See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/236114761

Italian Version of the Physical Therapy Patient Satisfaction Questionnaire:

Cross-Cultural Adaptation and Psychometric Properties

Article  in  Physical Therapy · April 2013

DOI: 10.2522/ptj.20120170 · Source: PubMed

CITATIONS READS
21 746

7 authors, including:

Carla Vanti Daniele Ceron

University of Bologna 7 PUBLICATIONS   45 CITATIONS   
121 PUBLICATIONS   1,449 CITATIONS   
SEE PROFILE
SEE PROFILE

Francesca Bonetti Raffaella Piccarreta

University of Rome Tor Vergata Università commerciale Luigi Bocconi
31 PUBLICATIONS   384 CITATIONS    58 PUBLICATIONS   723 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Effect of Multimodal Exercise Training on Walking Economy in Individuals With Parkinson's Disease View project

The ventilatory response to unaided treadmill walking and its contribution to walking endurance in incomplete spinal cord injury before and after overground
locomotor training. View project

All content following this page was uploaded by Carla Vanti on 05 April 2016.

The user has requested enhancement of the downloaded file.

 Italian Version of the Physical Therapy Patient
Satisfaction Questionnaire: Cross-Cultural
Adaptation and Psychometric Properties
Carla Vanti, Marco Monticone, Daniele Ceron, Francesca
Bonetti, Raffaella Piccarreta, Andrew A. Guccione and
Paolo Pillastrini
PHYS THER. 2013; 93:911-922.
Originally published online April 4, 2013
doi: 10.2522/ptj.20120170

The online version of this article, along with updated information and services, can be
found online at: http://ptjournal.apta.org/content/93/7/911

Online-Only Material http://ptjournal.apta.org/content/suppl/2013/06/26/93.7.91

1.DC1.html
Collections This article, along with others on similar topics, appears
in the following collection(s):
Cross-Cultural
Health Services Research
Professional Issues
Professional-Patient Relations
e-Letters To submit an e-Letter on this article, click here or click on
"Submit a response" in the right-hand menu under
"Responses" in the online version of this article.
E-mail alerts Sign up here to receive free e-mail alerts

Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016

 Research Report

Italian Version of the Physical Therapy

Patient Satisfaction Questionnaire: C. Vanti, PT, OMPT, MSc, Depart-
ment of Biomedical and Neuro-
Cross-Cultural Adaptation and motor Sciences (DIBINEM), Alma
Mater Studiorum, University of

Psychometric Properties Bologna, Bologna, Italy.

M. Monticone, MD, PhD, Opera-

Carla Vanti, Marco Monticone, Daniele Ceron, Francesca Bonetti, tive Unit of Physical and Rehabili-
tation Medicine, Scientific Insti-
Raffaella Piccarreta, Andrew A. Guccione, Paolo Pillastrini tute of Lissone, Salvatore Maugeri
Foundation, IRCCS, Lissone (MB),
Italy.
Background. Patient satisfaction is an important measure for evaluating inter-
ventions in health care. No patient satisfaction questionnaire for physical therapy D. Ceron, PT, OMPT, Riabilita
Physical Therapy, Masters in Man-
treatment has been validated to date for use in an Italian outpatient population. ual Therapy and Musculoskeletal
Rehabilitation, University of
Objective. The aim of this study was to translate, culturally adapt, and validate the Padova, Padova, Italy.
Italian version of the Physical Therapy Patient Satisfaction Questionnaire (PTPSQ-I).
F. Bonetti, PT, OMPT, Associazi-
one Italiana Riabilitazione Inseri-
Design. A measurement study was conducted. mento Invalidi, Rehabilitation
Center, Rome, Italy.
Methods. The PTPSQ-I was developed through forward-backward translation, R. Piccarreta, PhD, MStat, Depart-
final review, and pre-final version. An acceptability analysis was first conducted. ment of Decision Sciences, L. Boc-
Reliability was measured by internal consistency (Cronbach ␣), and a factor analysis coni University, Milan, Italy.
was applied to investigate the internal structure. Divergent validity was measured by A.A. Guccione, PT, PhD, DPT,
comparing the PTPSQ-I with a visual analog scale (VAS) and with a 5-point Likert-type FAPTA, Department of Rehabil-
scale evaluating the global perceived effect (GPE) for the physical therapy treatment. itation Science, College of Health
and Human Services, George
Results. The process for developing the PTPSQ-I required 3 months using data on Mason University, Fairfax,
Virginia.
315 outpatients. Based on our initial analyses, 5 items were deleted from the PTPSQ-I,
which was renamed the PTPSQ-I(15). The PTPSQ-I(15) showed high internal consis- P. Pillastrini, PT, Department of
tency (␣⫽.905). Divergent validity was moderate for the GPE (r⫽.33) but not Biomedical and Neuromotor Sci-
ences (DIBINEM), Alma Mater Stu-
significant for the VAS (r⫽⫺.07). A factor analysis revealed evidence for a 2-factor diorum, University of Bologna,
structure related to perceived “Overall Experience” and “Professional Impression” Bologna, Italy. Address all corre-
that explained 62% of the total variance. A third factor, “Efficiency and Convenience,” spondence to Professor Pillastrini
brought explained total variance to near 70%. at: paolo.pillastrini@unibo.it.

[Vanti C, Monticone M, Ceron D,

Limitations. It may be necessary to add items to the PTPSQ-I(15) to assess other et al. Italian version of the Physical
dimensions not currently represented by these 15 items. Therapy Patient Satisfaction Ques-
tionnaire: cross-cultural adapta-
tion and psychometric properties.
Conclusion. The PTPSQ-I(15) showed good psychometric properties, and its use Phys Ther. 2013;93:911–922.]
can be recommended with Italian-speaking outpatient populations.
© 2013 American Physical Therapy
Association

Published Ahead of Print:

