Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study

Leila Hamadou; Rihab Moncer; Rim Ghammam; Walid Ouanes; Sonia Jemni

doi:10.12688/f1000research.152248.1

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Research Article

Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study

[version 1; peer review: 1 not approved]

Leila Hamadou ¹, Rihab Moncer^1,2, Rim Ghammam^2,3, Walid Ouanes^1,2, Sonia Jemni^1,2

Leila Hamadou ¹, Rihab Moncer^1,2, [...] Rim Ghammam^2,3, Walid Ouanes^1,2, Sonia Jemni^1,2

PUBLISHED 19 Jun 2024

Author details Author details

¹ Department of Physical Medicine and Rehabilitation, Sahloul University Hospital, Sousse, Tunisia
² Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia
³ Department of Epidemiology (LR19SP03), Farhat Hached University Hospital, Sousse, Tunisia

Leila Hamadou
Roles: Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing

Rihab Moncer
Roles: Conceptualization, Methodology, Project Administration, Supervision, Validation

Rim Ghammam
Roles: Formal Analysis, Methodology, Software, Supervision, Validation

Walid Ouanes
Roles: Supervision, Validation, Visualization

Sonia Jemni
Roles: Supervision, Validation, Visualization

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Patients treated in Physical Medicine and Rehabilitation (PM&R) departments benefit from global and multidisciplinary long-term care. The study of satisfaction represents an important element in the evaluation of the quality of the healthcare provided. The aim of this study is to assess the level of satisfaction of patients treated in the PM&R department of Sahloul university hospital of Sousse Tunisia as well as the associated factors during the year 2020.

Methods

We conducted a cross-sectional study, including patients treated in the hospitalization and the outpatient units of the PM&R department. Monnin and Perneger scale validated in Arabic was used to measure satisfaction in its different dimensions. Medical data were completed from patients’ records.

Results

A total of 240 patients were included in our study. The level of satisfaction was significantly higher with the admission procedures for inpatients compared to outpatients (87.9% vs. 60.0%, p<0.001). Regarding the global assessment, 82.1% of patients were satisfied. Multivariate analysis showed that for administrative procedures, consultation for outpatients was a factor of dissatisfaction (aOR=0.18, p<0.001). Patients’ physiotherapy treatment during the Covid-19 period was negatively associated with satisfaction for logistics (aOR= 0.44, p=0.011) and for the global assessment of health care provided in our department (aOR= 0.46, p=0.04).

Conclusion

Our study showed overall good levels of satisfaction in the department of PM&R of Sahloul. However, more studies should follow to determine other factors that can influence satisfaction.

Keywords

physical medicine and rehabilitation, patient satisfaction, questionnaire, inpatients, outpatients.

Corresponding author: Leila Hamadou

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Hamadou L et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Hamadou L, Moncer R, Ghammam R et al. Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study [version 1; peer review: 1 not approved]. F1000Research 2024, 13:662 (https://doi.org/10.12688/f1000research.152248.1) First published: 19 Jun 2024, 13:662 (https://doi.org/10.12688/f1000research.152248.1) Latest published: 19 Jun 2024, 13:662 (https://doi.org/10.12688/f1000research.152248.1)

Introduction

Nowadays, the quality of care provided to patients by health establishments represents one of the essential objectives of health systems in the world and in Tunisia specifically. In fact, the evaluation of the quality of the services offered is a validated indicator of the efficiency of a health system.¹

Several elements reflect the quality of the healthcare, including patient satisfaction.²^–⁴

In Tunisia, a North-African developing country, intra-hospital activity in third line hospitals represents a very important part of the activity of the healthcare system, whether for hospitalizations, surgical procedures or outpatient consultations.

Sahloul University Hospital in Sousse is one of the largest 3rd line hospitals in the Tunisian center. It also drains several regions of east, center, north and south of Tunisia.

In physical medicine and rehabilitation (PM&R), the services differ from other medical or surgical department by the multidisciplinary management involving several healthcare providers (physiotherapists, nurses, occupational therapists, speech therapists, etc).

Several studies focusing on the measurement of patient satisfaction in the PM&R departments have been carried out internationally.⁵^–⁷ However, there are only a few publications on this subject in Tunisia.

The aim of our work is to study the satisfaction of inpatients and outpatients in the PM&R department of Sahloul hospital in 2020 and to specify the factors associated with satisfaction in order to improve the quality of the care provided during and after the Covid-19 era.

