LORMA COLLEGES

COLLEGE OF PHYSICAL AND RESPIRATORY THERAPY

Carlatan, City of San Fernando, La Union

In Partial Fulfillment for the Requirements in Research

Levels of Satisfaction of Patients with Musculoskeletal Conditions in the

Physical Therapy on Selected Hospitals in La Union

Submitted To:

Sir Bernard Tayaban Jr., PTRP, MDA

Submitted By:

Anin, Jerna C.

Bisquera, John Glenn D.

Campos, Bianca Joyce U.

Gurtiza, Joanna Eden A.

Imperial, Charmaine E.

Laureta, Chloei Ann D.

 Chapter I

INTRODUCTION

I. Background Study

Patients are individuals who have disorders that require interventions to improve

their function. (Pagliarulo, M.) A patient is any recipient of health care services. The

patient is most often ill or injured and in need of treatment by an advanced practice

registered nurse, physiotherapist, physician, physician assistant, psychologist, podiatrist,

veterinarian, or other health care provider.

Patients have this certain health needs or necessities in which they consult

health care providers or services like hospitals and rehabilitation centers to attain

satisfaction. Satisfaction is individuals feelings of pleasure or disappointment resulting

from comparing their perceptions of a product or services performance to their

expectation levels. It is the act of fulfilling a need, desire, or appetite, or the feeling

gained from such fulfillment.

Patient satisfaction is an important and commonly used indicator for measuring

the quality in health care. Patient satisfaction affects clinical outcomes, patient retention,

and medical malpractice claims. It affects the timely, efficient, and patient-centered

delivery of quality health care. Patient satisfaction is thus a proxy but a very effective

indicator to measure the success of doctors and hospitals. Patient satisfaction is only an

indirect or a proxy indicator of the quality of doctor or hospital performance. Delivery of

patient-focused care requires that we provide care in a particular way, not just

sometimes or usually, but always. It must be every patient every time. (Wendy L, Scott

G. USA: AHA company; 1994)

 Almost all of the patients around the world seek medical attention by means of

going to the hospital. Hospital is an integral part of the medical and social organization

which is to provide for the population complete health care, both curative and preventive;

and whose out-patient services reach out into the family in its home environment. The

hospital is also a center for the training of health workers and for bio-social research.

Every patient needs fulfillment on certain needs, this needs are given by health

care providers in which they have to attain the highest level of satisfaction of a patient.

Level of satisfaction is a term used to describe the degree of the health care factors

needed to meet the requirements for the well being of the patients in Physical Therapy

Rehabilitation Centers in connection with the services implemented in the organization.

In this study the level of satisfaction are categorized as very high, high, moderate, fair

and low.

Most of the hospitals around the world, patient complains of having problems

about their muscular system and skeletal system or basically the musculoskeletal

system in which it provides form, stability, and movement to the human body. It consists

of the body's bones, muscles, tendons, ligaments, joints, cartilage, and other connective

tissue. The musculoskeletal system incorporates bones, muscles, and connective

tissue (your ligaments, tendons, and fascia).

Hospitals globally provides services like pharmacological managements by

means of giving medications such as prescribing the use of nonsteroidal anti-

inflammatory drugs to relieve pain, surgeries such as arthroplasty to cure joint problems,

and the use of orthosis to prevent complications and structural problems.

Some patients undergo for rehabilitation to recover from musculoskeletal

conditions or related disorders. Rehabilitation is a treatment designed to facilitate the

process of recovery from injury, illness, or disease to as normal a condition as possible.

The purpose of rehabilitation is to restore some or all of the patient's physical, sensory,
and mental capabilities that were lost due to injury, illness, or disease. It includes

assisting the patient to compensate for deficits that cannot be reversed medically.

Rehabilitation should be carried out only by qualified therapists. Exercises and other

physical interventions must take into account the patient's deficit. (Medical Dictionary)

Most of the patients who are having injuries and disorders that affect the human

bodys movement or musculoskeletal system such as low back pain, sprain, strain,

osteoarthritis, rheumatoid arthritis seek for physical therapy rehabilitation.

Physical therapy provides services to individuals and populations to develop,

maintain and restore maximum movement and functional ability throughout the lifespan.

