Quality Evaluation of Physiotherapy Services

Cronicon
O P E N A C C E S S EC PSYCHOLOGY AND PSYCHIATRY
EC PSYCHOLOGY AND PSYCHIATRY
Review Article
Quality Evaluation of Physiotherapy Services in the Department of Physical
Medicine of the General Hospital of Volos “Achilopouleio”
Prekas Evangelos1
*, Sarafis Pavlos2
and Malliarou Maria3
1
Physiotherapist MSc, General Hospital of Volos ‘Achilopouleio’, Greece
2
Assistant Professor, Department of Nursing, Cyprus University of Technology, Greece
3
Professor, Department of Health Care Management, Hellenic Open University of Patras, Greece
Citation: Prekas Evangelos., et al. “Quality Evaluation of Physiotherapy Services in the Department of Physical Medicine of the General
Hospital of Volos “Achilopouleio””. EC Psychology and Psychiatry 9.12 (2020).
*Corresponding Author: Prekas Evangelos, Physiotherapist MSc, General Hospital of Volos ‘Achilopouleio’, Greece.
Received: September 09, 2020
Abstract
Keywords: Evaluation; Quality; Patient Satisfaction; Physiotherapy
Introduction
Introduction: Patient satisfaction is now an important indicator to assess the quality of health services.
Purpose: The purpose of the present study was to estimate the patient satisfaction of the General Hospital of Volos ‘Achilopouleio’
(GHV) who visited the Department of Physical Medicine for physiotherapy services.
Material and Methods: The PSQ questionnaire of Monnin and Perneger PSQ (2002) was given to 104 outpatients of the Department
of Physical Medicine of the GHV, who participated in this study. The average age of the sample was 53.7 years. 52.9% of the partici-
pants were women and 47.1% were men. The SPSS 19.0 statistical program was used to analyze the questionnaires.
Results: 90.43% of the patients participated in this survey. Total patient satisfaction was 90.6%. The satisfaction of the patients from
their relationship with the physiotherapist was 91.2%, the satisfaction of the patients from the physiotherapy services procedures
was 88.2%, the satisfaction of the patients from the hospital environment was 89, 5% and the overall assessment of patient experi-
ence at the end of their treatment was 95.3%.
Conclusion: Patient satisfaction as indicator quality of health service, of the Department of Physical Medicine of the GHV, ranged
at quite high levels. The physiotherapist’s relationship with the patient during therapy proved to be the most important factor of
satisfaction.
Patient satisfaction has now proven to be an important indicator evaluation of the quality of health services and programs. Measuring
it is especially important because it helps to highlight weaknesses-problems in the field of health and to draw useful information about
the operation of health units. It also contributes significantly to the management of health resources, making the services provided effi-
cient and effective [1]. The definition of patient satisfaction in the health sector has at times been rendered differently. A common feature
of all these definitions is the link between patient satisfaction and the level of health care they receive. Donabedian [2] defines patient

Quality Evaluation of Physiotherapy Services in the Department of Physical Medicine of the General Hospital of Volos
“Achilopouleio”
satisfaction as an indicator of the outcome of health services provided, which largely determines the evaluation of the quality of these
services. Robledo [3] states that patient satisfaction is not a fixed concept that pre-exists, but is always shaped by quality. Also, according
to Johansson., et al. [4] receives and is directly related to his expectations and values. The close relationship between patient satisfaction
and quality of services in the field of health has been pointed out by the World Health Organization (WHO). According to the WHO, quality
is referred to as the combination of the best possible outcome and maximizing patient satisfaction with procedures, outcomes and human
contact [5].
Many researchers in recent years have tried to track and capture patients’ satisfaction with physiotherapy services.
In the review of Hush., et al. Articles, 6 the main factors that appear to determine patients’ satisfaction with physiotherapy services are:
1. The environment of the health structure (facilities, location, physiotherapy equipment, hotel equipment, accessibility of the
space, parking space, etc.)
2. The process of providing physiotherapy services (patient waiting time, duration-frequency of treatment, administrative services
with which the patient comes in contact, etc.)
