Measuring Patients' Experience of Rehabilitation Services Across the Care Continuum. Part II: Key Dimensions

Published:August 17, 2015DOI:



      To identify key dimensions of patients' experience across the rehabilitative care system and to recommend a framework to develop survey items that measure the rehabilitative care experience.

      Data Sources

      Data were sourced from a literature review that searched MEDLINE (PubMed), CINAHL (Ebsco), and PsycINFO (APA PsycNET) databases from 2004 to 2014, the reference lists of the final accepted articles, and hand searches of relevant journals.

      Study Selection

      Four reviewers performed the screening process on 2472 articles; 33 were included for analysis. Interrater reliability was confirmed through 2 rounds of title review and 1 round of abstract review, with an average κ score of .69.

      Data Extraction

      The final sample of 33 accepted articles was imported into a qualitative data analysis software application. Multiple levels of coding and a constant comparative methodology generated 6 themes. There were 502 discreet survey questions measuring patient experience that were categorized using the following dimensions: rehabilitative care ecosystem, client and informal caregiver engagement, patient and health care provider relation, pain and functional status, group and individual identity, and open ended.

      Data Synthesis

      The most common survey questions examine the care delivery ecosystem (37%), the engagement of clients and their informal caregivers (24.9%), and the quality of relations between providers and patients (21.7%). Examination of patient's functional status and management of pain yielded (15.3%) of the instruments' questions.


      Currently available instruments and questions that measure patients' experience in rehabilitative care are unable to assess the performance of rehabilitative delivery systems that aspire to integrate care across the continuum. However, question panels derived from our 6 key themes may measure the key concepts that define rehabilitative care and facilitate measurement of patient experience at the system level.


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        • McMurray J.
        • McNeil H.
        • Lafortune C.
        • Black S.
        • Prorok J.
        • Stolee P.
        Measuring patients’ experience of rehabilitation services across the care continuum. Part I: a systematic review of the literature.
        Arch Phys Med Rehabil. 2016; 97: 104-120
        • Leff B.
        • Burton L.
        • Mader S.L.
        • et al.
        Comparison of functional outcomes associated with hospital at home care and traditional acute hospital care.
        J Am Geriatr Soc. 2009; 57: 273-278
      1. OACCAC, OFCMHAP, OHA. Ideas and opportunities for bending the health care cost curve. 2010. Available at: the Health Care Cost Curve %28Final Report - April 13 2010%29.pdf. Accessed July 3, 2015.

      2. Weeks C. Why the future of health care may depend on tearing down the hospital. The Globe and Mail 2014 February 21. Available at: Accessed June 6, 2015.