This includes providing services in circumstances where movement and function are

threatened by ageing, injury, disease or environmental factors. Functional movement is

central to what it means to be healthy. Physical therapy is concerned with identifying and

maximizing quality of life and movement potential within the spheres of promotion,

prevention, treatment/intervention, habilitation and rehabilitation. This encompasses

physical, psychological, emotional, and social well- being. Physical therapy involves the

interaction between physical therapist, patients/clients, other health professionals,

families, care givers, and communities in a process where movement potential is

assessed and goals are agreed upon, using knowledge and skills unique to physical

therapists. (Bernice Krumhansl)

Treatments are provided by physical therapist. Physical therapists are health

care professionals who maintain, restore, and improve movement, activity, and health

enabling individuals of all ages to have optimal functioning and quality of life, while

ensuring patient safety and applying evidence to provide efficient and effective care. In

addition, physical therapists are involved in promoting health, wellness, and fitness

through risk factor identification and the implementation of services to reduce risk, slow
 the progression of or prevent functional decline and disability, and enhance participation

in chosen life situations. (PPTA)

Most Physical Therapy Rehabilitation Centers around the world use new and

high technology in treating patients with musculoskeletal problems. They also provide

complete set and high class equipment to fulfill the patients satisfaction. Some Physical

Therapy Rehabilitation Centers around the world also has indoor pools specially

designed for hydrotherapy interventions.

Only few Physical Therapy Rehabilitation Centers in the Philippines have the new

and high technologies that can be used to provide treatment. None of the Physical

Therapy Rehabilitation Centers in the Philippines has any pools that can be used for

hydrotherapy interventions, but on the other hand they provide hydrotherapy treatment

on hubbard tanks.

Physical Therapist in La Union provides treatments like stretching and

strengthening exercises, using of heating modalities like hot moist pack, ultrasound,

paraffin wax bath, infrared radiation, and microwave diathermy, cryotherapy, spinal and

lumbar traction, use of different types of electrical stimulators such as functional

electrical stimulator, transcutaneous electrical stimulators, neuromuscular electrical

stimulation, joint mobilization in managing musculoskeletal disorders.

Theoretical framework

The following theories provided the foundation of the study.

Patients satisfaction is an attitude or a person`s general orientation towards a total

experience of health care. Satisfaction comprises both cognitive and emotional facets and

relates to previous experiences, expectations and social networks (Keegan et al 2002).

 Expectancy-value theory of Linder-Pelz (1982) postulated that satisfaction was mediated

by personal beliefs and values about care as well as prior expectations about care. Linder-Pelz

identified the important relationship between expectations and variance in satisfaction ratings

and offered an operational definition for patient satisfaction as positive evaluations of distinct

dimensions of healthcare (p578). The Linder-Pelz model was developed by Pascoe (1983) to

take into account the influence of expectations on satisfaction and then further developed by

Strasser et al. (1993) to create a six factor psychological model: cognitive and affective

perception formation; multidimensional construct; dynamic process; attitudinal response;

iterative; and ameliorated by individual difference.

Determinants and components theory of Ware et al. (1983) propounded that patient

satisfaction was a function of patients subjective responses to experienced care mediated by

their personal preferences and expectations.

Multiple models theory of Fitzpatrick and Hopkins (1983) argued that expectations were

socially mediated, reflecting the health goals of the patient and the extent to which illness and

healthcare violated the patients personal sense of self.

Healthcare quality theory of Donabedian (1980) proposed that satisfaction was the

principal outcome of the interpersonal process of care. He argued that the expression of

satisfaction or dissatisfaction is the patients judgement on the quality of care in all its aspects,

but particularly in relation to the interpersonal component of care.

According to the research done by WHO on Client Satisfaction and Quality of Health

Care in Rural Bangladesh, the research went deep to discover the effect of culture on patients

satisfaction, the findings showed that culture in most cases is what shapes the type of care that

should be given to a client/patients and hence they suggest that developing countries should go

into more detailed research about the role of culture on patients satisfaction.
 In another research done by Asma Ibrahim (http://www.li.mahidol.ac.th/e-

thesis/5037998.pdf) on Patients Satisfaction with Health Services at Outpatient Department of

Indira Gandhi Memorial Hospital. This research was used to find out more about the factors that

affects satisfaction and the researcher was more interested on the hospital protocols and how it

relates to patients satisfaction. The research findings showed that the patients are not satisfied

with the waiting time which they attributed to shortage of staff.