April 4, 2013
Accepted: April 1, 2013
Submitted: April 13, 2012

Post a Rapid Response to

this article at:
ptjournal.apta.org

July 2013 Volume 93 Number 7 Physical Therapy f 911

Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016
Italian Version of the Physical Therapy Patient Satisfaction Questionnaire
A
patient’s perceptions regard-
ing the process, outcome,
and quality of health care ser-
vices are increasingly recognized
as relevant to the evaluation of
health care outcomes.1 This rec-
ognition has led to the use of sur-
veys designed to measure a patient’s
experience.1,2 Patient satisfaction is
generally recognized as multidimen-
sional in nature and may be used as
either a process or outcome mea-
sure,3 although satisfaction with care
and with outcome may be distinct
in certain conditions.4 – 6 Ellwood
and Paul7 suggested that a dissatis-
fied patient is less inclined to follow
professional advice, with negative
consequences for primary and sec-
ondary prevention.
Some patient satisfaction measures
have been used as proxies for treat-
ment effectiveness, and positive
results are used by some facilities to
win the favor of the consumers.8,9
Satisfaction also has been linked to
the relationship a patient has with
the physical therapist and other
staff members, as well as to environ-
mental and economic factors (eg,
clinic location, parking facilities,
costs).9 –12
Research on satisfaction with physi-
cal therapy is relatively undevel-
oped, especially when compared
with medicine and nursing.9 Much of
the work on patient satisfaction in
physical therapy to date has cen-
tered on operationalizing the con-
cept and developing reliable and
valid instruments. There is no uni-
Available With
This Article at
ptjournal.apta.org
• eAppendix: Italian Version of the
Physical Therapy Patient
Satisfaction Questionnaire
• eFigure: Frequency Distributions
of the Variables
912 f Physical Therapy Volume 93 Number 7
Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016
versal gold standard for measuring
patient satisfaction, as the enormous
patient variability and wide range
of clinical conditions that require
physical therapy make it difficult
to identify a questionnaire suitable
for all patients and situations. A
totally comprehensive instrument
would comprise an unmanageably
high number of items. A useful ques-
tionnaire, therefore, should explore
satisfaction across multiple domains,
demonstrate strong psychometric
properties, and use a limited number
of items.
Even a brief review of the literature
on existing instruments identifies
substantial differences in structure
and content across currently used
questionnaires. One of the most
studied instruments on satisfaction
with physical therapy is the MedRisk
Instrument for Measuring Patient
Satisfaction With Physical Therapy
Care (MRPS), which was initially
developed for clients of a profes-
sional benchmarking service.11,13
This questionnaire consists of 12
items: 7 regarding patient-therapist
factors, 3 related to non-therapist
factors, and 2 global measures of
satisfaction. The MRPS also was vali-
dated as a measure of patient sat-
isfaction with chiropractic care.14
The Physical Therapy Outpatient
Satisfaction Survey (PTOPS) mea-
sures 4 distinct dimensions par-
tially adapted from concepts in
industrial management: enhancers
that increase satisfaction by enrich-
ing the patient’s experience beyond
an acceptable baseline and detrac-
tors that lessen satisfaction but do
not enhance satisfaction when pres-
ent.12 The PTOPS items are distrib-
uted across enhancers (10 items),
detractors (10 items), location (7
items), and cost (7 items).
Finally, the Physical Therapy Patient
Satisfaction Questionnaire (PTPSQ)
was developed in 2000,15 comprises
26 items, and is divided into 2 parts.
The first part contains 6 items con-
cerning demographic information
about the patient (eg, age, sex, loca-
tion of the musculoskeletal prob-
lem), as well as some information
about referral source and any previ-
ous care at that facility. For the sec-
ond set of questions, PTPSQ items
were developed to reflect 5 potential
dimensions of patient satisfaction
presumed to be related to quality:
access, administrative technical man-
agement, clinical technical manage-
ment, interpersonal management,
and continuity of care.15 Participants
rate their degree of satisfaction on
20 items regarding both the interac-
tion with the staff (physical thera-
pist, assistant, other staff members)
and some environmental character-
istics such as location, parking, and
cost. The score of the PTPSQ is
obtained by adding all of the scores
for items not marked a “9” (not
applicable) or missing and dividing
the sum by the maximum possible
score, which is the number of items
in the numerator multiplied by 5
(the highest possible score on each
item). Then the ratio is converted
to a percentage (Marc S. Goldstein,
EdD, Research, American Physical
Therapy Association; personal com-
munication; July 22, 2012). Gold-
stein et al15 tested the psychometric
properties of the original version
of the PTPSQ on 289 outpatients
from 12 practice settings, including
a hospital-based outpatient clinic
and a private office.
Although patients with musculoskel-
etal conditions were most common
across all clinics, patients with other
conditions, including stroke, fibro-
myalgia, and pelvic dysfunction,
were included in the study sample.
Goldstein et al15 observed high inter-
nal validity and good content valid-
ity. Goldstein et al15 established
concurrent validity by correlating a
summary score of 17 items with 3
criteria that were arguably most
related to overall satisfaction and
July 2013
 Italian Version of the Physical Therapy Patient Satisfaction Questionnaire
found exceptionally high correla-
tions between the summary score
and each criterion variable. To eval-
uate the construct validity, a princi-
pal components analysis was con-
ducted, and a unique factor was
extracted accounting for nearly 83%
of the total variance.
Cultural, economic, and social con-
text influence patient satisfaction,
and it is reasonable to assume that
patients in different countries have
different priorities with respect to
the factors shaping and influencing
satisfaction. Thus, instruments devel-
oped in one population have to be
validated for cross-cultural use.16 –21
To our knowledge, the PTPSQ has
never been validated in other cul-
tures outside of the United States or
in languages other than English. As a
consequence, its psychometric prop-
erties are not confirmed with differ-
ent populations. To measure the
results of physical therapy in Italy,
many scales are currently used for
pain, disability, function, and general
health, but no physical therapy sat-
isfaction questionnaire had been
translated and validated for the Ital-
ian population when we began our
study.
The aims of this study were: (1) to
translate, culturally adapt, and vali-
date (acceptability, reliability, and
validity) the Italian version of the
PTPSQ on a sample of outpatients
and (2) to investigate the relation-
ships between the characteristics of
the patients and physical therapists
and the indicators of satisfaction. We
selected the PTPSQ for translation
because it is brief, was based on
5 elements believed pertinent to
patient satisfaction, had acceptable
psychometric properties after test-
ing under conditions we believed
similar to ours, and allowed the user
to collect both general information
about respondents and judgments
about satisfaction on issues that we
July 2013
Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016
believed would most likely be perti-
nent to the Italian social context.
Method
Translation and Cross-Cultural
Adaptation of the PTPSQ
This stage followed the guidelines
for the process of cross-cultural
adaptation of self-report measures.22
Step 1: Forward translation. The
PTPSQ was forward translated from
English into Italian with the intent
to retain the meaning of the orig-
inal questionnaire. Two translations
were independently performed by
translators whose first language is
Italian. The first translator, who was
not familiar with the scale, was a
linguistics professor, and the other
translator was a physical therapist in
private practice. Translators aimed
to keep the language colloquial and
