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

OBJECTIVE: To identify elements of the physiotherapist-patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings. DESIGN: A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach. SETTING: Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain). PARTICIPANTS: Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries. RESULTS: Patients based their evaluations of quality of care on their assessment of physiotherapists' willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist-patient interaction emerged under all these themes, except for friendly and respectful communication. CONCLUSION: This study identified which elements of the physiotherapist-patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients' experiences of the physiotherapist-patient interaction in rehabilitation services to provide empirical and quantitative evidence.

Is patient satisfaction and perceived service quality with musculoskeletal rehabilitation determined by patient experiences?

OBJECTIVE: To assess the relationships between patient experiences and two overall evaluations - satisfaction and service quality - in outpatient rehabilitation settings. DESIGN: A cross-sectional, self-reported survey carried out in the year 2009. SETTING: Three outpatient rehabilitation units belonging to Spanish hospitals located in Barcelona, Madrid and Seville. SUBJECTS: Four hundred and sixty-five outpatients (response rate 90%) mean age 39.4 (SD = 11.9) years. MAIN MEASURES: Self-reported experiences on aspects of care, participants' perception of service quality, satisfaction with care, socio-demographic and health characteristics. RESULTS: Satisfaction and service quality were highly correlated (rho = 0.72, P< 0.001). Two multivariate logistic regression models using satisfaction and service quality (with adjusted R(2) 31.5% and 37.1%, respectively) indicated that patients' experiences and global rating of health improvement have more effect on those evaluations than socio-demographic characteristics. Mean satisfaction was 8.9 (SD = 1.2), and 88% of respondents described high service quality. However, nearly 25% of the respondents who reported high-quality evaluations also indicated a problem score of more than 50% in almost all aspects of care studied. CONCLUSIONS: Satisfaction and service quality provide a poor indicator of patients' experiences. Both are two proxies but distinct constructs in rehabilitation care. Besides, not all problems encountered by patients are equally important to them.

How the rehabilitation environment influences patient perception of service quality: a qualitative study.

OBJECTIVE: To identify elements of the environment that patients consider when evaluating the quality of a care experience in outpatient rehabilitation settings. DESIGN: A qualitative study using a modified grounded theory approach. Data collection used semistructured interviewing during 9 focus groups. SETTING: Three postacute ambulatory centers in metropolitan areas. PARTICIPANTS: Adults (N=57; 33 men, 24 women) undergoing outpatient rehabilitation for musculoskeletal conditions/injuries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Participants perceived the quality of rehabilitation service on the basis of their experiences with environmental factors, including 3 physical factors (facility design, ambient conditions, and social factors) and 4 organizational factors (duration of attendance, interruptions during delivery of care, waiting times in the sequence of treatment, and patient safety). CONCLUSIONS: This study identifies the specific environmental attributes that patients consider important when evaluating the quality of outpatient rehabilitation settings and develops a patient-based framework for assessing the overall perception of service quality. Further research should work to develop self-report questionnaires about patient experiences with the environment in rehabilitation services to provide empirical and quantitative evidence.

How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study.

BACKGROUND: The aim of this study is to explore perceptions of people with chronic neck or low back pain about how characteristics of home exercise programs and care-provider style during clinical encounters may affect adherence to exercises. METHODS: This is a qualitative study consisting of seven focus groups, with a total of 34 participants presenting chronic neck or low back pain. The subjects were included if they were receiving physiotherapy treatment and were prescribed home-based exercises. RESULTS: Two themes emerged: home-based exercise programme conditions and care provider's style. In the first theme, the participants described their positive and negative experiences regarding time consumption, complexity and effects of prescribed exercises. In the second theme, participants perceived more bonding to prescribed exercises when their care provider presented knowledge about the disease, promoted feedback and motivation during exercise instruction, gave them reminders to exercise, or monitored their results and adherence to exercises. CONCLUSIONS: Our experiential findings indicate that patient's adherence to home-based exercise is more likely to happen when care providers' style and the content of exercise programme are positively experienced. These findings provide additional information to health care providers, by showing which issues should be considered when delivering health care to patients presenting chronic neck or back pain.