        • Glenny C.
        • Stolee P.
        • Sheiban L.
        • Jaglal S.
        Communicating during care transitions for older hip fracture patients: family caregiver and health care provider’s perspectives.
        Int J Integr Care. 2013; 13: e044
        • Fletcher R.H.
        • O’Malley M.S.
        • Fletcher S.W.
        • Earp J.A.
        • Alexander J.P.
        Measuring the continuity and coordination of medical care in a system involving multiple providers.
        Med Care. 1984; 22: 403-411
        • McLeod J.
        • McMurray J.
        • Walker J.D.
        • Heckman G.A.
        • Stolee P.
        Care transitions for older patients with musculoskeletal disorders: continuity from the providers ’ perspective.
        J Integr Care. 2011; 11: e014
        • Doyle C.
        • Lennox L.
        • Bell D.
        A systematic review of evidence on the links between patient experience and clinical safety and effectiveness.
        BMJ Open. 2013; 3: e001570
        • Jenkinson C.
        • Coulter A.
        • Bruster S.
        • Richards N.
        • Chandola T.
        Patients’ experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care.
        Qual Saf Health Care. 2002; 11: 335-339
        • Crow R.
        • Gage H.
        • Hampson S.
        • et al.
        The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature.
        Health Technology Assessment, Southampton2002 (Available at:) (Accessed November 6, 2015)
        • Sitzia J.
        • Wood M.
        Patient satisfaction: a review of issues and concepts.
        Soc Sci Med. 1997; 45: 1829-1843
        • Anhang Price R.
        • Elliott M.N.
        • Zaslavsky A.M.
        • et al.
        Examining the role of patient experience surveys in measuring health care quality.
        Med Care Res Rev. 2014; 71: 522-554
        • Baumann C.
        • Rat A.C.
        • Mainard D.
        • Cuny C.
        • Guillemin F.
        Importance of patient satisfaction with care in predicting osteoarthritis-specific health-related quality of life one year after total joint arthroplasty.
        Qual Life Res. 2011; 20: 1581-1588
        • Beattie P.
        • Turner C.
        • Dowda M.
        • Michener L.
        • Nelson R.
        The MedRisk Instrument for measuring care: a psychometric analysis.
        J Otrhop Sports Phys Ther. 2005; 35: 24-32
        • Beattie P.F.
        • Pinto M.B.
        • Nelson M.K.
        • Nelson R.
        Patient satisfaction with outpatient physical therapy: instrument validation.
        Phys Ther. 2002; 82: 557-565
        • Beattie P.
        • Dowda M.
        • Turner C.
        • Michener L.
        • Nelson R.
        Longitudinal continuity of care is associate with high patient satisfaction with physical therapy.
        Phys Ther. 2005; 85: 1046-1052
        • Dibbelt S.
        • Schaidhammer M.
        • Fleischer C.
        • Greitemann B.
        Patient-doctor interaction in rehabilitation: the relationship between perceived interaction quality and long-term treatment results.
        Patient Educ Couns. 2009; 76: 328-335
        • Duijin A.J.
        • Coe J.
        • Bevins T.
        • Jack L.
        Relationship between patients’ perceptions of treatment outcomes and overall patient satisfaction in outpatient orthopedic settings: a pilot study.
        J of Health Policy & Administration. 2008; 8: J1-7
        • Fernandez R.S.
        • Salamonson Y.
        • Juergens C.
        • Griffiths R.
        • Davidson P.
        Validation of the revised cardiac rehabilitation preference form in patients with post-percutaneous coronary intervention.
        J Cardiopulm Rehabil Prev. 2007; 27: 390-394
        • French H.P.
        • Keogan F.
        • Gilsenan C.
        • Waldron L.
        • O’Connell P.
        Measuring patient satisfaction with exercise therapy for knee osteoarthritis: evaluating the utility of the physiotherapy outpatient survey.
        Musculoskelet Care. 2010; 8: 61-67
        • Grotle M.
        • Garratt A.
        • Løchting I.
        • et al.
        Development of the rehabilitation patient experiences questionnaire: data quality, reliability and validity in patients with rheumatic diseases.
        J Rehabil Med. 2009; 41: 576-581
        • Hills R.
        • Kitchen S.
        Satisfaction with outpatient physiotherapy: a survey comparing the views of patients with acute and chronic musculoskeletal conditions.
