Measurement of patient satisfaction with physical therapy care: revisiting the semantic and dimensional structure equivalence of MedRisk instrument in the Brazilian context

Abstract

Background

MedRisk is one of the several available measurement tools developed to assess patient satisfaction with outpatient physical therapy services and has been adapted to different countries, including Brazil. However, the literature shows conflicting results regarding its dimensional structure.

Objective

To evaluate the Brazilian version of MedRisk for semantic equivalence to the original English version, followed by an assessment of its dimensional structure.

Methods

The original 18-item version was first submitted to translation and back-translation, followed by a pre-test on 55 patients (semantic equivalence phase). Another 326 patients were interviewed to assess the dimensional structure. An initial confirmatory factor analysis (CFA) was followed by exploratory structural equation modelling (ESEM).

Results

CFA was performed on the 16-item version agreed upon in the first phase, and indicated poor fit (RMSEA = 0.10, 90% CI: 0.08–0.12; CFI = 0.84; TLI = 0.79). The ensuing ESEM pointed to a four-factor structure, but five cross-loadings emerged, suggesting violation of the item factor specificity. High residual variances were also found in 3 items (≥0.70), which is indicative of poor item reliability.

Conclusion

Although semantic equivalence was achieved, several uncovered psychometric (configural and metric) shortcomings show that MedRisk still requires refinements before recommending its use in Brazilian health services.

Keywords:

• Patient satisfaction
• questionnaires
• validation studies
• MedRisk

Disclosure statement

The authors declare that they have no conflict of interest.

Additional information

Funding

MER was partially supported by the Brazilian National Research Council (Conselho Nacional de Pesquisa – CNPq), grants 302224/2013-0 and 301381/2017-8. MM was partially supported by the Brazilian National Research Council (Conselho Nacional de Pesquisa – CNPq), grants 306023/2016-4. RA was partially supported by the National Council for the Improvement of Higher Education (CAPES), finance code 001.