Ease of care with patient controlled analgesia systems: questionnaire development and validation

AIM: This paper is a report of the development and validation of two questionnaires assessing ease of caring for patients receiving patient controlled analgesia from the perspectives of nurses and physical therapists. BACKGROUND: While studies have assessed patient satisfaction with and preference for patient controlled analgesia modalities, no instruments have been developed to assess the ease of providing care (ease of care) for patients receiving patient controlled analgesia from nurses' and physical therapists' perspectives. METHOD: Nurses and physical therapists participated in focus groups during 2003 to identify concepts associated with caring for patients receiving intravenous patient controlled analgesia. Based on these discussions, items were developed and included in draft questionnaires. Content validity of draft questionnaires was assessed, and final questionnaires were developed. Psychometric properties of the final questionnaires were assessed using data from 79 nurses and 80 physical therapists from two clinical trials conducted during 2004 and 2005 to compare the efficacy and safety of two modalities of patient controlled analgesia. FINDINGS: The Nurse and Physical Therapist Ease of Care Questionnaires had 22 items addressing three aspects of patient care: time-efficiency (time-consuming subscale), ease of use/convenience (bothersome subscale), and satisfaction (satisfaction subscale). All subscales on both questionnaires demonstrated evidence of internal consistency reliability, and subscale-to-subscale correlations suggested that the time-consuming and bothersome subscales contribute equally to overall ease of care. The subscales were statistically significantly correlated with clinical measures. CONCLUSION: These instruments may be valuable for assessing the impact of patient controlled analgesia modalities on patient care for these healthcare providers.     

Longitudinal continuity of care is associated with high patient satisfaction with physical therapy

BACKGROUND AND PURPOSE: Recent literature has suggested that longitudinal continuity (ie, the patient is seen by the same practitioner for the entire course of treatment) may be linked to high degrees of patient satisfaction with medical care. The purpose of this study was to provide preliminary information regarding the association between longitudinal continuity and reports of patient satisfaction with physical therapy outpatient care. SUBJECTS AND METHODS: A sample of 1,502 adult subjects completed the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care at the time of discharge from outpatient physical therapy. Relationships between satisfaction measures and the presence or absence of longitudinal continuity were assessed by use of binary logistic regression. RESULTS: Overall, 36.8% of the subjects reported complete satisfaction on the internal subscale (patient-therapist), and 47.9% of the subjects reported complete satisfaction on the external subscale (patient-support staff). Higher percentages of women (40.2% and 51.1% for internal and external subscales, respectively) than of men (31.9% and 43.3% for internal and external subscales, respectively) were completely satisfied with care. Of subjects who reported complete satisfaction on the internal subscale, 71.2% had longitudinal continuity of care, and 28.8% did not. A similar trend was noted for the external subscale (patient-support staff); 66.8% of subjects who reported complete satisfaction had longitudinal continuity, and 33.2% did not. Odds ratios describing the probability of complete satisfaction with care for subjects who had longitudinal continuity and for those who did not were significant and ranged from 2.7 to 3.5. DISCUSSION AND CONCLUSION: Subjects who received their entire course of outpatient physical therapy from only 1 provider were approximately 3 times more likely to report complete satisfaction with care than those who received care from more than 1 provider. These findings suggest that clinicians and managers should make efforts to preserve longitudinal continuity of care as a means of improving patient satisfaction with care.     

Relationship between duration of therapy services in a comprehensive rehabilitation program and mobility at discharge in patients with orthopedic problems