3. The relationship-communication of the patient with the physiotherapist during the treatment process.
The third factor is considered the most important as it plays the most important role in the result of patients’ satisfaction with phys-
iotherapy services. The personality traits of the physiotherapist such as self-confidence, extroversion, friendliness, etc. his knowledge of
physiotherapy, his professionalism, his communication skills and his empathy, contribute to the high satisfaction of patients in the field of
physiotherapy. In particular, the physiotherapist’s empathy and the good communication relationship he develops with the patient have
been shown to offer even greater satisfaction with the end result of the treatment [6,7].
The most popular psychometric tools (questionnaires) that have been used to detect patient satisfaction in the field of physiotherapy
is.
1. The American MedRisk instrument for Measuring Patient Satisfaction with Physical Therapy- (MRPS) [8].
2. The American Physical Therapy Patient Satisfaction Questionnaire- (PTPSQ) [9].
3. The American Physical Therapy Outpatient Satisfaction Survey- (PTOPS) [10].
4. The French Patient Satisfaction Questionnaire-PSQ11.
Purpose of the Study
The purpose of this study was to capture the degree of satisfaction of the outpatients of the General Hospital of Volos “Achillopouleio”
(GNB), who came to the Department of Physical Medicine for physiotherapy services.

“Achilopouleio”
Materials and Methods
The research took place in the physiotherapy clinic of the Department of Physical Medicine of the GNB. The specific department of the
hospital operates as an outpatient clinic of the hospital and provides physiotherapy services of Primary Health Care (PHC) to outpatients
of the Prefecture of Magnesia. The research was carried out within a defined time frame of 3 months, from 1/11/2017 to 31/1/2018
and in terms of the time of its conduct is characterized as a synchronous research. The researcher tracked the level of satisfaction of all
patients who participated in the study sample at a single given time point when it was the end of their treatment.
The sample of the study consisted of 104 outpatients who came to the Department of Physical Medicine (physiotherapy department)
for physiotherapy services. The selection criteria of the patients who participated in the study were the following:
• The age of the patients was from 18 - 75 years.
• All patients had the cognitive ability to complete the questionnaire given to them at the end of treatment.
• All patients knew the Greek language.
• All patients had a physiotherapy referral from a specialist for 10 treatments (sessions).
• The patients who participated in the study completed the 10 treatments (sessions) and had a complete view of the physio-
therapy services provided by the specific department of the hospital.
• The logistical equipment and infrastructure of the physiotherapy met the requirements of patients’ treatment.
• The study involved all patients who came to the Department of Physical Medicine of the hospital for physiotherapy without
discrimination. The research sample includes patients with traumatic injuries, musculoskeletal, neurological and cardiorespira-
tory diseases.
• In the research there was patient consent and information from the researcher about their participation in the research. To this
end, it was deemed necessary to give all patients a consent form confirming their willingness to participate in the study.
Research tool
The French Patnin Satisfaction Questionnaire-PSQ by Monnin and Perneger was the tool of the present study. Monnin and Perneger
[11] created the questionnaire at the University Hospital of Geneva, as part of the implementation of a program to ensure the quality of
health services. The specific questionnaire was translated by Mastrogiannis., et al. [12] in the context of completing the diploma thesis of
the Interdepartmental Program of the School of Business Administration of the University of Macedonia and was given written permis-
sion by both the research team and the original authors. In the process of translation-intercultural adaptation of the Monqin and Perneger
PSQ questionnaire in Greek, the 6 internationally recognized stages described in detail by Beaton., et al. [13] and Guillemin., et al. [14]
were strictly taken into account. According to the international literature and bibliography, these steps have been successfully applied
where the translation-intercultural adaptation of a questionnaire in a different language was considered necessary and are a reference
point for all researchers in similar surveys [15-18]. In the Greek version of the PSQ questionnaire of Monnin and Perneger it was deemed
appropriate to adopt some changes. These changes in no way altered the content of the original questionnaire and contribute to its better
interpretation in the Greek language.

“Achilopouleio”
In conclusion, the PSQ questionnaire of Monnin and Perneger in its Greek version includes a total of 19 closed-ended questions, mea-
surable on a five-point Likert scale and 2 open-ended questions [12].