compatible with a reading age level
of 14 years. When a concept had no
equivalent in the Italian culture, the
translators adapted the item to an
appropriate cultural context. Trans-
lational choices about the most chal-
lenging terms were resolved in a dis-
cussion between the 2 translators.
None of the original items was
omitted.
Step 2: Backward translation.
Two bilingual native English-
speaking translators backward trans-
lated the initial version to ensure the
fidelity of the Italian version with the
original questionnaire, while still
considering social and cultural dif-
ferences between the United States
and Italy. The 2 translators were
neither aware nor informed of the
concepts being explored, and they
did not have medical backgrounds
to avoid information bias and to
allow unexpected meanings of items
in the translated questionnaire to
emerge.22
Step 3: Expert committee. Both
forward and backward transla-
tions were submitted to a bilingual
Volume 93 Number 7
committee, which included our 4
translators. The committee dis-
cussed different options for items
and responses, emphasizing mean-
ing over literal translation to achieve
conceptual equivalence. None of the
items were omitted. This first cultur-
ally adapted translation was obtained
in 3 months.
Step 4: Test of the pre-final ver-
sion. The questionnaire then was
administered to 50 patients ran-
domly selected from all patients of
the involved centers who met the
inclusion and exclusion criteria to
verify the meaning of each item and
response choices. Patients filled in
the questionnaire before a session of
treatment, excluding the first ses-
sion. Each patient marked the items
that were not considered clear
enough or had doubtful meaning. All
items were re-evaluated by the com-
mittee of experts, and revisions were
made. None of the items was omit-
ted. At the end of this stage, which
took 1 month, this version was
named PTPSQ-I.
Participants
This study involved a university hos-
pital and 2 physical therapy services,
all chosen to represent different
social and cultural contexts within
different regions of Italy. All adult
(18 years or older) physical therapy
outpatients from April to September
2011 were eligible for the study if
they were able to read and speak
Italian. Patients who received only
an evaluation or had psychiatric or
cognitive deficits were excluded on
the basis of the clinical documenta-
tion provided by a physician at the
time of admission. All participants
gave their written consent.
Examiners
Questionnaires were presented by
research assistants to each partici-
pant, who was ensured that his
or her physical therapist was blinded
to the results. Questionnaires were
Physical Therapy f 913
Italian Version of the Physical Therapy Patient Satisfaction Questionnaire
administered before a session of
treatment, excluding the first ses-
sion, and in separate rooms, ensur-
ing privacy. Items were presented to
each participant in written form. Par-
ticipants answered each question
verbally, and research assistants
filled in the answers on the PTPSQ-I.
Research assistants could repeat
questions but could not change
wording. If a participant altered his
or her response, the assistant noted
the change on the form; if the par-
ticipant did not choose any answer,
the assistant did not mark any box.
The levels of patient understanding
and the time needed to answer were
recorded for each item by the
research assistant.
Administered Questionnaires
All participants completed a form
requiring some demographic infor-
mation not included in the first
part of the PTPSQ-I (marital status,
education, employment, mode of
payment) and whether the par-
ticipant attended all scheduled ses-
sions. Furthermore, all participants
completed a PTPSQ-I. A visual analog
scale (VAS) and a 5-point Likert-type
scale evaluating the global perceived
effect (GPE) of physical therapy
treatment were administered to eval-
uate concurrent validity. The VAS
score was obtained from a 10-cm
segmented line, whose extremes
correspond to “no pain” (score⫽0)
and “unbearable pain” (score⫽100).
Participants were asked to identify
the point on the 10-cm line indicat-
ing the pain felt at that moment.
The VAS is a one-dimensional tool
summarizing the subjective global
perception of pain, including its
physical, psychological, and cultural
aspects, without distinguishing
which of these components have
greater relevance. It is widely used,
simple, immediate, and reliable.23
The GPE questionnaire evaluates the
patient’s perception of the effective-
ness of the treatment by asking
“How do you rate the overall effec-
914 f Physical Therapy Volume 93 Number 7
Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016
tiveness of the treatment received
with respect to your needs?” Respon-
dents choose among 5 possible
answers, ranging from “really
helped” (score⫽1) to “made things
worse” (score⫽5). This scale reliably
measures the perceived improve-
ment at the time of administration.24
Data Analysis
All statistical analyses were per-
formed using PASW Statistics 18
(Release 18.0.3, SPSS Inc, Chicago,
Illinois) and SAS (Release 9.2, SAS
Institute Inc, Cary, North Carolina).
Acceptability. We recorded the
time needed to answer the ques-
tionnaire, and assistants noted any
comprehension difficulties and veri-
fied missing, changed, or multiple
responses.
Reliability. Reliability was investi-
gated with respect to internal consis-
tency. Internal consistency reflects
the extent to which different items
in a questionnaire measure different
aspects of the same general con-
struct. Following common practice,
we used Cronbach alpha (␣), esti-
mated for the whole questionnaire.
Internal structure and construct
validity. Factor analysis was used
to evaluate the internal structure of
the scale. This technique evaluates
whether it is possible to extract a
small number of factors explaining
the correlations among the original
items. If only one factor satisfactorily
summarizes all items, the total (ie,
the sum of the scores for all the
items) can be used to summarize sat-
isfaction. If instead more factors are
necessary, each related to one partic-
ular aspect of the satisfaction itself
(eg, satisfaction for the therapy ver-
sus satisfaction for the ambience
where the therapy is received), it
can be inferred that “satisfaction” is a
multifaceted construct, and the total
score can be broken down into more
detailed components (subtotals).
Divergent validity. Due to the
lack of validated outcome measures
concerning physical therapy patient
satisfaction in Italian, direct study of
convergent validity was not feasible.
However, divergent validity could be
investigated by comparing Pearson
correlation (r⬍.30⫽low; .30⬍r⬍
.60⫽moderate; r⬎.60⫽high) of the
PTPSQ-I with the GPE, as a measure
of the perception of the effective-
ness of the treatment, and with the
VAS, as a measure of pain perceived
by the patient. It was hypothesized
a priori that the correlation between
the PTPSQ-I and the GPE would be
moderate to low25 and the correla-
tion between the PTPSQ-I and the
VAS would be low.6
Dependency of satisfaction on
explanatory variables. Wilcoxon
and Kruskal-Wallis tests were used
to identify the extent to which sat-
isfaction scores depend on the
patient’s sociodemographic charac-
teristics (eg, sex, age class, marital
status, education, working status),
the characteristics of the therapy
received (eg, the facility attended,
the source recommending the facil-
ity, whether it was the first time the
patient attended that facility or had
an episode of care with a physical
therapist), the regular attendance of
the therapy, the therapist’s sex and
the combination of the therapist-
patient sexes, and payment method.
Results
A total of 865 patients received phys-
ical therapy during the period of
study, of whom 548 did not meet the
inclusion criteria: 513 were younger
than 18 years (most attended one
facility), and 35 had psychiatric or
cognitive deficits. A total of 317 out-
patients were eligible and were
asked to participate in the study. Of
these outpatients, 2 refused, leaving
a sample of 315 patients (211 [67%]
female, 104 [33%] male; mean
age⫽51.2 years, SD⫽13.1). In Table
1, the sociodemographic characteris-
July 2013
 Italian Version of the Physical Therapy Patient Satisfaction Questionnaire

