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Patient Satisfaction With Outpatient Physical Therapy: Instrument Validation

PF Beattie, PT, PhD, OCS, is Clinical Associate Professor, Program in Physical Therapy, Department of Exercise Science, School of Public Health, University of South Carolina, Columbia, SC 29208 (USA) (pbeattie{at}sph.sc.edu).
MB Pinto, PhD, is Assistant Professor of Marketing, School of Business, Penn State Erie, Erie, Pa
MK Nelson, PT, PhD, CPA, is Associate Professor, School of Business Administration Franklin & Marshall College, Lancaster, Pa
R Nelson, PT, PhD, FAPTA, is Vice President, Expert Clinical Benchmarks, MedRisk Inc, King of Prussia, Pa

Address all correspondence to Dr Beattie

Submitted May 2, 2001; Accepted November 12, 2001

	Abstract

 
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.

Key Words: Patient satisfaction • Physical therapy • Survey development

	Introduction

Top Abstract Introduction Method Results Discussion Conclusions Appendix References

 
In the current health care environment, physical therapists are faced with the challenge of practicing in an increasingly competitive marketplace. The rapidly growing number of practicing physical therapists and the widespread use of "care extenders" has allowed patients more options when choosing providers. Physicians are often under pressure to reduce referrals for physical therapy, and people from other disciplines, such as personal trainers, are aggressively marketing their services to prospective patients. As marketplace competition continues to grow, patient satisfaction with physical therapy is emerging as an outcome variable of critical importance.^1–4 Patients who report high satisfaction with care are more likely to continue the relationship with the health care practitioner, to seek additional medical care when needed, and to adhere to recommended treatment plans.^5–8

Patient satisfaction is often considered to be an abstract, multidimensional phenomenon.^6,7,9,10 Because it usually is not observable directly, patient satisfaction must often be measured in what we would consider an indirect manner (ie, from self-report measures).^{1–4,6,11–14} A simple self-report method for assessing satisfaction is to ask global questions such as, "Overall, I am completely satisfied with my care."⁶ These questions, although easy to administer, do not provide information about why a person is or is not satisfied; therefore, many authors^1–4,6,9,10 recommend the use of multidimensional measures. Consequently, the question arises about which variables are needed to assess patient satisfaction adequately. If a measure does not include all relevant variables, important information may be missed, whereas sampling too many variables may provide irrelevant or misleading information. For example, an instrument may erroneously identify a lack of parking and poor location as sources of patient dissatisfaction. This could result in a clinic undergoing an expensive relocation when the actual source of dissatisfaction was insufficient therapist time with the patient.

Numerous aspects of patient satisfaction have been described, and the most common factors are: the patient-practitioner relationship (competence, personality of the practitioner, communication), location and accessibility of services, continuity of care, cost and payment issues, and the facility (eg, cleanliness, noise, equipment).^1,4,6,14 Although several researchers^{5,8–10,12–22} have described the development or use of measures of patient satisfaction with overall medical care, the applicability of these measures to patient satisfaction with physical therapy is uncertain. In our opinion, the unique aspects of care related to outpatient physical therapy—such as the need for frequent visits over a short period of time as well as the need for patients to stay in the clinic for sessions that are longer than those of a typical physician's visit—may require a different, "specialty-specific" scale.

Recently, 2 groups^1,4 have described the development of instruments for assessing patient satisfaction in outpatient physical therapy settings. Both instruments had what we would consider good psychometric properties; however, we believe they reflect different aspects of patient satisfaction. Roush and Sonstroem⁴ developed an outpatient satisfaction survey by sequentially testing 3 patient samples totaling 607 people. The authors proposed using a 34-item survey questionnaire to measure 4 dimensions: enhancers, detractors, location, and cost. Location and cost were found to be the greatest influences to satisfaction. Goldstein et al¹ reported measurement properties on a different instrument that was tested on 289 subjects. The authors proposed a 15-item questionnaire that indicated that a single dimension representing patient-therapist interaction was most important. Cost of care was not correlated with overall satisfaction.

The variation in the content of these instruments suggests a need to investigate the variables associated with patient satisfaction. The purpose of our study was to develop and test an instrument that would provide adequate measurement properties to assess which variables were most closely associated with the overall satisfaction of patients receiving outpatient physical therapy for occupation-related musculoskeletal conditions.

