Patient satisfaction analysis in patients of low back ache undergoing physiotherapy

INTRODUCTION

Back pain is a leading cause of disability with a lifetime prevalence of 84%.¹ Management of patients presenting with low backache primarily is conservative or operative in select patients. Conservative treatment encompasses analgesics, lifestyle modifications, and physiotherapy.^2,3 Physiotherapy modalities in low backache (LBA) management are namely Short-wave Diathermy (SWD), Interferential Therapy (IFT), exercises or combinations of the above.

For a healthcare system to prevail and further improve, it is essential to have a healthy interaction between the patients, healthcare providers and the managers; however, it is equally important to have a feedback system in place.⁴ Various healthcare service managers incorporate the patient feedback system as a modality to analyse their delivery system and, if needed, improve their facilities in their respective centres. The feedback can be of three forms: voluntary events, surveys, or informal feedbacks.⁵ Such feedback can be received via various tools, such as digital platforms, written questionnaire forms, telephonically, or by face-to-face interaction.

In addition to the above, it is essential that comprehensive and deliberate feedback questions are enrolled and, at the same time, honest feedback is provided by the patients.

The authors carried out a written questionnaire-based patient satisfaction survey of its low backache patients on various parameters. The purpose of this study was twofold: first, to formulate a survey that would be helpful and available to various healthcare providers to incorporate into their system, and second, to analyse the lacking areas in the existing system.

MATERIAL AND METHODS

The study was carried out at a military setup deployed in an active field area. Patients with mechanical and degenerative origin LBA were considered for the study.⁶ All the patients reporting to the orthopaedic outpatient department with low backache were categorised into those needing conservative management and those needing operative intervention. Patients in need of operative intervention at the initial assessment were advised and subsequently referred to the higher centre. The patients who were advised physiotherapy based on the assessment by the orthopaedic surgeon were then referred to the physiotherapy department.

The demographic details of the patients were recorded and documented. Broadly, the patients were categorised into four types of low back ache: acute LBA, discogenic LBA, mechanical LBA and LBA with radiculopathy. The physiotherapy modality offered was based on the clinical assessment of the orthopaedic surgeon and comprised SWD, IFT, exercises, or a combination of the above.

A total of 127 patients attending the physiotherapy department were enrolled and provided their consent to be interviewed with a written satisfaction scorecard format, and their feedback was taken on 10 selected criteria in a questionnaire format and scored on a scale of 1–5 for each criterion. The selected criteria were as under:

1. Availability of sufficient infrastructure & information

2. Waiting time at registration

3. Behaviour and attitude of hospital staff

4. Amenities in the waiting area

5. Attitude and communication of physiotherapist

6. Time spent on consulting, examination & counselling

7. Availability of equipment

8. Promptness of therapy deliverance

9. Follow-up experience

10. Overall feedback.

RESULTS

1. Demographic details of patients are as follows:

   • 1.1 The patient age group of 20–70 years took part in the study; 73% of patients were between the age group of 30–50 years. Age-wise distribution with the average score is shown in Figure 1.

   • 1.2. 82% patients were male (n = 104) and 18% female (n = 23).

   • 1.3. Patients participated under the study reported multiple complaints and accordingly was provided with different modalities of treatment. Most of the patients (49%) reported with mechanical low backache.

2. On analysing the satisfaction score provided by the patients, along with their demographic profile, the following results were found:

   • 2.1 Average satisfaction score for the study group was 3.49 out of 5.

   • 2.2 Most satisfied age group was 21–30 years of age, with an average satisfaction score of 4.10, and the least satisfied age group was 61–70 years of age, with an average score of 2.70 out of 5 [Figure 2].

   • 2.3 The satisfaction level of female was higher than male counterparts.

   • 2.4 When analysed the score as per the diagnosis of cases under study, it was found that the most satisfied group of patients were those with a diagnosis of acute LBA with an average score of 3.60 as compared to the average total score of 3.49 out of 5. The least satisfied group were patients with discogenic LBA with an average score of 2.96 [Figure 3].

