Research reportPatient Satisfaction with a New Physiotherapy Telephone Service for Back Pain Patients
Section snippets
Background and Purpose
Back pain is a very common complaint. A comparison of two prevalence surveys at an interval of ten years demonstrated that the one-year prevalence of back pain rose from 36.4% to 49.1%. The trend was consistent across all ages in both men and women, and also within social classes and regions (Palmer et al, 2000). In 1995 back pain was estimated to cost the National Health Service up to £400 million a year (Klaber-Moffett et al, 1995). However, five years later these costs were reported as being
Aims and Objectives
The aim of the study was to test the hypothesis: ‘Providing telephone advice to people with back pain improves satisfaction with a physiotherapy service.’
Objectives were:
- 1.
To provide a telephone advice service to patients with back pain.
- 2.
To determine the usefulness of this service in terms of patient satisfaction.
Pilot Study
A pilot study was conducted before the main study. This included pre-pilot interviews with consumers (people who had used healthcare services for back pain) to establish issues, related to satisfaction, that were deemed important. This information was used when selecting a patient satisfaction questionnaire to improve content validity. A small pilot study (n = 15) was then conducted to refine the details and design of the pro-posed protocol for the main study.
Main Study
Patients from two practices who
Data Analysis
The computer software Statistical Package for the Social Sciences (SPSS) version 8.0 was used for all the data analysis. Data were double-entered by a second person to ensure accuracy and therefore reliability of data entry.
Results Descriptive Statistics
Of 295 questionnaires distributed, 223 were returned; a response rate of 75.6%. Of the respondents, 34.5% were men (mean age 51.2 years) and 65.5% were women (mean age 50.4 years).
Seven subjects telephoned the surgery and stated that they no longer required assessment as their symptoms had resolved. Six of these subjects were in the experimental group and had received the telephone advice and one was in the control group. Twenty-two subjects either failed to attend their first appointment or
Satisfaction Scores
Descriptive data of satisfaction scores may be seen in table 1.
The mean satisfaction score was higher in the experimental group (74.16) than in the control group (63.39). This difference was significant (p < 0.001). The lowest score in the experimental group was 61 (range 61-80) which was higher than that of the control group (lowest score 33, range 33-80).
This information is demonstrated in figure 3 and clearly supports the experimental hypothesis.
Subjects' Opinions
Responses to the statement ‘The tel-ephone advice the physiotherapist gave me has helped me get better’ are illustrated in figure 4, to ‘I felt very much better after talking to the physiotherapist on the telephone’ in figure 5, and to ‘I followed every detail of the physio-therapist's telephone advice’ in figure 6.
Subjects' Recollection
Table 2 illustrates the responses to the question:
‘When the physiotherapist telephoned you, did you receive any of the following advice?’
Reliability
Cronbach's alpha in this case was 0.94.
Representativeness of the Sample
The sample and population were the same, as no subject met the exclusion criteria.
The sample and ‘pre-study population’ demonstrated very similar age and sex distributions (table 3). It may be conclud-ed from these descriptive statistics that the sample did not differ in terms of age and sex from usual patients who are referred to physiotherapy with back pain.
Table 4 illustrates the age and sex distributions of the wider population. There is a pattern of similarity between this and the sample.
Discussion
The final sample size of 223 gave the statistical analysis a 90% power to detect a difference between the results of the two groups. The return rate of the quest-ionnaires was 75.6%.
Seven patients informed the practice that they did not require physiotherapy assessment as their symptoms had resolved. This may have been due to natural resolution, the medication or advice the general practitioner issued, receipt of another form of treatment – eg home remedies or private healthcare – or as a
Extraneous Variables
It is recognised, however, that other factors may have been of influence. The satisfaction data collected do not isolate satisfaction with the content of infor-mation given from the manner in which it was delivered. The satisfaction may not have been related only to the telephone advice. Other issues that may have in-fluenced the outcome are:
- ▪
The relationship between subjects and their physiotherapists, eg if the relationship was good but the treatment techniques were poor, respondents may
Conclusion
Telephone consulting is an increasingly popular means of healthcare inter-vention. It provides an accessible, con-venient and rapid response service to meet increasing patient demand (DoH, 2000a). The current Labour Government is encouraging its use, but so far no experimental studies have been reported that investigate telephone consulting in physiotherapy.
Findings from this study clearly showed that patients who received telephone advice for their back pain were more satisfied with the
Acknowledgements
Our thanks go to Hilda O'Flanigan, David Rhodes and David Merrick for statistical advice; to Professor Gene Marsh for permission to use the PSHCPS and to the staff and patients of the two general practices involved in this study.
The study was funded by the Royal College of General Practitioners, Connect Physical Health Centres Limited, Newcastle, and Central Surgery, Tyne and Wear.
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- 1
Siobhan Taylor MSc MCSP is a senior physiotherapist at Scarborough General Hospital. She is the lead author of the paper, which records an MSc project.
- 2
Ieuan Ellis MREd CertEd(FE) MCSP DipTP is head of physiotherapy in the School of Health and Professional Practice Studies at the University of Northumbria. He was academic supervisor of the project conducted as an MSc thesis, and co-author of the paper.
- 3
Morris Gallagher MB BS FRCGP is a general practitioner in South Sheilds. He was an external academic and clinical superviser of the project and a co-author of the paper.