	Method

Top Abstract Introduction Method Results Discussion Conclusions Appendix References

 
General Description

Our study was divided into 2 phases. The first phase consisted of instrument development and pilot testing. In the second phase, the instrument was revised and administered to a large sample of people who were from several geographic areas and who had a variety of diagnoses. Using these data, further instrument revision using factor analysis and reliability testing was performed.

Phase 1: Initial Development of the Instrument and Pilot Testing

Initial development of the instrument.
The first step in the development of the survey instrument was to create items that we believed could reflect the potential variables that influence patient satisfaction in an outpatient physical therapy setting. Taking into account the disagreement in the previous published work concerning the dimensions of satisfaction^1,4 and based on discussions with physical therapists and patients and our own views, we chose items reflecting what we considered 2 broad variables: personal aspects of the therapist and system/external aspects. The personal aspects consisted of a series of items regarding the patient's interaction with the physical therapist and associated staff (ie, physical therapist assistant, receptionist, and other office staff). The systems/external aspects related to issues such as clinic accessibility and location, waiting time, registration, and cleanliness of facilities. Research has suggested that cost of care is an important variable in patient satisfaction⁴; however, because we studied people receiving workers' compensation, we chose not to include this item.

A list of 25 questions reflecting personal aspects and system/external variables was initially generated through informal discussions with patients and physical therapists as well as through a review of the current literature.^2,3 To test face validity, all items were reviewed by 2 physical therapists who assessed the items for logical consistency and content. These therapists were both doctorally trained and had an average of 35 years of academic clinical experience. They followed a protocol for analyzing the scale items and indicated whether, in their opinion, there were any awkward or inappropriate words or misleading phrases. Based on their recommendations, a revised 18-item questionnaire was created for initial pilot testing. The sequence of the items was randomized (ie, by pulling numbers out of a hat), and each item was rated on a 5-point scale (1=strongly disagree and 5=strongly agree). To control for response bias, positively and negatively worded items were included. In addition, we initially included 4 global measures of patient satisfaction to act as dependent variables: (1) "Overall, I am completely satisfied with the services I receive from my therapist," (2) "I would return to this office for future care," (3) "I would not recommend this therapist to a friend," and (4) "This therapy has helped me as much as expected." We expected that the summary score on the final instrument would be highly correlated with one or more of these global measures of satisfaction.

Pilot testing.
Pilot testing was performed to assess the relationship of the 4 global items with one another and with each of the remaining variables. We used this information to determine the need to retain each of the global measures (ie, if a global measure is not strongly related to other items, it may reflect a different construct and may not be appropriate for this instrument).

The sample of respondents for this pilot phase included 191 people who were receiving outpatient physical therapy at any one of several physical therapy clinics throughout the United States. These clinics were privately or corporately owned, specialized in the evaluation and treatment of adults with musculoskeletal problems, and employed an average of 4.5 full-time physical therapists. All facilities were participating members of MedRisk Inc,^* which is a preferred provider organization and an expert provider organization that contracts with physical therapists and other health care practitioners to provide care for people who are covered by workers' compensation. Thus, all subjects were receiving workers' compensation. The subjects were receiving treatment for one or more musculoskeletal conditions commonly encountered by physical therapists. All subjects had to be able to read English. Subjects were asked to complete the survey after at least 3 visits.

All rights of the subjects were protected. All responses were obtained anonymously. Patients who were asked to fill out a questionnaire were assured in its written instructions that their responses would be aggregated so that no one person's response could be identified, either through survey code markings or any other method.

Data analysis and results.
An inter-item correlation matrix was calculated to determine the correlation (r) of each of the items (survey questions) with each of the global measures. All 18 items were correlated with each of the 4 global measures (ie, all of the questions were related to the patient's overall sense of satisfaction). A multiple regression analysis was used to estimate the correlation of variables with the global measures. The overall r values ranged from .35 to .74. Two of the 4 global measures were not strongly related to other items and were dropped, leaving a revised instrument of 18 items and the 2 remaining global measures: "Overall, I am completely satisfied with the services I receive from my therapist" and "I would return to this office for future care." The regression model had an adjusted r² value of .76; that is, the full model predicted approximately 76% of the causes of patient satisfaction with a physical therapy clinic. The Cronbach alpha, an indicator of internal consistency or the degree to which similar questions yield similar answers,¹ was calculated as .93 for the 18 items, thus indicating a high degree of internal consistency.

