Patients’ expectations, experiences, and satisfaction with musculoskeletal physiotherapy

Loughran, Iain (2017) Patients’ expectations, experiences, and satisfaction with musculoskeletal physiotherapy. Doctoral thesis, Northumbria University.

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Abstract

Musculoskeletal conditions are highly prevalent and result in a significant burden to individuals, the NHS, and the wider economy. Most treatment is delivered in primary care by physiotherapists and general practitioners. The patient experience has been linked to clinical outcome and service quality across healthcare, but there has been little research in musculoskeletal physiotherapy. This study used a mixed methods sequential approach to explore patients’ expectations, experiences, and satisfaction with musculoskeletal physiotherapy.

Phase one was a systematic review and narrative analysis exploring the existing literature and measures. A quality assessment was conducted using the CASP criteria to identify relevant articles. A range of common dimensions was identified that focused on interpersonal or service factors. Although service factors appeared more common, interpersonal factors appeared to provide data that was more useful. Satisfaction was typically used as a proxy for direct experience, however, lacked any sound theoretical construct to explain this. No suitable measure of patient experience was identified for use with musculoskeletal physiotherapy.

Phase two involved semi structured interviews with patients to explore their expectations, experiences, and satisfaction. The majority of references were made to direct experiences of care, and this produced the richest data. Dimensions previously reported in the literature as satisfaction were actually described in terms of experiences or expectations. The findings from the interviews appeared to support the need for a new questionnaire to measure patient experience, rather than satisfaction.

Phase three was the development of a patient reported experience measure, specific to musculoskeletal physiotherapy. There were no differences in overall experience between demographic groups including gender, age group, employment status, problem area, and referral source. Condition durations over 24 months showed small but significant differences in the global dimensions (p > 0.05). A model of patient experience of musculoskeletal physiotherapy was proposed, based on the findings from the three phases. This proposed model included the dimensions of patient experience evaluated in the measure.

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