Clinimetric evaluation of a Satisfaction-with-Stroke-Care questionnaire

There is a lack of sound instruments for measuring patient satisfaction with stroke care. One self-report instrument comprising two subscales, satisfaction with inpatient care and satisfaction with care after discharge, has been validated, but only in the United Kingdom. In later studies, items have been added without further validation. Therefore, we tested this extended questionnaire (Satisfaction with Stroke Care questionnaire; SASC-19) for feasibility, reliability (homogeneity and test-retest agreement), and construct validity (convergent and divergent validity and factor analysis) in the Netherlands in 166 prospectively collected stroke patients living at home 6 months after discharge. To determine the test-retest reliability, 51 patients completed the SASC-19 again two weeks after they first completed it. The response rate was 90 %; the mean time needed to complete the SASC-19 was less than 10 minutes. Six items were omitted by more than 10 % of the patients. Both subscales showed good homogeneity and almost perfect test-retest reliability (Cronbach's alpha's > 0.80; Intraclass Correlation Coefficients > 0.80). The correlations with the General Satisfaction questionnaire (convergent validity) ranged between 0.33 and 0.55; those with the Barthel Index, the Hospital Anxiety and Depression Scale (HADS), and the Short Form 36 (SF-36) health survey questionnaire (divergent validity) ranged between 0.12 and 0.47. Factor analysis showed a total explained variance of 49 %, which supports the subscale structure. We conclude that the SASC-19 is a reliable and valid instrument for measuring patient satisfaction with stroke care and it is easy to complete. The feasibility in terms of missing values is moderate.