Phase 2: Content Validation and Reliability Testing

The revised 20-item instrument (18 specific questions and 2 global measures) was completed by patients following their course of physical therapy. Once again, all patients were receiving treatment under workers' compensation regulations. Outpatient clinics in 17 states participated in this phase of the study. Representatives of MedRisk Inc mailed the survey instrument to the patient's home approximately 4 weeks after completion of physical therapy. Of the 9,315 survey questionnaires that were sent out, 1,868 (20%) were returned and used in the analysis. The 20% return rate, in our opinion, represents a satisfactory return, but others may disagree.²³ The mean age of the respondents was 46.9 years (SD=11.9); 676 respondents were female, and 1,192 respondents were male. Table 1 lists the number of respondents by geographic region. The majority of respondents received care in the Mid-Atlantic region. Table 2 summarizes the anatomic location of symptoms for which the patient sought treatment. There was a difference by gender for symptom location (²=24.12, df=5, P=.00). Observed counts exceeded those expected for male patients with thoracolumbar or lower-extremity problems and for female patients with hand problems or "other" symptoms.

To determine how many components the final questionnaire should include and to determine whether a 2- or 3-component solution was superior, a factor analysis was performed. Factor analysis acts to maximize apparent differences among groups of questions, and it provides a coefficient of strength of association for each question to groups of questions (now called "factors").^4,24,25 "Rotating factors" is a procedure used to clarify the differences among the factors. We used "Oblimin rotation" because this procedure is recommended to clarify relationships between attitude or belief components.⁴ A .60/.30 criterion for factor retention was used to indicate the degree of correlation (loading) of each item to each factor (ie, an item must load greater than or equal to .60 on one factor and less than .30 on all other factors), representing a conservative inclusion criterion.²⁶

Reliability.
Reliability of the measurements obtained was tested by calculating the standard error of measurement (SEM).^27–30 Using the method described by Roddey et al²⁷ and others,^28,29 the SEM was calculated using the following equation:

where SD is the standard deviation of the observed scale or subscale and is the Cronbach alpha for that scale or subscale. The lower the SEM, the less error is associated with the measure (ie, the closer the observed score is likely to be to the "true score"). The SEM provides a range or interval of scores about which the true measure is likely to fall. By adding and subtracting 1.96 SEMs to an observed score, one can estimate (with 95% certainty) the range in which the true score for a person will lie. For example, if the observed mean score on a scale is 4.5 and the SEM is 0.25, one may be 95% certain that the true score lies between 4.01 and 4.99 (4.5–0.49 and 4.5+0.49).

	Results

Top Abstract Introduction Method Results Discussion Conclusions Appendix References

 
Data Reduction and Reliability Testing

The item-correlation matrix revealed that all items were positively correlated with the 2 global measures (Tab. 3). The values ranged from .095 ("The clinic location is convenient") to .722 ("My therapist explains the treatment") for global measure 1 ("Overall, I am completely satisfied with the services I receive from my therapist") and from .106 ("The clinic location is convenient") to .681 ("My therapist answers my questions") for global measure 2 ("I would return to this office for future care").

View this table: [in this window] [in a new window] Table 3. Inter-item Correlation Matrix Representing the Correlation (r) of the Items With Each of the 2 Global Measures (''Overall, I Am Completely Satisfied With the Services I Receive From My Therapist [Overall Satisfaction] and ''I Would Return to This Office for Future Care'' [Would Return]) and With the Mean of These 2 Measuresa

View this table: [in this window] [in a new window] Table 7. Pearson Correlation Coefficient (r) and Spearman Rank Correlation () Between 2- and 3-Component Solutions and the Global Measures (''Overall, I Am Completely Satisfied With the Services I Receive From My Therapist'' [Overall Satisfaction] and ''I Would Return to This Office for Future Care'' [Would Return])

	Discussion

Top Abstract Introduction Method Results Discussion Conclusions Appendix References

