INTRODUCTION

With the advent of evidence-based practice, there has been a growing interest in the evaluation of patient satisfaction in healthcare research. It is generally regarded as an important component in quality health care.¹

Patient satisfaction is an important indicator of quality care,² this is buttressed by evidence that satisfied patients adhere better to treatment with resultant higher quality of life.³ Patient satisfaction surveys are used by health organizations to identify areas of care that needs improvement,⁴ to determine quality assurance and the accreditation of hospitals and health care centres.⁵ However, while patient satisfaction is an idea most health institutions desire to attain, evaluating this concept in healthcare settings in a reliable and valid manner is challenging.

Physical therapy is an area of rehabilitation that has a major role in maintaining health and overcoming impairments. It involves examination, evaluation, diagnosis, prognosis, and plan of care for the patient, which may be directly or indirectly assessed by the patient. Although survey results have consistently showed high levels of overall satisfaction, satisfaction levels varied when separate dimensions of the construct were investigated. They asserted that patients may be satisfied with some aspects of their physical therapy care, but less satisfied with other aspects. Several dimensions of patient satisfaction with physical therapy services have been assessed. In 1994, Yoshioka measured satisfaction with physical therapy at the end of life by considering the dimensions of technical competence, professionalism, courtesy, and caring ⁶ Oermann et al in 2000 and Beattie in 2005 assessed satisfaction of patients with cystic fibrosis and considered the domains of efficacy, convenience, comfort, overall satisfaction, internal factors associated with patient/therapist interactions and external factors associated with clinic and environmental factors.^7,8

The healthcare industry like other service industries has become highly receptive to the notion that service quality and consumer satisfaction are critically important factors in the success of healthcare organizations.^9,10 Patient satisfaction is indicative of patients perception of the quality of healthcare they receive and the quality of the specific institution offering the care.¹¹ This evaluation of patient’s satisfaction is a demonstration of the move towards a patient-centered care.¹² Identifying what the client perceives as quality helps create a measure for quality healthcare services.¹³ Numerous factors impact on the patient’s perception of the care provided by a health institution throughout the time spent in the facility.

Patient satisfaction is an important clinical health outcome and is a primary means of evaluating the effectiveness of healthcare delivery. Differences between patient expectation and services rendered is related to decreased satisfaction.¹⁴ The major goal of a tertiary healthcare facility as the highest level of health-care provision is to pro­vide the best possible care to the patients. Patient satisfac­tion is one of the established yardsticks to measure success of the healthcare services being provided.¹⁵ Thus, there is a need to assess the healthcare systems regarding patient satisfaction as often as possible^.16

In a study by Grimmer et al, (1999)¹⁷ reasons for which patients attend physiotherapy clinics were stated, the most common of these were convenience, reputation, previous good experience and recommendation, the physiotherapist’s interpersonal skills and ability to impart information.

In recent years, Nigeria instituted certain reforms to improve the quality of health care delivery in public hospitals. The provision of physiotherapy equipment to six federal government tertiary hospitals may have been a result of these reforms with the intent of providing qualitative care. This study therefore evaluated the extent to which outpatient physiotherapy services have met patients’ expectations and preferences in Federal medical Centre, Yenagoa, Bayelsa State, South-South Nigeria.

MATERIALS AND METHOD

This study is a descriptive survey. Data were collected using a self-administered questionnaire with very minimal assistance from trained Research Assistants, who explained the objectives and procedure of the study to the participants and obtained the patient’s informed consent. Participants were drawn from patients who have had at least 3 sessions of physiotherapy on outpatient basis in the physiotherapy clinic, aged 18 to 64 years and consented to participate in the study. They were recruited on a consecutive basis throughout the period of one year that the study lasted.  Patients with poor cognitive abilities were excluded from the study.^18,19

A two-section study instrument was used for data collection. Section One contains structured questions that explored the socio-demographic characteristics. The Patient Satisfaction Questionnaire (PSQ-III) formed the second section of the study instrument.²⁰ The PSQ-III is a 50-item questionnaire assessing patient satisfaction in 7 domains on a 5-point Likert scale: 1 = strongly agree, 2 = agree, 3 = uncertain, 4 = disagree, 5 = strongly disagree. The PSQ-III has 26 positively worded questions in which low score reflects satisfaction and 24 negatively worded questions which were reverse scored.

Data Analysis

Data collected were analyzed using the version 22.0 of the SPSS package. To assess satisfaction, responses to positively worded items on the scale were recoded so that higher item scores indicated greater satisfaction, while for the negatively worded items, the pre-coded responses of 1 = strongly agree, 2 = agree, 3 = uncertain, 4 = disagree, 5 = strongly disagree were maintained so that higher scores also indicated greater dissatisfaction. Total satisfaction score and domain scores were obtained by the summation of all items in the PSQ-III and its domains and division by the number of items in the total scale and domain, respectively. Categorization of scores was done and scores greater than 85% were considered as ‘excellent’ satisfaction, 71% to 85% reflected ‘very good’ satisfaction, 56% to 70% were categorized as ‘good’ while 41% to 55% presented fair satisfaction and 40% and below depicted poor satisfaction. Other continuous variables in the study are presented as mean and standard deviation, while categorical variables are presented as frequencies and percentages.

RESULTS

Sociodemographic characteristics of study participants

A total of 150 patients were eligible and had the study instrument administered on them over a period of one year. Of this, 141 participants completed and returned the questionnaires giving a response rate of 94.0%. Table 1 presents the socio-demographic characteristics of the study participants and reveals that 56.0% of the study population were males while the remaining 44.0% were females. Most of the participants were aged between 36 and 45 years (47.5%), in public formal employment (64.5%), married/cohabiting (75.2%) and had post-secondary education as the highest level of educational attainment (77.3%).

