Abstract
Background Patient feedback surveys are increasingly seen as a key component of health care quality monitoring and improvement.
Objective The study objective was to describe the development and initial psychometric evaluation of a fixed-length questionnaire about the experiences of patients receiving physical therapist treatment in postacute outpatient settings.
Design This was an instrument development study with validity and reliability testing.
Methods A total of 465 participants attending 3 rehabilitation centers for musculoskeletal conditions completed the questionnaire. A cognitive pretest was applied to the draft version (n=94), and a revised version was evaluated for test-retest reliability (n=90). Analyses to evaluate variance and nonresponse rates for items, the factor structure of the questionnaire, and the metric properties of multi-item scales were conducted.
Results Exploratory factor analyses yielded evidence for a 7-factor structure of the questionnaire, with 3 factors that may be conceptually viewed as professionals' attitudes and behavior (providing information and education, sensitivity to patients' changes, and emotional support) and 4 factors that conceptually reflect organizational environment (duration of attendance, interruptions during care delivery, waiting times, and patient safety). Item-scale correlations ranged from .70 to .93. The percentage of scaling success was 100% for all of the scales. Cronbach alpha coefficients ranged from .70 to .87. Intraclass correlation coefficients ranged from .57 to .80 (median=.68).
Limitations Generalization to other patients is not known.
Conclusions The questionnaire has test-retest reliability, and the scales have internal consistency and convergent and discriminant validity. All of the scales are distinct and unidimensional.
In many clinical settings with physical therapist services, people are routinely asked for feedback about the care that they have received.1–3 Such surveys have primarily elicited information about satisfaction with services.4–7 However, in recent health services research, the concept of patients' satisfaction was criticized because of its inherent sources of bias.8,9 It is widely recognized, for example, that patients are reluctant to express low levels of satisfaction about their care and that, as a consequence, questionnaires about patients' satisfaction provide an optimistic picture of performance.10 Patients can even describe high levels of satisfaction at the same time as they describe experiences that are suboptimal.9
Concern about problems with surveys about patients' satisfaction has led to an emphasis on measuring patients' experiences rather than satisfaction.11 Patients' satisfaction and experiences are closely linked but have distinct meanings and are measured in different ways. “Experience” is related to things that happened during care and the extent to which people's needs were met, whereas “satisfaction” is related more to how people feel about those things.12 Although questionnaires about patients' satisfaction ask respondents to rate their care using general evaluation categories (eg, excellent), questionnaires about patients' experiences ask respondents to indicate whether certain processes or events occurred during a particular visit or care episode.13
A recent review illustrated that several generic tools have been developed to assess patients' experiences in primary care and hospital settings.12 Some examples are the Picker Patient Experience Questionnaire (PPE),8 the English National Health Service National Adult Inpatient Survey,14 the Patient Experience Questionnaire in primary health care,15 and the Generic Short Patient Experiences Questionnaire (GS-PEQ).16 Two of these generic tools have been used to capture the experiences of people receiving outpatient physical therapist services (GS-PEQ16 and PPE8).
The GS-PEQ, created by Sjetne et al in 2011,16 includes 10 items asking about outcome, clinician services, user involvement, incorrect treatment, information, organization, and accessibility. The GS-PEQ has been applied to physical therapist services, but it was not specifically designed for this context. This fact, as well as its brevity, means that the results of the questionnaire are not specific enough for small units within an organization.17 The PPE was adapted to capture the experiences of people with specific musculoskeletal disorders (Picker MSD questionnaire)18 and has been used in clinics with multidisciplinary services. The Picker MSD questionnaire is a 30-item instrument with 7 scales that were identified in a previous qualitative study18 as the aspects that matter to patients with musculoskeletal disorders: accessibility, information, respect, emotional support, coordination, continuity, and overall impression. The content validity of these scales was based on a qualitative analysis with 2 focus groups, but no additional analysis was carried out to evaluate the dimensionality of each scale.18
Despite the large amount of active research and the large number of scientific publications in the field of patients' experiences and satisfaction,8,14–18 very few context-specific questionnaires measure patients' experiences with physical therapist services. Some exceptions are the Perceived Quality Questionnaire in Primary Physical Therapy Care (PQ-PPC)19 and the Client-Centered Rehabilitation Questionnaire20 (CCRQ) for inpatient care. The PQ-PPC measures 4 dimensions (waiting times, organization, professional competence, and information). The CCRQ measures 7 dimensions of client-centered rehabilitation in inpatient units (decision making, information, outcome evaluation, family involvement, emotional support, physical comfort, and continuity) identified on the basis of previous work8,21 and focus groups with clients. These instruments reflect substantial variations in the dimensions of care that matter to patients in different contexts. Some authors have indicated that useful questionnaires should explore patients' experiences in each specific context across well-defined domains.20
Both the PQ-PPC and the CCRQ were developed with the same methodology as the Picker MSD questionnaire; as a consequence, the structure and content validity of their scales were supported just by a conceptual approach defined by a qualitative analysis with focus groups, and their unidimensionality was not specifically examined. The notion of unidimensionality in measurement theory refers to a condition in which a set of indicators share only one underlying factor.22 The assessment of unidimensionality has been presented as a top priority in any outcome instruments used in rehabilitation.23,24 When items do not fit a common unidimensional scale, all calculations based on a total score, with the exception of statistical correlations with other quantitative criteria (predictive validity), become uninterpretable.25 However, little evidence about the dimensionality of scales for patients' experiences is available.
