Acessibilidade / Reportar erro

Satisfaction of patients receiving physiotherapy care for musculoskeletal conditions: a cross-sectional study

ABSTRACT

We measured the satisfaction of patients who receive physiotherapy care for musculoskeletal conditions in the Southeast region of Brazil. The MRPS instrument (MedRisk instrument for measuring Patient Satisfaction) was used to measure the satisfaction of 403 patients of eight physiotherapy clinics of the states of Minas Gerais and São Paulo. In addition, we collected demographic and clinical characteristics of participants and the Global Perceived Effect (GPE) scale. The MRPS was described through mean and standard deviation. Pearson correlation coefficients were calculated to investigate the association between GPE and the total score of the MRPS. Linear regression models were used to analyze the characteristics of patients that could predict total satisfaction. High satisfaction was observed with the physiotherapeutic care, being the mean score a total of 4.5 points (SD=0.4). A moderate correlation was observed between the total satisfaction and the GPE (Pearson's r of -0.31, p<0.001). Only gender influenced the total score of satisfaction, as males showed the highest satisfaction with the received care. The level of patient satisfaction with the physiotherapy treatment in the Southeast region of Brazil can be considered high.

Keywords:
Physiotherapy; Patient Satisfaction; Orthopedics

RESUMO

Mensurou-se a satisfação dos pacientes que recebem cuidados fisioterapêuticos para condições musculoesqueléticas na região Sudeste do Brasil. O instrumento MedRisk Instrument for Measuring Patient Satisfaction (MRPS) foi utilizado para mensurar a satisfação de 403 pacientes de oito clínicas de fisioterapia dos estados de Minas Gerais e São Paulo. Além disso, foram coletadas as características demográficas e clínicas dos participantes e a Escala de Percepção do Efeito Global (GPE). O MRPS foi descrito por meio de média e desvio-padrão. Coeficientes de correlação de Pearson foram calculados para investigar a associação entre a GPE e o escore total do MRPS. Modelos de regressão linear foram utilizados para analisar as características dos pacientes que poderiam predizer a satisfação total. Foi observada alta satisfação com os cuidados fisioterapêuticos, sendo a média do escore total 4,5 pontos (DP=0,4). Foi observada moderada correlação entre a satisfação total e a GPE (coeficiente de Pearson -0,31, p<0,001). Apenas o gênero influenciou o escore total de satisfação, sendo que o gênero masculino apresentou maior satisfação com os cuidados recebidos. O nível de satisfação do paciente com o tratamento de fisioterapia recebido na região Sudeste do Brasil pode ser considerado alto.

Descritores:
Fisioterapia; Satisfação do Paciente; Ortopedia

RESUMEN

Se mensuró la satisfacción de los pacientes que reciben cuidados fisioterapéuticos para condiciones musculoesqueléticas en la región Sudeste del Brasil. Se utilizó el instrumento MedRisk Instrument for Measuring Patient Satisfaction (MRPS) para mensurar la satisfacción de 403 pacientes de ocho clínicas de fisioterapia de los estados de Minas Gerais (MG) y São Paulo (SP). Además, se colectó las características demográficas y clínicas de los participantes y la Escala de Percepción de Efecto Global (GPE). El MRPS fue descrito mediante la media y desviación estándar. Se calculó los coeficientes de correlación de Pearson para investigar la asociación entre la GPE y la puntuación total del MRPS. Modelos de regresión linear fueron utilizados para analizar las características de los pacientes que podrían predecir la satisfacción total. Se observó alta satisfacción con los cuidados fisioterapéuticos, siendo la media de puntuación total 4,5 puntos (DP=0,4). Se observó moderada correlación entre la satisfacción total y la GPE (coeficiente de Pearson -0,31, p<0,001). Solamente el género influenció la puntuación total de satisfacción; el género masculino presentó mayor satisfacción con los cuidados recibidos. El nivel de satisfacción del paciente con el tratamiento de fisioterapia recibido en la región Sudeste del Brasil es considerado alto.