tics of these patients are reported, Table 1.

together with information about the Sociodemographic Characteristics of the Patients and Information on Their Therapy
therapy received, including facility Variable Category n Percentage
attended, regularity of attendance,
Sex Female 211 67.0
sex of the therapist, and payment
Male 104 33.0
method.
Age (classes) 18–25 8 2.5

Acceptability 25–40 45 14.3

On average, the questionnaire was 40–65 225 71.5
completed in 4.7 minutes (SD⫽ ⬎65 37 11.7
1.65). Only 147 errors (eg, correc- a
Married Yes 208 66.0
tions, deletions) were noted, corre-
Nob 107 34.0
sponding to 3.1% of the total number
of answered questions (15 items for Worker Yes 236 75.0

315 patients, for a total of 4,725). No 23 7.3

Very few questions were left unan- Retired 56 17.7
swered (9 out of the total of 4,725). Education Elementary 13 4.2
No multiple answers were found. No
Middle school 58 18.4
problems with item comprehension
Upper school 163 51.7
were reported.
University 81 25.7
The “I do not know” responses Facility Bologna 143 45.0
equaled 19% (879 out of a total of Castenaso 90 29.0
4,725). These responses were Roma 82 26.0
treated as equivalent to missing val-
Facility recommended by Physician 59 18.7
ues. The frequency distributions of
Friends 40 12.7
responses by item are reported in
the eFigure (available at ptjournal. Other patients 32 10.1
apta.org). The height of each bar rep- Other 184 58.5
resents the number of nonmissing First treatment in the facility Yes 205 65.0
responses for the item itself. Some No 110 35.0
items were characterized by a very
First episode of physical therapy care Yes 120 38.1
high proportion of missing values.
No 195 61.9
The most critical variables are those
related to costs: item Q16 (“My bills Regularly attends scheduled sessions Yes 278 88.3

were accurate”) with 206 patients No 37 11.7

(65.4%) who did not express an Therapist’s sex Female 141 44.8
opinion and item Q24 (“The cost Male 174 55.2
of the physical therapy treatment
Payment Direct payment 92 29.3
received was reasonable”) with 195
Copayment 2 0.6
such patients (61.9%), and to a lesser
extent item Q25 (“If I had to, I Fully covered (National 80 25.3
Health System)
would pay for these physical therapy
services myself”) with 74 patients Insurance 141 44.8

(23.5%) (Tab. 2). Also, a relatively a

high number of missing responses
was observed for item Q17 (“I was
satisfied with the services provided
by my physical therapist assistants”)
with 145 patients (46%) and item
Q18 (“Parking was available for me”)
with 105 patients (33.3%).
Married, living together.
b
Single, widowed, or divorced.
The inclusion of these items in fur-
ther analyses would have involved a
large proportion of missing data, as
only 39 participants answered all
of the questions. In addition, we
observed that the patients who did
not respond to these questions had
specific characteristics in terms of
employment, mode of payment, and
facility attended (Tab. 3). We
decided, therefore, to delete these
particular items from further analysis

July 2013 Volume 93 Number 7 Physical Therapy f 915

Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016
Italian Version of the Physical Therapy Patient Satisfaction Questionnaire

Table 2.
Number of Not Missing and Missing Values for Each Variable

Not Percentage
Item Label Missing Missing Missing

Q07 My privacy was respected during my physical therapy care. 305 10 3.17

Q08 My physical therapist was courteous. 314 1 0.32

Q09 All other staff members were courteous. 232 83 26.35

Q10 The clinic scheduled appointments at convenient times. 314 1 0.32

Q11 I was satisfied with the treatment provided by my physical therapist. 312 3 0.95

Q12 My first visit for physical therapy was scheduled quickly. 310 5 1.59

Q13 It was easy to schedule visits after my first appointment. 313 2 0.63

Q14 I was seen promptly when I arrived for treatment. 314 1 0.32

Q15 The location of the facility was convenient for me. 309 6 1.90

Q16 My bills were accurate. 109 206 65.40

Q17 I was satisfied with the services provided by my physical therapist assistant(s). 170 145 46.03

Q18 Parking was available for me. 210 105 33.33

Q19 My physical therapist understood my problem or condition. 305 10 3.17

Q20 The instructions my physical therapist gave me were helpful. 309 6 1.90

Q21 I was satisfied with the overall quality of my physical therapy care. 311 4 1.27

Q22 I would recommend this facility to family or friends. 302 13 4.13

Q23 I would return to this facility if I required physical therapy care in the future. 302 13 4.13

Q24 The cost of the physical therapy treatment received was reasonable. 120 195 61.90

Q25 If I had to, I would pay for these physical therapy services myself. 241 74 23.49

Q26 Overall, I was satisfied with my experience with physical therapy. 310 5 1.59

and to consider a 15-item PTPSQ-I,
referred to as PTPSQ-I(15) (eAppen-
dix, available at ptjournal.apta.org).
As indicated in the eFigure, most of
the respondents chose the fourth or
fifth levels of satisfaction, whereas
responses indicating low satisfaction
were very rare. The most relevant
exceptions (disregarding deleted
items) were observed for the items
Q12 (“My first visit for physical ther-
apy was scheduled quickly”) and
Q15 (“The location of the facility
was convenient for me”), which
were characterized by a relatively
higher proportion of scores of 3 or
lower.
Reliability
Internal consistency. The Cron-
bach ␣ value after deleting items
Q16, Q17, Q18, Q24, and Q25 was
.905. The total score determined by
summing the values observed for
each item had a mean and variance
of 70.44 and 44.45, respectively.
Table 4 displays results obtained by
deleting one item at a time. Deleting
only item Q15 (“The location of the
facility was convenient for me”) or
only item Q12 (“My first visit for
physical therapy was scheduled
quickly”) slightly increased the Cron-
bach ␣. Also, these 2 questionnaire
items had the weakest item-total cor-
relations. As noted above, Q12 and
Q15 were the items characterized by
the highest proportions of scores of
3 or lower. Also, from Table 4, it is
possible to appreciate that item Q11
(“I was satisfied with the treatment
provided by my physical therapist”)
and items Q19 to Q26 (all explicitly
referring to satisfaction) appear to be
more interconnected: their deletion
causes a relatively large decrease in
Cronbach ␣, and they show a higher
correlation with the total.
Internal structure and construct
validity. To investigate the rela-
tionships among the 15 items in
PTPSQ-I(15), we applied factor anal-
ysis, using the principal components
extraction method. Three factors
met the standard rule of an eigen-
value of 1 or higher. The first factor,
explaining about 51% of the total
variance, was the dominant one.
Nonetheless, the second and third
factors, explaining 11% and 7% of
the total variance, respectively, also
contributed to a cumulative propor-
tion of nearly 70% explained.
To individuate the dimensions
underlying respondent satisfaction,
factors were extracted and rotated
using the varimax criterion for ease
of interpretation. Table 5 presents
the correlations (loadings) between
the PTPSQ-I(15) and the extracted
factors. The data in Table 5 support
the notion that “satisfaction” is a

916 f Physical Therapy Volume 93 Number 7 July 2013

Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016
 Italian Version of the Physical Therapy Patient Satisfaction Questionnaire

Table 3.
Characteristics of the Patients Who Did Not Respond to the Critical Items