        Physiother Theory Pract. 2007; 23: 21-36
        • Hush J.M.
        • Lee H.
        • Yung V.
        • et al.
        Intercultural comparison of patient satisfaction with physiotherapy care in Australia and Korea: an exploratory factor analysis.
        J Man Manip Ther. 2013; 21: 103-112
        • Kneebone I.I.
        • Hull S.L.
        • McGurk R.
        • Cropley M.
        Reliability and validity of the neurorehabilitation experience questionnaire for inpatients.
        Neurorehabil Neural Repair. 2012; 26: 834-841
        • Knight P.K.
        • Cheng A.N.
        • Lee G.M.
        Results of a survey of client satisfaction with outpatient physiotherapy care.
        Physiother Theory Pract. 2010; 26: 297-307
        • Medina-Mirapeix F.
        • Jimeno-Serrano F.J.
        • Escolar-Reina P.
        • Del Baño-Aledo M.E.
        Is patient satisfaction and perceived service quality with musculoskeletal rehabilitation determined by patient experiences?.
        Clin Rehabil. 2013; 27: 555-564
        • Medina-Mirapeix F.
        • Jimeno-Serrano F.J.
        • Del Bano-Aleda M.E.
        • et al.
        Outpatients’ perceptions of their experiences in musculoskeletal rehabilitation care.
        Eur J Rehabil Med. 2012; 48: 475-482
        • Normann B.
        • Moe S.
        • Salvesen R.
        • Sørgaard K.W.
        Patient satisfaction and perception of change following single physiotherapy consultations in a hospital’s outpatient clinic for people with multiple sclerosis.
        Physiother Theory Pract. 2012; 28: 108-118
        • Roush S.E.
        • Jones M.
        • Nassaney M.
        Patient satisfaction in physical therapy: concurrent comparison of two instruments in outpatient settings.
        Journal of Health Policy & Administration. 2007; 7: 1-8
        • Van der Linde H.
        • Hofstad C.J.
        • Geertzen J.H.
        • Postema K.
        • Van Limbeek J.
        From satisfaction to expectation: the patient’s perspective in lower limb prosthetic care.
        Disabil Rehabil. 2007; 29: 1049-1055
        • Vanti C.
        • Bonetti F.
        • Ceron D.
        • et al.
        Cross-cultural adaptation and validation of the Physical Therapy Outpatient Satisfaction Survey in an Italian musculoskeletal population.
        BMC Musculoskelet Disord. 2013; 14: 125
        • Cott C.
        • Teare G.
        • McGilton K.S.
        • Lineker S.
        Reliability and construct validity of the client-centred rehabilitation questionnaire.
        Disabil Rehabil. 2006; 28: 1387-1397
        • Delanian Halsdorfer N.
        • Blasquez J.
        • Bensoussan L.
        • et al.
        An assessment of patient satisfaction for a short-stay program in a physical and rehabilitation medicine day hospital.
        Ann Phys Rehabil Med. 2011; 54: 236-247
        • Elwood D.
        • Heckman J.
        • Bonder J.
        • et al.
        Assessing patient expectations and concerns in a physical medicine and rehabilitation unit: a real-time snapshot.
        PM R. 2010; 2: 521-527
        • Grosset K.A.
        • Grosset D.G.
        Patient-perceived involvement and satisfaction in Parkinson’s disease: effect on therapy decisions and quality of life.
        Mov Disord. 2005; 20: 616-619
        • Monnin D.
        • Perneger T.V.
        Scale to measure patient satisfaction with physical therapy.
        Phys Ther. 2002; 82: 682-691
        • Ottonello M.
        • Franchignoni F.
        • Giordano A.
        • Benevolo E.
        Patient satisfaction with hospital rehabilitation: validation of the SAT-16 questionnaire through Rasch analysis.
        Minerva Med. 2012; 103: 1-11
        • Quaschning K.
        • Körner M.
        • Wirtz M.
        Analyzing the effects of shared decision-making, empathy and team interaction on patient satisfaction and treatment acceptance in medical rehabilitation using a structural equation modeling approach.
        Patient Educ Couns. 2013; 91: 167-175
        • Slade S.C.
        • Keating J.L.
        Measurement of participant experience and satisfaction of exercise programs for low back pain: a structured literature review.
        Pain Med. 2010; 11: 1489-1499
        • Almborg A.H.
        • Ulander K.
        • Thulin A.
        • Berg S.
        Patients’ perceptions of their participation in discharge planning after acute stroke.