Methods

Study design

This is a cross-sectional study conducted in the PM&R department of Sahloul university hospital, Sousse, Tunisia from January 2020 to December 2020 including inpatients and outpatients of the same department.

The inclusion criteria were patients of all ages consulting or hospitalized during the period from January 2020 to December 2020 until the calculated sample size was obtained.

Non-inclusion criteria were comprehension or expression problems with the absence of a family member who accompanied the patient during his rehabilitation treatment to answer the questionnaire in his place and patients whose treatment did not require functional rehabilitation sessions as well as those who underwent rehabilitation sessions in another public hospital structure or in the private sector.

The size of our sample was calculated according to an expected prevalence of patient satisfaction estimated at 80.6%⁸ with a precision of 5% and an α risk of 5%. Thus, it was estimated at 237 patients.

Data collection

Data collection was conducted by a single trained interviewer.

For each patient, we established a questionnaire in Arabic to collect data about:

• Anamnestic data: The first part is an anamnesis of each patient on their socio-demographic characteristics: age, sex, educational level was specified for all patients whose age was greater than or equal to 06 years. The nature of the service offered (hospitalization or outpatient consultation), the pathology for which the patient is followed in PM&R and the occurrence or the absence of complication during hospitalization were also collected from patients’ medical records.
• The Monnin and Perneger satisfaction scale: The second part was dedicated to the study of the satisfaction of patients treated in the physical medicine department.

For this, we used the scale developed by Monnin and Perneger⁹ published in 2002 and validated for inpatients and outpatients in rehabilitation settings. We used the validated Arabic version of this scale¹⁰ published by Devreux et al. in 2012⁸ after contacting the corresponding author and obtaining permission to use the scale for our study.

This scale is made up of 14 questions exploring four dimensions (D) of satisfaction:

• D1=Admission subscale (03 questions: item 1,2 and 3).
• D2=Treatment subscale (05 questions: from item 4 to item 8).
• D3=Logistic subscale (04 questions: from item 9 to item 12).
• D4=Global assessment subscale (02 questions: item 13 and 14).

The satisfaction response for each question is based on a 05-point Likert scale (01 “poor,” 02 “fair,” 03 “good,” 04 “very good,” 05 “excellent”). Each item on the scale is then converted into a score out of 100 using the following formula: score _(0–100) = 25 x (score _(1–5)-1).⁹

We define a satisfied patient if he has a score >75 for the item considered corresponding to a response of 04=very good or 05=excellent for this item.

Data analysis

Data were analyzed using IBM SPSS version 10.0 software (IBM Corp., Armonk, NY, USA). The qualitative variables were presented in the form of counts and percentages. Quantitative variables were expressed as means +/- standard deviations or median and their interval interquartile (Q1-Q3).

The comparison of the percentages was carried out using the Chi 2 test according to the indication. The degree of significance (p) was set at 5%.

Binary logistic regression model was performed for each satisfaction dimension. Variables with p value ≤0.2 at univariate analysis were included in the model (except the variable onset of complications during hospitalization).

Ethical considerations

Approval from the Ethics Committee of the Faculty of Medicine “Ibn El Jazzar” Sousse was obtained for this study.¹¹

Our study does not involve any risk for the participants. We respected anonymity and medical secrecy when collecting the data. For minors, consent from the legal guardian has been obtained.¹²

Results

The total number of patients included in this study was 240. Among these patients, there were 58.3% inpatients and 41.7% outpatients. Participants answered the questionnaire themselves in 84.6% of cases and 15.4% of the answers were provided by a family member who accompanied the patient during his physical therapy.¹³

The average age of the patients was 42±19.56 years with a minimum of 06 months and a maximum of 77 years (median: 45 [Q1=29, Q3=57] years). The majority of our study’s participants had primary education level (38.2%) and 22.3% of patients were illiterate. The distribution of participants according to socio-demographic characteristics is described in Table 1.