Percentage of Missing Responses to the Items

Variable Category n Q16 Q17 Q18 Q24 Q25

Sex Female 207 68.1 47.3 36.2 69.1 21.3

Male 102 60.8 42.2 28.4 49.0 27.5

Age (classes) 18–25 8 25.0 50.0 12.5 25.0 12.5

25–40 45 66.7 48.9 31.1 68.9 24.4

40–65 219 65.8 46.1 33.3 62.6 22.8

⬎65 37 73.0 37.8 43.2 62.2 27.0

Worker Yes 232 64.2 51.3 31.9 62.1 25.4

No 21 85.7 28.6 47.6 81.0 9.5

Retired 56 64.3 28.6 35.7 57.1 19.6

Married Yesa 203 63.1 47.3 27.6 57.6 25.6

Nob 106 70.8 42.5 45.3 71.7 18.9

Education Elementary 13 69.2 53.8 30.8 61.5 23.1

Middle school 58 77.6 62.1 39.7 79.3 20.7

Upper school 160 66.9 41.9 33.8 61.3 21.3

University 78 53.8 39.7 29.5 52.6 29.5

Facility Bologna 141 87.2 53.9 46.8 86.5 23.4

Castenaso 86 15.1 52.3 4.7 4.7 38.4

Roma 82 81.7 24.4 41.5 81.7 7.3

Facility recommended by Physician 59 52.5 30.5 35.6 55.9 22.0

Friends 38 34.2 39.5 13.2 28.9 31.6

Other patients 31 58.1 51.6 19.4 45.2 16.1

Other 181 77.9 50.8 39.8 74.6 23.2

First treatment in the facility Yes 201 66.2 50.2 32.3 62.7 25.9

No 108 64.8 37.0 36.1 62.0 18.5

First episode of physical therapy care Yes 120 70.0 48.3 43.3 68.3 25.0

No 189 63.0 43.9 27.5 58.7 22.2

Regularly attends scheduled sessions Yes 273 64.1 46.2 32.2 60.1 23.1

No 36 77.8 41.7 44.4 80.6 25.0

Therapist’s sex Female 137 46.7 34.3 24.8 44.5 16.8

Male 172 80.8 54.7 40.7 76.7 28.5

Payment Direct payment 89 13.5 49.4 4.5 5.6 37.1

Copayment 2 50.0 0.0 0.0 0.0 0.0

Fully covered 79 88.6 22.8 45.6 89.9 10.1

Insurance 139 86.3 56.8 46.0 84.2 22.3

a
Married, living together.
b
Single, widowed, or divorced.

multifaceted phenomenon, which
can be parceled into at least 2 com-
ponents described by the first 2 fac-
tors in Table 5. The first subtotal,
obtained by summing the scores of
items Q11, Q20 to Q23, and Q26, is
clearly a summary judgment about
the value of the overall experience.
We named this subtotal “Overall
Experience.” The second subtotal,
obtained by summing the scores of
items Q07 to Q09, Q14, and Q19,
relates to the immediate experience
of therapy at each visit, particularly
at the start of therapy. We propose it

July 2013 Volume 93 Number 7 Physical Therapy f 917

Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016
Italian Version of the Physical Therapy Patient Satisfaction Questionnaire

Table 4. captures “Professional Impression.”

Reliability Analysis With Each Question Deleteda Although the loadings on the third
Corrected
factor were not particularly high,
Deleted Cronbach ␣ Item-Total Scale Mean Scale Variance we built a third subtotal based on 4
Variable if Item Deleted Correlation if Item Deleted if Item Deleted items (Q10, Q13, Q12, and Q15),
Q07 .899 .631 65.625 40.336 which we named “Efficiency and
Q08 .900 .625 65.545 41.224 Convenience.”
Q09 .899 .608 65.625 40.648
Divergent validity. The divergent
Q10 .901 .541 65.855 38.607
validity was measured by calculating
Q11 .893 .748 65.715 38.245
the Pearson correlation coefficient
Q12 .912 .481 66.165 36.430 between the totals of the PTPSQ-
Q13 .903 .472 65.800 39.769 I(15) and the scores of the VAS
Q14 .901 .530 65.725 40.472 and GPE. The PTPSQ-I(15) total was
Q15 .916 .254 66.005 40.648
moderately correlated with GPE
(r⫽⫺.33). Also, the correlations of
Q19 .895 .732 65.660 39.442
“Overall Experience” and “Efficiency
Q20 .893 .791 65.665 38.405
and Convenience” showed similar
Q21 .892 .795 65.690 38.004 results (r⫽⫺.420 and ⫺.316, respec-
Q22 .891 .798 65.745 37.467 tively). However, the correlation
Q23 .891 .797 65.720 37.479 between “Professional Impression”
Q26 .893 .770 65.690 38.104
and GPE was low (r⫽⫺.09). The cor-
relations between the total and the 3
a
When all of the items are considered, the following results are obtained: Cronbach ␣⫽.905, scale
mean⫽70.44, scale variance⫽44.45. Bolded numbers refer to items less correlated with global subtotals and VAS were close to zero
satisfaction. and not significant (the 4 correla-
tions were ⫺.07, ⫺.10, ⫺.04, and
⫺.09, respectively).

Table 5.
Factor Analysis Loadingsa (Model With 2 and 3 Factors; Extraction Method: Principal Components; Rotation Method⫽Varimax)

2 Factors 3 Factors

Item Description 1 2 1 2 3

Q21 I was satisfied with the overall quality of my physical therapy care. .91 .23 .90 .25 .14

Q26 Overall, I was satisfied with my experience with physical therapy. .89 .22 .89 .26 .09

Q23 I would return to this facility if I required physical therapy care in the .90 .22 .88 .22 .19
future.

Q22 I would recommend this facility to family or friends. .88 .24 .85 .22 .24

Q20 The instructions my physical therapist gave me were helpful. .83 .31 .82 .34 .15

Q11 I was satisfied with the treatment provided by my physical therapist. .75 .34 .70 .29 .32

Q19 My physical therapist understood my problem or condition. .53 .63 .51 .65 .17

Q09 All other staff members were courteous. .29 .79 .28 .83 .08

Q08 My physical therapist was courteous. .28 .81 .25 .83 .16

Q07 My privacy was respected during my physical therapy care. .32 .77 .29 .77 .18

Q14 I was seen promptly when I arrived for treatment. .19 .72 .12 .63 .40

Q10 The clinic scheduled appointments at convenient times. .46 .32 .33 .08 .74

Q13 It was easy to schedule visits after my first appointment. .31 .45 .21 .28 .57

Q12 My first visit for physical therapy was scheduled quickly. .54 .14 .45 ⫺.03 .56

Q15 The location of the facility was convenient for me. .02 .46 ⫺.09 .29 .54
a
Numbers in bold and in italics indicate high and medium correlations, respectively. The items are arranged so as to better emphasize their relationship
with the considered factors.

