Patient satisfaction and perception of change ...

Physiotherapy Theory and Practice, 2011, Early Online, 1–11 Copyright © Informa Healthcare USA, Inc. ISSN: 0959-3985 print/1532-5040 online DOI: 10.3109/09593985.2011.574782

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Patient satisfaction and perception of change following single physiotherapy consultations in a hospital’s outpatient clinic for people with multiple sclerosis Britt Normann, MSc, PT,1 Siri Moe, PhD, PT,2 Rolf Salvesen, PhD, MD,3 Knut W. Sørgaard, PhD4 1

Assistant Professor, Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, Norway; Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway 2 Associate Professor, Department of Health and Care Sciences, University of Tromsø, Norway 3 4

Professor, Nordland Hospital Trust, Bodø, Norway; Department of Clinical Medicine, University of Tromsø, Norway Nordland Hospital Trust, Bodø, Norway; Department of Clinical Medicine, University of Tromsø, Norway

ABSTRACT The aim of this study was to investigate satisfaction with physiotherapy and perception of change following single physiotherapy consultations in a hospital’s outpatient service for people with multiple sclerosis (MS) (PwMS). The consultation included assessment, exploration of treatment, information, and instruction in self-assisted exercises based on the British guidelines for PwMS. Seventy-two PwMS were consecutively included, 54 women and 18 men with a mean age 45 (range 26–80). The Outpatient Experience Questionnaire (OPEQ) was used to record satisfaction; the Patient Global Impression of Change (PGIC) and the Borg’s Rating Scale of Perceived Exertion (BRSPE) were used to investigate perceived changes in standing up, sitting down, and walking following the consultation. Sixty-four patients (89%) returned the OPEQ. The results showed strong satisfaction with physiotherapy regarding both interpersonal and clinical skills (mean 9.4, SD 1.0, best score 10) and no significant differences regarding the level of ambulatory independence, gender, or age. The PGIC indicated perceived short-term improvement for 35 (57%) patients, with no patients reporting deterioration. The BRSPE showed a significantly lower perception of exertion during walking after the consultation (Wilcoxon signed-rank test, Z–2.58, p = 0.010). The study indicates a high level of satisfaction regarding interpersonal and clinical skills, information, and instruction in self-assisted exercises and indicates that perceptions of short-term improvement may occur after single consultations. The study suggests an important role for physiotherapy in hospital outpatient services for PwMS, but further studies are necessary to deepen our understanding.

INTRODUCTION Multiple sclerosis (MS) is the most frequent cause of neurological disability among young and middle-aged people in the Western world (Myhr et al, 2001). Common symptoms are balance and walking problems, muscle weakness, pathological tone, pain, fatigue and disturbed sensibility, vision, and coordination (De Souza and Bates, 2004). Because of the complex course of the disease, access to specialised Accepted for publication 22 March 2011 Address correspondence to Britt Normann, Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, 9037 Tromsø, Norway. E-mail: [email protected]

neurological rehabilitation services is recommended (European Multiple Sclerosis Platform, 2004; National Institute of Health and Clinical Excellence (NICE), 2004). The advocated service includes specialists in physiotherapy and other disciplines such as neurology, nursing, and occupational therapy. The Multiple Sclerosis Society (MSS) of the United Kingdom, in cooperation with the Chartered Society of Physiotherapy and the Association of Chartered Physiotherapists interested in Neurology, has expanded the NICE guidelines into physiotherapy guidelines for MS. These recommendations are underpinned by the growing evidence for the effect of physiotherapy on people with MS (PwMS) (Freeman, Thompson, and Freeman, 2001; Khans et al, 2007; Mostert and 1