Palabras clave:
Fisioterapia; Satisfacción del Paciente; Ortopedia

INTRODUCTION

Satisfaction has been used as an indicator of quality of care received in the health sector11. Asadi-Lari M, Tamburini M, Gray D. Patients' needs, satisfaction, and health related quality of life: towards a comprehensive model. Health Qual Life Outcomes. 2004;2:32.), (22. Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.'. The current consensus is that satisfaction reflects the patient's perception regarding the quality of the service received33. Casserley-Feeney SN, Phelan M, Duffy F, Roush S, Cairns MC, Hurley DA. Patient satisfaction with private physiotherapy for musculoskeletal pain. BMC Musculoskelet Disord. 2008;9:50.. As a concept, it is a broad theme, influenced by three factors: sociocultural values, therapist-patient interaction and environmental conditions of the service44. Beattie PF, Nelson RM. Preserving the quality of the patient-therapist relationship: an important consideration for value-centered physical therapy care. J Orthop Sports Phys Ther. 2008;38(2):34-5.. In the physiotherapy field, therapist-patient interaction tends to be more intense than in other health care professions, due to the nature of the physiotherapeutic treatment, divided into multiple scheduled sessions, in which the patient's satisfaction can be directly influenced22. Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.'), (33. Casserley-Feeney SN, Phelan M, Duffy F, Roush S, Cairns MC, Hurley DA. Patient satisfaction with private physiotherapy for musculoskeletal pain. BMC Musculoskelet Disord. 2008;9:50.), (55. Beattie PF, Pinto MB, Nelson MK, Nelson R. Patient satisfaction with outpatient physical therapy: instrument validation. Phys Ther. 2002;82(6):557-65.), (66. Moreira C, Borba J, Mendonça K. Instrumento para aferir a satisfação do paciente com a assistência fisioterapêutica na rede pública de saúde. Fisioter Pesq. 2007;14(3):37-43.), (77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89..

Usually, satisfaction is measured through multidimensional questionnaires22. Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.'), (33. Casserley-Feeney SN, Phelan M, Duffy F, Roush S, Cairns MC, Hurley DA. Patient satisfaction with private physiotherapy for musculoskeletal pain. BMC Musculoskelet Disord. 2008;9:50.. Different models of questionnaires were validated in several countries22. Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.'), (77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89.), (88. Mendonça K, Guerra R. Desenvolvimento e validação de um instrumento de medida da satisfação do paciente com a fisioterapia. Rev Bras Fisioter. 2007;11(5):369-76.), (99. Roush SE, Sonstroem RJ. Development of the physical therapy outpatient satisfaction survey (PTOPS). Phys Ther. 1999;79(2):159-70.. In Brazil, only two instruments were properly tested66. Moreira C, Borba J, Mendonça K. Instrumento para aferir a satisfação do paciente com a assistência fisioterapêutica na rede pública de saúde. Fisioter Pesq. 2007;14(3):37-43.), (88. Mendonça K, Guerra R. Desenvolvimento e validação de um instrumento de medida da satisfação do paciente com a fisioterapia. Rev Bras Fisioter. 2007;11(5):369-76.. The instrument proposed by Moreira et al.66. Moreira C, Borba J, Mendonça K. Instrumento para aferir a satisfação do paciente com a assistência fisioterapêutica na rede pública de saúde. Fisioter Pesq. 2007;14(3):37-43. was developed for applicability only in the public health sector, and the instrument proposed by Mendonça and Guerra88. Mendonça K, Guerra R. Desenvolvimento e validação de um instrumento de medida da satisfação do paciente com a fisioterapia. Rev Bras Fisioter. 2007;11(5):369-76. was tested in the private health sector. Both studies, conducted in the northeastern region of Brazil, measured the satisfaction of the patient who receives physiotherapy care for different health conditions, such as, for example, patients with neurological, musculoskeletal, or cardiorespiratory disorders.

A new instrument, MRPS55. Beattie PF, Pinto MB, Nelson MK, Nelson R. Patient satisfaction with outpatient physical therapy: instrument validation. Phys Ther. 2002;82(6):557-65. (MedRisk instrument for measuring Patient Satisfaction), was developed to investigate the variables associated with the global satisfaction of patients receiving physiotherapy care for musculoskeletal conditions in public or private sectors. This instrument was previously translated and transculturally adapted into Brazilian Portuguese77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89. and has already been used in some countries such as the United States of America and Australia, facilitating possible international comparisons22. Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.'), (1010. Hush JM, Yung V, Mackey M, Adams R, Wand BM, Nelson R, et al. Patient satisfaction with musculoskeletal physiotherapy care in Australia: an international comparison. J Man Manip Ther. 2012;20(4):201-8.), (1212. Beattie P, Nelson R, Lis A. Spanish-language version of the MedRisk intrumento for measuring patient satisfaction with physicla therapy care (MRPS): preliminary validation. Phys Ther. 2007;87(6):793-800..