918 f Physical Therapy Volume 93 Number 7 July 2013

Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016
 Italian Version of the Physical Therapy Patient Satisfaction Questionnaire
Dependency of satisfaction on
explanatory variables. We also
explored whether satisfaction, mea-
sured by the total score of the
PTPSQ-I(15), broken down into its
component “Overall Experience,”
“Professional Impression,” and “Effi-
ciency and Convenience” subscores,
varied according to the levels of the
possible explanatory variables listed
in Table 1.
Because a preliminary analysis
showed non-normal distributions of
the total satisfaction score and of
the subscores, we used a nonpara-
metric approach: the Kruskal-Wallis
test. The Wilcoxon test was used
for explanatory variables having only
2 levels. Instead of being based on
the means of the observed response
values, these tests are based on the
means of the ranked values (ie, the
position of a value in the ordered
sequence of values).
Table 6 presents the means of the
totals within the groups described
by the levels of the explanatory vari-
ables and the P values of the
Kruskall-Wallis or Wilcoxon tests
based on the ranks’ means. Groups
with very small frequencies (the
group of patients aged 18 –25 years
with only 8 valid cases and the group
of patients who partially paid for
the therapy with only 2 valid cases)
were not analyzed. For each satis-
faction score and for each explana-
tory variable, the P value for testing
the null hypothesis is reported. For
the explanatory variables with more
than 2 levels, a further Wilcoxon test
was applied to test the differences
between all the pairs of means in
order to identify which means were
statistically different from one
another.
Considering sociodemographic char-
acteristics (sex, education level, age
class, and working status), we
observed differences in satisfaction
scores across age classes: both total
July 2013
Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016
score and subscores increased with
age, on average. The total satis-
faction score and the “Overall Expe-
rience” and “Efficiency and Conve-
nience” subscores also differed
depending on working status: retired
patients and nonworkers reported
more satisfaction than workers.
With respect to facility and charac-
teristics of the therapy and of the
therapist, the “Professional Impres-
sion” subscore did not vary across
the levels of the explanatory vari-
able (focusing only on P values less
than .05). The total satisfaction score
and the “Overall Experience” sub-
score differed according to facility
attended, regularity of attendance,
payment method, recommendation
source, therapist’s sex, and the
combination of the therapist-patient
sexes. Notably, the levels of each
explanatory variable can be parti-
tioned into 2 groups of statistically
different means (ranks). The most
satisfied patients were those attend-
ing the facilities in Castenaso and
in Rome; those referred to the facil-
ity by their physician, by friends,
or by other patients; those regu-
larly attending the therapy; and
those who paid for the therapy
directly or were fully covered by the
National Health System. Interest-
ingly, patients treated by female
physical therapists are more satis-
fied, irrespective of the patient’s or
therapist’s sex. Similar patterns also
were observed for the “Efficiency
and Convenience” subscore. None-
theless, the level of satisfaction of
female patients treated by female
physical therapist was not statisti-
cally different, on average, from that
of male patients treated by male
physical therapist.
Discussion
We described a cross-cultural adap-
tation, reliability, and validity study
of the Italian version of the PTPSQ
in a sample of outpatients that was
balanced with respect to sex and
Volume 93 Number 7
conducted in facilities in different
parts of Italy. The original question-
naire was first translated (PTPSQ-I)
and administered to a sample of
Italian outpatients. Based on these
initial results, we deleted 5 items to
develop the PTPSQ-I(15). Like other
instrument developers, we needed
to exclude certain items in order
to adapt the original questionnaire
to the Italian cultural and social
context.26
A possible explanation for this
high number of “I do not know”
answers resides in differences
between the United States and Italy
in their economic and social organi-
zation. The health care system in
Italy is complex. Depending of their
clinical or social situation, in some
cases, patients can have access to
completely free medical care; in
other cases, physical therapy treat-
ments are reimbursed by private
insurance; and in still other cases,
patients directly pay for the treat-
ment received. As a consequence,
items related to payments and costs
in the initial translation received a
substantial proportion of “I do not
know” answers in our sample.
We also found a cultural difference
in item Q17, most likely due to the
lack of an equivalent worker to an
American “physical therapist assis-
tant” in Italy. Finally, the item refer-
ring to the availability of the parking
was not answered by several partic-
ipants, probably because they were
taken to the physical therapy facility
by another person. Thus, the trans-
lated PTPSQ-I using all of the items of
the original US version, did not have
sufficient reliability and validity to be
used to evaluate physical therapy
patient satisfaction in Italian health
care facilities.
Our final translated questionnaire
demonstrated strong psychometric
properties. The Cronbach ␣ index
(.905) was very high, indicating
Physical Therapy f 919
Italian Version of the Physical Therapy Patient Satisfaction Questionnaire

Table 6.
Means of the Totals Within Groups of Patients and Results of Tests on the Equality of the Means (of the Ranks, Kruskal-Wallis or
Wilcoxon Test)
Overall Professional Efficiency and
Total Experience Impression Convenience

Variable Levels Meana Pb Meana Pb Meana Pb Meana Pb

Sex Female 70.47 28.17 24.13 17.40

.624 .735 .376 .013
Male 70.35 28.13 23.80 18.21

Age (classes)c 25–40 66.77 26.31 23.40 16.61

40–65 70.63 .000 28.29 .000 24.11 .006 17.70 .000

⬎65 72.66 29.39 24.34 19.06

Marriedd Yes 70.16 27.94 23.99 17.83

.798 .513 .750 .067
No 70.91 28.58 24.07 17.36

Education Elementary 72.63 29.33 24.38 19.08

Middle school 70.96 28.24 24.29 17.63

.389 .372 .511 .217
Upper school 70.55 28.27 24.00 17.62

University 69.62 27.68 23.87 17.56

Worker Yes 69.49 27.74 23.88 17.35

No 71.94 .005 29.47 .000 24.22 .241 18.00 .000

Retired 72.53 29.33 24.33 18.87

Facility Bologna 68.01 27.14 23.96 16.81

Castenaso 72.30 .000 29.18 .000 24.18 .173 18.56 .000

Roma 71.27 28.73 23.95 18.09

Facility recommended by Physician 70.71 28.64 23.73 17.91

Friends 71.97 28.89 24.10 18.44

.006 .000 .105 .001
Other patients 72.71 29.29 24.48 18.77

Other 69.33 27.60 24.00 17.21

First treatment in the facility Yes 69.77 27.91 23.91 17.50

.416 .318 .347 .070
No 71.29 28.59 24.16 17.95

First episode of physical therapy care Yes 70.00 27.75 24.13 17.43
.581 .371 .936 .246
No 70.62 28.40 23.96 17.80

Regularly attending Yes 70.73 28.36 24.05 17.80

.011 .003 .132 .001
No 66.73 26.29 23.68 16.55

Therapist’s sex Female 71.67 29.15 24.06 18.39

.000 .000 .100 .000
Male 68.98 27.30 23.96 17.05

Combination of sexes patient/physical therapist Both females 71.75 29.31 24.14 18.23

Female patient, male 69.19 27.39 24.13 16.85

physical therapist

Male patient, female 71.55 .001 28.93 .000 23.96 .191 18.61 .000
physical therapist

Both patient and physical 68.48 27.05 23.54 17.66

therapist male

Paymentc Direct payment 71.28 28.93 23.86 18.45

Fully covered 71.76 .000 28.81 .000 24.20 .168 17.90 .000

Insurance 68.24 27.18 23.95 16.95

a
In the case of significant relations, levels with the same format (normal, bold, italics, or underlined) are not statistically different one from another. Instead, levels with
different formats are all statistically different one from another.
b
P value: the null hypothesis is that the means of the ranks are all equal one to another; the alternative hypothesis is that at least 2 means (of ranks) differ.
c
The group of 8 patients aged 18 –25 years and the group of 2 patients who partially paid for the therapy were not considered due to the too low number of patients.
d
Yes⫽married, living together; no⫽single, widowed, or divorced.