Participants’ responses to subscale domains on the PSQIII measuring satisfaction

Table 2 presents the item mean scores, and standard deviation. The minimum and maximum item mean values for the items were 32.09±18.49 and 85.99±14.75 in PSQ4 and PSQ22 respectively. Domain mean values range from 60.3±8.1 in the GSAT domain to 77.6±9.9 in the communication domain (Table 3). Table 3 reveals that COMM, INTER and TECH domains had the highest responses in satisfaction level. ACC and FINAN recorded poor satisfaction values while TIME spent was the least

Level of Satisfaction with Physiotherapy care

Table 4 shows that most participants reported either good, very good or excellent satisfaction with the communication (95.7%), technical quality (92.9%) and interpersonal aspects (90.1%) of their contact with the Physiotherapists; while highest level of poor and fair satisfaction was reported in the ‘Time spent with physiotherapist’ domains (41.9%) of the scale (Table 4).

Table 1: Sociodemographic characteristics of study participants

Table 2: Mean score and standard deviation distribution of 50 items of the PSQ-III questionnaire

Table 3: Domain mean scores, and standard deviation estimates of the PSQ-III subscales

Table 4: Level of satisfaction in respect of domain

DISCUSSION

This study was to assess the level of satisfaction with physiotherapy services among patients attending outpatient physiotherapy clinic in a public health facility situated in Bayelsa State, Nigeria. An adapted form of the PSQIII was used for the study to suit physical therapy services with changes in words like ‘Doctor’ and ‘Specialist’ to read Physiotherapist and ‘Medical care’ was changed to ‘Physiotherapy care’. Five research experts reviewed the adapted questionnaire to ensure face and content validities.

The mean total scale score is 68.2% with a large proportion of participants in the study expressing ‘good’ and ‘very good’ level of satisfaction with the Physiotherapy care they received at the hospital. This is similar to satisfaction levels reported by other studies.^18,21,22 This finding underscores the importance of the patient-centered approach employed in the care of patient in the hospital which entails a good blend of effective communication, interpersonal skills and high technical know-how as reflected from the domain scores.

Effective communication has been identified as a strong predictor of satisfaction in several satisfaction studies. In this study, communication has the highest mean score and the highest proportion of participants with ‘very good’ level of satisfaction. This shows that the patients appreciated the listening skills of the therapists which affected their level of satisfaction.²³The perception from the patients that the therapist understands their feelings makes them receptive to suggestions, instructions and enhance compliance with treatment plans.

Another factor contributing to the good satisfaction observed in this study is the technical quality or expertise of the therapist. Therapist are seen to pay meticulous attention to details and demonstrate competence. It is thought that the perceived technical quality should motivate patients to follow treatment plan, since patients are likely to believe that the plan will be effective.

The therapist’s character, courtesy, respect, and friendliness towards the patient also contributed remarkably to the total satisfaction score in this study. This supports the position presented by many research findings which suggest that health-care providers who are empathetic, cheerful, kind, and courteous encourage patient satisfaction.²² and that the strongest significant predictors of satisfaction are an expression of concern for the patient’s comfort, professionalism and the therapist’s attitude and character. ²⁴

Participants in the current study were not satisfied with the time spent with Therapist.²³ Most participants consider the time spent with the Therapist too short just like Olubukola reported among participants in their studies.²² Most patients desire longer sessions with the therapist believing that this improves their chance of recovery. However, this is not possible in the physiotherapy department of most public hospital in Nigeria because of the workload resulting from a low therapist-to-patient ratio.²¹

Response to items in the ‘Access, Availability, Convenience’ domain of the PSQ-III suggest that participants are not satisfied with the opening hours of the physiotherapy department of the hospital. Long appointment as reported in Ibadan was also an issue that engender dissatisfaction among participants. Olubukola et al’s study stated that more frequent appointments with the Therapist will expedite rehabilitation and impact on quality of life.¹⁸

Participants in this study were not satisfied with the financial aspect of physiotherapy care.  Cost of Physiotherapy care is reportedly an issue that most patients are not satisfied with. This is because most patients pay out-of-pocket and this may expose them to financial catastrophe and/or impoverishment.²⁵ For participants under some form of pre-payment schemes (Social and Private health Insurance), who are not expected to worry about payment, the number of sessions covered under such schemes are dictated by the payer (HMO) and this affects the satisfaction the patients experience.²⁵

RECOMMENDATIONS

Although patients were generally satisfied with the services provided, the following factors such as access to physiotherapy services at all levels, increase in number of physiotherapists in the healthcare workforce across the levels of health care, in the number of visits for participants utilizing a prepayment scheme and its availability to the entire population would enhance the quality of care rendered.

CONCLUSION

Patient satisfaction is a key index in evaluating quality of healthcare services. Research in patient satisfaction within the health system, will show areas of deficiencies which would require adequate strengthening in order to achieve quality healthcare provision.

LIMITATIONS

This study is not without limitations. The study only measures patients’ satisfaction with care received without linking such satisfaction with expected outcome of care. Satisfaction with service may not translate to satisfaction with outcome of care which is the ultimate reason to seek care.²³

CONFLICT OF INTEREST

Authors declare no conflict of interest

AUTHORS’ CONTRIBUTIONS

The main research work was done by OO, AA analyzed the data collected, PO reviewed the initial draft while MU and RS reviewed the final paper.

ETHICAL CONSIDERATION

Ethical approval for study was obtained from the FMC ethical committee and informed consent obtained in writing from all eligible participant