Therefore, it is necessary to research patients' satisfaction level concerning the assistance of musculoskeletal physiotherapy in Brazil66. Moreira C, Borba J, Mendonça K. Instrumento para aferir a satisfação do paciente com a assistência fisioterapêutica na rede pública de saúde. Fisioter Pesq. 2007;14(3):37-43.), (88. Mendonça K, Guerra R. Desenvolvimento e validação de um instrumento de medida da satisfação do paciente com a fisioterapia. Rev Bras Fisioter. 2007;11(5):369-76.. Therefore, the primary objective of this study was to evaluate the satisfaction of patients who received physiotherapy care for musculoskeletal conditions in the Southeast region of Brazil, using a previously validated instrument77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89.. The secondary objectives were to verify the existence of a correlation between clinical improvement and patient satisfaction and to investigate which characteristics of the sample could predict patient satisfaction.

METHODOLOGY

Participants

This study counted with 403 patients, who were undergoing physiotherapy treatment for any musculoskeletal condition. Literate patients were recruited, aged between 18 and 80 years, with any musculoskeletal injury, at any stage of duration of symptoms. Patients were recruited, for convenience, in eight physiotherapy clinics (four were private and four were school clinics). These clinics were located in the cities of Belo Horizonte (four clinics) and São Paulo (four clinics). This study was approved by the Research Ethics Committees.

Instruments

Evaluation form

Participants' characteristics were collected through an evaluation form with questions related to demographic and anthropometric data, as well as information about the clinical situation of the participants, for example, the health condition being treated and the duration of the patient's symptoms.

MRPS (MedRisk instrument is measuring Patient Satisfaction)

The MRPS instrument77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89. is a questionnaire containing 13 items, subdivided into three factors. Factor 1 is called Interpersonal, and contains six items related to therapist-patient interaction or the patient's interaction with other employees of the clinic. Factor 2 is called Convenience and Efficiency, and it is composed by three items such as the statement "The opening hours of this clinic were convenient for me." Factor 3 is called Patient Education, and has two items regarding the commitment of the physical therapist in raising awareness and educating their patients such as the statement "My physical therapist gave me detailed instructions about the home exercise program." Finally, the instrument has two items not allocated in specific factors, for being considered global items, for example, the statement "I would return to this clinic for future services"77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89.. The patients answer their level of satisfaction for each item through a Likert-type scale ranging from 1 (I completely disagree) to 5 (I completely agree), in addition to the option "it does not apply", available for some statements. Higher scores represent higher satisfaction. This instrument was previously translated and transculturally adapted for the Brazilian population77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89..

Global Perceived Effect Scale (GPE)

GPE77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89. verifies the global impression of the patients' recovery, comparing the start of their symptoms with their current health condition. It is a Likert-type scale of 9 points77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89., ranging from 1 (extremely better) to 9 (extremely worse), in which lower scores represent patients who were better and higher scores represent those that worsened after the beginning of the treatment.

Procedures

Potential participants were approached in the waiting room of physiotherapy clinics. Therefore, there was no interference in the treatments received by the patients. All patients received information about the objectives and procedures of the study and signed an informed consent form that guaranteed the confidentiality and anonymity of responses. Then, patients answered the evaluation form, the MRPS instrument and the GPE. All data were collected after patients had performed at least five sessions of physiotherapy. Thus, patients would have established opinions about their satisfaction regarding the received services.

Statistical Analysis

To analyze the participants' characteristics, the means (standard deviations - SD) were calculated from the continuous variables and the description of categorical data was calculated through numbers (percentages). To calculate the satisfaction of patients who received physiotherapy, means (SD) were calculated for each item of MRPS and for the total score of the questionnaire. Pearson correlation coefficients were calculated to investigate the association between GPE and the total score of the MRPS. To predict patient satisfaction, linear regression models were built.

RESULTS

A total of 403 patients were included in this study. We observed that 54.6% of the sample were women, with an average age of 50.5 (SD=16.7) years. Regarding the body area under treatment, 24.6% (N=99) of the patients had lumbar spine disorders, followed by 22.8% (N=92) with malfunctions in the hip and/or knee. The comprehensive features of these participants can be found in Table 1.

Table 1
Data concerning the characteristics of the participants (n=403)

Chart 1 presents the means (SD) of patients' satisfaction for each item evaluated in the MRPS instrument along with the mean (SD) of the total score. In general, patients were satisfied with the physiotherapy care, showing an average of 4.5 (SD=0.4) of total score. We noticed that Factor 1, Interpersonal, showed the highest average 4.6 (SD=0.4) of total score. Followed by Factor 2, Convenience and Efficiency, with average point of 4.5 (SD=0.6); while Factor 3, Patient Education, presented the lowest average of 4.0 of total score (SD=1.1).