920 f Physical Therapy Volume 93 Number 7 July 2013

Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016
 Italian Version of the Physical Therapy Patient Satisfaction Questionnaire
strong internal consistency among
the items selected for the final ver-
sion. Divergent validity and con-
struct validity were satisfactory for
all items. The PTPSQ-I(15) version
was easily understood and required
only a few minutes to be completed.
With respect to construct validity,
we found that the first factor esti-
mated using the principal compo-
nents method accounted for only
51% of the total variance in contrast
to 83% observed by Goldstein et al15
for the US questionnaire. Although
Goldstein et al15 extracted only one
factor from their data, they noted
that several researchers have hypoth-
esized that patient satisfaction is a
multidimensional phenomenon, and
our results appear to confirm this
belief.27–30 Also, in studies by Mon-
nin and Perneger21 and Franchignoni
et al,31 patient satisfaction appeared
split into several factors.
These differences in factor structure
between the original US instrument
and its Italian derivative could be
easily misinterpreted as one or
the other is “better.” However, these
differences actually hold some criti-
cal lessons about construct valida-
tion and the relationship between
the sociocultural context and the
concept of “satisfaction” itself. Con-
struct validity of an instrument is
not established by a single study or
even a series of studies. Further
work on the English-language ver-
sion of the PTPSQ using a different
population may identify a more com-
plex factor structure for this instru-
ment, given that its items were
drawn from several hypothesized
domains of satisfaction.
We do not recommend that inves-
tigators of complex phenomena
such as “patient satisfaction” should
avoid using any instrument whose
psychometric properties are known
and sufficient for their particular
research interests. We do recom-
July 2013
Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016
mend that researchers and clinicians
be very clear about the questions
they are asking and carefully exam-
ine whether a proposed instru-
ment will answer their questions
as fully or with sufficient granularity
to be useful to making the kinds
of inferences from the data that
they would like to make. Further-
more, we must be alert to the possi-
bility, particularly as cross-cultural
research opportunities expand, that
fundamental assumptions regarding
our constructs, methods, and instru-
ments may not hold exactly as pre-
vious experiences might suggest.
For Italian patients, the more rele-
vant factors for satisfaction with
physical therapy appeared to be
those related to the physical thera-
pist and to the staff, both from a
technical and from a relationship
point of view, summarized by the
factor we named “Overall Experi-
ence.” This technical factor appears
related to global and retrospective
judgments about the quality of phys-
ical therapy treatment and useful-
ness of the instructions, which
appeared strongly linked to overall
satisfaction and to positive judg-
ment about the facility. “Professional
Impression” seems related to the
immediate experience of therapy
and impression the physical thera-
pist and the other members of staff
make on the patient from the begin-
ning (prompt, courteous, respect-
ful). The third factor, “Efficiency
and Convenience,” is related to
convenient scheduling of appoint-
ments and facility location. The
3-factor solution, having previously
removed the items related to costs,
bears some similarity to the factor
structure of another questionnaire,
the PTOPS.12
Within Italian culture, the profes-
sional aspect appeared more rele-
vant than those related to ”Efficiency
and Convenience” items in influenc-
ing satisfaction, perhaps explaining
Volume 93 Number 7
why the variable related to facility
location was more weakly related
to the factors than other variables.
These results are consistent with
those of Beattie et al,11 who reported
that being treated with respect by
health care providers and being
involved in treatment decisions are
strongly linked to patient satisfac-
tion.20 Overall, satisfaction appears
strongly linked to the professional
behavior of the clinician (ie, treating
the patient with respect and provid-
ing meaningful information), consid-
ering the courtesy aspect together
with the technical factor.11,20
In the evaluation of divergent valid-
ity, we observed moderate to low
correlations between PTPSQ-I(15)
total and subtotals and GPE and
a nonsignificant correlation with
the VAS. These results, which are
oriented to the care received rather
than specifically to the outcome
of the care received, are in line
with the systematic review of Hush
and colleagues,25 who concluded
that the relationship between sat-
isfaction and clinical outcome is
weak. The nonsignificant correlation
between patient satisfaction and
amount of pain corroborates the
results obtained by Kelly6 in a differ-
ent population.
We could not perform any analysis
on convergent validity because there
is no other Italian-language ques-
tionnaire that investigates the same
construct. Other existing instru-
ments investigating patient satisfac-
tion refer to completely different
clinical settings, and their use would
not be suitable for this purpose.
Some limitations of the study must
be reported. Our sample size was
greater than that used by Goldstein
and colleagues,15 but less than that
of many other studies on physical
therapy patient satisfaction. In our
sample, we observed a high amount
of “I do not know” answers to 5
Physical Therapy f 921
Italian Version of the Physical Therapy Patient Satisfaction Questionnaire
questions (Q16, Q17, Q18, Q24, and
Q25) from patients with specific
characteristics in terms of employ-
ment and mode of payment. We do
not know whether a larger sample
would lead to the same result or
whether the differences between
the United States and Italy with
respect to their economic and social
organization alone are sufficient to
explain the large number of “I do not
know” answers. As “patient satisfac-
tion” is multidimensional, it also may
be necessary to add items to the
PTPSQ-I(15) to assess other dimen-
sions not currently represented for
specific research aims.
The measurement properties were
evaluated based on verbal answer to
a research assistant, which may have
increased the effects of social desir-
ability. We do not know whether a
self-administration would yield the
same results. The PTPSQ-I(15) can
be recommended for administrative
and research purposes, for outpa-
tients, and for adult male and female
patients. Further studies focusing on
construct validity and on the rela-
tionship between satisfaction and
severity of the patient’s clinical con-
dition across various diseases, disor-
ders, and impairments should be
conducted.
Ms Vanti, Dr Monticone, Ms Ceron, Ms