Table 1. Characteristics of patients of the PM&R department, Sahloul University Hospital, Sousse 2020.

		n	%
Age	≤ à 18	38	15.8
	]18, 45[	77	32.1
	[45, 60[	68	28.3
	≥ à 60	57	23.8
Sex	Male	103	42.9
Sex	Female	137	57.1
Education level	Illiterate	49	22.3
	Primary level	84	38.2
	Preparatory	22	10.0
	Secondary	45	20.5
	University	20	9.1
Pathology	Central nervous system	126	52.5
	Peripheral nervous system	19	7.9
	Osteoarticular/musculotendinous	95	39.6
Complications	No complications	119	85
	Urinary tract infection	10	7.1
	Pressure ulcer	4	2.9
	Pulmonary embolism	2	1.4
	Pressure ulcer + pulmonary embolism	2	1.4
	Osteosynthesis associated infection	1	0.7
	Focal myositis	1	0.7
	Drug eruption: DRESS syndrome	1	0.7

The most frequent conditions were the pathologies of the central nervous system (52.5%) with a predominance of post-traumatic paraplegia (10.4%), cerebral palsy (9.2%) and stroke sequelae (8.8%). Cauda equina syndrome represents the most common condition for the pathologies of the peripheral nervous system (2.9%). Polyarthralgia was the most common osteoarticular condition (11.7%).

Among the hospitalized patients included in our sample, 15% developed complications. Urinary tract infection was the most common complication (7.1%), followed by pressure ulcer (2.9%) and pulmonary embolism (1.4%) (Table 1).

Patients’ satisfaction in the PM&R department

The satisfaction regarding admission procedures (D1) was 76.2% (Figure 1). For the ease of administrative procedures (item 1), 71.7% of patients were satisfied. The rate of dissatisfaction (poor, fair and good) was higher with outpatients (45%) compared to the inpatients (16.5%). Concerning the courtesy and helpfulness of the secretaries (item 2), the overall satisfaction was 97.5% (95.7% for inpatients and 100% for outpatients). The participants questioned were 97.1% satisfied with the simplicity of scheduling and the time required to obtain the first appointment (item 3).

Figure 1. Patients’ satisfaction according to the dimensions explored by the Monnin and Perneger questionnaire in the PM&R department, Sahloul University Hospital, Sousse 2020.

For functional treatment (D2) satisfaction was 58.8% (Figure 1): 85.1% of patients were satisfied with the physiotherapist's ability to put them at ease and reassure them (item 4). The explanations received regarding the treatment (item 5) were satisfying in 60.9% of cases (57.8% for hospitalization and 65% for outpatient consultation). The patients were satisfied with the feeling of security during the treatment (item 7: 88.3%) and the extent to which treatment was adapted to their problem (item 8: 73.3%).

Regarding satisfaction with logistics (D3), 92.1% of patients were satisfied with the ease of access of physical therapy facilities (item 9), and 67.5% with the indications to help find the way around and in hospital buildings. The comfort of the room where physical therapy was provided (item 11) was satisfying in 75% of cases. The atmosphere in the physical therapy rooms was considered calm and restful (item 12) for 86.3% of patients.

The physical therapy was overall satisfying for 77.1% of patients (81.4% for inpatients and 71% for outpatients) (item 13).

In our population, 90.1% of participants would recommend our PM&R department to people close to them (item 14). The degrees of satisfaction regarding the items of Monnin and Perneger questionnaire in the Sahloul PM&R department are reported in Table 2.

Table 2. Description of the items of the Monnin and Perneger satisfaction questionnaire, Sahloul University Hospital, Sousse 2020.