BACKGROUND AND PURPOSE: The purpose of this study was to examine the relationship between duration of physical therapy and occupational therapy and mobility at the time of discharge from a comprehensive rehabilitation program in a group of patients with orthopedic diagnoses. SUBJECTS: Subjects were 116 consecutive patients with orthopedic diagnoses (mean age=72.6 years, SD=12.0, range=21-99) who were admitted to a comprehensive inpatient rehabilitation program. METHODS: This retrospective cohort study utilized the Uniform Data Set, social service records, and quality assurance records to provide demographic and medical information. The Functional Independence Measure (FIM) provided information regarding mobility at admission and discharge. The duration of physical therapy and occupational therapy was measured in hours. RESULTS: Subjects received an average of 40.8 hours of therapy and showed an average change in FIM mobility subscale scores of 24.5. Multiple linear regression was used to demonstrate that duration of therapy was a predictor of FIM score at the time of discharge (partial correlation=.069) after controlling for length of stay, number of diagnoses, FIM cognitive subscale score at admission, and FIM mobility subscale score at admission. Duration of therapy accounted for 6.9% of the variance in the model. CONCLUSION AND DISCUSSION: This study indicates that the amount of physical therapy and occupational therapy that patients with orthopedic diagnoses receive during enrollment in an inpatient comprehensive rehabilitation program is related to the FIM mobility subscale score at the time of discharge. The authors suggest that increasing the hours of therapeutic intervention that a patient receives in inpatient rehabilitation could improve functional outcomes at discharge.     

Satisfaction with rehydration therapy for terminally ill cancer patients: concept construction,scale development,and identification of contributing factors

Comprehensive assessment is important in determination of the efficacy of rehydration therapy for terminally ill cancer patients. To validate a multidimensional satisfaction scale, a multicenter cross-sectional study was performed. The participants were requested to complete a questionnaire on their satisfaction levels with rehydration therapy, and the primary physician recorded each patient's background. A total of 173 patients were included in this study. After the development phase, the initial instrument was shortened to a 12-item scale. In the validation phase, an exploratory factor analysis revealed underlying three subscales: satisfaction with "information giving," "disturbance of daily activities," and "treatment effect." This factor structure was ascertained by a confirmatory factor analysis. The overall Cronbach's alpha coefficient was 0.73, and those for subscales ranged from 0.73 to 0.83. The total score was significantly correlated with global satisfaction score (rho=0.53), and the "treatment effect" subscale score was moderately correlated with self-perceived improvement of dehydration symptoms (rho=0.25-0.33). The test-retest examination showed fair reproductive reliability (intraclass correlation = 0.78 for total and 0.63-0.78 for subscale scores). Multivariate analyses identified that disclosure of the incurability, 15 min or more daily contact with physicians, presence of a primary responsible nurse, absence of cachexia, and absence of fluid retention symptoms were significantly associated with higher patient satisfaction. In conclusion, this scale had acceptable psychometric properties for measurement of patient satisfaction with rehydration therapy.     

Development and validation of a measure of dental patient satisfaction

As part of the Washington State Dental Auxiliaries Project, a 42-item measure of patient satisfaction with dental care was developed. The measure is comprised of 13 subscales: dentist-patient relations, technical quality of care, access, patient waiting time, cost, facilities, availability, continuity, pain, auxiliaries performing expanded duties, staff-patient relations, staff technical quality of care, and office atmosphere. The measure was developed from a set of 52 items included in a questionnaire administered to the patients of private dental practices in Washington state. Usable questionnaires were returned by 30.8% of patients receiving questionnaires in 1979, 40.1% in 1980, and 34.0% in 1981. Factor analysis plus categorization of items by a panel of professionals were used initially to group items into subscales. Contribution to internal consistency was the final criterion for an item's inclusion in a subscale. Internal consistency of subscales ranged from 0.44 to 0.80. The concurrent validity of subscales was assessed by relating patient satisfaction to characteristics of the dental practices. The following statistically significant relationships between subscales and criterion variables were observed: dentist-patient relations and percent of patients seen by the dentist; access and number of weeks appointments must be booked in advance; patient waiting time and actual patient waiting time; continuity of care and percent of patients seen by the dentist; auxiliaries performing expanded duties and delegation to auxiliaries; and staff technical quality and percent of hygienist restorations with satisfactory quality. Each relationship was in the expected direction.     