In contrast to our findings, Roush and Sonstroem⁴ contended that patient satisfaction is strongly influenced by factors such as location and cost. In the instrument proposed by Roush and Sonstroem, 15 of 34 questions sampled the patient's satisfaction with location, accessibility, and cost of care. In our sample, however, we found very low correlations among location and the global measures of satisfaction. In our analysis, the item addressing "location" factor-loaded with time spent waiting for the physical therapist; however, this component had low internal consistency, and, when it was deleted, the overall internal consistency of the measurements obtained from the remaining items improved. Because the population we studied was receiving workers' compensation, no items relating to cost of care were included. Recent data, however, suggest that less than 1% of patients receiving physical therapy pay the complete charges out of pocket (Advisory Committee on Practice, American Physical Therapy Association, personal communication, November 1998). Goldstein et al¹ also found a low correlation between cost of service and satisfaction. We question whether an instrument that is heavily weighted toward questions relating to cost and location is appropriate. Further study using concurrent comparisons of these instruments should be performed.

Maximizing patient satisfaction is a sound philosophy from both a clinical perspective and a business perspective. Satisfied patients are more likely to adhere to treatment and to continue to seek health care at a given facility.^32–39 Our findings indicate that adequate time spent in patient care and the professionalism of the therapist and clinic staff are more important for patient satisfaction than are the location of the facility, the quality of equipment, and the availability of parking. We believe that, in the current health care environment, the emphasis on cost-cutting, high patient volume, and the use of "care extenders" can reduce the time for the patient-therapist interactions that appeared to contribute to satisfaction. We believe that this trend will have a negative effect on patient satisfaction, which, in turn, will have a negative effect on the marketplace and on job satisfaction.

Hudak and Wright⁶ provided an excellent review of the characteristics and use of a patient satisfaction measure. They noted that it is important to differentiate between patient satisfaction with outcome and patient satisfaction with care. Patient satisfaction with outcome relates to the results of treatment, whereas satisfaction with care reflects the service the patient received during a course of care. Arguably, these represent separate entities and should be assessed with different instruments. The instrument developed in our study was designed to be a self-administered, forced-choice format for assessing a person's satisfaction with the process of receiving physical therapy in an outpatient environment. We did not examine satisfaction with outcome. Based on our data, we believe that the 10-item instrument (which also includes 2 global questions and thus contains 12 total questions) provides a tool that is complete and easy to administer. We believe the instrument has sound measurement properties for assessing current patient satisfaction within the population of people receiving outpatient physical therapy related to workers' compensation (Appendix).

We believe instrument validation is an ongoing process. Our data suggest that reliable measurements may be obtained that describe various aspects of patient satisfaction with care at a given time. Although a repeated-measures design was not used in this study, test-retest reliability using the SEM has been described previously.²⁷ The low values of SEM for the 10-item instrument and its 2 subscales indicate a low degree of measurement error and, therefore, a high degree of test-retest reliability. Further study is needed to assess the criterion-referenced validity of the measurements obtained from this instrument.

We believe that a satisfaction measure must be viewed in the context in which it will be used.⁶ We argue that, in many cases, standardized measures may not provide adequate data.⁶ By including both closed- and open-ended survey questions, we contend that a richer understanding of satisfaction can be obtained. In addition to a standardized instrument, we suggest that clinicians may want to include a small number of open-ended questions to target issues unique to a given facility. We have no data, however, to suggest that this would be beneficial.

The data we obtained, in our opinion, are generalizable to adults with occupation-related musculoskeletal impairments from a large geographic area. The appropriateness of the proposed instrument to people who are not receiving workers' compensation is not known. Our instrument was constructed to assess patient satisfaction with care and is not adequate to measure satisfaction with outcomes. The overall assessment of outcome is a multidimensional task that, in addition to patient satisfaction with care, should also include other relevant measures such as health status, functional capacity, and quality of life.

	Conclusions

Top Abstract Introduction Method Results Discussion Conclusions Appendix References

 
The instrument developed during the process described here has been demonstrated to yield measurements that are reasonably reliable and have some content and concurrent validity. The results of our study show that patient satisfaction with care is most strongly correlated with the quality of patient-therapist interactions. This includes the therapist spending adequate time with the patient, demonstrating strong listening and communication skills, and offering a clear explanation of treatment. Non-patient care issues such as clinic location, equipment, and parking are less important in determining patient satisfaction. We did not study patient satisfaction with the outcome of care.