        J Clin Nurs. 2009; 18: 199-209
        • Cramm J.M.
        • Strating M.M.
        • Nieboer A.P.
        Satisfaction with care as a quality-of-life predictor for stroke patients and their caregivers.
        Qual Life Res. 2012; 21: 1719-1725
        • Soderback I.
        Hospital discharge among frail elderly people: a pilot study in Sweden.
        Occup Ther Int. 2008; 15: 18-31
        • Stubbe J.H.
        • Gelsema T.
        • Delnoij D.M.
        The Consumer Quality Index Hip Knee Questionnaire measuring patients’ experiences with quality of care after a total hip or knee arthroplasty.
        BMC Health Serv Res. 2007; 7: 60
        • Curry A.
        • Sinclair E.
        Assessing the quality of physiotherapy services using Servqual.
        Int J Health Care Qual Assurance. 2002; 15: 197-205
        • Strauss A.
        • Corbin J.
        Basics of qualitative research: techniques and procedures for developing grounded theory.
        2nd ed. Sage, Thousand Oaks1998
        • Bowen G.A.
        Grounded theory and sensitizing concepts.
        Int J Qual Methods. 2006; 5: 12-23
        • Guba E.
        • Lincoln Y.S.
        Epistemological and methodological bases of naturalistic inquiry.
        Educational Communication and Technology. 1982; 30: 233-252
        • Maykut P.
        • Morehouse R.
        Beginning qualitative research: a philosophic and practice guide.
        The Falmer Pr, London1994
        • Willis A.J.
        The ecosystem: an evolving concept viewed historically.
        Funct Ecol. 1997; 11: 268-271
        • Machlis G.E.
        • Force J.E.
        • Burch W.R.
        The human ecosystem. Part I: the human ecosystem as an organizing concept in ecosystem management.
        Soc Nat Resour. 1997; 10: 347-367
        • Watson D.
        • Peterson S.
        • Black C.D.
        In pursuit of quality: opportunities to improve patient experiences in British Columbia emergency departments.
        2009 (Available at:) (Accessed June 30, 2015)
        • Blank F.S.
        • Tobin J.
        • Jaouen M.
        • Smithline E.
        • Tierney H.
        • Visintainer P.
        A comparison of patient and nurse expectations regarding nursing care in the emergency department.
        J Emer Nurs. 2014; 40: 317-322
        • Mothabeng D.J.
        • Malinga C.P.
        • Van der Merwe C.
        • Qhomane P.T.
        • Motjotji S.N.
        The views of patients with spinal cord injuries on their rehabilitation experience.
        S Afr J Physiothe. 2007; 63: 22-25
        • Baker S.M.
        • Marshak H.H.
        • Rice G.T.
        • Zimmerman G.J.
        Patient participation in physical therapy goal setting.
        Phys Ther. 2001; 81: 1118-1126
        • Abelson J.
        • Forest P.G.
        • Casebeer A.
        • Mackean G.
        Will it make a difference if I show up and share? A citizens’ perspective on improving public involvement processes for health system decision-making.
        J Health Serv Res Policy. 2004; 9: 205-212
        • Kaplan S.H.
        • Greenfield S.
        • Ware Jr., J.E.
        Assessing the effects of physician-patient interactions on the outcomes of chronic disease.
        Med Care. 1989; 27: S110-S127
        • Potter M.
        • Gordon S.
        • Hamer P.
        The physiotherapy experience in private practice: the patients’ perspective.
        Aust J Physiother. 2003; 49: 195-202
        • Carman B.K.
        • Dardess P.
        • Maurer M.
        • et al.
        Patient and family engagement: a framework for understanding the elements and developing interventions and policies.
        Health Aff (Millwood). 2013; 32: 223-231
        • Jackson K.
        • Oelke N.D.
        • Leffelaar D.
        • Besner J.
        • Harrison A.
        Report on the patient journey study.
        2009 (Available at:) (Accessed July 1, 2015)
        • Lewis S.
        Patient-centered care: an introduction to what it is and how to achieve it. A discussion paper for the Saskatchewan Ministry of Health.
        2009 (Available at:) (Accessed May 20, 2015)
        • Cott C.A.
        • Boyle J.
        • Fay J.
        • Sutton D.
        • Bowring J.
        • Lineker S.
        Client-centred rehabilitation.
        2001 (Available at:) (Accessed May 20, 2015)
        • Haggerty J.L.
        • Reid R.J.