2 Normann et al.

Kesselring, 2002; Thompson, 2000; Wiles, Newcombe, and Fuller, 2001). However, research focusing on how people with MS (PwMS) perceive and evaluate physiotherapy service has been neglected. The user perspective is increasingly recognised as an essential component in the evaluation of health care (Fitzpatrick, 2002), in which patient satisfaction constitutes an incorporated element. Patient satisfaction is a complex construct in which elements such as expectations, interpersonal relationships, psychological factors, and the effect of intervention may influence the users’ opinions of a service (Sitzia and Wood, 1997). Hills and Kitchen (2007a; 2007b) propose that patient satisfaction in physiotherapy depends on the perception that biopsychosocial needs are met as well as the success of the therapeutic intervention (i.e., satisfaction with the process and the outcome of care). Perception of change following physiotherapy consultations may be regarded as subjectively perceived outcome of care and are therefore interesting to explore as a part of patient satisfaction. The body of research in this field with regard to physiotherapy is limited compared to other health disciplines (Hills and Kitchen, 2007a). Studies regarding physiotherapy in outpatient settings (CasserleyFeeney, Duffy, Roush, and Hurley, 2006; O’Sullivan, Gilchrist, Holland, and Langford, 2006) and in rehabilitation centres (Stiller, Cains, and Drury, 2009) report a high degree of satisfaction with the overall standard of physiotherapy service and with therapists’ interpersonal skills. For PwMS in the primary health care, Roush (1995) reported high satisfaction with interpersonal factors but less satisfaction with the physiotherapists’ technical skills. In a survey performed in a British hospital, Gillanders, Murphy, and Crosbie (2006) found a high degree of satisfaction with physiotherapy but lack of teaching and guidance in self-assisted training. Dawson, Jones, Lhussier, and Buri (2004) describe positive evaluations from PwMS in a final report evaluating four programmes of physiotherapy treatment for PwMS, developed in the United Kingdom. The literature reports high satisfaction, but there are methodological weaknesses such as small studies, the use of a variety of mostly nonvalidated questionnaires, and few studies involving PwMS in particular. To our knowledge, there are no studies that explore perceptions of PwMS regarding physiotherapy in the hosptials’ outpatient service. In Norway, people with MS are offered specialty health care services in regional hospitals. During the last decades, the outpatient clinics for PwMS have become the main arena for this care. These clinics always have teams consisting of neurologists and a special trained nurse, and some have a specialist in physiotherapy. On a regular basis PwMS have one to

four appointments per year in these outpatient clinics (the number is decided by the team and the person with MS together). Because of this organisation, physiotherapy in the hospitals’ outpatient services implies single consultations of assessment and a responsibility for the guidance of the patient and the community physiotherapist, who carry on the treatment. Assessment and clinical reasoning applied in single consultations may include exploration of the patient’s potential to improve. The reasoning also enables the physiotherapist to identify the underlying conditions that result in limitations in performing activities of daily living (ADL) and select appropriate treatments for those limitations (Edwards et al, 2004; Gjelsvik, 2008; Johnson 2009). Research in physiotherapy has so far paid little attention to single sessions. However, Smith, AdeneySteel, Fulcher, and Longley (2006) report temporary decrease in sensibility and no perception of change with regard to fatigue or function for PwMS following a single session of strengthening and fitness exercises carried out in a rehabilitation setting. Because single physiotherapy sessions in the specialist health care are part of the recommended guidelines (MSS, NICE), it will be of interest to explore whether PwMS perceive any change in functional activities following sessions based on these guidelines. The aim of this study was to investigate PwMS’ satisfaction with single physiotherapy consultations in a hospital’s outpatient service. We wanted to examine patient satisfaction for the process of care as well as the outcome of care, the latter by focusing on perception of change in ADL following single consultations.

METHOD Ethical considerations The Regional Committee for Medical Research Ethics and The Norwegian Social Science Data Services have given their approval for the implementation of the study, which was carried out according to the Helsinki declaration.

Context of the study The study was carried out at the outpatient clinic for PwMS in a regional Norwegian hospital serving a population of approximately 240,000 inhabitants. The clinic had 128 persons in their files and a team consisting of neurologists, nurses with specialised training in MS, and physiotherapists with specialised training in neurological conditions. At the time of Copyright © Informa Healthcare USA, Inc.

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the study, physiotherapy was a relatively new element in the service, and one physiotherapist performed all the consultations.


Subjects Because of the exploratory character of the study, we chose to include all persons above 18 years of age diagnosed with MS and registered at the outpatient clinic. The administration at the clinic consecutively sent written information about the study to all registered persons; 23 persons had moved or had terminated their relationship with the clinic for other reasons. Of the 105 remaining subjects, 72 (69%) returned their informed consent by mail to the secretary at the clinic, who delivered it to the project leader. Three persons (