Our research group developed a questionnaire about patients' experiences in primary care by using a qualitative approach to develop scales.19 In the outpatient setting studied, physical therapy was provided to people who had chronic clinical conditions but usually continued working and who had a low level of dependence. The next phase of our research, which is the focus of the present article, examined the use of psychometric methodology to develop scales for measuring patients' experiences with physical therapist services in a postacute outpatient setting. We selected this context because it remained unexplored by existing questionnaires about patients' experiences. In Spain, there are outpatient settings that solely provide postacute care to patients after an acute care admission and others that also provide care to patients who are ambulatory. We selected the first setting because all of the patients were receiving early rehabilitation and were in a situation of dependence, with problems of pain, mobility, and functionality.23,24,26
In this article, therefore, we describe the development and initial psychometric evaluation of the fixed-length Questionnaire of Patients' Experiences in Postacute Outpatient Physical Therapy Settings (PEPAP-Q). The specific aims of the psychometric evaluation were to examine variance and nonresponse rates for items, the factor structure of the questionnaire, the unidimensionality of each scale, test-retest reliability, and construct validity.
Method
The instrument development was conducted in 3 phases. In phase 1, 9 domains of patients' experiences were identified on the bases of a literature review, focus groups with patients, and review by experts. In phase 2, several items for each domain were developed and tested for clarity and relevance through cognitive pretesting with patients in rehabilitation and physical therapists. In phase 3, the psychometric properties of the tool were examined with a self-administered survey of patients discharged from 3 physical therapy facilities. We evaluated item reduction, the factor structure and unidimensionality of scales, test-retest reliability, and construct validity.
Phase 1: Domains of Patients' Experiences in Physical Therapy Settings
Several models have been proposed to identify the specific aspects of health care that are relevant to patients.27,28 According to the research evidence, most instruments consider 3 domains as the highest priority for measuring patients' experiences: characteristics of the interaction (patient-professional relationship), elements of the organization of the service (eg, waiting times, facilities, and security), and overall assessments (eg, general satisfaction and perceived quality).12
To better understand the importance of experiences of physical therapy from the client's perspective, we set up 9 focus groups with adults who had musculoskeletal disorders and were receiving postacute physical therapist services in outpatient settings. A semistructured interview topic guide formed from a literature review was used. Additional questions based on themes that emerged from the initial focus groups were included. Data analysis was undertaken with grounded theory.
The results of this qualitative phase are reported elsewhere.29,30 In summary, 9 domains grouped in 2 areas were identified: one was professionals' attitudes and behavior, and the other was organizational environment. In the “professionals' attitudes and behavior” area, the domains focused on providing information and education, sensitivity to patients' changes, emotional support, friendly and respectful communication, and technical expertise. In the “organizational environment” area, the domains focused on duration of attendance, interruptions during care delivery, waiting times in the sequence of treatment, and patient safety.
Phase 2: Development of Items
The frequency with which certain processes and events occurred during the course of physical therapist treatment was investigated. Several candidate items were written for each domain. The precise wording of the items was based on patients' comments in the qualitative study and modified through a process of discussion and consensus among the members of the study team. The response format used was a 5-point Likert frequency scale. Response options ranged from “never” to “always.” An initial pool of 30 items distributed among 9 domains was generated: information (4 items), sensitivity (3 items), support (5 items), friendliness (4 items), expertise (3 items), duration of attendance (3 items), interruptions (3 items), waiting times (3 items), and safety (2 items).