In the questionnaire there are 4 questions regarding the demographic characteristics of patients, the frequency of their visits to the
physiotherapy center and how to choose it as a treatment site. The questions that evaluate the secretariat-administrative services of the
hospital are a total of 3 (1, 2, 3). The questions evaluating the treatment process are 5 in total (4, 5, 6, 7, 8). The questions that evaluate
the environment of the physiotherapy center are 5 in total (9, 10, 11, 12, 13). The questions that evaluate the overall experience of the
patient who experienced from the beginning to the end of his treatment are a total of 2 (14, 15). Questions 16, 17 are the open-ended
questions in the questionnaire. In the 2 open-ended questions, the patient freely expresses his impressions and suggests interventions
aimed at improving the operation of the physiotherapy clinic [12]. The five-point scale (Likert type) of the questionnaire was translated
and converted into numerical data as follows: exceptional = 5, very good = 4, good = 3, moderate = 2 and bad = 1. This questionnaire cov-
ers all the factors of patient satisfaction with physiotherapy services, it is short, easy and practical. The questionnaire in its final form as
it was formulated in the Greek language is listed in annex A.
Data collection process
The researcher, when the patients completed the 10 sessions (Therapies) of physiotherapy, personally informed them about the pur-
pose and the process of the research. In addition, for this purpose patients were asked to read a consent form which had been formulated
especially for them by the researcher. The consent form contained information not only on the purpose and procedure of the investigation,
but also made it clear that the protection of patients’ personal data and the principle of confidentiality would be respected. The patients
who agreed to participate in the study were then given a questionnaire. The researcher urged patients to fill it in freely, stressing that
there are no right or wrong answers. After completing the questionnaire, the patients gave it to the researcher without commenting or
discussing their answers. Finally, the researcher requested a phone call from the patients who participated in the study, in order to con-
firm their participation in it.
Statistical analysis
The adequacy of the questionnaire used in the research consists in the adequacy of its psychometric properties. The psychometric
properties examined in this research are the reliability of the questionnaire and its validity. The present study will assess the internal
consistency of the questionnaire. Internal consistency reliability assesses the consistency of patient surveyed responses to questionnaire
data (i.e. if they respond in a similar manner).
The validity of a questionnaire refers to the degree to which the questionnaire measures the meaning or otherwise the variable it
claims to measure [20]. The validity of the Monnin and Perneger PSQ questionnaire was assessed by examining content validity and
conceptual construct validity. or construct validity. Content validity refers to whether the specific questionnaire as a research tool con-
ceptually covers the range of the dependent variable that counts [20]. Content validation questionnaires should have as few unanswered
questions as possible. Conceptual validity refers to the degree to which the scale of the Monnin and Perneger PSQ questionnaire measures
exactly the meaning (variable) we have defined that counts. Its control can be achieved with the factual validity, convergent validity, the
distinguishing validity and the method of the known groups [20]. In the present work the factual validity and the convergent validity of
the questionnaire were checked. Factor validity was checked by factor analysis which is a complex statistical process and convergent
validity was examined with the Spearman correlation coefficient (r).

“Achilopouleio”
Cronbach’s alpha coefficient for the 4 subscales of the questionnaire ranged from 0.75 to 0.86 and the reliability of internal consistency
is considered quite satisfactory (acceptable limit 0.7). In the Greek language there is no similar psychometric tool that could serve as a
reference for the definition of conceptual validity. For this reason, the method of multiple characteristics analysis was used to check the
convergent validity. The Spearman correlation coefficients between the scale questions and the satisfaction scores in each area with the
total satisfaction ranged from 0.78 to 0.90. There was a significant positive correlation of the overall satisfaction score with both the ques-
tions on the scale and with the satisfaction scores from each sector separately. Regarding the factor validity (Based on the factor analysis
with the Principal Component method, Rotation Method: varimax), the questions were grouped into 3 factors. The first factor explains
28.50% of the variability, the second 24.40% and the third 13.44%. Overall, the 3 factors explain 66.34% of the variability. Finally, there
were no missing values (unanswered questions) in any of the questionnaires and the content validity is complete. Overall, the reliability
and validity of the questionnaire is considered quite satisfactory. The statistical program SPSS 19.0 was used for the analysis of the results
in the research.