Items of « Monnin and Perneger » questionnaire		Poor n(%)	Fair n(%)	Good n(%)	Very Good n(%)	Excellent n(%)
D1: Admission	ITEM 1: Ease of administrative admission procedures
	Total	23(9.6)	22(9.2)	23(9.6)	97(40.4)	75(31.3)
	Inpatient	5(3.6)	5(3.6)	13(9.3)	59(42.1)	58(41.4)
	Outpatient	18(18.0)	17(17.0)	10(10.0)	38(38.0)	17(17.0)
	ITEM 2: Courtesy and helpfulness of secretary
	Total	1(0.4)	3(1.3)	2(0.8)	132(55.0)	102(42.5)
	Inpatient	1(0.7)	3(2.1)	2(1.4)	59(42.1)	75(53.6)
	Outpatient	0(0.0)	0(0.0)	0(0.0)	73(73.0)	27(27.0)
	ITEM 3: Simplicity of scheduling and time to get first appointment
	Total	0(0.0)	2(0.8)	5(2.1)	104(43.3)	129(53.8)
	Inpatient	0(0.0)	2(1.4)	2(1.4)	58(41.4)	78(55.7)
	Outpatient	0(0.0)	0(0.0)	3(3.0)	46(46.0)	51(51.0)
D2: Treatment	ITEM 4: Ability of physical therapist to put you at ease and reassure you
	Total	7(2.9)	10(4.2)	19(7.9)	63(26.3)	141(58.8)
	Inpatient	5(3.6)	5(3.6)	12(8.6)	35(25.0)	83(59.3)
	Outpatient	2(2.0)	5(5.0)	7(7.0)	28(28.0)	58(58.0)
	ITEM 5: Explanations about what will be done to you during treatment
	Total	43(17.9)	21(8.8)	30(12.5)	46(19.2)	100(41.7)
	Inpatient	24(17.1)	12(8.6)	23(16.4)	30(21.4)	51(36.4)
	Outpatient	19(19.0)	9(9.0)	7(7.0)	16(16.0)	49(49.0)
	ITEM 6: Quality of information you received at the end of treatment regarding future
	Total	42(17.5)	22(9.2)	37(15.4)	69(28.7)	70(29.2)
	Inpatient	26(18.6)	17(12.1)	25(17.9)	28(20.0)	44(31.4)
	Outpatient	16(16.0)	5(5.0)	12(12.0)	41(41.0)	26(26.0)
	ITEM 7: Feeling of security at all times during the treatment
	Total	3(1.3)	12(5.0)	13(5.4)	69(28.7)	143(59.6)
	Inpatient	3(2.1)	9(6.4)	8(5.7)	26(18.6)	94(67.1)
	Outpatient	0(0.0)	3(3.0)	5(5.0)	43(43.0)	49(49.0)
	ITEM 8: Extent to which treatment was adapted to your problem
	Total	6(2.5)	22(9.2)	36(15.0)	67(27.9)	109(45.4)
	Inpatient	5(3.6)	8(5.7)	21(15.0)	35(25.0)	71(50.7)
	Outpatient	1(1.0)	14(14.0)	15(15.0)	32(32.0)	38(38.0)
D3: Logistics	ITEM 9: Ease of access of physical therapy facilities
	Total	0(0.0)	2(0.8)	17(7.1)	106(44.2)	115(47.9)
	Inpatient	0(0.0)	2(1.4)	16(11.4)	40(28.6)	82(58.6)
	Outpatient	0(0.0)	0(0.0)	1(1.0)	66(66.0)	33(33.0)
	ITEM 10: Indications to help you find your way around and in hospital buildings
	Total	3(1.3)	20(8.3)	55(22.9)	103(42.9)	59(24.6)
	Inpatient	3(2.1)	6(4.3)	27(19.3)	68(48.6)	36(25.7)
	Outpatient	0(0.0)	14(14.0)	28(28.0)	35(35.0)	23(23.0)
	ITEM 11: Comfort of the room where physical therapy was provided
	Total	9(3.8)	17(7.1)	34(14.2)	76(31.7)	104(43.3)
	Inpatient	6(4.3)	5(3.6)	14(10.0)	43(30.7)	72(51.4)
	Outpatient	3(3.0)	12(12.0)	20(20.0)	33(33.0)	32(32.0)
	ITEM 12: Calm and relaxing atmosphere in physical therapy rooms
	Total	9(3.8)	3(1.3)	21(8.8)	51(21.3)	156(65.0)
	Inpatient	9(6.4)	3(2.1)	13(9.3)	34(24.3)	81(57.9)
	Outpatient	0(0.0)	0(0.0)	8(8.0)	17(17.0)	75(75.0)
D4: Global assessment	ITEM 13: Your physical therapy overall
	Total	4(1.7)	7(2.9)	44(18.3)	101(42.1)	84(35.0)
	Inpatient	2(1.4)	3(2.1)	21(15.0)	50(35.7)	64(45.7)
	Outpatient	2(2.0)	4(4.0)	23(23.0)	51(51.0)	20(20.0)
	ITEM 14: Would you recommend this facility to people close to you?
		Certainly not	Probably not	Not sure	Yes, probably	Yes, certainly
	Total	5(2.1)	10(4.2)	9(3.8)	33(13.8)	183(76.3)
	Inpatient	2(1.4)	5(3.6)	3(2.1)	19(13.6)	111(79.3)
	Outpatient	3(3.0)	5(5.0)	6(6.0)	14(14.0)	72(72.0)