Establishing reliability and validity of the critical care family satisfaction survey

OBJECTIVE: To develop and validate the Critical Care Family Satisfaction Survey as a proxy for patient satisfaction. DESIGN: Instrument validation study. SETTING AND TIME FRAME: The Medical Intensive Care, Shock Trauma, Acute Coronary Care, Central Nervous System, Surgical Intensive Care, and Special Care units of Lehigh Valley Hospital (Allentown, PA), for the period December 1997 through September 1998. PATIENTS/PARTICIPANTS: One family member for each of 237 critical care patients. INTERVENTION(S): Content and construct validity were examined on 37 items and 6 constructs thought to measure family satisfaction with the quality of critical care in hospitals. Initially, 14 items and 1 construct were removed from the questionnaire based on this analysis. It was then administered to 237 family members. MEASUREMENTS AND MAIN RESULTS: Factor analysis and confirmatory factor analysis using path models were performed. Internal consistency using Pearson correlations and Cronbach's alpha, and discriminant validation were also calculated. Factor analysis yielded a single eigenvalue >1 (3.712), whereas confirmatory factor analysis led to the final instrument being reduced to 20 items and 5 subscale constructs. One subscale ("Comfort") performed poorly, indicating the possible need for a four-factor model. Subsequently, internal consistency assessed by Cronbach's alpha was 0.9101 for the five-factor model and 0.9327 for the four-factor model. Subscale correlations were no lower than 0.750 for the five-factor model and 0.856 for the four-factor model. CONCLUSIONS: This study provides support that the Critical Care Family Satisfaction Survey-which yields five subscales, "Assurance," "Information," "Proximity," "Support," and "Comfort"--is reliable and valid. Using five constructs rather than four is recommended because of the following: a) the internal consistency loss of 0.0226 for the "Comfort" subscale is not enough to warrant its removal, b) a four-factor questionnaire can be administered and totaled independently of this subscale, c) the need for the fifth construct is indicated by this study's results, and d) including the extra data may allow for more detailed analysis.     

Development of a questionnaire to evaluate patient satisfaction with medical encounters

Given that a medical practice exists for patients, it is worth determining the degree of patient satisfaction with regard to the medical practice's quality of care. Considering the importance of noticing patient satisfaction and its influence on clinical care, intense evaluation of a questionnaire's validity and reliability is essential. The purpose of this study was to establish a valid and reliable self-administered scale to measure patient satisfaction with fewer questions than previous scales applicable in medical settings in Japan. A qualitative method was used to develop and revise content-valid question items of the questionnaire. Factor analysis revealed five subscales among 12 items: "overall satisfaction", "complete examination", "patient centeredness", "examination time", and "whole person care". A test of internal consistency was also assessed. The concurrent validity was assessed to evaluate the association between the score of the current questionnaire and that of the visual analogue scale or other questionnaire. Agreement between two sets of score, scores just after consultation and 30-50 min after that, was assessed to evaluate the test-retest reliability of each question item. The results revealed satisfactory validity, including the content and concurrent validity, internal consistency (Cronback alpha = 0.77-0.85), and the test-retest reliability of our questionnaire (Kappa score = 0.61-0.71). In conclusion, we have developed a short-form self-administered patient satisfaction questionnaire applicable in Japan, with acceptable validity and reliability. This questionnaire may contribute to conducting further studies related to patient subjective responses to encounters in Japanese medical settings, and evaluating and improving the clinical interview skills of medical students or trainees in medical education.     

Patient satisfaction with outpatient physical therapy: instrument validation

BACKGROUND AND PURPOSE: Patient satisfaction with physical therapy is used as an outcome variable. The purpose of this study was to develop and test an instrument used to determine which variables are associated with the satisfaction of patients receiving outpatient physical therapy. SUBJECTS: During the pilot study, 191 patients participated, and 1,868 patients then participated in the main phase of this work. METHODS: Using a survey instrument developed by the authors, subjects responded to global questions concerning overall satisfaction with physical therapy. Content validation of the instrument was investigated using item correlation, principal components analysis, and factor analysis. Reliability was measured using the standard error of measurement. Concurrent validity was investigated by correlating summary scores of the final survey instrument with global measures of satisfaction. RESULTS: Reliability was best for a 10-item questionnaire. Patient satisfaction was most associated with items that reflected a high-quality interaction with the therapist (eg, time, adequate explanations and instructions to patients). Environmental factors such as clinic location, parking, time spent waiting for the therapist, and type of equipment used were not strongly correlated with overall satisfaction with care. DISCUSSION AND CONCLUSION: Because the time the therapist spent with patients and the behavior of the therapists are important for patient satisfaction, emphasis on cost-cutting, high patient volume, and the use of "care extenders" may jeopardize satisfaction.     

