Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Clin Orthop Relat Res. 2021 Sep 1;479(9):2022-2032. doi: 10.1097/CORR.0000000000001794.
A patient's satisfaction with a treatment result is an important outcome domain as clinicians increasingly focus on patient-centered, value-based healthcare. However, to our knowledge, there are no validated satisfaction metrics focusing on treatment results for hand and wrist conditions.
QUESTIONS/PURPOSES: Among patients who were treated for hand and wrist conditions, we asked: (1) What is the test-retest reliability of the Satisfaction with Treatment Result Questionnaire? (2) What is the construct validity of that outcomes tool?
This was a prospective study using two samples: a test-retest reliability sample and a construct validity sample. For the test-retest sample, data collection took place between February 2020 and May 2020, and we included 174 patients at the end of their treatment with complete baseline data that included both the primary test and the retest. Test-retest reliability was evaluated with a mean time difference of 7.2 ± 1.6 days. For the construct validity sample, data collection took place between January 2012 and May 2020. We included 3742 patients who completed the Satisfaction with Treatment Result Questionnaire, VAS, and the Net Promotor Score (NPS) at 3 months. Construct validity was evaluated using hypothesis testing in which we correlated the patients' level of satisfaction to the willingness to undergo the treatment again, VAS scores, and the NPS. We performed additional hypothesis testing on 2306 patients who also completed the Michigan Hand Outcomes Questionnaire (MHQ). Satisfaction with the treatment result was measured as the patients' level of satisfaction on a 5-point Likert scale and their willingness to undergo the treatment again under similar circumstances.
We found high reliability for level of satisfaction measured on Likert scale (intraclass correlation coefficient 0.86 [95% CI 0.81 to 0.89]) and almost-perfect agreement for both level of satisfaction measured on the Likert scale (weighted kappa 0.86 [95% CI 0.80 to 0.91]) and willingness to undergo the treatment again (kappa 0.81 [95% CI 0.70 to 0.92]) of the Satisfaction with Treatment Result Questionnaire. Construct validity was good to excellent as seven of the eight hypotheses were confirmed. In the confirmed hypotheses, there was a moderate-to-strong correlation with VAS pain, VAS function, NPS, MHQ pain, and MHQ general hand function (Spearman rho ranged from 0.43 to 0.67; all p < 0.001) and a strong to very strong correlation with VAS satisfaction and MHQ satisfaction (Spearman rho 0.73 and 0.71; both p < 0.001). The rejected hypothesis indicated only a moderate correlation between the level of satisfaction on a 5-point Likert scale and the willingness to undergo the treatment again under similar circumstances (Spearman rho 0.44; p < 0.001).
The Satisfaction with Treatment Result Questionnaire has good-to-excellent construct validity and very high test-retest reliability in patients with hand and wrist conditions.
This questionnaire can be used to reliably and validly measure satisfaction with treatment result in striving for patient-centered care and value-based healthcare. Future research should investigate predictors of variation in satisfaction with treatment results.
随着临床医生越来越关注以患者为中心、以价值为基础的医疗保健，患者对治疗结果的满意度是一个重要的结果领域。然而，据我们所知，针对手部和腕部疾病的治疗结果，目前还没有经过验证的满意度衡量标准。
问题/目的：在接受手部和腕部疾病治疗的患者中，我们提出了以下问题：（1）治疗结果满意度问卷的测试-重测信度如何？（2）该结果工具的结构效度如何？
这是一项前瞻性研究，使用了两个样本：测试-重测信度样本和结构效度样本。在测试-重测样本中，数据收集于 2020 年 2 月至 2020 年 5 月之间，我们纳入了 174 名在治疗结束时完成了基线数据采集的患者，这些数据包括主要测试和重测。使用平均时间差 7.2±1.6 天评估测试-重测信度。在结构效度样本中，数据收集于 2012 年 1 月至 2020 年 5 月之间。我们纳入了 3742 名在 3 个月时完成治疗结果满意度问卷、视觉模拟评分（VAS）和净推广者得分（NPS）的患者。结构效度通过假设检验进行评估，即通过比较患者的满意度水平与再次接受治疗的意愿、VAS 评分和 NPS。我们对另外 2306 名同时完成密歇根手部结果问卷（MHQ）的患者进行了额外的假设检验。治疗结果满意度通过患者在 5 点李克特量表上的满意度水平以及他们在类似情况下再次接受治疗的意愿来衡量。
我们发现，在 5 点李克特量表上的满意度测量具有很高的可靠性（组内相关系数 0.86 [95%置信区间 0.81 至 0.89]），并且在李克特量表上的满意度测量（加权kappa 0.86 [95%置信区间 0.80 至 0.91]）和再次接受治疗的意愿（kappa 0.81 [95%置信区间 0.70 至 0.92]）方面几乎完全一致。治疗结果满意度问卷的结构效度良好至优秀，有八项假设中的七项得到了证实。在确认的假设中，与 VAS 疼痛、VAS 功能、NPS、MHQ 疼痛和 MHQ 一般手部功能有中度至强相关性（Spearman rho 范围为 0.43 至 0.67；均 p<0.001），与 VAS 满意度和 MHQ 满意度有强至非常强相关性（Spearman rho 0.73 和 0.71；均 p<0.001）。被拒绝的假设仅表明在 5 点李克特量表上的满意度水平与在类似情况下再次接受治疗的意愿之间存在中度相关性（Spearman rho 0.44；p<0.001）。
治疗结果满意度问卷在手和腕部疾病患者中具有良好至优秀的结构效度和非常高的测试-重测信度。
该问卷可用于可靠和有效地测量以患者为中心、以价值为基础的医疗保健中患者对治疗结果的满意度。未来的研究应调查满意度结果变化的预测因素。