Patients’ satisfaction in the PM&R department and associated factors

For admission procedures (D1), inpatients were more satisfied than outpatients (87.9% vs 60.0%) with a statistically significant difference (p<0.001). Furthermore, we did not find any significant difference in satisfaction between hospitalization department and outpatient unit for functional treatment (D2), logistics (D3), and global assessment (D4). Regarding admission procedures (D1), patients aged 45 to 60 were satisfied at 88.2%. We found a statistically significant difference in satisfaction between the age groups for this dimension D1 (p=0.017). For functional treatment (D2), 73.7% of patients under 18 were satisfied. There was a statistically significant difference in the level of satisfaction between the different age groups for this dimension D2 (p=0.036). For the logistics (D3) and the global assessment of physical therapy (D4), we did not find a statistically significant relationship between age and patient satisfaction.

In our study sample, men were more satisfied than women with admission procedures (D1) (80.6% vs 73.0%). However, the difference was not significant (p=0.17). The level of satisfaction was not significantly different between men and women regarding the other dimensions (D2, D3 and D4).

Patients with a secondary or university level of education had a higher level of satisfaction than those who were illiterate or had primary level of education for admission procedures (D1) (81.5% vs 78.1%) and functional treatment (D2) (61.5% vs 56.8%). However, the difference in satisfaction was not significant between these education levels and these two dimensions (D1 and D2) (p=0.563 and p=0.513 respectively). Besides, patients who were illiterate or had a primary education level (primary + preparatory) were more satisfied than those with a secondary or university education level for logistics (D3) (74.2% vs 60.0%) with a statistically significant difference (p=0.036). The level of satisfaction regarding the global assessment of the physical therapy (D4) was not significantly different between the two groups (p=0.14).

Before the Covid-19 pandemic, patients were significantly more satisfied (83.2%) with admission procedures (D1) than patients treated during the pandemic (71.7%) (p=0.042). However, the period of care (before or during the pandemic) did not affect the satisfaction of our population regarding the treatment received or the logistics (p=0.568 and p=0.051 respectively). In addition, global satisfaction of the physical therapy (D4) was significantly higher before this pandemic (88.4% vs 77.9%, p=0.038) (Figure 2).

Figure 2. Satisfaction of the population studied according to the period of physical therapy, PM&R department, Sahloul University Hospital, Sousse 2020.

The level of satisfaction with admission procedures (D1) was not statistically different according to the type of patient's pathology (p=0.892). Similarly, the level of satisfaction was not associated with the type of patients’ pathologies in the different dimensions (treatment, logistics and global assessment).

The patients included in our study who were hospitalized in the PM&R department were more satisfied in the absence of the occurrence of complication(s) during hospitalization for admission procedures (D1) (89.1%), functional treatment (D2) (58.8%), logistics (D3) (73.1%) and global assessment of care (D4) (86.6%) We did not find a statistically significant difference in satisfaction with services for all the dimensions studied in patients who presented one or more complications during hospitalization versus those who did not present complications. The satisfaction of our population according to the associated factors is reported in Table 3.

Table 3. Satisfaction of the population studied according to the associated factors, Sahloul University Hospital, Sousse 2020.

