Satisfaction With Medical Rehabilitation in Patients With Orthopedic Impairment Melodee Mancuso, PhD, Pamela Smith, DNS, RN, Sandra Illig, MS, RN, Carl V. Granger, MD, Vera A. Gonzales, PhD, Richard T. Linn, PhD, Kenneth J. Ottenbacher, PhD, OTR ABSTRACT. Mancuso M, Smith P, Illig S, Granger CV, Gonzales VA, Linn RT, Ottenbacher KJ. Satisfaction with medical rehabilitation in patients with orthopedic impairment. Arch Phys Med Rehabil 2003;84:1343-9. Objective: To examine patient satisfaction after orthopedic impairment at 80 to 180 days after inpatient rehabilitation. Design: Retrospective design examining records from facil- ities subscribing to the Uniform Data System for Medical Rehabilitation (UDSMR). Setting: Information submitted to UDSMR from 1997 to 1998 by 177 hospital and rehabilitation facilities from 40 states. Participants: The sample (N=7781) was 72.63% female and 88.60% non-Hispanic white, with a mean age  standard deviation of 73.0711.81 years, and average length of stay (LOS) of 13.8410.48 days. Intervention: Usual rehabilitation care. Main Outcome Measures: Level of satisfaction 80 to 180 days after discharge as well as motor, cognitive, and subscale ratings for the FIM™ instrument. Predictor variables included gender, age, English language, marital status, discharge setting, LOS, rehospitalization, FIM gain, and primary payer. Results: A logistic regression model was used to predict patient satisfaction at follow-up. Five statistically significant (P.05) variables were found and correctly classified 94.9% of the patients. Discharge motor FIM rating, rehospitalization, age, patient’s primary language, and discharge setting were associated with increased satisfaction. Discharge motor FIM ratings were significantly associated with increased satisfaction in patients with joint replacements and lower-extremity frac- tures. Conclusion: Functional and demographic variables were identified as predictors of satisfaction in patients with orthope- dic impairments. Key Words: Arthroplasty, replacement; Hip fractures; Joints; Rehabilitation; Treatment outcome. © 2003 by the American Congress of Rehabilitation Medi- cine and the American Academy of Physical Medicine and Rehabilitation Q UALITY OF HEALTH CARE has traditionally been as- sessed by adherence to standards and practices determined exclusively by health professionals or by outcomes established by the providers on behalf of the patients they serve. 1 These outcomes are usually assessed by performance-based and phys- iologic-focused measurements, such as muscle strength or range of motion, which are selected and administered by health care professionals. Patient-centered practice and outcome-focused accreditation standards increasingly emphasize patient values and prefer- ences in goal setting, treatment, and evaluation. 2 As a result, patient satisfaction has emerged as an important health care quality indicator. 3 In medical rehabilitation, patient participa- tion and satisfaction are essential for success in treatment, because successful intervention is dependent on patient partic- ipation in learning skills to improve functional abilities and physical status. 4 Evidence indicates that satisfied patients are more likely to cooperate with treatment regimens, to keep follow-up appointments, to disclose important information, and to use the same facilities for future care. 5,6 Conversely, patients who are dissatisfied may reduce the effectiveness of their treatment by not participating fully in their rehabilitation ac- tivities or by failing to comply with prescribed treatment after discharge. Because patient participation directly influences the outcomes of treatment in medical rehabilitation, satisfaction information can be of great value to rehabilitation profession- als, managers, and consumers. 7,8 Several instruments have been developed to assess patient satisfaction, and a substantial literature exists that examines patient perceptions and satisfaction with general health care. 9-14 The amount of research that examines patient satisfaction in medical rehabilitation, however, is modest. 4 Research on pa- tient satisfaction in general and acute health care is divided into studies of “process” and “outcomes.” Satisfaction with how health care is delivered is referred to as process, whereas satisfaction with the measurable results of care is referred to as outcome. 15 For example, a patient undergoing a knee replace- ment may be highly satisfied with the attention and interaction with the surgical, nursing, and therapy staff, but disappointed in the level of function or rate of recovery. We were interested in examining the relationship between satisfaction with ser- vices received during medical rehabilitation and functional status at discharge. We hypothesized that there would be a positive relationship between level of patient satisfaction at follow-up from medical rehabilitation and functional status as measured by ratings on the FIM™ instrument at discharge. We also examined sociodemographic and patient characteristics associated with high or low levels of patient satisfaction at follow-up. METHODS Source of Data The data for 9737 patients with orthopedic impairments and receiving inpatient medical rehabilitation services from 1996 to 1998 were obtained from the Uniform Data System for Medical From the Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX (Mancuso, Gonzales, Ottenbacher); National FollowUp Services, Buffalo, NY (Smith, Illig); and Department of Rehabilitation Medicine (Granger) and Uniform Data System for Medical Rehabilitation (Granger, Linn), State University of New York, Buffalo, NY. Supported by the National Institute on Disability and Rehabilitation Research, US Department of Education (grant no. H133P990001), National Institutes of Health (grant no. R01-HD34622), and the American Heart Association (grant no. 027045N). No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated. Reprint requests to Kenneth J. Ottenbacher, PhD, Div of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555- 1028, e-mail: kottenba@utmb.edu. 0003-9993/03/8409-7788$30.00/0 doi:10.1016/S0003-9993(03)00144-8 1343 Arch Phys Med Rehabil Vol 84, September 2003