Assessing patient expectations and concerns in a physical medicine and rehabilitation unit: a real-time snapshot

To evaluate patient expectations, concerns, and satisfaction during physical medicine and rehabilitation (PM&R) inpatient hospitalization. Patients were also asked to comment on what resources might benefit them during their stay.

More than 150 PM&R patients were asked to fill out a self-administered survey in a cross-sectional design. Patients receiving care under 5 other specialties (general medicine, obstetrics and gynecology, general surgery, orthopedics, and neurology) also were surveyed to determine whether qualitative differences existed between PM&R and other departments. In all, more than 1100 patients were given surveys to complete. Patients rated how concerned they were with more than 20 elements of their hospitalization, ranging from quality of food to pain management. Questions were divided into 2 sections: retrospectively before hospitalization and during current admission.

This study was completed in a large tertiary care PM&R facility with an adjoining medical center in an urban area.

Patients were given the option to complete this survey in an anonymous fashion during their hospital stay. All those who did so were included in this analysis. Six different specialties were represented in the final tally, but the emphasis was on the PM&R department.

The survey itself included more than 20 questions regarding the details of patients' hospital stays and how concerned they were with them. These categories included plans after discharge, duration of hospitalization, pain management, follow-up of medical issues, cost, insurance, and familiarity with diagnosis, physician, and medications. Other outcomes included patient input into what interventions they thought would most benefit them as well as a global satisfaction rating.

Data analysis was performed with SPSS. Tukey tests provided comparison information across specialties. The response rate within PM&R was 68% (n = 128), whereas for all specialties combined it was 54% (n = 606). Multiple factors were found to be significant when examining expectations versus actual admission concerns. Most prominently within PM&R, patients indicated that they were less concerned during their admission than they thought they would be about potential duration of hospitalization (P < .001), understanding of diagnosis (P < .04), follow-up of medical issues (P < .01), and plan of care (P < .001), among others. However, patient expectations in other areas did not change or were negatively affected, such as help at home (P < .05), plans for discharge (P < .001), family involvement at home (P < .01), and future pain management at home (P < .05). Furthermore, qualitative comparisons among other specialties demonstrated differences in many areas.

Results support the idea that the multidisciplinary approach inherent in PM&R positively alters many patient expectations related to outcomes. This has direct relevance to patient satisfaction and outcomes and warrants further investigation. The authors offer some potential interventions for future improvement in this area.