Dimensions	D1			D2			D3			D4
Satisfaction	Yes n (%)	No n (%)	p	Yes n (%)	No n (%)	p	Yes n (%)	No n (%)	p	Yes n (%)	No n (%)	p
*Unit*
Inpatient	123(87.9)	17(12.1)	<0.001	79(56.4)	61(43.6)	0.387	102(72.9)	38(27.1)	0.414	119(85.0)	21(15.0)	0.163
Outpatient	60(60.0)	40(40.0)	<0.001	62(62.0)	38(38.0)	0.387	68(68.0)	32(32.0)	0.414	78(78.0)	22(22.0)	0.163
*Age category*
≤ à 18	24(63.2)	14 (36.8)	0.017	28(73.7)	10(26.3)	0.036	31(81.6)	7(18.4)	0.291	32(84.2)	6(15.8)	0.359
]18, 45[	59(76.6)	18(23.4)		49(63.6)	28(36.4)		52(67.5)	25(32.5)		61(79.2)	16(20.8)
[45, 60[	60(88.2)	8(11.8)		38(55.9)	30(44.1)		50(73.5)	18(26.5)		60(88.2)	8(11.8)
≥ à 60	40(70.2)	17(29.8)		26(45.6)	31(54.4)		37(64.9)	20(35.1)		44(77.2)	13(22.8)
*Gender*
Male	83(80.6)	20(19.4)	0.171	57(55.3)	46(44.7)	0.352	71(68.9)	32(31.1)	0.574	80(77.7)	23(22.3)	0.122
Female	100(73.0)	37(27.0)	0.171	84(61.3)	53(38.7)	0.352	99(72.3)	38(27.7)	0.574	117(85.4)	20(14.6)	0.122
*Education level*
Illiterate + basic education	121(78.1)	34(21.9)	0.563	88(56.8)	67(43.2)	0.513	115(74.2)	40(25.8)	0.036	132(85.2)	23(14.8)	0.140
Secondary + university education	53(81.5)	12(18.5)	0.563	40(61.5)	25(38.5)	0.513	39(60.0)	26(40.0)	0.036	50(76.9)	15(23.1)	0.140
*Period of physical therapy*
Before Covid-19	79(83.2)	16(16.8)	0.042	58(61.1)	37(38.9)	0.558	74(77.9)	21(22.1)	0.051	84(88.4)	11(11.6)	0.038
During Covid-19	104(71.7)	41(28.3)	0.042	83(57.2)	62(42.8)	0.558	96(66.2)	49(33.8)	0.051	113(77.9)	32(22.1)	0.038
*Pathology*
Neurological	111(76.6)	34(23.4)	0.892	87(60.0)	58(40.0)	0.627	101(69.7)	44(30.3)	0.620	119(82.1)	26(17.9)	0.994
Osteoarticular/musculotendinous	72(75.8)	23(24.2)	0.892	54(56.8)	41(43.2)	0.627	69(72.6)	26(27.4)	0.620	78(82.1)	17(17.9)	0.994
*Occurrence of complications*
No	106(89.1)	13(10.9)	0.287	70(58.8)	49(41.2)	0.174	87(73.1)	32(26.9)	0.873	103(86.6)	16(13.4)	0.371
Yes	17(81.0)	4(19.0)	0.287	9(42.9)	12(57.1)	0.174	15(71.4)	6(28.6)	0.873	16(76.2)	5(23.8)	0.371

Multivariate analysis of satisfaction’s factors of patients treated in physical medicine

We determined the factors independently associated with each domain of our population's satisfaction scale. For this, we performed 04 binary logistic regression models (Table 4). The only independent factor after multivariate analysis for dimension 2 (Treatment) was age ≥ 60 years. Treatment during the pandemic decreased the level of satisfaction by 0.44 times (95% CI [0.233; 0.827], p=0.011) after adjustment for education level for dimension 3 and by 0.46 times (CI at 95% [0.218; 0.964] p=0.04) after adjusting for gender for dimension 4 (Table 4).

Table 4. Factors associated with patient satisfaction in relation to studied dimensions in the PM&R department, Sahloul University Hospital, Sousse 2020.

Dimensions of satisfaction	Variable	p	(aOR)	95% CI
D1: Admission	Service provided: (outpatient consultation)	<0.001	0.179	0.087-0.367
	Age categories: ≤ 18 ans	0.033
	]18, 45[	0.718	0.838	0.321-2.187
	[45, 60[	0.025	3.268	1.164 – 9.177
	≥ à 60	0.872	0.926	0.363 – 2.362
D2: Treatement	Age categories: ≤ 18 ans	0.040
	]18, 45[	0.283	0.625	0.265 – 1.475
	[45, 60[	0.073	0.452	0.190 – 1.076
	≥ à 60	0.008	0.300	0.123 – 0.730
D3*: Logistics	Year of physical therapy (2020)	0.011	0.439	0.233 – 0.827
D4**: Global assessment	Year of physical therapy (2020)	0.040	0.458	0.218 – 0.964

* D3 education level adjusted model.

** D4 gender adjusted model.

Discussion

Currently in Tunisia, there are only two hospitalization departments in physical medicine: in Tunis at the Kassab Institute of Orthopedics and at the Tunisian center at the Sahloul university hospital in Sousse. The PM&R department of Sahloul Hospital drains all patients from the center and sometimes from southern Tunisia where there is not yet a PM&R hospitalization unit. However, no work has been conducted in this department with the aim of evaluating the quality of the health care and describing the shortcomings of the services provided.

We decided to conduct a descriptive cross-sectional study to measure the satisfaction of inpatients and outpatients of the PM&R department of Sahloul university hospital during the year 2020, including patients from all age groups, which has not been achieved until now in a physical medicine department in Tunisia.