Results
The participation of patients in the research was quite high at 90.43%. Specifically, the Monnin and Perneger PSQ questionnaire was
distributed to 115 outpatients over a period of 3 months, of which 104 eventually met the requirements of the study (11 questionnaires
were not returned). Table 1 gives the demographic data of the participants as well as data related to the visit and the selection of the
physiotherapy center as a treatment site. 52.9% of the participants were women and 47.1% were men. The mean age of the sample was
53.7 years (SD = 16.0 years). 77.9% of the participants went to the specific hospital for the first time while the remaining 22.1% had gone
at least once again for physiotherapy services. The majority of participants chose the hospital after the recommendation of their doctor
41.3%, 29.8% chose it themselves and 24.0% chose it on the recommendation of an acquaintance/friend. Finally, 4.8% of the patients in
the sample stated that they chose the physiotherapy clinic because they had no other choice.
Age (in years), mean value (±T) 53,7 (± 16,0)
N %
Sex
Men 49 47,1
Women 55 52,9
Frequency of visits
Yes, it’s the first time 81 77,9
No, I’ve been here once before 11 10,6
No, I’ve been here two or ten times before 10 9,6
No, I’ve been here more than 10 times 2 1,9
Choice of
physiotherapeutic
On my own 31 29,8
On the recommendation of my doctor 43 41,3
From acquaintance/friend 25 24,0
I had no choice 5 4,8
TA: Standard Deviation
Table 1: Patient demographics and data on the visit and choice of treatment area.

“Achilopouleio”
The results of the research showed that the total satisfaction of patients in the physiotherapy services of the hospital amounted to
90.6%. More specifically, the satisfaction of patients from the hospital environment amounted to 89.5% and the satisfaction of patients
from the service delivery procedures physiotherapy was 88.2%. The satisfaction of the patients from the relationship-communication
with their physiotherapist during their treatment was 91.2% and the overall evaluation of the experience of the patients who gained at
the end of their treatment was 95.3%. Table 2 describes the statistics of the answers given by the participants in the research. These data
are the range of the score gathered by each sub-scale and the total satisfaction, its average value and the percentage of one hundred (%)
of the respondents who scored the minimum and maximum score.
Minimum
value
Maximum
value
Average
price
SD Base effect, N
(%)
Ceiling effect,
N (%)
Satisfaction with the secretariat-administrative
services of the Hospital
9,00 15,00 13,24 1,62 0 (0,0) 36 (34,6)
Satisfaction with the treatment process 16,00 25,00 22,80 2,44 0 (0,0) 36 (34,6)
Satisfaction with environment of the physiotherapist 16,00 25,00 22,38 2,37 0 (0,0) 31 (29,8)
Overall assessment 6,00 10,00 9,53 0,68 0 (0,0) 63 (60,6)
Overall satisfaction 50,00 75,00 67,94 6,15 0 (0,0) 19 (18,3)
Table 2: The statistics of the questionnaire answers.
More specifically, 47.1% of the participants rated the simplicity of the procedures for closing the appointments as excellent and 38.5%
as excellent as the time required for the closing of the appointments. Also, 73.1% of the participants rated the helpfulness, courtesy and
willingness of the staff to answer the questions and meet their expectations as excellent (Table 3). 74.0% of the participants rated the
therapist’s ability to make them feel comfortable and possibly reassure them as excellent. 59.6% rated the explanations they received
about what he would do during his treatment and what he was expected to do as excellent. Also, 47.1% of the participants evaluated as
excellent the information they received about the development of their disease in the future. 68.3% of the participants rated as excellent
their therapist’s effort to adapt his treatment to the special needs of their problem and 66.3% as exceptional the sense of security they
felt throughout their treatment (Table 4).