Distinguishing patient satisfaction with treatment delivery from treatment effect: a preliminary investigation of patient satisfaction with symptoms after physical therapy treatment of low back pain

OBJECTIVE: To investigate the discrepancy between ratings of pain intensity and patient satisfaction by evaluating a questionnaire item that assesses patient satisfaction with treatment effect. DESIGN: Inception cohort. SETTING: Ambulatory care. PARTICIPANTS: Sixty-six consecutive patients referred to outpatient physical therapy (PT) with acute low back pain (LBP). INTERVENTION: PT using treatment-based classification guidelines. MAIN OUTCOME MEASURE: Patient satisfaction 6 months after receiving PT for LBP. RESULTS: Patient satisfaction with symptoms was considerably lower than the other patient satisfaction items. Patient satisfaction with symptoms was responsive to measures of treatment effect (Spearman rho range, .36-.44, P < .01) and with whether expectations were met (Spearman rho = .45, P < .01). Patients who were satisfied with symptoms reported higher physical function, lower pain intensity, and less symptom bothersomeness (P < .01) at 6 months. The 2 strongest absolute and unique predictors of patient satisfaction with symptoms at 6 months were whether treatment expectations were met and change in symptom bothersomeness. CONCLUSIONS: This study suggested that a questionnaire item assessing patient satisfaction with symptoms allows patients to distinguish between satisfaction with treatment effect and treatment delivery.     

Development of an instrument to assess expectations of and preference for an insulin injection pen compared with the vial and syringe

BACKGROUND: Before using a product, patients form expectations regarding the extent of a product's desirable attributes. These expectations can be used to understand their preference and anticipate potential satisfaction with the product. OBJECTIVE: The aim of this study was to produce a valid and reliable data collection instrument (the Insulin Injection Preference questionnaire [IIP-q]) to measure expectations of and preference for the insulin injection pen compared with the vial and syringe. METHODS: This study was initiated at the University of Mississippi (University, Mississippi). The IIP-q was developed to determine the extent to which respondents' prepurchase expectations of a product's attributes relate to preference for an insulin injection pen compared with the vial and syringe. Instrument development began with item generation related to product attributes important to patients who inject insulin. Items originated from an extensive search of the peer-reviewed Internet-based literature, marketing reports, clinical studies, and existing instruments. Content validity also was assessed using expert panel and focus group review. The resultant instrument (the IIP-q) was mailed to 1200 patients known to have type 1 or type 2 diabetes mellitus who either did or did not use insulin. Subscales were identified through exploratory factor analysis. Reliability and validity were assessed using Cronbach alpha for subscale items. Product-moment correlations between subscale dimensions and 2 global measures of preference were used to test the relationship between attribute expectations and preference. RESULTS: Seventeen of the questionnaires were returned as undeliverable, leaving 1183 in the sample population. Questionnaires were received from 302 individuals, 55 of whom failed to complete > or = 85% of the items and thus were not included in the final analysis. Of the 247 respondents (135 women, 112 men; mean [SD] age, 52.4 [13.2] years (range, 18-83 years]), 99 (40.1%) were current insulin users and 143 (57.9%) were not using insulin. Exploratory factor analysis resulted in a 13-item solution (Cronbach alpha = 0.92), accounting for 73.6% of the total explained variance. Ease of use, activity interference, and social acceptability emerged as expectation subscales from exploratory factor analysis. Cronbach alpha for items comprising the subscales ranged from 0.82 to 0.92. The 3 subscales were significantly correlated with patient preference (ease of use, r = 0.520, P < 0.001; activity interference, r = 0.570, p < 0.001; social acceptability, r = 0.602, p < 0.001). CONCLUSIONS: The results of the present study provide support for the IIP-q as a reliable and valid instrument to assess patient expectations of product attributes and preference. This instrument can be modified for use in clinical trials to determine the role of patient expectations and preference in their judgments regarding satisfaction with insulin delivery devices.     