Our study showed an overall satisfaction with administrative procedures (D1) of 76.3% with a statistically higher rate for hospitalizations versus outpatient consultations (87.9% vs 60.0%, p<0.001). Delanian et al.¹⁴ in 2008, using a self-administered questionnaire, studied the satisfaction of patients treated in a PM&R day hospital created at the Timone hospital in Marseille and the satisfaction with the reception at the admission office was 94%.

The difference in satisfaction of dimension D1 of our questionnaire that we found between hospitalization and outpatient consultation could be explained by the fact that at Sahloul university hospital, the hospitalization department and the admissions’ office for hospitalizations are located in the same main hospital building. Besides, registering for the outpatient consultation is done in a second building where the waiting time in front of the counters is longer, which is a major inconvenience for patients with a functional limitation.

Our results showed a satisfaction rate for the treatment received in our service (D2) of 58.8%. The highest satisfaction rate was for the feeling of security during treatment (88.3%) and the lowest rate for the quality of information received at the end of treatment (57.9%). This is similar to the study conducted by Devreux et al.⁸ in Jeddah including the questionnaire on which we based to conduct our study, they found a satisfaction with the treatment of 79.9%, the feeling of security of 81.6% with the lowest rate for information received at the end of treatment: 69.2%.⁸

Joublin¹⁵ studied the satisfaction of patients treated in “Le Belloy” functional and professional rehabilitation center, located in Oise-France. She found a high rate of satisfaction reaching 100% for the feeling about the competence of the physiotherapist and the quality of care, while the lowest satisfaction rate was 90% for the continuity of care.¹⁵ In Tunisia, Ghidaoui et al.¹⁶ found that 86% of parents believed that doctors were understanding with their children. Listening, availability and general benevolence of doctors towards the child were appreciated with 95% of parents satisfied.¹⁶ For satisfaction with the logistics (D3), our results showed a rate of 70.8%. This is far from the results of Joublin¹⁵ who found a satisfaction rate of 99% for the logistics of the functional and professional rehabilitation center Le Belloy, while Delanian et al.¹⁴ found 81% satisfaction with the logistics of the PM&R day hospital at the Timone hospital center in Marseille.

The global assessment of physical therapy (D4) in our department showed a satisfaction rate of 82.1%. This is similar to data from Devreux et al.,⁸ where the global satisfaction rate for rehabilitation care is 80.6%. Delanian et al.¹⁴ found global satisfaction estimated at 98% for patients treated in the PM&R day hospital in Marseille.¹⁴

Concerning the factors associated with satisfaction studied in our work, our results showed for the socio-demographic factors a statistically significant difference in satisfaction between the age groups for the D1 admission procedures (p=0.017) and for the treatment received D2 (p=0.036). Our results join the data of the literature. In the study of factors associated with global patient satisfaction in rehabilitation facilities in New Jersey, USA, Oh-Park et al.¹⁷ found that the dissatisfied patients were older (mean age 68.9 versus 67.7).¹⁷

In our study, there was no statistically significant relationship between patient satisfaction and patients’gender for all the dimensions studied. For Afzal et al.¹⁸ also, gender did not show a significant effect on the satisfaction score. Besides, Thi et al.¹⁹ noted a higher frequency of complaints for women (60.4%) when measuring satisfaction.

Regarding the education level, our results showed that patients who were illiterate or had a basic level of education were more satisfied than those with a secondary or university education level for logistics (D3) (p=0.036). Worldwide, Afzal et al.¹⁸ showed that illiterate or less educated patients were significantly more satisfied (p=0.003) with the care provided by the health establishment considered. Thi et al.¹⁹ reported a higher level of dissatisfaction in patients with a post-secondary level of education (72%) towards the quality of care.¹⁹ In Tunisia, in a rehabilitation department, Ghidaoui¹⁶ found similar results: the high level of education of mothers negatively influences satisfaction with the proper functioning of the department as well as therapeutic interventions.¹⁶

Regarding the period of physical therapy, patients were more satisfied before the Covid-19 period for all the dimensions of the questionnaire in our study. In the literature, we found several studies of satisfaction during the Covid period before and after the implementation of new measures to protect patients.²⁰^,²¹

