Patient satisfaction is considered greatly important for health sectors from government to private hospitals. Its importance is not as a health care indicator quality, but also to understand how the therapy can help and increase treatment success.1 It is subjectively related to each individual's sociopsychological state and directly related to patients’ credibility with service provided and how it meets all his or her expectations.2–5

The satisfaction level in health area has been considered an excellent care quality indicator and an essential element that intimately affects treatments potential and effectiveness.1–4 Peiris et al.6 suggested that patient's perception and attitude directly influence rehabilitation outcome process.6

Physical therapy aims to promote early patient recovery and rehabilitation, as well as their independence, autonomy and quality of life.7,8 Reducing patient hospitalization time is a high priority and efficiency indicator, with potentially significant implications for each individual, health service and community.7,8 Currently the patient professional ratio can be highly disproportionate, which is evidenced mainly in public sectors and this fact may have satisfaction level impact.9 It would be necessary that professionals prioritize patients who need more attention and to consider patient's point of view which often results in a compromise on service quality provided.9,10 However, in hospital environment satisfaction level with physical therapy care remains poorly known.

Therefore, the aim of this study is to measure inpatient satisfaction level receiving physical therapy care and to evaluate which aspects of these treatments are flawed.

A total of 200 patients were evaluated; 58% were male, 60% had only elementary education and 39% had a higher monthly income than $568.13 (equivalent to more than two Brazilian minimum wages). Regarding hospitalization sector, 37.5% of patients were hospitalized in orthopedic sector, and most of them (89%) received only one physical therapy session per day. Patients’ detailed characteristics are presented in Table 1.

Table 2 summarized patients’ satisfaction mean (SD) for each MRPS instrument evaluated item (including four items from original instrument) and its total score, as well as the GPE. In general, patients were satisfied with physical therapy care, presenting an average of more than 4 in all items, except for items where the physical therapist would give home instructions, which obtained an average of 1.82 (1.53).

In Table 3, factorial exploratory analysis of five components was performed with 9 items (two items were considered “not applied” and two global items were not allocated to specific factors). Factor 1 is related to convenience and efficiency, factor 2 is about interpersonal relationship between patient and therapist, factor 3 is related to hospital infrastructure, factor 4 is referring to administrative hospital process (admission) and factor 5 is about home guidelines provided by physical therapist. All components (factors) explain 63.10% of total variation.

The findings of this study indicate that patients in physical therapy care were very satisfied with convenience and efficiency, interpersonal relationship with therapist, hospital infrastructure and administrative hospital process. However, home orientation provided by professionals needs to be improved. Most of obtained items averaged near or above 4 on a 1 to 5 scale (best answer). Among 200 evaluated patients, the majority (89%) received only one physical therapy care visit per day. Considering that 60% of patients had only elementary school education we can infer that lesser educated patients despite representing a substantially higher demand, become satisfied even when they receive the minimum care. These results can corroborate with Peiris et al. 6which affirmed that interpersonal relationship between therapist and patient seems to be a more important factor for patients in hospital settings than amount of therapy sessions received.6

The item with highest score was in reference to physical therapist/patient respect. Due to university hospital settings, patients received physical therapy care performed by undergraduate students and residents who are always oriented to be respectful to patients and their relatives. In contrast, item with the lowest score dealt with home guidelines. This may be attributable to the fact that not all patients were evaluated at the exact discharge moment. Also, hospital does not have an oriented and multidisciplinary discharge program, so several times physical therapists were not informed about patient's discharge, preventing professional from passing on appropriate home guidelines. In addition, university hospitals tend to have high resident turnover rates, and patients rarely have physicians or physical therapists who can treat them with regularity and address all their complaints.9

For evaluation and to explore how our patients understand MRPS items, a factorial analysis was performed. We found a factorial load that explains 63.10% of total variation with five factors, different from previous studies. The original MRPS study12 was performed with musculoskeletal patients and found three factors in factorial analysis and it explains 57.03% of total variation. Oliveira et al.13 evaluated the satisfaction level of musculoskeletal patients also and found three factors in their validation study in Brazilian Portuguese: “interpersonal”, “convenience and efficiency” and “patient education” that explains 53.8% of total variation. What we can observe is that some items could be not only in a single factor, such as “My therapist advised me on ways to avoid future problems”. It has a higher load in factor 2 (interpersonal relationship), but could also be allocated in factor 5 (home orientation), which presents only one item. However, we believe that it is a very important item for evaluation in hospital environments, since this is the lowest score and that it should be improved both in physical therapeutic treatment and in new learning strategies and interprofessional education in hospital scope.

Different population studies have shown that home guidelines are essentially important to patients and to those who live with them, since they help prevention and rehabilitation.16,17 By broadening people's knowledge about rehabilitation indications and contraindications in relation to presented disease, some continuity can be given to home treatment, which can help prevent negative attitudes from forming that may cause complications in patient's health status and even possible readmission.16,17

Medeiros et al. evaluated patient satisfaction with musculoskeletal conditions under physical therapy treatment in Brazil's southeast region through MRPS instrument and also observed a high satisfaction level with service provided.5 In addition to this study, Casserley-Feeney et al.18 evaluated physical therapy satisfaction in patients having musculoskeletal conditions, however, this study took place in a developed country where a high satisfaction level with physical therapy services was noted.18

Almeida et al. evaluated satisfaction level in patients under care at a public university hospital in Brazil (as well as in this study) and reported that patients were satisfied even under public health service care.19 In a public university hospital, patients are often admitted where vacancy is available at that moment, e.g. patients can present a cardiologic disease and can be hospitalized in a nephrology ward. Results observed in this study showed us that this condition was not important to patient satisfaction. This suggests that studies that evaluate patients’ satisfaction under physical therapeutic care tend to present a positive result (ceiling effect), independent of whether physical therapy service provided is public or private.5,18,19

As a limitation of this study, we can point out that MRPS instrument was not directly validated for physical therapy care in hospital settings and that evaluations (instrument application) were done close to hospital discharge moment, but not exactly on discharge day. This situation may have contributed to a lower score on items that evaluate how patients were instructed to continue treatment in home environment. In addition, we should point out that perhaps results obtained in this study cannot be generalized to less developed cities and states. As a strong point, even with all limitations found, including lack of human resources, infrastructure, and materials, professionals are committed to respect and care for patients, dedicating and committing themselves to obtain better results.

This study makes it possible to inform physical therapists working in hospitals how to improve their delivery services, especially concerning home guidelines and need to reeducate multidisciplinary teams in relation to patients’ discharge, thus facilitating future investments for local improvements regarding patient perceptions. We also suggest future studies that can validate and adapt MRPS for patients in hospital setting. Given results obtained, we can conclude that hospital patients in this study were satisfied with physical therapy service provided.

The authors declare no conflicts of interest.