The questionnaire was pretested for clarity and adequacy of content with 7 professionals (with mean care provision experience of 10 years) and participants from the physical therapy settings. A total of 94 participants with musculoskeletal disorders were randomly selected from people receiving postacute physical therapy. Both professionals and participants were asked to report on the relevance and understanding of each item.
A question was considered to have poor face validity if less than 80% of either participants or professionals rated the item as being comprehensible and adequate. Thus, items in the “technical expertise” domain were considered to be unsuitable because many physical therapists thought that patients would not be capable of evaluating professional competence. For this reason, the 3 items in the “technical expertise” domain were removed from the questionnaire.
The instrument finally distributed for evaluation comprised 27 items of patients' experiences with physical therapy. Two overall quality evaluations, 1 item about treatment adherence, and 4 questions related to patients' characteristics also were included. Patients' overall evaluations were assessed with 2 additional items.31 For the first—referred to as the “satisfaction item”—patients were asked to rate their satisfaction with care on a 10-point scale ranging from 1 (minimum) to 10 (maximum). For the second—referred to as the “perceived service quality item”—patients were asked to rate their perceptions of service quality on a 5-point scale (with the following responses: poor, fair, good, very good, and excellent). Adherence to prescribed exercise (if applicable) was measured with a frequency-based response scale (with the following responses: never, seldom, often, almost always, and always) adapted from the adherence scale of Sluijs et al.32
Phase 3: Pilot Study and Psychometric Testing
In phase 3, psychometric testing of the questionnaire was carried out by surveying people who were receiving outpatient postacute physical therapist services at 3 centers in Barcelona, Madrid, and Seville, Spain. During a 6-month period, a sample of consecutive eligible people was identified from the registry of patients and recruited by the attending physical therapist, who assessed the eligibility criteria. Eligible people were included if they were more than 18 years old and receiving physical therapy care. They had to speak, read, and understand Spanish. People who had any cognitive deficit were excluded.
An informed consent form was signed by all participants. The questionnaire was administered during the participants' clinical appointments at the end of the course of the specific episode of physical therapy. The questionnaire and an introductory letter were given to the participants by the attending physical therapist. The participants were asked to place the questionnaire in a box in the administrative area of the center within the following 1 or 2 days. If necessary, nonrespondents received a reminder letter from the physical therapist after 1 week and another letter 2 weeks later. The participants were assured that the professionals would not be able to identify individual answers. For the analysis of test-retest reliability, a subsample of participants completed the questionnaire a second time within 5 days of the initial responses.
Data Analysis
Descriptive statistics were used to assess the demographic and clinical characteristics of the study participants. We conducted a series of analyses to assess item reduction, the factor structure of the questionnaire, and the metric properties of multiitem scales. Finally, the underlying structure of the scales was examined.
Item reduction and instrument structure.
Variance and nonresponse rates for items were evaluated for item reduction. As described elsewhere,33 items with high rates of nonresponses (≥10%) and standard deviations of less than 0.60 were removed to avoid items that were poorly understood, showed poor variability, or both.
Exploratory factor analyses were performed to identify latent factors that could be responsible for the covariation of the data. Principal components analysis and varimax rotation were used for the initial extraction of factors. Items with loadings of 0.50 or higher were retained, but items with factor loadings of higher than 0.40 on more than 1 factor were removed.24 To examine the stability of the structure, we also performed supplementary exploratory factor analyses with 2 subgroups: participants with high levels of satisfaction with care (above the mean) and participants who were not satisfied (below the mean). The Kaiser-Meyer-Olkin value (preferably >0.60) and the Bartlett test of sphericity (preferably significant) were used to assess the sampling adequacy for factorization.
In a multitrait scaling analysis, a correlation matrix of all items and scales is used to test the extent to which items converge with and diverge from scales. Scales were scored with a summative method as described elsewhere.31 Each item was coded with a dichotomous score, indicating either the presence or the absence of a problem. A problem was defined as an aspect of health care that could, from a patient's perspective, be improved. Thus, the response “always” was considered to represent the absence of a problem in direct items. We assumed that any other responses could indicate at least 1 problematic event during the episode of care. For each respondent, a score for each of the scales of the aforementioned instrument was created. Each scale was scored from 0 (no problem) to 100 (every item coded as a problem). Correlations between each item and its hypothesized scale were calculated and corrected for overlap by not including the item in the scale. Correlations of .40 or higher were considered to be satisfactory; items with correlations of less than .40 were removed from further analyses.34 Scaling success rates were computed for each scale as the percentage of items within a scale that correlated more highly or significantly more highly with the hypothesized scale than with the other scales. An item correlated significantly more highly with its own scale if the correlation between the item and its hypothesized scale was more than 2 standard errors higher than its correlation with other scales.35 In addition, we calculated internal consistency reliability for each hypothesized domain by using the Cronbach alpha coefficient (considered acceptable if >.7).