The two researches have unfolded a lot of useful information that can maximize the

satisfaction level of the patients especially as regards culture and the factors that deter-mines

satisfaction level of clients. (www.podiatrywa.com.au/news/146-Patient-Centred%20Care

%20Paper%20-%20web.pdf) This research is based on the theory of client centered therapy,

its a theory proposed by Carle Roger, an American psychologist and a humanistic thinker who

believes that everyone has the ability and capacity to achieve and attain to any level he or she

wants based on the person thinking. He proposed that therapist should adopt the use of non-

directive system of care when dealing with clients.non directive approach here is the act of

allowing the client to be in control or in charge of the decisions that concerns him or her.

He proposed that a client centered therapist would possess the following qualities 1)

Genuiness 2) Unconditional positive regards 3 Empathetic understanding. (Carl Rogers 2007)

In this research the Author intend to find out the satisfaction level of elderly people as

regards the physiotherapy management of musculoskeletal conditions in Enugu State Nigeria.

The Author intend to adopt a new way of physical therapy management which is based on

Patient Centered Approach, which is an innovative approach to the planning, delivery, and

evaluation of health care that is grounded in mutually beneficial partnerships among health care

providers, patients, and families. Patient- and family-centered care applies to patients of all

ages, and it may be practiced in any health care setting.

 It appears that the level of satisfaction varies with the disease condition. Hence,

satisfaction is generally higher in patients with acute conditions than in those with chronic

conditions (Hills R et. Al 2007), possibly because those with acute conditions are more

optimistic about their outcome. Patients age also appears to be an important factor, with older

patients reporting more satisfaction (Casserley-Feeney SN 2008 et.al) . This may be because

older patients, coping with chronic pain and mobility problems, have a greater need for and

hence appreciation of physiotherapy services. Further, older people may have lower

expectations than younger patients ( McKinnon AL 2001). There also appears to be sex-related

differences in satisfaction, with females reporting more satisfaction than males (Hills R et. Al

2007). Longitudinal continuity of care is important too; patients treated by the same practitioner

over time are approximately three times more likely to report satisfaction than those who receive

care from multiple therapists (Beattie P et. Al 2008). The mode of treatment may also impact

satisfaction. For instance, patients with back pain were found to be equally or more satisfied

with exercise-based physiotherapy than with passive treatment modalities. Higher satisfaction is

reported when the treatment process is more consultative. However, some patients prefer less

involvement considering the physiotherapist as the expert ( Cooper KS et. Al 2008). This

highlights the need for physiotherapists to tailor make their approach accordingly. The extent to

which a patient is prepared for treatment appears to affect his/her level of satisfaction too;

patients prepared in advance may collaborate better with the physiotherapist (Baker SM et. Al

2001) (Tread FV 2000)

Further, a lower satisfaction level may be associated with an increase in the waiting time

for treatment, inadequate waiting area facilities, a low level of faith on the therapist/health

facility, and ineffective communication with the patient about his/her disease condition (Kumarito

et. Al 2009).
 Other than patient- and physiotherapist-related factors, patient satisfaction is also

associated with the organization and infrastructure of the physiotherapy treatment facility. Well-

organized physiotherapy care is a determinant of high patient satisfaction [5]. Patients are more

satisfied if the physiotherapy service is easy to access (in terms of location, parking, and clinic

hours), involves helpful administrative staff, and is associated with low waiting times, and the

premises are of a high standard [4]. Patient satisfaction was also associated with the type of

facility, where patients were more satisfied in a private clinic than in a government hospital,

possibly because of better resources in private clinics, in particular, the therapist time.

The theories discussed above explains

Statement of the problems

This study aims to determine the Levels of Satisfaction among Musculoskeletal

Condition on Selected Hospitals in La Union.

1. What is the profile respondent as to:

a. Age

b. Civil status

c. Gender

d. Educational attainment

e. Occupation

f. Length of service

2. What is the level of satisfaction as to:

a. Treatment

b. Facilities

c. Services

3. What is the relationship of the patient to the patient level of satisfaction?

Significant of the Study

 The study will benefit the Rehabilitation Center of the different hospitals in La Union in

promoting excellent rehabilitation services among the patients with musculoskeletal conditions.

This study aims to determine the patients rating of their care experienced based on what they

did or did not experience in their interaction in obtaining health care. Patient satisfaction surveys

can help gauge patients perceptions of practice services and functions. These study are

invaluable means for improving communication between providers and patients and engaging

patients in their care.

The study will benefit the Physical Therapist in helping the patient to understand the

treatment and procedures given by them and their role in providing a care to prevent the

condition of the patient with musculoskeletal problems. This study also helps the physical

therapist in expanding their roles in different aspects of health care.