Bonetti, and Professor Pillastrini provided
concept/idea/research design. Ms Vanti, Dr
Monticone, Ms Ceron, Dr Piccarreta, Dr
Guccione, and Professor Pillastrini provided
writing. Dr Monticone, Ms Ceron, and Ms
Bonetti provided data collection. Ms Vanti,
Dr Piccarreta, and Dr Guccione provided
data analysis. Ms Vanti provided project
management. Ms Vanti and Ms Bonetti
provided study participants. Ms Bonetti
provided facilities/equipment and institu-
tional liaisons. Ms Vanti, Ms Ceron, Ms
Bonetti, Dr Piccarreta, Dr Guccione, and
Professor Pillastrini provided consultation
(including review of manuscript before sub-
mission). The authors thank Maurizio Conti,
Jacopo Deserti, Marina D’Onofrio, Sabrina
Lambrilli, Elisabetta Pulice, and Barbara
922 f Physical Therapy Volume 93 Number 7
Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016
Rocca for the assistance provided with this
research.
The Ethics Committee of the University Hos-
pital S. Orsola-Malpighi of Bologna (Italy)
approved the trial (code 32/2011/U/OssN).
DOI: 10.2522/ptj.20120170
References
1 Crow R, Gage H, Hampson S, et al. The
measurement of satisfaction with health-
care: implications for practice from a sys-
tematic review of the literature. Health
Technol Assess. 2002;6:1–244.
2 Sitzia J. How valid and reliable are patient
satisfaction data: an analysis of 195 stud-
ies. Int J Qual Health Care. 1999;11:319 –
328.
3 Slade SC, Keating JL. Measurement of par-
ticipant experience and satisfaction of
exercise programs for low back pain: a
structured literature review. Pain Med.
2010;11:1489 –1499.
4 Hirsh AT, Atchison JW, Berger JJ, et al.
Patient satisfaction with treatment for
chronic pain: predictors and relationship to
compliance. Clin J Pain. 2005;21:302–310.
5 Hurwitz EL, Morgenstern H, Yu F. Satisfac-
tion as a predictor of clinical outcomes
among chiropractic and medical patients
enrolled in the UCLA low back pain study.
Spine (Phila Pa 1976). 2005;30:2121–
2128.
6 Kelly AM. Patient satisfaction with pain
management does not correlate with ini-
tial or discharge VAS pain score, verbal
pain rating at discharge, or change in VAS
score in the Emergency Department.
J Emerg Med. 2000;19:113–116.
7 Ellwood PM Jr, Paul BA. But what about
quality? Health (Aff Millwood). 1986;5:
135–140.
8 Bryant R, Graham MC. Advanced practice
nurses: a study of client satisfaction. J Am
Acad Nurse Pract. 2002;14:88 –92.
9 Hills R, Kitchen S. Satisfaction with out-
patient physiotherapy: a survey compar-
ing the views of patients with acute and
chronic musculoskeletal conditions. Phys-
iother Theory Pract. 2007;23:21–36.
10 Beattie PF, Nelson RM, Heintzelman M.
The relationship between patient satisfac-
tion with physical therapy care and global
rating of change reported by patients
receiving worker’s compensation. Phys-
iother Theory Pract. 2011;27:310 –318.
11 Beattie PF, Turner C, Dowda M, et al. The
MedRisk Instrument for Measuring Patient
Satisfaction With Physical Therapy Care: a
psychometric analysis. J Orthop Sports
Phys Ther. 2005;35:24 –32.
12 Roush SE, Sonstroem RJ. Development of
the Physical Therapy Outpatient Satisfac-
tion Survey (PTOPS). Phys Ther. 1999;79:
159 –170.
13 Beattie PF, Pinto MB, Nelson MK, Nelson
R. Patient satisfaction with outpatient
physical therapy: instrument validation.
Phys Ther. 2002;82:557–565.
14 Beattie PF, Nelson R, Murphy DR. Develop-
ment and preliminary validation of the
MedRisk instrument to measure patient sat-
isfaction with chiropractic care. J Manipu-
lative Physiol Ther. 2011;34:23–29.
15 Goldstein MS, Elliott SD, Guccione AA.
The development of an instrument to mea-
sure satisfaction with physical therapy.
Phys Ther. 2000;80:853– 863.
16 Meakin R, Weinman J. The “Medical Inter-
view Satisfaction Scale” (MISS-21) adapted
for British general practice. Fam Pract.
2002;19:257–263.
17 Wolf MH, Putnam SM, James SA, Stiles WB.
The Medical Interview Satisfaction Scale:
development of a scale to measure patient
perceptions of physician behavior.
J Behav Med.1978;1:391– 401.
18 Lam WW, Fielding R, Chow L, et al. The
Chinese Medical Interview Satisfaction Scale-
revised (C-MISS-R): development and valida-
tion. Qual Life Res. 2005;14:1187–1192.
19 Casserley-Feeney SN, Phelan M, Duffy F,
et al. Patient satisfaction with private
physiotherapy for musculoskeletal pain.
BMC Musculoskelet Disord. 2008;9:50.
20 Beattie PF, Nelson RM, Lis A. Spanish-
language version of the MedRisk instrument
for measuring patient satisfaction with phys-
ical therapy care (MRPS): preliminary valida-
tion. Phys Ther. 2007;87:793– 800.
21 Monnin D, Perneger TV. Scale to measure
patient satisfaction with physical therapy.
Phys Ther. 2002;82:682– 691.
22 Beaton DE, Bombardier C, Guillemin F,
Ferraz MB. Guidelines for the process of
cross-cultural adaptation of self-report
measures. Spine (Phila Pa 1976). 2000;
25:3186 –3191.
23 von Korff M, Jensen MP, Karoly P. Assess-
ing global pain severity by self-report in
clinical health services research. Spine
(Phila Pa 1976). 2000;25:3140 –3151.
24 Huskisson EC. Measurement of pain. Lan-
cet. 1974;2:1127–1131.
25 Hush JM, Cameron K, Mackey M. Patient
satisfaction with musculoskeletal physical
therapy care: a systematic review. Phys
Ther. 2011;91:25–36.
26 Guermazi M, Mezghani M, Ghroubi S, et al.
The Oswestry index for low back pain
translated into Arabic and validated in an
Arab population [article in French]. Ann
Readapt Med Phys. 2005;48:1–10.
27 Linder-Pelz SU. Toward a theory of patient
satisfaction. Soc Sci Med. 1982;16:577–582.
28 Cleary PD, McNeil BJ. Patient satisfaction
as an indicator quality of care. Inquiry.
1988;25:25–36.
29 Edgman-Levitan S, Cleary PD. What infor-
mation do consumers want and need?
Health Aff (Millwood). 1996;15:42–56.
30 Keith RA. Patient satisfaction and rehabil-
itation services. Arch Phys Med Rehabil.
1998;79:1122–1128.
31 Franchignoni F, Benevolo E, Ottonello M,
Tesio L. Assessment of a patient satisfac-
tion scale in rehabilitation [article in Ital-
ian]. Minerva Med. 1997;88:237–244.
July 2013
 Italian Version of the Physical Therapy Patient
Satisfaction Questionnaire: Cross-Cultural
Adaptation and Psychometric Properties
Carla Vanti, Marco Monticone, Daniele Ceron, Francesca
Bonetti, Raffaella Piccarreta, Andrew A. Guccione and
Paolo Pillastrini
PHYS THER. 2013; 93:911-922.
Originally published online April 4, 2013
doi: 10.2522/ptj.20120170

References This article cites 31 articles, 10 of which you can access

for free at:
http://ptjournal.apta.org/content/93/7/911#BIBL
Cited by This article has been cited by 1 HighWire-hosted articles:

http://ptjournal.apta.org/content/93/7/911#otherarticles
Subscription http://ptjournal.apta.org/subscriptions/
Information
Permissions and Reprints http://ptjournal.apta.org/site/misc/terms.xhtml
Information for Authors http://ptjournal.apta.org/site/misc/ifora.xhtml

Downloaded from http://ptjournal.apta.org/ by guest on January 7, 2016

View publication stats