        • Freeman G.K.
        • Starfield B.H.
        • Adair C.E.
        • McKendry R.
        Continuity of care: a multidisciplinary review.
        BMJ. 2003; 327: 1219-1221
        • Coleman E.A.
        Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs.
        J Am Geriatr Soc. 2003; 51: 549-555
        • Deschepper R.
        • Grigoryan L.
        • Lundborg C.S.
        • et al.
        Are cultural dimensions relevant for explaining cross-national differences in antibiotic use in Europe?.
        BMC Health Serv Res. 2008; 8: 123
        • Welch S.J.
        Twenty years of patient satisfaction research applied to the emergency department: a qualitative review.
        Am J Med Qual. 2010; 25: 64-72
        • Meyer T.
        • Gutenbrunner C.
        • Kiekens C.
        • et al.
        ISPRM discussion paper: proposing a conceptual description of health-related rehabilitation services.
        J Rehabil Med. 2014; 46: 1-6
        • Hicks E.
        • Sims-Gould J.
        • Byrne K.
        • Khan K.M.
        • Stolee P.
        “She was a little bit unrealistic”: choice in healthcare decision making for older people.
        J Aging Stud. 2012; 26: 140-148
        • Toscan J.
        • Mairs K.
        • Hinton S.
        • Stolee P.
        Integrated transitional care: patient, informal caregiver and health care provider perspectives on care transitions for older persons with hip fracture.
        Int J Integr Care. 2012; 12: e13
        • McMurray J.
        • Johnston J.
        • Elliot J.
        • et al.
        “Trying to find information is like hating yourself every day”: the collision of electronic information systems in transition with patients in transition.
        Health Informatics J. 2013; 19: 218-232
        • Elliott M.
        • Forbes D.
        • Chesworth B.M.
        • Ceci C.
        • Stolee P.
        Information sharing with rural family caregivers during care transitions of hip fracture patients.
        Int J Integr Care. 2014; 14: e018
        • Deloitte
        The patient experience: strategies and approaches for providers to achieve and maintain a competitive advantage.
        2009 (Available at:) (Accessed November 31, 2014)
        • Manary J.P.
        • Boulding W.
        • Staelin R.
        • Glickman S.W.
        The patient experience and health outcomes.
        N Engl J Med. 2013; 368: 199-201
        • Jenkinson C.
        • Coulter A.
        • Bruster S.
        The Picker Patient Questionnaire: development and validation using data from in-patient surveys in five countries.
        Int J Qual Health Care. 2002; 14: 353-358
        • Coulter A.
        • Fitzpatrick R.
        • Cornwell J.
        The point of care: measures of patients' experience in hospital: purpose, methods and uses.
        The King's Fund, London2009
        • Gordon J.
        • Sheppard L.A.
        • Anaf S.
        The patient experience in the emergency department: a systematic synthesis of qualitative research.
        Int Emerg Nurs. 2010; 18: 80-88
        • Castle N.G.
        • Brown J.
        • Hepner K.A.
        • Hays R.D.
        Review of the literature on survey instruments used to collect data on hospital patients’ perceptions of care.
        Health Serv Res. 2005; 40: 1996-2017
        • Wells J.
        • Seabrook J.A.
        • Stolee P.
        • Borrie M.J.
        • Knoefel F.
        State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment.
        Arch Phys Med Rehabil. 2003; 84: 890-897
        • Canadian Institute for Health Information
        Inpatient rehabilitation in Canada.
        Canadian Institute for Health Information, Ottawa2008
        • Heruti R.J.
        • Lusky A.
        • Barell V.
        • Ohry A.
        • Adunsky A.
        Cognitive status at admission: does it affect the rehabilitation outcome of elderly patients with hip fracture?.
        Arch Phys Med Rehabil. 1999; 80: 432-436
        • Van Servellen G.
        • Fongwa M.
        • Mockus D’Errico E.
        Continuity of care and quality care outcomes for people experiencing chronic conditions: a literature review.
        Nurs Health Sci. 2006; 8: 185-195
        • Bjertnaes O.A.
        • Sjetne I.S.
        • Iversen H.H.
        Overall patient satisfaction with hospitals: effects of patient-reported experiences and fulfilment of expectations.
        BMJ Qual Saf. 2012; 21: 39-46