Chest
Volume 118, Issue 1, July 2000, Pages 92-97
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Clinical Investigations: Cystic Fibrosis
Validation of an Instrument Measuring Patient Satisfaction With Chest Physiotherapy Techniques in Cystic Fibrosis

https://doi.org/10.1378/chest.118.1.92Get rights and content

Objectives

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.

Design

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.

Results

One hundred twenty-nine individuals returned completed surveys (39%; 66 males and 63 females; age range, 2 months to 47 years). FEV1values 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 α 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 (R2 = 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.

Conclusions

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.

Section snippets

Setting

This study was performed at Baylor College of Medicine, a large, metropolitan, academic CF care center accredited by the United States Cystic Fibrosis Foundation. It was completed in compliance with institutional review board policies.

Study Design

A two-page written survey containing two separate questionnaires was mailed to 349 CF patients cared for at the center. A $5 gift certificate was sent to individuals returning a completed survey. Responses were provided by either the patient or, in the case of

Results

Seventeen survey packets (5%) were returned by the postal service as undeliverable. Of the remainder, 129 survey packets (39% of those delivered) were completed and returned. A repeat survey was sent to 20 responders to perform test-retest analysis. Sixteen of these surveys (80%) were completed and returned.

Survey responders included 66 male (51%) and 63 female (49%) subjects, ranging in age from 2 months to 47 years. FEV1 data were available on 82 subjects, with a mean of 76% of predicted

Discussion

Although the use of CPT for airway clearance in CF has been a cornerstone in CF therapy for > 40 years, it is only within the past 5 years that studies have clearly shown PDPV to be effective in slowing the deterioration of lung function in CF.12, 13, 14 Studies by Reisman and colleagues13 and Desmond and colleagues14 have established PDPV as an effective therapy in CF, and the ”gold standard” against which other CPT techniques are measured. Despite the proven efficacy of PDPV, compliance is

Conclusion

Despite its role as a cornerstone therapy for airway clearance in CF, PDPV continues to be plagued with compliance and satisfaction concerns that limit its effectiveness in home self-care. Studies have demonstrated the benefit of PDPV and, to a limited extent, some of the newer ACTs, but there is a continued need for research in this area, with expanded attention to secondary outcomes such as patient satisfaction and quality of life. This satisfaction measure can provide useful information in

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