Original Article
Patient satisfaction and perception of treatment in a student-led osteopathy teaching clinic: Evaluating questionnaire dimensionality and internal structure, and outcomes

https://doi.org/10.1016/j.ijosm.2019.01.002Get rights and content

Highlights

  • Patient satisfaction and perception of treatment are easily measured.

  • Positive effect of treatment is possibly related to increasing age and higher life satisfaction.

  • Gender and previous osteopathy care do not appear to be related to treatment satisfaction and effect.

Abstract

Objective

The aim of the study was to evaluate patient satisfaction with, and perception of their, osteopathy treatment. A secondary aim was to evaluate the measurement properties of a short patient satisfaction questionnaire in an osteopathy patient population.

Design

Questionnaire study. Patients completed a brief demographic questionnaire, patient satisfaction questionnaire and perception of treatment questionnaire at the conclusion of their osteopathy consultation.

Setting

Osteopathy student-led teaching clinic (Melbourne, Australia).

Main outcome measures

Two questionnaires: 1) Short Assessment of Patient Satisfaction (SAPS); and, 2) the Patient Perception Measure – Osteopathy (PPM-O).

Results

Complete data were available for 68 patients. Mean age was 36 years and over half were female. Participants' median satisfaction with life (SWL) was 4 on a 0–5 scale. The SAPS did not satisfy the requirements of a Mokken scale nor was it unidimensional in this population. The reliability estimations for the PPM-O subscales were acceptable (>0.80). Both age and SWL were positively correlated with effect of treatment as measured on the SAPS. Age, gender and previous osteopathy treatment did not relate to SAPS responses. The PPM-O Education and Effectiveness subscale was positively correlated with the SAPS items related to treatment effect, appointment duration and overall satisfaction with care.

Conclusions

Patients in the present study were largely satisfied with treatment and positive about their perception of the osteopathy treatment provided. Further testing of the SAPS to evaluate if it is suitable for use as a measure of satisfaction with osteopathy care or testing of an alternative measure is required.

Introduction

Patient satisfaction is a multi-faceted [1] and complex phenomenon that is not readily defined [2] but is considered to be a measure of both treatment outcome and provision of care [3]. Although not readily defined, authors have identified determinants of the patient experience that contribute to their satisfaction with care. Communication and interpersonal skills [1,2,[4], [5], [6], [7], [8]], practical skills of the clinician [4,5], individualised nature of the care provided [1,4,9,10], continuity of care [5,11] and the physical and organisational environment [[4], [5], [6]] have all been identified as determinants of patient satisfaction. Demographic variables may also be related to patient satisfaction however the only consistent finding is that older patients are generally more satisfied with their care [5,10,12]. The effect of gender on satisfaction is inconsistent [5,13], as are other variables such as education level, marital status, and religion [13]. Further, the patients' psychosocial situation may also be a determinant, where those with mental health conditions and lower self-rated general health demonstrate lower satisfaction [3,5]. Batbaatar et al. [5] in their systematic review of the patient satisfaction literature suggest that “self-assessed health status was one of the strongest predictors of patient satisfaction” (p. 96). With respect to the presenting complaint, Hill and Kitchen [14] identified that patients with acute musculoskeletal complaints were more likely to be satisfied with their physical therapy care compared to those with chronic complaints. Patient satisfaction appears to be independent of the health practitioners’ respective profession [3] however practitioners who are older and male appear to have higher satisfaction scores with both male and female patients [12].

The measurement of patient satisfaction may provide an opportunity to capture another element of treatment outcome. Patient satisfaction is directly associated with improved outcomes, adherence to management strategies [15] and maintenance of a therapeutic relationship with a health professional [3] and with the shift in healthcare toward a patient-centred approach [9], it may be that patient satisfaction is a measure of this patient-centred care approach [1]. Previous studies have explored the patient experience of osteopathic healthcare in private practice in Australia [9] and the UK [16,17], and teaching clinics in the UK [2]. Several common themes have emerged in this research including the value of the therapeutic relationship and communication, holistic treatment and patient-centred management. These themes appear to be somewhat consistent with the wider patient satisfaction literature. Tied with these themes is the concept of the patient's perception of their treatment. Previous work in osteopathy has explored the patient's perception of their treatment, including sensations felt during or after treatment [[18], [19], [20]]. Perception also incorporates the quality of care, and the comparison between what the patient expected and what they experienced [21]. DiGiacinto et al. [19] suggested that low perception of care quality can significantly affect overall satisfaction with care however this has yet to be explored in osteopathy.

To date, no studies have investigated both patient satisfaction and perception of osteopathy in a student clinic in Australia. Victoria University (VU, Melbourne, Australia) operates a campus-based osteopathy clinic to provide pre-clinical students an opportunity to develop their skills and knowledge to manage patients in a clinical setting. In these clinics, students practise under the supervision of qualified practitioners for between 5 and 10 h per week for up to 34 weeks each year [22]. This setting is somewhat similar to student-led clinics in medicine and physiotherapy where high patient satisfaction has been reported, particularly the amount of time spent with a patient, and interpersonal aspects of care [[23], [24], [25], [26]]. Further the presence of medical students does not appear to impact patient satisfaction [[27], [28], [29], [30]]. The current study explored the relationship between satisfaction with osteopathic treatment and perception of osteopathic treatment in an Australian student-led osteopathy teaching clinic. Further aims were to explore a potential link between perception and satisfaction with treatment, and demographic data, and the measurement properties of the questionnaires used.

Section snippets

Participants

Participants were recruited from the Victoria University (VU) Osteopathy Clinic (Melbourne, Australia). Each participant was required to have at least one osteopathic treatment from a senior osteopathy student and have sufficient English to complete the questionnaires. The study was approved by the Victoria University Human Research Ethics Committee. Potential participants who attended the clinic between March 2016 and August 2016, regardless of presenting complaint, or whether they were a new

Results

Four thousand and four hundred patient visits occurred at the VU Osteopathy Clinic during the data collection period with 105 questionnaires being distributed (2.3%). Seventy-nine (n = 79) questionnaires were returned with complete data available for 68 patients representing a 1.5% response rate. Demographic data for these patients is presented in Table 1 and Fig. 1 respectively. Descriptive statistics for the SAPS and PPM-O are presented in Table 2.

Discussion

This study aimed to explore the relationship between satisfaction with osteopathic treatment and patient perception of osteopathic treatment in an Australian student-led osteopathy clinic. Two questionnaires were used to explore this relationship. This study has highlighted several areas where osteopathy students may need to change their care strategies and approaches to improve patient satisfaction. The demographic data suggest that the patient profile in the present study is consistent with

Conclusion

Satisfaction with treatment and care can influence a patient's compliance and participation with management. The results of the present study suggest that patients were satisfied with the effect of their treatment and satisfied with the care they received. Patient satisfaction was positively correlated with the Education & Effectiveness subscale on the PPM-O, providing evidence to support the content validity of this subscale. The results associated with the PPM-O are consistent with previous

Conflicts of interest

The authors report no conflict of interest in relation to this study.

Statement of competing interests

Brett Vaughan is a member of the Editorial Board of the International Journal of Osteopathic Medicine but was not involved in review or editorial decisions regarding this manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgement

The authors would like to acknowledge the assistance of Janet Sansoni in the initial stages of the design of the study and for the approval to use the Short Assessment of Patient Satisfaction in the study.

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