Patient satisfaction is a measure of how pleased a person is with the healthcare they receive. It is used as an indicator of healthcare quality and is influenced by two main factors: "human attributes" and "system attributes." Human attributes refer to the healthcare provider's skills, such as their communication style and expertise. System attributes refer to the logistics of care, like wait times and the convenience of the clinic's location.
This research focuses on a specific type of care called advanced practice physiotherapy, or APP. APP is a model where physiotherapists have a higher level of training and responsibility than in standard practice. This model of care is being used more frequently in healthcare systems around the world. The goal of this work was to review existing research to evaluate how satisfied patients are with APP internationally.
To do this, researchers conducted a "systematic mixed studies review." This means they followed a strict, pre-planned method to find and analyze all relevant studies on the topic. The plan for the review was registered and published ahead of time, and its design was informed by a patient advisory group.
The researchers looked for studies that measured patient satisfaction with APP. They searched multiple large scientific databases as well as "grey literature," which includes reports and documents not published in traditional academic journals. Two researchers worked independently to screen the results, extract the key data, and assess the quality of each included study.
The review included both quantitative studies (those that produce numerical data, like satisfaction ratings on a scale) and qualitative studies (those that collect data from interviews or focus groups about people's experiences). The researchers analyzed the quantitative data to create a narrative summary and analyzed the qualitative data to identify common themes. They then used a system called GRADE to rate the certainty of the quantitative evidence and a system called GRADE-CERQual to rate the confidence in the qualitative findings.
The review included 32 studies of varying quality (8 high, 14 moderate, and 10 low). The overall finding from the quantitative, or numerical, data was that patients internationally report high satisfaction with APP. However, the researchers rated the certainty of this evidence as "very low," which means future research could produce different results.
The findings were broken down by human and system attributes.
Regarding human attributes, the qualitative studies provided evidence in which the researchers have moderate-to-high confidence. Four main themes emerged about what patients valued in their advanced practice physiotherapist:
- Proficient communication and interpersonal skills: Patients felt the physiotherapists listened to them carefully.
- Credible and competent experts: Patients viewed the physiotherapists as knowledgeable and skilled professionals.
- Patient empowerment and self-management: The physiotherapists helped patients feel in charge of their own health and equipped them with tools to manage their condition.
- Thorough assessments: Patients felt their physical examinations were comprehensive.
Regarding system attributes, the qualitative studies provided evidence in which the researchers have moderate confidence. Three main themes were identified about the systems in which APP was delivered:
- Fast access to specialist care: Patients reported being seen much more quickly than if they had to wait for another type of specialist, such as a General Practitioner.
- Convenient location and amenities: The accessibility and features of the care setting were valued.
- Integrated care: This model allowed the physiotherapist and the patient's primary care team to share information easily, leading to more coordinated care for conditions like low back pain.
The review suggests that the personal qualities and skills of advanced practice physiotherapists, such as their ability to empower patients, are integral to driving high patient satisfaction. The evidence supporting this conclusion has moderate-to-high confidence. Furthermore, the way the healthcare system is structured to deliver APP, such as by providing fast and integrated care, also contributes to high patient satisfaction. The evidence for this has moderate confidence. These conclusions are consistent with research on advanced practice in other health professions.
A limitation of this review is that the certainty of the evidence from quantitative (numerical) studies is very low. Therefore, more high-quality research is needed to provide more reliable numerical data. Future studies should also explore the relationship between patient satisfaction and the overall patient experience to better understand how satisfaction contributes to the quality of healthcare.