Chart 1
Patient satisfaction regarding the physiotherapeutic treatment received, measured through the MRPS instrument

Data described in the Table are presented as mean (standard deviation). The score of each item of the questionnaire varies from 1 (completely dissatisfied) to 5 (completely satisfied). Chart 1. Patient satisfaction regarding the physiotherapeutic treatment received, measured through the MRPS instrument.

We observed a negative and statistically significant correlation between GPE and the total score of the MRPS instrument and also between GPE and the two global items of MRPS instrument. Pearson correlation coefficient was -0.31 (p<0.001) for the total score of the MRPS instrument; -0.27 (p<0.001) for the item "In general, I am completely satisfied with the physiotherapy services"; and -0.17 (p=0.001) for the item "I would return to this clinic for future services or treatment." Although statistically significant, these estimates are considered to be from low to moderate in magnitude.

Among the traits evaluated, only gender was able to influence the level of satisfaction, and the male gender showed higher satisfaction with the care received, with beta coefficient = 0.09 point (95%CI 0.01 to 0.18), p=0.03.

DISCUSSION

The proposed objective of this study was to evaluate the satisfaction of 403 users of musculoskeletal physiotherapy services regarding the physiotherapeutic care received in the Southeast region of Brazil using the MRPS instrument. We observed that, in general, patient satisfaction was high regarding the received physiotherapy treatment. The items that presented the highest points were "My physical therapist treated me respectfully", "The clinical staff were respectful" and "I would return to this clinic for future services or treatment", presenting average points of 4.8 for each item. The items with lower scores, however, were "My physical therapist advised me about ways to avoid future problems" and "My physical therapist gave me detailed instructions about the home exercise program", both with an average of 4.0 points.

When separating the items of the MRPS instrument into three factors, as proposed in the validation of the instrument into Brazilian Portuguese77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89., we identified that patients have higher levels of satisfaction on Factor 1, Interpersonal, which gathers items concerning therapist-patient interaction. This result is consistent with other studies already published, both in the national and international scenarios, since therapist-patient interaction is a strong predictor of satisfaction22. Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.'), (33. Casserley-Feeney SN, Phelan M, Duffy F, Roush S, Cairns MC, Hurley DA. Patient satisfaction with private physiotherapy for musculoskeletal pain. BMC Musculoskelet Disord. 2008;9:50.), (55. Beattie PF, Pinto MB, Nelson MK, Nelson R. Patient satisfaction with outpatient physical therapy: instrument validation. Phys Ther. 2002;82(6):557-65.), (66. Moreira C, Borba J, Mendonça K. Instrumento para aferir a satisfação do paciente com a assistência fisioterapêutica na rede pública de saúde. Fisioter Pesq. 2007;14(3):37-43.), (77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89.), (88. Mendonça K, Guerra R. Desenvolvimento e validação de um instrumento de medida da satisfação do paciente com a fisioterapia. Rev Bras Fisioter. 2007;11(5):369-76.. On the other hand, Factor 3, Patient Education, with items related to the commitment of the physical therapist to raise awareness and educate their patients, obtained the lowest averages. In contrast, a study that assessed the satisfaction of patients with musculoskeletal disorders through the MRPS instrument in the United States of America1212. Beattie P, Nelson R, Lis A. Spanish-language version of the MedRisk intrumento for measuring patient satisfaction with physicla therapy care (MRPS): preliminary validation. Phys Ther. 2007;87(6):793-800. obtained high levels of satisfaction for the items allocated in the Factor 3. This difference can be explained due to distinct populations that present different ways of conducting physiotherapeutic treatment.