Reliability and validity.
The reliability of the PEPAP-Q scales was assessed with test-retest methods. Intraclass correlation coefficients were calculated for test-retest reliability with a 2-way mixed-effect, single-rater model (judged excellent if >.75).
We designed several construct validation strategies in which we hypothesized various associations and evaluated the extent to which our data corresponded to the hypotheses. Known-group validity was examined by defining 2 groups: a subgroup of participants who rated the overall quality item as “very good” or “excellent” and another subgroup that evaluated it as “poor.” We hypothesized that the problem scores for all of the scales would be lower in participants with high evaluations of service quality and higher in those who perceived quality to be poor. A Student t test was used to test for a difference in the mean scale scores between these 2 groups. Also, the mean scores for the responses to the questionnaire across men and women were compared with a Student t test for independent samples. Our hypothesis was that there would be no significant difference in the mean scores between these 2 groups.
Convergent validity was tested by calculating correlations between scales and patients' satisfaction, and correlations with the treatment adherence item were used to test discriminative validity. A priori hypotheses for these correlations were as follows: first, the scale scores would correlate strongly (>.30) with patients' satisfaction, and second, none of the scale scores would correlate significantly with the treatment adherence item. The Spearman correlation coefficient was used in these analyses. A P value of less than .05 was considered statistically significant. All analyses were performed with the SPSS statistical software program (SPSS v.15; IBM SPSS, Chicago, Illinois).
Role of the Funding Source
The study was supported by a research grant from the Ministry of Health and Consumer Affairs (PI060836), Madrid, Spain. This grant provided support for coordination tasks and several materials for use during the study. The Ministry of Health had no role in the design, conduct, or planned statistical analysis of the study and had no influence on the analysis, interpretation, or decision to submit the study for publication.
Results
During a 6-month period, 520 participants were identified. The data for 4 participants were not taken into account because these participants were not able to understand the instructions for the questionnaire. Of 516 participants, 355 responded initially and another 110 responded after reminders. In total, 465 completed the questionnaire (90%). A total of 94 participants were included in the test-retest evaluation. The demographics of the participants and the test-retest subsample of participants are shown in Table 1. Of the respondents, 71.3% were men, and the length of inpatient hospital stays ranged from 0 to 30 days (X̅=9 days). The health problems were surgical recovery from lower back injury (7.2%), upper limb fracture (30%), lower limb fracture (39.3%), shoulder injury (12.5%), and knee injury (11%). Respondents and nonrespondents were not compared to assess nonresponse bias because of the high response rate (90%).
Characteristics of Participants (N=465) and Test-Retest Subsample of Participants (n=94)
A first selection of items was made from the descriptive response distribution for each item. The 4 items of the “friendly communication” scale did not satisfy the cutoff criterion of a variance of greater than 0.60, so they were deleted. No additional items were removed because of poor item-scale correlations or factor loadings of higher than 0.40 on more than one factor. The definitive version of the questionnaire is shown in the Appendix.
Instrument Structure
A factor analysis restricted to the 23 items of participants' experiences confirmed a 7-dimensional structure; the 7 factors explained 68.6% of the total variance, the Kaiser-Meyer-Olkin statistic was 0.83, and the Bartlett statistic was 5,018.03 (P<.01). Table 2 shows the factors and the items that loaded onto them significantly. Furthermore, the same 7-factor structure was obtained for participants who were satisfied and participants who were not satisfied (data not shown). The 7 factors explained 70.0% of the total variance for participants who were satisfied (n=319) and 72.5% of the total variance for participants who were not satisfied (n=138). The Kaiser-Meyer-Olkin and Bartlett statistics were 0.75 and 3,134.16, respectively, for participants who were satisfied (P<.01) and 0.79 and 1,563.27, respectively, for participants who were not satisfied (P<.01).
Factor Analysis of 23 Items of Participants' Experiences With Physical Therapy (N=465)a
Multitrait scaling analysis generally supported the scaling of items into the hypothesized scales (Tab. 3). Item-scale correlations ranged from .70 to .93. The percentage of scaling success was 100% for all of the scales. Cronbach alpha coefficients ranged from .70 to .87 and exceeded .70 for all of the scales.