49.0% of the participants rated the ease of access to the physiotherapy center as excellent, 38.5% rated the ease of orientation inside
the building as excellent and 58.7% as the comfort and cleanliness of the room where they were treated. Furthermore, 57.7% of the
participants rated the lighting and temperature of the room in which they were treated as excellent and 64.4% as excellent the quiet, the
protection of their privacy and the relaxing atmosphere in the treatment areas (Table 5). Finally, 61.5% of the participants rated their
physical therapy as excellent and 93.3% would go to this hospital again without a doubt if needed (Table 6). Also, in the research no statis-
tically significant correlation was found in satisfaction patients according to gender (p = 0.069), frequency of visits (p = 0.550) and choice
of physiotherapy (p = 0.059) (Table 7). The same was found in the study with the age of her sample (p = 0.418).

“Achilopouleio”
N %
How do you assess your therapist’s ability to make you feel
comfortable and possibly reassure you?
Bad 0 0,0
Moderate 0 0,0
Good 2 1,9
Very good 25 24,0
Excellent 77 74,0
How do you evaluate the explanations you have received,
about what you will do during treatment and what you
expect to do?
Bad 0 0,0
Moderate 0 0,0
Good 9 8,7
Very good 33 31,7
Excellent 62 59,6
How do you evaluate the information you have received
about the development of your condition in the future?
Bad 0 0,0
Moderate 1 1,0
Good 17 16,3
Very good 37 35,6
Excellent 49 47,1
How do you assess your therapist’s effort to adapt the
treatment you received to the specific needs of your
problem?
Bad 0 0,0
Moderate 0 0,0
Good 5 4,8
Very good 28 26,9
Excellent 71 68,3
How do you assess the sense of safety you felt
throughout treatment?
Bad 0 0,0
Moderate 0 0,0
Good 2 1,9
Very good 33 31,7
Excellent 69 66,3
Table 4: Patient satisfaction with the treatment process.
N %
How do you assess the ease of access to the
physiotherapist?
Bad 0 0,0
Moderate 0 0,0
Good 9 8,7
Very good 44 42,3
Excellent 51 49,0
How do you assess the ease of orientation
within the building?
Bad 0 0,0
Moderate 1 1,0
Good 17 16,3
Very good 46 44,2
Excellent 40 38,5

“Achilopouleio”
How do you assess the comfort and
cleanliness of the room in which you were
treated?
Bad 0 0,0
Moderate 0 0,0
Good 0 0,0
Very good 43 41,3
Excellent 61 58,7
How do you assess the lighting and
temperature of the room in which you were
treated?
Bad 0 0,0
Moderate 0 0,0
Good 2 1,9
Very good 42 40,4
Excellent 60 57,7
How do you assess the quietness, privacy
and relaxing atmosphere in the treatment
rooms?
Bad 0 0,0
Moderate 0 0,0
Good 2 1,9
Very good 35 33,7
Excellent 67 64,4
Table 5: The satisfaction of patients with the environment of the physiotherapist.
Sum up your
physical therapy
in one word.
N %
Bad 0 0,0
Moderate 0 0,0
Good 1 1,0
Very good 39 37,5
Excellent 64 61,5
If you need to do
physical therapy
again, would you
come back to our
service?
No, under no circumstances 0 0,0
Well, I guess not. 0 0,0
Perhaps 1 1,0
I guess so. 6 5,8
Yes, no doubt. 97 93,3
Table 6: The satisfaction of patients with the overall assessment of their experience.
Open-ended questions
The answers recorded in the open-ended questions (16, 17) of the questionnaire constitute 53% of the total survey. Although these
questions were excluded from the statistical analysis of the results, they serve as useful feedback for the staff and the administration of
the hospital, in order to make similar improvements in the field of physiotherapy services. All responses contained positive feedback on

“Achilopouleio”
Overall satisfaction
Mean Standard Deviation
Sex
Men 69,10 5,92
p = 0,069
Women 66,91 6,23
Frequency of visits
Yes, it’s the first time. 68,02 5,71
p = 0,550
No, I’ve been here once before. 65,73 9,27
No, I’ve been here two or ten times before. 69,50 5,54
No, I’ve been here more than 10 times. 69,00 8,49
Choice of
physiotherapeutic
On my own 69,13 5,29
p = 0,059
On the recommendation of my doctor 68,14 5,80
From acquaintance / friend 67,48 6,27
I had no choice. 61,20 10,33
Table 7: Average values of overall satisfaction according to demographic and other characteristics.
the willingness, courtesy, discretion, helpfulness and empathy of the staff. Also, the patients freely expressed their opinion and suggested
interventions for the operation of the physiotherapy center, such as afternoon opening hours, more staff, music in the treatment area,
better maintenance of the physiotherapy equipment, etc.