Development and factor analysis of a questionnaire to measure patient satisfaction with injected and inhaled insulin for type 1 diabetes

OBJECTIVE: To develop a self-administered questionnaire to address alternative delivery routes of insulin and to investigate aspects of patient satisfaction that may be useful for subsequent assessment and comparison of an inhaled insulin regimen and a subcutaneous insulin regimen. RESEARCH DESIGN AND METHODS: Attributes of patient treatment satisfaction with both inhaled and injected insulin therapy were derived from five qualitative research studies to arrive at a 15-item questionnaire. Each item was analyzed on a five-point Likert scale so that higher item scores indicated a more favorable attitude. There were 69 subjects with type 1 diabetes previously taking injected insulin therapy who were enrolled in a phase II clinical trial. Their baseline responses on the questionnaire were evaluated and subjected to an exploratory factor analysis. Meaningful factors were retained and interpreted based on their psychometric properties. RESULTS: Exploratory factor analysis suggested a two-factor solution accounting for 66 and 20% of the variance, respectively. The first factor contained 10 reliable items (Cronbach's alpha = 0.89) relating to convenience and ease of use, and the second contained 5 reliable items (Cronbach's alpha = 0.82) relating to social comfort. CONCLUSIONS: Among patients with type 1 diabetes, this analysis highlighted and quantified two key factors contributing to patient satisfaction: convenience/ease of use and social comfort. The questionnaire underwent rigorous development, had reliable properties, and an interpretable and rich factor structure. This report is intended to help advance, in subsequent investigations, the understanding and measurement of treatment satisfaction with novel and existing forms of insulin delivery.     

Evaluation of patient satisfaction as quality assurance measure in the hospital

The importance of patient satisfaction as one indicator of quality care in the hospital is undisputed. This article discusses the findings of a survey on patient satisfaction that was conducted in patients with mainly gastrointestinal diseases. The aim was to find out whether the questionnaire is sensitive enough to discern levels of care in order to indicate which aspects of hospital care require improvement. The questionnaire comprised 63 items and measured satisfaction with 4 specific dimensions of hospital care, namely physician services, nursing care, food/accommodation and administration/organisation of daily activity, and two questions for open-ended responses. 319 questionnaires were distributed which the patients should deposit anonymously on the ward on the day of discharge. The response rate was 60.5%. 53.3% were completely filled in and could be analysed. The results show typically high levels of satisfaction with the core performances in hospital namely medical and nursing care. On the other hand the data clearly revealed detailed criticism about certain aspects of care. The four-dimensional questionnaire proved to be a useful and economically reasonable way to obtain a considerable amount of information on quality of care from the patient's perspective. The problem of losing precious information because of standardized answer categories can be met partly by providing the possibility of positive and negative remarks in open-ended questions. Despite several shortcomings of the method (i. e. social desirability) it can be used as a starting point for improvement in the clinical setting.     

Patients report being satisfied with private musculoskeletal physical therapy when therapists educate effectively and facilitate shared decision making

BackgroundOverall satisfaction with physical therapy care can improve patient adherence and active involvement in their management. However, which individual factors most influence satisfaction with private practice physical therapy care is not well established.ObjectiveTo identify which aspects of the private practice musculoskeletal physical therapy experience best delineated “completely satisfied” and “dissatisfied patients”.MethodsThe MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) was used in a cross-sectional design within 18 Australian private musculoskeletal physical therapy practices. The area under the curve (AUC) of receiver operator characteristic curves (ROC) was used to quantify the ability of the individual patient experience questions to classify the global impressions of satisfaction and likelihood to recommend to others.Results1712 patients completed the survey (out of 7320 survey recipients - response rate 23%). High scores were identified for overall satisfaction (4.8/5 ± 0.61) and likelihood to recommend (4.78/5 ± 0.67). Individual items relating to education (AUC = 0.839 and 0.838) and shared decision making (AUC = 0.832 and 0.811) were the most accurate indicators of satisfaction and likelihood to recommend to others, respectively.ConclusionIndividual questionnaire items relating to education and shared decision making were the most accurate indicators of satisfaction and likelihood to recommend in patients attending private practice musculoskeletal physical therapy in Australia. Clinicians and educators should focus on developing these skills to encourage an effective therapeutic alliance and promote greater levels of patient satisfaction.     