	Appendix

Top Abstract Introduction Method Results Discussion Conclusions Appendix References

 

View larger version (43K): [in this window] [in a new window] Appendix. Patient Survey Instrument

	Footnotes

 
All authors provided concept/research design and consultation (including review of manuscript before submission). Dr Beattie, Dr Pinto, and Dr Martha Nelson provided writing. Dr Roger Nelson provided data collection, fund procurement, and facilities/equipment. Dr Beattie and Dr Roger Nelson provided data analysis. Dr Beattie and Dr Martha Nelson provided project management. Dr Roger Nelson and Claire Coyne provided clerical/secretarial support. The authors thank Ann Wilhelm, Rosselle Perrucci, PT, MBA, Shelly Boyce, Claire Coyne, and Paul Stratford, PT, for their valuable assistance on this project. Dr Beattie and Dr Pinto were paid consultants for this project.

This study was approved by the Human Subject Policy Review Board of MedRisk Inc.

This study was supported by MedRisk Inc, 640 Freedom Business Center, Ste 300, King of Prussia, PA 19406-1332.

^* MedRisk Inc, 640 Freedom Business Center, Ste 300, King of Prussia, PA 19406-1332.

	References

Top Abstract Introduction Method Results Discussion Conclusions Appendix References

 

1. Goldstein MS, Elliott SD, Guccione AA. The development of an instrument to measure satisfaction with physical therapy. Phys Ther.2000; 80:853–863.[Abstract/Free Full Text]
2. Patient Satisfaction Instruments: A Compendium. Alexandria, Va: American Physical Therapy Association,1995 .
3. Pinto MB. Outcome measures in assessing physical therapy. Orthop Clin North Am.1995; 4:269–281.
4. Roush SE, Sonstroem RJ. Development of the Physical Therapy Outpatient Satisfaction Survey (PTOPS). Phys Ther.1999; 79:159–170.[Abstract/Free Full Text]
5. Bush T, Cherkin D, Barlow W. The impact of physician attitudes on patient satisfaction with care for low back pain. Arch Fam Med.1993; 2:301–305.[Abstract/Free Full Text]
6. Hudak PL, Wright JG. The characteristics of patient satisfaction measures. Spine.2000; 25:3167–3177.[Web of Science][Medline]
7. Keith RA. Patient satisfaction and rehabilitation services. Arch Phys Med Rehabil.1998; 79:1122–1128.[Web of Science][Medline]
8. Nitse PS, Rushing V. Patient satisfaction: the new area of focus for the physician's office. Health Mark Q.1996; 14(2):73–84.
9. Linder-Pelz S, Struening EL. The multidimensionality of patient satisfaction with a clinical visit. J Community Health.1985; 10:42–54.[Medline]
10. Hall JA, Dornan MC. Meta-analysis of satisfaction with medical care: description of research domain and analysis of overall satisfaction levels. Soc Sci Med.1988; 27:637–644.[Web of Science][Medline]
11. Olejnik S, McKinely CO, Ellis RA, et al. Construct validation of customer satisfaction inventories. Journal of Rehabilitation Outcomes Measurement.1998; 2(5):30–38.
12. Baker R. Development of a questionnaire to assess patients' satisfaction with consultations in general practice. Br J Gen Pract.1990; 40:487–490.[Web of Science][Medline]
13. DiTomasso RA, Willard M. The development of a patient satisfaction questionnaire in the ambulatory setting. Fam Med.1991; 23:127–131.[Medline]
14. Ware JE Jr, Hays RD. Methods for measuring patient satisfaction with specific medical encounters. Med Care.1988; 26:393–402.[Web of Science][Medline]
15. Cherkin DC, MacCornack FA. Patient evaluations of low back pain care from family physicians and chiropractors. West J Med.1989; 150:351–355.[Web of Science][Medline]
16. Deyo RA, Diehl AK. Patient satisfaction with medical care for low-back pain. Spine.1986; 11:28–30.[Web of Science][Medline]
17. Elliott-Burke TL, Pothast L. Measuring patient satisfaction in an outpatient orthopedic setting, part 1: key drivers and results. Journal of Rehabilitation Outcomes Measurement.1997; 1:18–25.
