Patient satisfaction with hospital rehabilitation: validation of the SAT-16 questionnaire through Rasch analysis.

AIM: The SAT-16 is a 16-item self-administered questionnaire measuring patient satisfaction with the quality of care during stay in a rehabilitation unit. A comprehensive psychometric analysis of SAT-16 was performed using both classical test theory and Rasch analysis (RA) to examine its validity and metric properties, and provide further insights for its clinical use in rehabilitation settings. METHODS: A sample of 9458 patients, consecutively admitted to two Rehabilitation Centres, was examined with SAT-16. Factor (both explorative and confirmatory) analysis and RA were used to process the data in order to examine validity and metric properties of SAT-16. Dimensionality, item fit to the model, response category performance and internal construct validity were assessed. RESULTS: Two subscales were identified by factor analysis and expert review, respectively related to satisfaction with clinical care (items 1-9), and satisfaction with hospital organization and facilities ("hotel" aspects of care, items 10-16). Each subscale underwent a separate RA. Response categories were revised in both subscales of SAT-16, obtaining a new 3-level rating scale. Both subscales showed high internal consistency and internal validity. CONCLUSION: RA confirmed the appropriateness of SAT-16 and its usefulness in identifying areas for quality improvement. Overall, the questionnaire allows to assess patient satisfaction with the services through: 1) two sub-scores respectively specific for satisfaction with "clinical care" and "hotel aspects of care"; 2) additional information gathered in the optional open-ended questions.

The influence of comorbidities and complications on discharge function in stroke rehabilitation inpatients.

AIM: The aims of this prospective study were: 1) to assess the frequency, type and severity of comorbidities (COMs) and complications (COMPLs) in acute stroke patients, according to the weighted comorbidity index (w-CI) of Liu et al. and 2 new indices, respectively COM severity index (COM-SI) and COMPL severity index (COMPL-SI); 2) to separately analyse the interference of COMs and COMPLs with functional status and recovery during stroke rehabilitation treatment; 3) to compare the ability of COM-SI and COMPL-SI to predict functional independence at discharge with that of w-CI. METHODS: Eighty-five stroke rehabilitation inpatients participated in the study. The type, incidence and severity of COM at admission and of COMPL during the whole hospital stay were studied prospectively. The Functional Independence Measure (FIM) scale was administered at both admission and discharge. RESULTS: About 1/3 suffered from some significant COM and another 1/3 developed COMPLs needing specific medical treatment and/or clinical monitoring. The most frequent COMs and COMPLs were cardiovascular and psychiatric/psychological diseases. The odds of having a high efficiency in the daily functional gain (FIM score) were greater for patients without any COM (3.5) and/or COMPL (4.6). Similarly, the odds of having a high FIM score at discharge were greater (3.5) for patients without COM or COMPL. The COM-SI demonstrated a higher predictive capacity of the FIM score at discharge (5%) than w-CI (4%), and COMPL-SI (1%). CONCLUSIONS: COM-SI resulted as the most interesting predictive index of functional outcome at discharge, after accounting for the functional status at admission.

Falls in a rehabilitation setting: functional independence and fall risk.

AIM: With this study we wanted to determine the incidence, characteristics and consequences of falls in our rehabilitation setting. METHODS: An observational study was carried out in a rehabilitation setting for postacute orthopedic and neurological inpatients. Three-hundred and twenty patients were enrolled. Falls risk factors (Downton index [DI] and other known parameters), disability (functional independence measure [FIM]) and balance (Berg balance scale [BBS]) were assessed at admission. Falls that occurred during the rehabilitation stay were prospectively classified (St. Louis Older Adult Service and Information System [OASIS] system) and analyzed. RESULTS: Forty patients experienced a fall (12.5%). The faller group was characterized by a major clinical complexity; 70% of fallers were neurological patients and 30% presented cognitive impairment (mini mental state examination [MMSE] <24). They presented a statistically significant worse score on FIM (motor and cognitive), BBS and DI at admission, with 74% predictability of falls as measured by total FIM score and age. Falls recorded with the OASIS classification showed a prevalence (52.5%) for not bipedal (wheelchair transfer) and self-generated falls; 35% were intrinsic falls (caused by subject-specific factors) and 12.5% extrinsic falls (caused by environmental factors). Falls resulted in only minor clinical consequences, except for one rib fracture, but led to a significant increase in length of stay. CONCLUSIONS: In a rehabilitation centre, for good management of resources and safe prescriptions of a patient's independence in activities of daily living, fall risk is better evaluated with appropriate scales.

[Assessment of a patient satisfaction scale in rehabilitation]. / Validazione di una scala di soddisfazione del paziente in degenza riabilitativa.

BACKGROUND: A new scale is presented, measuring patients' satisfaction with respect to the quality of care during stay in a rehabilitation unit. The questionnaire is self-administered and anonymous, and it includes 15 items, scored 1 to 4. The cumulative score may thus range 15-60; the higher the score, the higher the patient's satisfaction. MATERIALS AND METHODS: The instrument was proposed to 175 disabled patients, admitted to a free-standing Centre for rehabilitation following neurological or orthopedic impairments. RESULTS: One hundred and forty questionnaires were completed. Of these, 131 could be analyzed. The mean score was > 3 in every item. Factor analysis disclosed that the questionnaire comprises 5 factors, which may be defined as "medical care", "physiotherapy", "nursing care", "food" and "physical environment and facilities". A satisfactory internal consistency of the items was found (item-remainder correlations > 0.5, Cronbach alpha > 0.9). This suggests that the scale is sufficiently unidimensional to permit cumulative summing of the item scores. CONCLUSIONS: The results suggest the content and construct validity of the scale. The questionnaire thus merits further psychometric investigation.