儿童期虐待问卷中文版的信度及效度评估

背景目前国际公认的儿童期虐待问卷为美国心理学家Bemstein 1998年的编制版.目的建立儿童期虐待问卷28个条目量表的中文版,并分析其信度和效度.设计团体调查.单位中南大学湘雅二医院精神卫生研究所.对象于2004-10在河南省某市一所乡村中学,随机抽取8个班级共441名学生.方法用儿童期虐待问卷对441名中小学生进行测评,2个月后对其中93名学生进行重测.儿童期虐待问卷共有28个条目,分为5个分量表情感虐待;躯体虐待;性虐待;情感忽视;躯体忽视.每个条目采用5级评分1分从不;2分偶尔;3分有时;4分经常;5分总是.每个虐待分量表在5～25分之间,总分在25～125分之间.分析问卷的内部一致性、重测信度、条目间平均相关系数和总分与各分量表间的相关系数,并进行验证性因素分析.主要观察指标儿童期虐待问卷的同质信度,重测信度,效度,绝对拟合指数,相对拟合指数,省俭指数.结果现场发放问卷441份,收回回答完整、规范的问卷435份.2个月后第二次评定发放问卷93份,收回回答规范的问卷93份,用于评测该量表的重测信度.①儿童期虐待问卷中文版的Cronbach α系数为0.64;重测信度为0.75.各分量表的Cronbach α系数为0.16～0.65,重测信度为0.27～0.73.条目间相关系数在-0.20～0.44之间.②总分与各分量表的相关系数为0.36～0.68,各分量表间的相关系数为-0.01～0.39.③验证性因素分析的指标躯体忽视的负荷系数为0.09～0.64,有2个条目小于0.20.复相关系数为-0.2l～0.82.X2/df(2.48);近似均方根误差(0.06);增指指数IFI(0.76),CFI(0.75),TLI(0.72);省俭指数PNFI(0.58),PCFI(0.67).结论儿童期虐待问卷中文版具有较好的信度和效度,根据验证性分析,各个指标除躯体忽视外,基本符合测量学标准,同时标准路径分析结果理想,说明该量表模型中文版分量表具有较好的匹配性,具有较好的构想效度.     

Patients' perspectives on information received in outpatient psychiatry

The purpose of this study is to develop a scale in order to determine the informational needs deemed most important by psychiatric outpatients, and to determine their level of satisfaction with information received. The 'Patients' Perspective on Information Questionnaire' (PPIQ) scale was created and given to a volunteer sample of 86 psychiatric outpatients. The Client satisfaction questionnaire (CSQ-8), assessing global satisfaction, was also completed to assess the convergent validity of the PPIQ-Satisfaction subscale. Internal consistency for the two PPIQ subscales (Information and Satisfaction) is excellent (alpha = 0.90 and 0.91). Convergent validity between the Satisfaction subscale and the CSQ is adequate (r = 0.5). The PPIQ reveals high importance ratings given to items such as 'side effects of medication' and 'confidentiality and access to chart'. Elevated satisfaction ratings are given to items from the conceptual category 'treatment information'. Dissatisfaction on the PPIQ is highest for components of 'information on service modality and organization'. The PPIQ appears to distinguish between information that is important to clients and their level of satisfaction with that information. Satisfaction on multiple components of information, such as treatment, service modality and organization, and clinical difficulties should be assessed to generate feedback to improve services.     

Assessing psychosocial distress in diabetes: development of the diabetes distress scale

OBJECTIVE: The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples. RESEARCH DESIGN AND METHODS: In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic (n = 200), waiting room at a diabetes specialty clinic (n = 179), a diabetes management study program (n = 167), and an ongoing diabetes management program (n = 158). RESULTS: Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high (r = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r = 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (alpha > 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenced the highest mean DDS total scores, whereas diet-controlled subjects displayed the lowest scores (P < 0.001). CONCLUSIONS: The DDS has a consistent, generalizable factor structure and good internal reliability and validity across four different clinical sites. The new instrument may serve as a valuable measure of diabetes-related emotional distress for use in research and clinical practice.     

Quality of life on admission to the intensive care: can we query the relatives?

