In summary, this study was designed to replicate and further
the research based on the PTOPS instrument by Roush and
7 5 8 7 1 5 10 7 0 2 Sonstroem17 and to determine whether the reliability and valid-
00 2 0875 079
.7.7 .6 .6.5.5-. .5.4.3 ity of the instrument remained consistent in a different sample
and using a different methodology. The construct validity of the
instrument was shown to be adequate in this study, being con-
sistent with the factor analysis in the original study. Instrument
inter-item reliability was also found to be good to excellent in
7 08 3 this sample. Finally, ordinal logistic regression analysis sug-
45 7
.5-. .4 gests that the PTOPS may have adequate degrees of predictive
validity in illuminating overall patient satisfaction.
It should be noted that the participants often lamented the
length of the survey and redundancy of the items, as well as
“trickiness” of questions. Further analysis of individual items
themselves appears to be needed in order to choose the most
predictive ones. If the number of items on the survey could be
reduced, then this may have a positive impact on response
rates. Further, alternative item wording should also be investi-
gated to minimize the perceived difficulty of negative question-
ing. Continued investigation of the survey items that decreased
scale reliability could lead to more reliable dimension scales.
ntinued The facility was flexible about payment options. It could have been easier to make the arrangements to pay for my therapy. My therapist did not expect me to pay significantly more that what my insurance covers. I enjoyed listening to my therapist. My therapist seemed to have a genuine interest in me as a person. I got along well with everyone at this physical therapy facility. This facility was a nice place to get my therapy. This facility appreciated my business. The office staff was attentive to my needs. My therapist should have listened more carefully to what I told him/her. I was given privacy when I needed it. I could get around easily inside of the facility. I anticipated my questions would be answered easily. MtiCTusasntmR1n2aesaupusi..hftnaetuerEOpriaeirvncvs csec ioyiecFBMfehtfatNnaafyei i rono igvlcE wa snt,Coondn teh h ciotreRrdi nedoooan iLrd u orninn rkSgPfEuabeen Uf s,nTociPse.re- n NT eadus orYOJtS bimetotohf o.tipPonCA eom ouIAtaatftS hdnmOhti uit Enpn gnivais rssea ar sleattNua S,Neensh toms ntri lrteatougevLiv auprnapnr reli. dblbadsye htcyiMy .pel nwsly peaa hii1gsp dhsn edri9ami iroaycsucpofn9ots nsayelrfrd2lvutiole tu o c ; ithrt tav1mctdhahiioohgnana7leeecde eegtl toiinrcbso( d hoda1glupotoleesn po)rpanttww.r:soyheg tpac5I iu.rhh ypeoeat2mqp ee pnnyr-aaunnst6ttid ls a .snp s3f p u’ilaoowrw .niasasnt rvtieaicra tintteeltsetthhligiits n vs caoeta atfeeiei f salgnc .s il captaoswa Thtrn tatniaciieihdotnttscoireih nfeg inqn a aa n Pcuuswc pltoimT,eta asiisndntOo-taahvitnietiPel--nS-t
o as it relates to contemporary nursing care. J Adv Nurs. 1996;24
c
3. (6):1241-1248.
ble 3. Minick SA, Young WB, Roberts MJ. 2000 patients relate
Ta 4 30 25 2 24 34 18 29 12 33 7 22 26 their hospital experiences. Nurs Man. 1995;26(12):25-31.
JOURNAL J9
Health Policy & Administration