The purpose of this study is to survey the patient level of satisfaction in rehabilitation

services in public and private hospitals in La Union. This study measures the quality of care in

patients with musculoskeletal condition wherein it helps the patient to overlook on the costs of

services, the quality of care delivered and the impact of the treatment facilities on improving

their quality of life.

The result of the study focus on achieving high or excellent ratings of patient satisfaction

to improve the quality of service delivery among the patient, therefore physical therapist need to

characterize the factors influencing patient satisfaction which are used as a means to assess

the quality of healthcare delivery.

Scope and Delimitation

The study focused on the reaction of the Musculoskeletal patients from the three

selected hospitals in La Union regarding on the levels of their satisfaction within treatments,

facilities and services.

 This study is interested on how the musculoskeletal patients reacts on the treatments

and services given by the hospital they chose and also the hospital facilities. It aims to

recognize the patients reactions.

This study would also like to know the patients perception about the treatments,

services and hospital facility.

This research study is limited or focuses only on the musculoskeletal patients from the

three selected hospitals in La Union.

Definition of Terms

1. Care - Level of active concern, or lack of negligence, towards avoidance of possible

dangers, mistakes, pitfalls, and risks, demanded of a party as a duty or legal obligation.

2. Effective - is the capability of producing a desired result. When something is deemed

effective, it means it has an intended or expected outcome, or produces a deep, vivid

impression

3. Efficient - performing or functioning in the best possible manner with the least waste of time

and effort

4. Facility - a place, amenity, or piece of equipment provided for a particular purpose.

5. Fulfillment - is a feeling of satisfaction that you get from doing or achieving

something, especially something useful.

6. Health - As defined by World Health Organization (WHO), it is a "State of complete physical,

mental, and social well-being, and not merely the absence of disease or infirmity." Health is

a dynamic condition resulting from a body's constant adjustment and adaptation in response

to stresses and changes in the environment for maintaining an inner equilibrium called

homeostasis.
7. Health Care - The treatment and management of illness and the preservation of health,

dental, complementary and alternative medicine, pharmaceutical, clinical sciences, nursing,

and allied health professions. Health care embraces all the goods and services designed to

promote health including preventive, curative, and palliative, interventions whether directed

to individuals or to populations.

8. Health Care Service - the furnishing of medicine,medical or surgical treatment,

nursing, hospital service, dental service, optometrical service, complementary health

services or any or all of the enumerated services or any other necessary services of like

character, whether or not contingent upon sickness or personal injury, as well as the

furnishing to any person of any and all other services and goods for the purpose of

preventing, alleviating, curing or healing human illness, physical disability or injury.

9. Low back pain - Low back pain is pain, muscle tension, or stiffness localized below the

costal margin and above the inferior gluteal folds, with or without sciatica, and is defined as

chronic when it persists for 12 weeks or more.

10. Maslows Hierarchy of Needs - is a motivational theory in psychology comprising a five tier

model of human needs, often depicted as hierarchical levels within a pyramid.

11. Need - A motivating force that compels action for its satisfaction. Needs range from basic

survival needs (common to all human beings) satisfied by necessities, to cultural,

intellectual, and social needs (varying from place to place and age group to age group)

satisfied by necessaries. Needs are finite but, in contrast, wants (which spring from desires

or wishes) are boundless.

12. Osteoarthritis- is the most common form of arthritis, affecting millions of people worldwide.

It occurs when the protective cartilage on the ends of your bones wears down over time.

13. Rheumatoid arthritis- is the most common type of autoimmune arthritis. It is triggered by a

faulty immune system (the bodys defense system) and affects the wrist and small joints of

the hand, including the knuckles and the middle joints of the fingers.
14. Sprain - Severe stress, stretch, or tear of soft tissues such as the joint capsule, ligament,

tendon, or muscle

15. Strain - Overstretching, overexertion, overuse of soft tissue; tends to be less severe than a

sprain; results from slight trauma or unaccustomed repeated trauma of a minor degree. It

also refers to the amount of deformation that occurs in tissues when a stress is applied

The Paradigm of the Study

Input Process Output

Extent of the patients I. Interview with the Level of satisfaction on

having problems about patients treatment, facilities and

their muscular system II. Extent of patients services rendered to

and skeletel system or a. Age patients with

basically b. Civil status musculoskeletal

musculoskeletal system c. Gender conditions on selected

d. Educational hospitals in La Union

attainment

e. Occupation

f. Length of service

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