18. Hall JA, Dornan MC. What patients like about their medical are and how often they are asked: a meta-analysis of the satisfaction literature. Soc Sci Med.1988; 27:935–939.[Web of Science][Medline]
19. Pinto MB, Leonidas L. The impact of office characteristics on satisfaction with medical care: a "before and after" analysis. Health Mark Q.1994; 12:43–54.[Medline]
20. Safran DG, Taira DA, Rogers WH, et al. Linking primary care performance to outcomes of care. J Fam Pract.1998; 47:213–220.[Web of Science][Medline]
21. Sixma HJ, Spreeuwenberg PM, van der Pasch MA. Patient satisfaction with the general practitioner: a two-level analysis. Med Care.1998; 36:212–229.[Web of Science][Medline]
22. Smucker DR, Konrad TR, Curtis P, Carey TS. Practitioner self-confidence and patient outcomes in acute low back pain. Arch Fam Med.1998; 7:223–228.[Abstract/Free Full Text]
23. Dilman DA. Mail and other self-administered questionnaires. In: Rossi PH, Wright JD, Anderson AB, eds. Handbook of Survey Research. New York, NY: Academic Press,1982 :68–95.
24. Nunnally JC. Psychometric Theory. New York, NY: McGraw-Hill Inc,1978 .
25. Domholdt E. Physical Therapy Research: Principles and Applications. Philadelphia, Pa: WB Saunders Co,1993 :290–294.
26. Hair JF Jr, Anderson RE, Tatham RL, Black WC. Multivariate Data Analysis With Readings. 3rd ed. New York, NY: Macmillan Publishing Co,1987 .
27. Roddey TS, Olson SL, Cook KF, et al. Comparison of the University of California–Los Angeles Shoulder Scale and the Simple Shoulder Test with the Shoulder Pain and Disability Index: single-administration reliability and validity. Phys Ther.2000; 80:759–768.[Abstract/Free Full Text]
28. McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res.1995; 4:292–307.
29. Diamond JJ. A practical application of reliability theory to family practice research. Fam Pract Res J.1991; 11:357–362.[Medline]
30. Rothstein JM, Echternach JL. Primer on Measurement: An Introductory Guide to Measurement Issues. Alexandria, Va: American Physical Therapy Association,1993 :64.
31. Cleary PD, Edgman-Levitan S. Health care quality: incorporating customer perspectives. JAMA.1997; 278:1608–1612.[Abstract/Free Full Text]
32. Baker J, Lamb CW Jr. Physical environment as a hospital marketing tool. J Hosp Mark.1992; 6:25–35.[Medline]
33. Bitner MJ. Evaluating service encounters: the effects of physical surroundings and employee responses. Journal of Marketing.1990; 54(April):69–82.[Web of Science]
34. Brand RR, Cronin JJ, Routledge JB. Marketing to older patients: perceptions of service quality. Health Mark Q.1997; 15:1–31.[Medline]
35. Gardner K. Patients decision to sue often hinges on therapeutic relationship. American Academy Pediatric News.1998; 14(10):13.
36. Hawes JM, Prough GE. Analyzing the market for dental services. Health Mark Q.1987 –88;5(1–2):171–182.
37. Rao CP, Rosenberg LJ. Consumer behavior analysis for improved dental services marketing. Health Mark Q.1986; 3(Summer):83–96.[Medline]
38. Rubin HR. Patient evaluations of hospital care: a review of the literature. Med Care.1990; 28:S3–S9.[Web of Science][Medline]
39. Simon SE, Patrick A. Understanding and assessing consumer satisfaction in rehabilitation. Journal of Rehabilitation Outcomes Measurement.1997; 1(5):1–14.

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This Article Abstract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Beattie, P. F Articles by Nelson, R. Search for Related Content PubMed PubMed Citation Articles by Beattie, P. F Articles by Nelson, R. Related Collections Health Services Research Professional Issues Professional-Patient Relations Social Bookmarking                      What's this?