Highlights
- •The WatLX measures the experience of patients in ambulatory rehabilitative care.
- •Psychometric testing of the 10-question WatLX, that measures 6 key constructs, was positive.
- •A trial across regional borders confirmed the feasibility of using the WatLX on a larger scale.
Abstract
Objective
To evaluate the internal consistency and test-retest reliability, construct validity,
and feasibility of the WatLX, a measure of the experience of patients in rehabilitative
care.
Design
Multisite, cross-sectional, and test-retest self-report study.
Setting
Outpatient rehabilitative care settings.
Participants
The WatLX was administered to English-speaking, cognitively intact outpatients (N=1174)
over 18 years old who had completed a program of cardiac, musculoskeletal, neurologic,
stroke, pulmonary, or speech language rehabilitative care, at 2 separate time points:
(1) immediately following completion of their rehabilitation program, and (2) 2 weeks
later (n=29). A subsequent feasibility study was conducted with 1013 patients from
19 clinics.
Interventions
Not applicable.
Main Outcome Measures
The WatLX measures 6 concepts, previously identified as key to outpatient rehabilitative
care patients’ experience: (1) ecosystem issues, (2) client and informal caregiver
engagement, (3) patient and health care provider relations, (4) pain and functional
status, (5) group and individual identity, and (6) open-ended feedback.
Results
Reliability analyses were conducted on 2 versions of the WatLX. Using a 7-point versus
a 5-point Likert scale resulted in higher internal consistency and reliability scores.
Cronbach’s alpha coefficients were .863 and .957 for the 5- and 7-point scale, respectively,
and the ICC scores were .827 and .880, respectively. The proof of concept study recruited
1013 patients with little interruption of workflow; results displayed strong internal
consistency (Cronbach’s alpha coefficient =.906). There is evidence of ceiling effects.
Conclusions
The WatLX is a parsimonious question set that is feasible for administration in ambulatory
rehabilitative care settings, and which shows promising psychometric properties.
Keywords
List of abbreviations:
CI (confidence interval), ICC (intraclass correlation coefficient)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The patient experience and health outcomes.N Engl J Med. 2013; 368: 199-201
- Patient satisfaction and quality of surgical care in U.S. hospitals.Ann Surg. 2015; 261: 2-8
- Patient satisfaction with cardiac rehabilitation: association with utilization, functional capacity, and heart-health behaviors.Patient Prefer Adherence. 2017; 11: 821-830
- A systematic review of evidence on the links between patient experience and clinical safety and effectiveness.BMJ Open. 2013; 3e001570
- Examining the role of patient experience surveys in measuring health care quality.Med Care Res Rev. 2014; 71: 522-554
- Effective surgical safety checklist implementation.J Am Coll Surg. 2011; 212: 873-879
- Analysis & commentary. Measuring patient experience as a strategy for improving primary care.Health Aff. 2010; 29: 921-925
- Measuring patients' experience of rehabilitation services across the carecontinuum. Part I: A systematic review of the literature.Arch Phys Med Rehabil. 2016; 97: 104-120
- Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation.BMJ Open. 2016; 6e011959
- Why the future of health care may depend on tearing down the hospital. The Globe and Mail. February 21, 2014.(Available at:) (Accessed June 16, 2014)
- Increasing referral and participation rates to outpatient cardiac rehabilitation: the valuable role of healthcare professionals in the inpatient and home health settings. A science advisory from the American Heart Association.Circulation. 2012; 125: 1321-1329
- Measuring patients' experience of rehabilitation services across the carecontinuum. Part II: Key dimensions.Arch Phys Med Rehabil. 2016; 97: 121-130
- WatLX™: Development and validation of a rehabilitative care patient experience instrument.Arch Phys Med Rehabil, [in press]. 2018;
- The method of sorting as a data-gathering procedure in multivariate research.Multivar. 1975; 10: 489-502
- Mixing qualitative and quantitative methods: Triangulation in action.Adm Sci Q. 1979; 24: 602-611
- Pretesting survey instruments: an overview of cognitive methods.Qual Life Res. 2003; 12: 229-238
- Improvement of psychometric properties of a scale measuring inpatient satisfaction with care: a better response rate and a reduction of the ceiling effect.BMC Health Serv Res. 2007; 7: 197
- Health measurement scales: a practical guide to their development and use.4th ed. Oxford University Press, Oxford, U.K.2008
- A comparison of two time intervals for test-retest reliability of health status instruments.J Clin Epidemiol. 2003; 56: 730-735
- A critical analysis of test-retest reliability in instrument validation studies of cancer patients under palliative care: a systematic review.BMC Med Res Methodol. 2014; 14: 8
- Measuring health status: what are the necessary measurement properties?.J Clin Epidemiol. 1992; 45: 1341-1345
- Research methods in psychiatry: a checklist for evaluating the usefulness of rating scales.Can J Psychiatry. 1993; 38: 140-148
- Psychometric evaluation of the brachial assessment tool part 1: reproducibility.Arch Phys Med Rehabil. 2017; 99: 629-634
- Forming inferences about some intraclass correlation coefficients.Psychol Methods. 1996; 1: 30-46
- Measuring the quality of life of cancer patients: a concise QL-index for use by physicians.J Chron Dis. 1981; 34: 585-597
- The development of an instrument to measure satisfaction with physical therapy.Phys Ther. 2000; 80: 853-863
- A power primer.Psychol Bull. 1992; 112: 155-159
- Sample size requirements for reliability studies.Stat Med. 1987; 6: 441-448
- How many subjects? Statistical power analysis in research.Sage Publications, Newbury Park1987
- Measuring patient experience. Vol. 18. the Health Foundation, London, U.K.2013
- Missing data.Organ Res Methods. 2014; 17: 372-411
- Organizational research: determining appropriate sample size in survey research.Inf Technol Learn Perform J. 2001; 19: 43-50
- Measurement of participant experience and satisfaction of exercise programs for low back pain: a structured literature review.Pain Med. 2010; 11: 1489-1499
- How valid and reliable are patient satisfaction data? An analysis of 195 studies.Int J Qual Heal Care. 1999; 11: 319-328
- Patient satisfaction with private physiotherapy for musculoskeletal pain.BMC Musculoskelet Disord. 2008; 9: 50
- 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
- Continuity of care preferably measured from the patients’ perspective.J Clin Epidemiol. 2010; 63: 998-999
- Towards an understanding of PREMS and PROMS in COPD.Breathe. 2013; 9: 358-364
- From satisfaction to expectation: the patient’s perspective in lower limb prosthetic care.Disabil Rehabil. 2007; 29: 1049-1055
- The MedRisk instrument for measuring care: a psychometric analysis.J Otrhopaedic Sport Phys Ther. 2005; 35: 24-32
- Reliability and construct validity of the client-centred rehabilitation questionnaire.Disabil Rehabil. 2006; 28: 1387-1397
- Assessing the quality of physiotherapy services using Servqual.Int J Health Care Qual Assur. 2002; 15: 197-205
- Methods for testing and evaluating survey questionnaires. Vol. 546. John Wiley & Sons, Hoboken2004
- Mail surveys and response rates: a literature review.J Mark Res. 1975; 12: 440-453
- Life in the fast lane: how are Canadians managing?, 2016. Statistics Canada (Government of Canada). The Daily, Ottawa, CanadaNovember 2017: 1-3 (Available at:) (Accessed March 7, 2018)
Article info
Publication history
Published online: May 28, 2018
Footnotes
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