Discussion
Comparing the results of the present survey with similar surveys in the past that used the same questionnaire as a tool, leads to useful
conclusions for discussion. The sample of the present study consists of 104 outpatients with a mean age of 53.7 years. 52.9% of patients
are women and 47.1% are men. The participation of patients in the research ranged at 90.43%. In the Monnin and Perneger study [11]
the sample of the study consists of 528 outpatients and inpatients with a mean age of 58.6 years. 46% of patients are women, 48.9% men
and a small percentage of 5.1% who participated in the study did not report demographic data. Patient participation in the study ranged
from 52%. In the Scascighini., et al. [18] the study sample consisted of 123 outpatients with a mean age of 58.7 years. 63% of patients are
women and 37% are men. Patient participation in the study was 82%.
In the research of Devreux., et al. [21] the research sample consists of 725 outpatients and inpatients with a mean age of 34.9 years.
38.1% of patients are women and 61.9% are men. Patient participation in research ranged at a low of 18.9%. In the research of Mastrogi-
anni., et al. [12] carried out in a health unit of the Greek health system, the sample of the research consists of 107 patients with an average
age of 57.8 years. 63% of the sample are women and 37% are men. The participation of patients in the research ranged at a rate of 79.85%.
The results of the research showed that the total satisfaction of patients with physiotherapy services of the Department of Physical
Medicine of GNB was 90.6%, the highest percentage ever recorded compared to previous surveys. In contrast, in the Monnin and Perneger
[11] study the overall patient satisfaction ranged at 68.3% and in the Scascighini., et al. [18] study in 76.6%. In the research of Devreux.,
et al. [21] the total patient satisfaction in public and private hospitals of Saudi Arabia ranged from 75.7% to 88.5% and in the research of
Mastrogianni., et al. [12] the percentage of total patient satisfaction ranged at 81.4%. The physiotherapist’s relationship with the patient

“Achilopouleio”
during the treatment process proves to be the most decisive factor in patient satisfaction in the provision of physiotherapy services at the
Department of Physical Medicine of the General Hospital. The physiotherapist’s relationship with the patient during treatment has been
shown to be the most important determinant of patient satisfaction in previous studies by Monnin and Perneger [11], Scascighini., et al.
[18] and Devreux., et al [21]. In contrast, In the research of Mastrogianni., et al. [12] carried out in a Greek unit of PHC, the secretariat-
administrative services for the provision of physiotherapy services gathered a higher percentage of satisfaction compared to the other
two satisfaction factors.
Also, in the present study as in the researches of Monnin and Perneger [11], Mastrogianni., et al. [12], Scascighini., et al. [18] and
Devreux., et al. [21] no statistically significant correlation was found in patient satisfaction according to gender, frequency of visits, the
choice of physiotherapy center, and the age of the research sample.
Conclusion
Patient satisfaction is today one of the most important tools for evaluating the quality of health services and systems. In the present
study, this indicator was used to evaluate the quality of physiotherapy services of the Department of Physical Medicine of GNB. According
to its results, the satisfaction of the patients of the Department of Physical Medicine of GNB was quite high. The relationship-communica-
tion that the physiotherapist develops with the patient during the treatment proved to be the most determining factor of patient satisfac-
tion. A second factor of patient satisfaction was the physiotherapy environment in which the physiotherapy services took part. The third
factor of satisfaction was the procedures that the patient had to face in order to have access to the physiotherapy services of the specific
health unit.
The sample size may be considered limited, but it meets the requirements of a quantitative research based on the international litera-
ture and articles. However, there is room for improvement in order to confirm on a larger scale the results of the research and to investi-
gate in depth the factors that determine and to a greater extent the satisfaction of patients in the field of physiotherapy.
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Volume 9 Issue 12 December 2020
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