[Validity and reliability of a new questionnaire on patient satisfaction in rehabilitative therapy]. / Validità ed affidabilità di un nuovo questionario sulla soddisfazione del paziente in degenza riabilitativa.

BACKGROUND: The aim of this study was to examine some psychometric properties of a new questionnaire measuring patients' satisfaction with respect to the quality of care during stay in a rehabilitation unit. The instrument (called SAT-16) is composed of 16 four-level items and 2 open-ended questions. The construct validity of the 16-item section was already demonstrated in a previous study based on factorial analysis. In this study the concurrent validity, further aspects of the construct validity and test-retest reliability were analyzed. METHODS: The SAT-16 was administered to 339 inpatients, admitted consecutively to a Rehabilitation Center. RESULTS: 262 questionnaires (77%) were returned, of which 221 with all items filled in. The SAT-16 correlated well with two other measures of satisfaction (CSQ-8 and global satisfaction regarding the hospital stay). The answers to two open-ended questions came out to be consistent with those to the 16 closed-ended questions. The high values for the indices of test-retest reliability (ICC and kappa) are evidence of the stability of the scores in two repeated administrations. CONCLUSIONS: The SAT-16 was found to be provided with good psychometric characteristics. It can be proposed as a valid instrument for use in clinical practice for the continuous quality improvement of inpatient medical rehabilitation programmes.

Mixed infection by Staphylococcus and Candida, and Wegener's granulomatosis.

We describe the case of a patient who initially presented with pneumonia from Staphylococcus aureus and Candida parapsilosis, which was resolved with antibiotic treatment, but reappeared 6 months later as full-blown Wegener's granulomatosis. The possible pathogenetic correlations between infective agents, in particular Staphylococcus aureus and Candida, and Wegener's granulomatosis are discussed.

Length of stay of stroke rehabilitation inpatients: prediction through the functional independence measure.

A model for prediction of length of stay (LOS, in days) of stroke rehabilitation inpatients was developed, based on patients' age (years) and function at admission (scored on the Functional Independence Measure, FIMSM). One hundred and twenty-nine cases, consecutively admitted to three free-standing rehabilitation centres in Italy, were analyzed. A multiple linear regression using forward stepwise selection procedure was adopted. Median admission and discharge scores were: 57 and 75 for the total FIM score, 29 and 48 for the 13-item motor FIM subscore, 29 and 30 for the 5-item cognitive FIM subscore (potential range: 18-126, 13-91, 5-35, respectively). Median LOS was 44 days (interquartile range 30-62). The logLOS predictive model included three FIM items ("toilet transfer", TTr; "social interaction"; "expression") and patient's age (R2 = 0.48). TTr alone explained 31.3% of the variance of logLOS. These results are consistent with previous American studies, showing that FIM scores at admission are strong predictors of patients' LOS, with the transfer items having the greatest predictive power.

Life Satisfaction Index: Italian version and validation of a short form.

The Life Satisfaction Index-version A (LSIA) is a 20-item questionnaire providing a cumulative score acknowledged as a valid index of quality of life. In the present study, an Italian version was produced through validated procedures of repeated back-translations. The final Italian version (LSIA.it) was administered to 90 healthy subjects (55 women; aged 40-65 yr, median 51). Cronbach alpha was 0.74, in agreement with previous studies on English, Greek, and Spanish versions, suggesting satisfactory internal consistency of the scale. Also in agreement with previous studies, factor analysis identified three factors (mood tone, zest for life, and congruence between desired and achieved goals), with eigenvalues of 2.80, 1.72, and 1.34, respectively. Nine of the original 20 items were dropped because of inconsistency with the overall scale and/or because of ambiguous loading onto the extracted factors. The resulting 11-item short form (LSI-11) had alpha = 0.69 and Kaiser-Meyer-Olkin measure of sample adequacy = 0.65. In our sample, the mean score of LSIA.it was almost the same as that previously reported in the literature for LSIA, and the correlation between LSIA and LSI-11 was very high (r = 0.91). In a test-retest trial, the cumulative score of LSI-11 showed a percentage of agreement ranging from 73.9 to 100 and Cohen's k statistic for reliability ranging from 0.51 to 1. The individual items of the LSI-11 presented substantial (k > 0.6) to excellent (k > 0.8) levels of agreement. The responsiveness of LSIA and LSI-11 during a hospital stay for 30 consecutive inpatients for medical rehabilitation programs, as measured by effect size, was 0.57 and 0.63, respectively. The results suggest that (1) the LSIA it has cultural equivalence with the English LSIA and that (2) the 11-item short form of LSIA is not only simpler but also more valid from a psychometric standpoint.

[An ergonomic analysis of 5 technics for moving patients]]. / Analisi ergonomica di cinque tecniche di spostamento del paziente.

Nursing personnel and physical therapists refer to the lifting and moving of patients as the most important determinant of occupationally related low-back pain. This study was conducted in 12 nurses and 12 patients, to compare three methods of transferring patients from bed to wheelchair; (I) manual lifting, (II) an assistive device-a walking belt (with both one- and two-person transfers) and (III) a mechanical hoist. After completion of a given transfer, nurses were asked to rate the physical stress and how secure they felt the method was. Patients were asked to rate how secure and comfortable they felt. We also recorded the time required to make each transfer. The walking belt two persons had the most favourable ratings (the least stressful and most secure and comfortable), however transfers with this method took longer than those with the manual methods (although less than transfers with the hoist). Both nurses and patients rated one-person manual lifting as most stressful and least secure. Two-person transfer methods were preferred to the corresponding one-person methods. The hoist was the least suitable transfer method in view of the corresponding one-person methods. The hoist was the least suitable transfer method in view of the considerable physical stresses to the nurses, perceived lack of safety, discomfort for the patients and time involved.