Oermann C M, Swank P R, Sockrider M M
Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Chest. 2000 Jul;118(1):92-7. doi: 10.1378/chest.118.1.92.
Chest physiotherapy (CPT) has been an important part of cystic fibrosis (CF) treatment regimens for > 40 years. Techniques with different perceived costs, benefits, and patient satisfaction exist. An instrument measuring patient satisfaction with CPT has not been reported. Our goal was to develop and validate such an instrument.
A cross-sectional survey sent to 349 patients seen at a large, urban, academic CF care center. The two-page survey asked 17 questions related to CPT satisfaction (efficacy, convenience, comfort, overall satisfaction), followed by 4 general CF-care questions (disease severity, importance of therapies, prescribed vs missed therapies). A 5-point Likert-type scale was used for responses. Psychometric analysis included itemetric performance, confirmatory factor analysis, test-retest reliability, and evaluation of subject's responses to the general CF-care questions.
One hundred twenty-nine individuals returned completed surveys (39%; 66 males and 63 females; age range, 2 months to 47 years). FEV(1)values were 21 to 155% predicted (mean, 76%; n = 82). Disease severity was as follows: 60 mild, 47 moderate, and 14 severe. Seventy-nine subjects used postural drainage, percussion, and vibration (PDPV), 21 used a flutter device, and 14 used high-frequency chest wall oscillation (HFCWO). Five subjects used more than one technique. Internal consistency analysis found an overall coefficient alpha of 0.87 (range, 0.74 to 0.89 for four domains). Factor analysis demonstrated domains for efficacy, convenience, comfort, and overall satisfaction. Mean total satisfaction scores differed significantly among therapies (R(2) = 0. 118; F[ 2,111] = 7.56; p = 0.0008): PDPV, 3.8 (SD = 0.6); Flutter, 4. 3 (SD = 0.5); and HFCWO, 4.1 (SD = 0.5). Therapies also differed significantly on all subscores. Perceived importance of CPT and compliance with CPT increased linearly with disease severity. Overall satisfaction was positively correlated with CPT compliance.
The CPT satisfaction survey has good reliability and content validity. Significant differences in patient satisfaction exist among therapies. Sicker patients recognize the importance of, and demonstrate better compliance with prescribed CPT. Increased satisfaction is associated with better compliance with therapy.
胸部物理治疗（CPT）在超过40年的囊性纤维化（CF）治疗方案中一直是重要组成部分。存在不同的技术，其在成本、益处和患者满意度方面各有不同。尚未有报道一种用于测量患者对CPT满意度的工具。我们的目标是开发并验证这样一种工具。
对一家大型城市学术性CF护理中心的349名患者进行横断面调查。这份两页的调查问卷包含17个与CPT满意度相关的问题（疗效、便利性、舒适度、总体满意度），随后是4个一般性CF护理问题（疾病严重程度、治疗的重要性、规定治疗与漏做治疗情况）。采用5点李克特量表进行作答。心理测量分析包括条目性能、验证性因素分析、重测信度以及对受试者对一般性CF护理问题回答的评估。
129人返回了完整的调查问卷（39%；66名男性和63名女性；年龄范围为2个月至47岁）。第1秒用力呼气容积（FEV₁）值为预测值的21%至155%（平均为76%；n = 82）。疾病严重程度如下：60例轻度，47例中度，14例重度。79名受试者采用体位引流、叩击和振动（PDPV），21名使用震荡器，14名使用高频胸壁振荡（HFCWO）。5名受试者使用了不止一种技术。内部一致性分析发现总体信度系数α为0.87（四个领域的范围为0.74至0.89）。因素分析显示了疗效、便利性、舒适度和总体满意度等领域。不同治疗方法的总体满意度平均得分存在显著差异（R² = 0.118；F[2,111] = 7.56；p = 0.0008）：PDPV为3.8（标准差 = 0.6）；震荡器为4.3（标准差 = 0.5）；HFCWO为4.1（标准差 = 0.5）。所有子得分在不同治疗方法之间也存在显著差异。患者对CPT的感知重要性和对CPT的依从性随疾病严重程度呈线性增加。总体满意度与CPT依从性呈正相关。
CPT满意度调查问卷具有良好的信度和内容效度。不同治疗方法在患者满意度方面存在显著差异。病情较重的患者认识到规定CPT的重要性，并表现出更好的依从性。满意度提高与更好的治疗依从性相关。