3. When the satisfaction score data was analysed considering individual criteria under study, the following results were obtained:

   • 3.1 It was found that the most satisfying criteria for the patients was the attitude and communication of the physiotherapist, with an average score of 3.80, followed by follow-up experience and time spent on consultation, examination and counselling, with average scores of 3.75 and 3.72, respectively.

   • 3.2 Most dissatisfying factor for the patients was found to be waiting time at registration, followed by amenities in the waiting area with average scores of 2.66 and 2.75, respectively.

   • 3.3 The distribution of average satisfaction scores for each of the study criteria is shown in the following Figure 4.

4. It was observed that 6% of the patients (n = 8) gave satisfaction scores below 2 out of 5 (average 1.64). The maximum number of patients (40%, n = 51) had an overall satisfaction score between the range of 3–4. 21% of patients (n = 27) gave satisfaction scores between 4 and 5.

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Figure 1:

Age wise distribution of patients.

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Figure 2:

Age wise satisfaction score.

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Figure 3:

Average score among different diagnosis groups. LBA: Low back-ache.

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Figure 4:

Criteria wise satisfaction score among the patients.

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DISCUSSION

Healthcare services have evolved significantly over the previous years to a level where a lot of focus is now being paid to improve the existing services. At this stage, it is of paramount importance that a feedback system is enrolled and is an integral part of the system. Patient satisfaction surveys is one of the feedback systems which revolve around the patients and gives them the opportunity to be a part of improving the services. Donabedian, in his quality assessment work, had included patient satisfaction as an outcome measure along with changes in health, knowledge, and behavior.^7,8 In addition, a satisfied patient is known to respond well to the treatment offered, be more punctual with the therapy routine, and be compliant with the therapy. So, it is of utmost importance that a satisfaction survey is conducted from time to time in the healthcare services to achieve optimal outcomes.

Patient satisfaction has been perceived differently by various authors.^9,10 The satisfaction is driven by various factors like the patient expectations, their feelings, emotions, and perception of healthcare services, and their attitude towards services.

Physiotherapy involves providing physical therapy for various ailments, which has a positive impact on the mental, psychological, and social well-being of the individual. However, not all the patients are similar in all the aspects, and thus the disabilities or different ailments respond differently to the treatment offered. We choose a single disability of low backache for the purpose of reducing the bias towards the disease and thus reduce confounding.

It is also essential that the survey should consider all the facilities being rendered to the patient. The formulated feedback system was compact and comprehensive and was designed keeping in mind every possible point of contact of the patient with the physiotherapy department.

It has been suggested that the satisfaction assessment should consider technical, interpersonal, social, and moral aspects of care.¹¹ Our survey tried to address all these aspects in a concise way. Additionally, demographics are also known to influence satisfaction levels.^9,12 However, all these factors are non-modifiable and are thus of no use for the managers as an assessment tool to modify the services.

The average overall experience of our patients was 3.70 on the Likert scale. Of these, the factors pertaining to the therapist and hospital staff were scored better by the patients. The patients were most satisfied with the behaviour and attitude of the hospital staff, followed by the attitude and communication of the therapist.

A pleasant and a therapist-adhered follow-up is known to improve the outcomes in the patients.¹³ The same was replicated in the results at our centre in the form of higher satisfaction rates among the patients.

The promptness of therapy deliverance was marginally lower than the average score and could be attributed to the young therapist posted with the centre.

Areas which were scored less were those related to the availability of equipment, infrastructure, amenities and waiting period at the registration desk.

Although various tools are available for carrying out the patient satisfaction survey, we tried to shorten and make the questionnaire in a compact manner. Physical therapy outpatients’ survey and MedRisk instruments are two such tools.^14,15 Our survey enrolled questionnaires, which were concise and comprehensive and were addressing all the areas of possible impact.

CONCLUSION

The patient satisfaction survey is an essential tool to gather feedback from the patient; however, at the same time, it is pertinent that such a survey is concise, comprehensive, and addresses various aspects of healthcare. Our questionnaire considered all of these and is a handy option which can be used by other healthcare organisations.