Summary of Results for Multitrait Scaling Analysis and Test-Retest Reliabilitya
Reliability and Validity
Intraclass correlation coefficients ranged from .57 to .80 (median=.68). As expected, the mean scores between subgroups of participants with high evaluations of service quality and those who perceived quality to be poor differed significantly, except for the “patient safety” scale (Tab. 4). The difference in the mean scores ranged from 17.13 to 43.21 points, with lower scores for the first group. As hypothesized, there was no significant difference in the scale scores between men's and women's subgroups.
Construct Validity of Scales
As hypothesized, all of the correlations between the scales and participants' satisfaction were good. The recommended level of .3 was achieved for all but 3 scales: duration of attendance, waiting times in the sequence of treatment, and patient safety. Because the 3 scales had high face validity, important aspects of care, and good reliability and known-group validity, we decided to retain them in the final instrument.
As expected, the correlations obtained with the treatment adherence item were lower and not significant for almost all of the scales, reinforcing convergent validity.
Factor Structure of PEPAP-Q Scales
Exploratory factor analyses of the scales identified 2 factors with eigenvalues of 2.484 and 1.401, which explained 31.05% and 17.51% of the total variance, respectively (Tab. 5). Correlations for 3 scales (providing information and education, emotional support, and friendly and respectful communication) were high on the first factor and low on the second. Conversely, correlations for 4 other scales (duration of attendance, interruptions during care delivery, waiting times in the sequence of treatment, and patient safety) were high on the second factor and low on the first.
Factor Analysis of Scales (N=465)a
Discussion
The present study provided preliminary evidence of the validity and reliability of the scales of the fixed-length PEPAP-Q. Seven scores pertaining to distinct dimensions of patients' experiences in postacute outpatient physical therapy settings could be computed: providing information and education, sensitivity to patients' changes, emotional support, duration of attendance, interruptions during care delivery, waiting times in the sequence of treatment, and patient safety. For our sample, all scores had strong item-scale correlations, excellent item scaling success, good internal consistency (Cronbach alpha coefficients of >.7), and acceptable test-retest reliability. The stability of the scales was supported by a stable factorial structure for participants with high evaluations of service quality as well as those who perceived quality to be poor.
Cott et al20 used a qualitative approach to develop the CCRQ and found that most of the scales were moderately to strongly intercorrelated, so these scales did not identify unique dimensions of patients' experiences. Therefore, our approach to developing the PEPAP-Q, based on a combination of qualitative research and multitrait scaling analysis, appears to be more promising than previous approaches used for questionnaires of patients' experiences. Moreover, the PEPAP-Q can be used both to monitor service performance and to provide information about quality improvement efforts in postacute outpatient physical therapy settings. In addition, the PEPAP-Q can be considered more effective than generic instruments (eg, GS-PEQ), which do not reflect what really matters to patients in a specific context.16
The initial analysis undertaken in the present study to explore the high-order factor structure of 7 dimensions of the PEPAP-Q suggested that 2 major conceptual domains underlie these dimensions. One factor or domain had high loadings for scales that reflected experiences related to professionals' attitudes and behavior. A second domain showed an affinity for scales that reflected aspects of the organizational environment. The findings of other authors and our previous study support this idea. For example, Cott et al20 also identified 7 domains that were important components of client-centered rehabilitation from the client's perspective and that were related to the client–physical therapist interaction and organizational aspects of care, such as continuity and physical comfort. Some differences from our instrument in the domains were due to the specific characteristics of inpatient services20 or primary health care.19
Tests of known groups indicated that the scales initially discriminated on the basis of respondents' perception of quality, suggesting that the instrument is reasonably well suited to the populations in the postacute outpatient physical therapy settings. Discrimination by sex of the respondent was not observed. Previous studies36 have shown that men and women have different perceptions about specific areas of care, such as the ambient conditions of facilities (eg, temperature and cleanliness), but these differences were not assessed in the present study because the questionnaire did not include items about the physical environment of the setting.
In the evaluation of convergent validity, the professional aspect appeared to be more relevant than the organizational aspect in influencing satisfaction and perceived quality. These results are consistent with those of other authors, who reported that being treated with respect by health care providers and being involved in treatment decisions are strongly linked to patients' satisfaction.4–7 In contrast and, as expected, in the evaluation of divergent validity, low and nonsignificant correlations of the PEPAP-Q scales with adherence to prescribed exercise were observed.