OBJECTIVE: To study whether the Short Form-36 questionnaire can be used to assess the patient's quality of life on admission to the ICU by use of proxies in both scheduled and emergency admissions. DESIGN AND SETTING: Prospective study involving direct interviews of patients and relatives before or during ICU stay in a 10-bed mixed intensive care unit in a 654-bed university affiliated hospital. PATIENTS AND PARTICIPANTS: Patients before major elective surgery ( n=55) or following emergency admissions ( n=57). MEASUREMENTS AND RESULTS: Patients and proxies completed a health questionnaire in the first 72 h following emergency admission or the day before a scheduled admission to the ICU. Internal consistency was evaluated by measurement of Cronbach's alpha. All dimensions of the SF-36 had adequate internal consistency. On all eight dimensions a significant correlation was found between the patient and their proxy. In general, proxies underestimated the patient's quality of life although differences were small (less than 5%). On most items a good to very good agreement was found (alpha>0.6). Quality of life assessment was not affected by the admission status of the patient (acute or elective admission and surgical or medical diagnosis). CONCLUSIONS: The SF-36 questionnaire completed by a proxy can reliable assesses the quality of life of the critically ill patient on admission to the ICU. Proxies underestimated the patient's quality of life, although the differences were small.     

Development and validation of a questionnaire to evaluate patient satisfaction with diabetes disease management

OBJECTIVE: To develop a reliable and valid questionnaire to measure patient satisfaction with diabetes disease management programs. RESEARCH DESIGN AND METHODS: Questions related to structure, process, and outcomes were categorized into 14 domains defining the essential elements of diabetes disease management. Health professionals confirmed the content validity. Face validity was established by a patient focus group. The questionnaire was mailed to 711 patients with diabetes who participated in a disease management program. To reduce the number of questionnaire items, a principal components analysis was performed using a varimax rotation. The Scree test was used to select significant components. To further assess reliability and validity; Cronbach's alpha and product-moment correlations were calculated for components having > or =3 items with loadings >0.50. RESULTS: The validated 73-item mailed satisfaction survey had a 34.1% response rate. Principal components analysis yielded 13 components with eigenvalues > 1.0. The Scree test proposed a 6-component solution (39 items), which explained 59% of the total variation. Internal consistency reliabilities computed for the first 6 components (alpha = 0.79-0.95) were acceptable. CONCLUSIONS: The final questionnaire, the Diabetes Management Evaluation Tool (DMET), was designed to assess patient satisfaction with diabetes disease management programs. Although more extensive testing of the questionnaire is appropriate, preliminary reliability and validity of the DMET has been demonstrated.     

Zufriedenheit chronischer Schmerzpatienten mit ihrer analgetischen Medikation

BACKGROUND: A newly developed questionnaire to measure the satisfaction of chronic pain patients with their analgetic treatment is introduced. METHODS: Based on pilot studies, a multidimensional questionnaire (QAMPAS) for the measurement of patient satisfaction was developed. In addition to a module on general patient satisfaction, it includes two specific modules with regard to medical treatment using tablets and transdermal systems (patches). In a validation study the questionnaire was administered at two measurement points to ambulatory chronic pain patients. RESULTS: The QAMPAS subscales possess satisfactory psychometric properties. Medication-specific satisfaction shows a well-differentiated multidimensional structure. With minor limitations, correlations with the general patient satisfaction module and the SF-36 and BPI subscales indicate it to be a valid instrument. CONCLUSION: The QAMPAS questionnaire is a standardized instrument with satisfactory psychometric properties for the measurement of patient satisfaction with their analgesic treatment.     

The satisfaction of patients with multiple sclerosis regarding services received from physical and occupational therapists

The purpose of this study was to describe the satisfaction of patients with multiple sclerosis regarding the services they received from their physical and occupational therapists. Eighty-one patients volunteered for the study in response to advertisements and completed the Therapist Evaluation Form (TEF). Subjects had to have been a physical or occupational therapy patient within the last year and also had to have seen the same therapist for a minimum of four treatment visits. Total score and item analysis of the results demonstrated a high degree of satisfaction among the patients surveyed. The content of two open-ended questions on the TEF also showed that patients value therapist characteristics of being friendly and caring. Patients reported less satisfaction with the therapists' technical skills as opposed to rapport issues. These results reinforce the literature, which cites the importance of interpersonal aspects of patient/professional relationships for persons with disabilities. In addition, the initial reliability and validity data on the TEF obtained in this study support its further development as an instrument to measure patient satisfaction in physical and occupational therapy.