Satisfaction with outpatient physiotherapy: Focus groups to explore the views of patients with acute and chronic musculoskeletal conditions

Abstract

Patient satisfaction is generally regarded as an important component in quality health care. However, there has been little satisfaction research in physiotherapy compared with that in other clinical fields with few qualitative studies that have explored patients' perceptions and attitudes toward physiotherapy. We report on the use of focus groups, as part of a multimethod approach of qualitative data collection into patients' satisfaction with their outpatient physiotherapy within the NHS system of care in the United Kingdom. We explored the factors that affect patients' satisfaction with musculoskeletal outpatient physiotherapy. A purposeful sample of patients with acute and chronic musculoskeletal patients who had been discharged from physiotherapy within the previous 4 months was drawn from both an inner city and suburban hospital. Two acute groups (n = 4, n = 10) and two chronic groups (n = 5, n = 11) were convened. A topic guide drew on themes that had emerged from the earlier qualitative phases of the study and guided the discussion in relation to pretreatment, treatment, and outcome stages of physiotherapy care. Sessions were tape-recorded, transcribed, and content was analyzed to code and categorise the primary patterns in the data. Although subjects in both the acute and chronic groups expected that treatment would improve their symptoms and function, they differed in the degree to which they perceived that this was achieved. Both satisfactory and unsatisfactory aspects of care emerged under the principal themes of expectations, communication, perceptions of the therapist, treatment process, and outcome. Those in the acute group were optimistic of a good result, whereas those with chronic degenerative conditions were either doubtful of improvement or unrealistic in their hopes for complete resolution of their symptoms. It was also apparent that subjects could be further divided into one of three groups (positive, negative, ambivalent), depending on the degree to which they perceived their needs and expectations had been met. Verbatim comments are presented to illustrate the spectrum of views expressed. The therapeutic encounter between therapist and patient is complex and reflects the multidimensional construct of satisfaction. Focus groups were used in this study as part of a multimethod approach into patient satisfaction with outpatient physiotherapy; they provided additional valuable insight into the reasoning process behind patients' evaluation of their care. Establishing patients' needs, particularly the extent to which these might be psychosocial rather than physical, could point the way to a more patient-focussed and productive physiotherapy experience. Although rich in-depth information was obtained from this study, caution should be applied in generalizing the findings because of the small sample sizes and the setting of the study within the NHS system of care. Therefore, further work to identify the full spectrum of issues relating to patients' satisfaction with their outpatient care is indicated.