The MRPS instrument has already been applied in patients from different countries, such as Australia22. Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.', South Korea1111. Hush JM, Lee H, Yung V, Adams R, Mackey M, Wand BM, et al. Intercultural comparison of patient satisfaction with physiotherapy care in Australia and Korea: an exploratory factor analysis. J Man Manip Ther. 2013;21(2):103-12., Canada1313. MacDonald C, Cox P, Bartlett D. Productivity and client satisfaction : A comparison between physical therapists and student-therapist pairs. Physiother Can. 2012:92-101.), (1414. Law B, Driediger M, Hall C, Forwell L. Imagery use, perceived pain, limb functioning and satisfaction in athletic injury rehabilitation. NZ J Physiother. 2006;34(1):10-6., United States of America1515. Beattie P, Turner C, Dowda M, Michener L, Nelson R. The MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care: a psychometric analysis. J Orthop Sports Phys Ther. 2005;35(1):24-32., Ireland33. Casserley-Feeney SN, Phelan M, Duffy F, Roush S, Cairns MC, Hurley DA. Patient satisfaction with private physiotherapy for musculoskeletal pain. BMC Musculoskelet Disord. 2008;9:50., England1616. Hills R, Kitchen S. Satisfaction with outpatient physiotherapy: a survey comparing the views of patients with acute and chronic musculoskeletal conditions. Physiother Theory Pract. 2007;23(1):21-36., and Sweden1717. Seferlis T, Nemeth G, Carlsson A, Gillstrom P. Conservative treatment in patients sick-listed for acute low-back pain: a prospective randomised study with 12 months' follow-up. Eur Spine J. 1998;7(4):61-70.. From this study, we observed that Brazil is the third country where patients report higher satisfaction with the care received in the physiotherapy sector for musculoskeletal conditions, with an average of 4.54 points of total score. The countries that presented the higher averages were: Canada, with 4.67 points1313. MacDonald C, Cox P, Bartlett D. Productivity and client satisfaction : A comparison between physical therapists and student-therapist pairs. Physiother Can. 2012:92-101.; and Australia, with 4.55 points1010. Hush JM, Yung V, Mackey M, Adams R, Wand BM, Nelson R, et al. Patient satisfaction with musculoskeletal physiotherapy care in Australia: an international comparison. J Man Manip Ther. 2012;20(4):201-8.. Among these countries, coincidentally, the lowest average of satisfaction with 3.5 points was in Canada1414. Law B, Driediger M, Hall C, Forwell L. Imagery use, perceived pain, limb functioning and satisfaction in athletic injury rehabilitation. NZ J Physiother. 2006;34(1):10-6., but this study had a smaller sample size. It was possible to observe that Brazilian physical therapists, even though residing in a developing nation, offered a high quality service, when compared to developed countries such as the United States of America1515. Beattie P, Turner C, Dowda M, Michener L, Nelson R. The MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care: a psychometric analysis. J Orthop Sports Phys Ther. 2005;35(1):24-32., Sweden1717. Seferlis T, Nemeth G, Carlsson A, Gillstrom P. Conservative treatment in patients sick-listed for acute low-back pain: a prospective randomised study with 12 months' follow-up. Eur Spine J. 1998;7(4):61-70., Ireland33. Casserley-Feeney SN, Phelan M, Duffy F, Roush S, Cairns MC, Hurley DA. Patient satisfaction with private physiotherapy for musculoskeletal pain. BMC Musculoskelet Disord. 2008;9:50., England1616. Hills R, Kitchen S. Satisfaction with outpatient physiotherapy: a survey comparing the views of patients with acute and chronic musculoskeletal conditions. Physiother Theory Pract. 2007;23(1):21-36., and Canada1414. Law B, Driediger M, Hall C, Forwell L. Imagery use, perceived pain, limb functioning and satisfaction in athletic injury rehabilitation. NZ J Physiother. 2006;34(1):10-6. that showed smaller average points of 4.48; 4.40; 4.32; 3.77; and 3.50, respectively.

It is important to consider that patient satisfaction regarding the care received, as evaluated by MRPS, must be differentiated from the satisfaction with the clinical results obtained55. Beattie PF, Pinto MB, Nelson MK, Nelson R. Patient satisfaction with outpatient physical therapy: instrument validation. Phys Ther. 2002;82(6):557-65.), (77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89.. Conceptually, the first term describes the service that the patient receives during treatment. The second, however, refers to the treatment effect on the general state of health. These two constructs, although potentially tied to each other, are different and should be evaluated separately. It was possible to notice that the satisfaction related to the care received appears to be independent of the satisfaction with clinical results, due to the low magnitude of the correlation. This fact is consistent with other studies that applied the MRPS and that also showed low correlation between GPE and the global satisfaction items77. Oliveira NdFC, Costa LOP, Nelson R, Maher CG, Beattie PF, de Bie R, et al. Measurement Properties of the Brazilian Portuguese Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care. J Orthop Sports Phys Ther. 2014;44(11):879-89..