The aim of the present study was to develop a context-specific questionnaire about patients' experiences in postacute outpatient physical therapy settings. We selected this context because it is a service that is in high demand and that remained unexplored by existing questionnaires about patients' experiences with rehabilitation services.19,20 Moreover, postacute outpatient physical therapy settings have several characteristics that differ from those of other physical therapist services; for instance, patients are in a situation of dependence, with important problems of mobility and functionality, so the importance of feeling physically secure is highly regarded by them.
Limitations
Despite what we consider to be the generally good psychometric properties of the instrument, several limitations should be noted. First, the instrument was developed in Spanish, and the English translation included in this article has not been revalidated. People interested in using the questionnaire in a non-Spanish translation should conduct a formal adaptation of the instrument that achieves conceptual and semantic equivalence between the original version and the translated version of the questionnaire to assess the usefulness of the cross-cultural adaptation.37,38 We recommend following the guidelines for the process of cross-cultural adaptation of self-report measures.39
Second, the instrument is limited to postacute outpatient settings and patients with musculoskeletal conditions, so the appropriateness of the proposed instrument for different settings is not known. Nevertheless, evidence in the literature about patients' satisfaction40 suggests that there are differences in the treatment of patients with acute, postacute, and chronic musculoskeletal conditions.
Third, the PEPAP-Q does not address technical aspects of care. Nevertheless, we decided to remove questions about technical expertise because many of the physical therapists consulted thought that patients' assessments of technical expertise could be biased by outcomes achieved at the time of their participation in the survey. Moreover, some authors41 have argued that questionnaires used for patients' assessments are not reliable for assessing the technical quality of care.
Implications for Practice and Research
The potential applications of the findings of the present study are numerous. From a strategic standpoint, the performance of each organizational unit across the dimensions can be tracked. From a competitive standpoint, the factors identified can be used to compare rehabilitation services with competitors' offerings. The identification and resolution of problems perceived by patients are important for health care services because of the serious impact that even a small percentage of such problems has on service outcomes.42
The PEPAP-Q allows for analysis at several levels of postacute outpatient physical therapy settings. For example, a health care manager interested in an overview of the service can use the global measures for an overall evaluation; alternatively, if the objective is a deeper analysis of patients' experiences, each scale score can be used to identify specific aspects of the service to improve.
Although the results of the present study provide evidence of the good psychometric properties of the questionnaire, it is important to recognize the scope of the present study and to consider future research directions. For example, researchers could explore possible associations between patients' experiences and other outcome measurements, such as clinical results or the relative importance of patients' experiences in overall quality measurements. Further validity testing of the PEPAP-Q must be conducted to assess its predictive validity. In the present study, we measured levels of patients' satisfaction during treatment, so the predictive validity of the questionnaire remains unknown.
In conclusion, the PEPAP-Q was developed, pretested, and refined as a result of an extensive consultation with participants and professionals. The instrument has strong test-retest reliability, and all of the scales have internal consistency and convergent and discriminative construct validity. All of these properties support the value of the PEPAP-Q for use in quality improvement tasks as well as in research.
Appendix.
Item Scoring and Scales for Questionnaire of Patients' Experiences in Postacute Outpatient Physical Therapy Settingsa
a Item statements are presented in the order in which they appeared in the questionnaire. However, the style of the questionnaire is not reproduced here. Scoring was done with a 5-point Likert scale for items 1–12 (5=always, 4=very often, 3=sometimes, 2=rarely, 1=never), and reversed scoring was used for items 13–23 (5=1, 4=2, 2=4, 1=5). Items in each of the 7 scales were as follows: information—1–4; sensitivity—5–9; support—10–12; duration of attendance—13–15; interruptions—16–18; waiting times—19–21; and safety—22 and 23.
Footnotes
Dr Medina-Mirapeix, Dr del Baño-Aledo, Dr Martínez-Payá, and Dr Lillo-Navarro provided concept/idea/research design, writing, and data collection. All authors provided data analysis. Dr Escolar-Reina provided project management, fund procurement, and consultation (including review of manuscript before submission).
The study was approved by the Bioethics Committee of the University of Murcia.
The study was supported by a research grant from the Ministry of Health and Consumer Affairs (PI060836), Madrid, Spain.
- Received February 4, 2014.
- Accepted November 12, 2014.
- © 2015 American Physical Therapy Association
References
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