Comparing five demographic characteristics of the sample with the total score of the MRPS, we observed that only gender influenced satisfaction. Male patients were likely to report higher satisfaction with the care received. Our results are potentially linked to two studies that analyzed several factors that can influence the overall satisfaction22. Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.'), (1616. Hills R, Kitchen S. Satisfaction with outpatient physiotherapy: a survey comparing the views of patients with acute and chronic musculoskeletal conditions. Physiother Theory Pract. 2007;23(1):21-36.. In these studies, it was observed that although the term satisfaction and expectation of treatment are distinct, the expectation of clinical improvement for male patients was significantly higher compared to the female gender22. Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.'), (1616. Hills R, Kitchen S. Satisfaction with outpatient physiotherapy: a survey comparing the views of patients with acute and chronic musculoskeletal conditions. Physiother Theory Pract. 2007;23(1):21-36..

Summarizing the studies that have in common the satisfaction outcome, regardless of the health sector assessed, of the population or of the instrument used22. Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.'), (55. Beattie PF, Pinto MB, Nelson MK, Nelson R. Patient satisfaction with outpatient physical therapy: instrument validation. Phys Ther. 2002;82(6):557-65.), (66. Moreira C, Borba J, Mendonça K. Instrumento para aferir a satisfação do paciente com a assistência fisioterapêutica na rede pública de saúde. Fisioter Pesq. 2007;14(3):37-43.), (88. Mendonça K, Guerra R. Desenvolvimento e validação de um instrumento de medida da satisfação do paciente com a fisioterapia. Rev Bras Fisioter. 2007;11(5):369-76.), (99. Roush SE, Sonstroem RJ. Development of the physical therapy outpatient satisfaction survey (PTOPS). Phys Ther. 1999;79(2):159-70., the interviewees showed high satisfaction for the care received. This result is supported by the literature due the fact that satisfaction is a measure that has a ceiling effect, making it difficult, therefore, to detect differences and important aspects that could influence or distinguish the different levels of satisfaction1818. Hudak PL, Wright JG. The characteristics of patient satisfaction measures. Spine (Phila Pa 1976). 2000;25(24):3167-77.. The possible reason in measuring satisfaction for the ceiling effect is the distribution of questionnaires, in which, the wider the question, smaller was the ability to specify the level of satisfaction1818. Hudak PL, Wright JG. The characteristics of patient satisfaction measures. Spine (Phila Pa 1976). 2000;25(24):3167-77..

It is important to highlight, as a limitation of this study, that the results cannot be generalized to all physiotherapeutic areas, it represents only patients who were undergoing treatment for musculoskeletal conditions. This happened because the questionnaire had been prepared and validated to the Brazilian population only in the musculoskeletal physiotherapy field, being necessary a new validation with adaptations for neurology patients or hospitalized ones to whom other aspects can be recommended to measure satisfaction. At the end of this study, we obtained means to assist physical therapists working in the musculoskeletal area to improve the provision of their services, in which, although the level of satisfaction presents the ceiling effect when evaluated, we identified that if the instrument is applied in private, public clinics and clinic schools the weakest points of these clinics can be identified, making future investments for local improvements close to the perception of the patient.

CONCLUSION

The satisfaction of users of musculoskeletal physiotherapy service in private clinics and clinic schools, in the southeast region of Brazil can be considered high, getting almost the maximum mean. In addition, we observed that the clinical improvement of the patient is not correlated with their level of satisfaction regarding the care received. And finally, male patients seemed to be more satisfied.

REFERÊNCIAS

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    Asadi-Lari M, Tamburini M, Gray D. Patients' needs, satisfaction, and health related quality of life: towards a comprehensive model. Health Qual Life Outcomes. 2004;2:32.
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    Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.'
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    Casserley-Feeney SN, Phelan M, Duffy F, Roush S, Cairns MC, Hurley DA. Patient satisfaction with private physiotherapy for musculoskeletal pain. BMC Musculoskelet Disord. 2008;9:50.
  • 4
    Beattie PF, Nelson RM. Preserving the quality of the patient-therapist relationship: an important consideration for value-centered physical therapy care. J Orthop Sports Phys Ther. 2008;38(2):34-5.
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    Beattie PF, Pinto MB, Nelson MK, Nelson R. Patient satisfaction with outpatient physical therapy: instrument validation. Phys Ther. 2002;82(6):557-65.
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  • Financing source: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
  • 8
    Approved by the Ethics Committee of PUC-MG: CAAE 0175.0.213.000-08 and Unicid-SP: CAAE 07681512.4.0000.0064.

Publication Dates

  • Publication in this collection
    Jan-Mar 2016

History

  • Received
    May 2015
  • Accepted
    Feb 2016
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