Regarding the difference in satisfaction between the before and during Covid-19 period found in our study, this could be the consequence of the long waiting time in the queues at the check-in counters in the outpatient unit and its association with a greater risk of contamination by Covid-19 because of the non-respect of distancing and the wearing of masks by certain patients. During the waves of the pandemic, paramedical staff with chronic illnesses and the visually impaired have benefited from long-term leaves. This resulted in a lack of staff of physiotherapists working in the Sahloul PM&R department with deployment and solicitation of the remaining staff. These measures would have caused an exhaustion of the staff working in the Covid period, having as a probable consequence a drop in the performance and quality of the care provided, thus responsible for patient dissatisfaction. In Tunisia, telemedicine should be developed: prepare the legislative framework (virtual medical visits and remote drug prescriptions recognized by social security) and provide the necessary means (computers, internet connection available in doctors' offices) in order to overcome the shortcomings in healthcare, especially in times of crisis.

For the satisfaction of patients hospitalized in the Sahloul PM&R department, we did not find a relationship with the pathologies treated (neurological or osteoarticular/musculotendinous) in the different dimensions of satisfaction studied. In the literature, Oh-Park¹⁷ reported that patients dissatisfied with rehabilitation had more neurological diagnoses (44.0% versus 31.3%).¹⁷

Ghidaoui¹⁶ in her study including children with cerebral palsy found a significant positive correlation (p=0.05) between the satisfaction of the patient-caregiver relationship and the GMFCS classification (The Gross Motor Function Classification System is a 5-level clinical classification that describes the gross motor function of people with cerebral palsy and therefore reflects the severity of the motor disability). There was also a significant positive correlation between satisfaction with the care provided and the level of impairment according to the GMFCS classification (p=0.01). The heavier the pathology, the less satisfied the mothers were.¹⁶

In our study, for the occurrence of complications in hospitalized patients, we found that patients who had no complications were more satisfied than those who had one or more complications for all the dimensions studied without statistically significant difference. In the literature, authors found that patients were significantly less satisfied when they develop complications.²²^–²⁴

Our descriptive cross-sectional study of the patients’ satisfaction treated in the Sahloul-Sousse PM&R department during the year 2020 has strengths and limitations.

Considering the international studies of satisfaction in rehabilitation settings, the numbers of patients included vary considerably from one publication to another. The size of our sample was calculated and represents a strength of this study compared to previous work conducted in our country.¹⁶ The questionnaire used is a validated tool in Arabic, easy to administrate with limited number of questions. In addition, this scale was validated for inpatients and outpatients, which enabled us to recruit patients from both units of the PM&R Sahloul department. Another positive point of our work tool is the use of four dimensions of satisfaction which are: administrative procedures, functional treatment received, logistics as well as the global assessment of the physical therapy, which enabled us to have a general idea of satisfaction in the rehabilitation setting.⁸ The presence of a validated version in Arabic encouraged the use of this questionnaire in our study since it goes with the socio-cultural context of the Tunisian population.¹⁰ The limitation of this tool may be the absence of open questions allowing patients to express themselves regarding their satisfactions and dissatisfactions without being limited in their answers by pre-established proposals. Another limitation of our study is that satisfaction is a subjective concept and may vary over time, hence the utility of using validated scales. In addition, the data collection conditions were more appropriate for hospitalized patients (ward rooms, calm atmosphere, more time to ask questions and explain them properly to patients) than for consultants at the outpatient unit. To avoid variability in data collection we standardized data collection: for each participant, the interviewer should introduce himself, explain the objective of the study and ask for the patient's approval for participation, then his answers should be collected without intimidating or influencing him. Data collection was performed also by the same trained interviewer.

Finally, based on the results of our study, we suggest the following recommendations in order to improve patients’ satisfaction and to ensure the proper functioning of PM&R departments:

• Digitization of admission procedures in order to limit patients’ movements and the duration of registration.
• In times of crisis, the appointments for rehabilitation sessions should be divided between the morning and the afternoon to avoid overcrowding and reduce the waiting time.
The number of rehabilitation sessions prescribed should be reduced and focused on learning self-rehabilitation exercises and educating patients for therapeutic observance at home.
• Develop the technical and legislative platform in order to establish telemedicine to ensure patients’ follow up.

Conclusion

Patient satisfaction with the healthcare services provided is a major criterion for evaluating the health system and the continuous improvement of the services offered. For this, several teams around the world have opted for the study of satisfaction and its associated factors in order to improve the quality of their services. Our study showed globally good levels of satisfaction in the Sahloul PM&R department. Nevertheless, other studies need to be conducted in order to study the other factors that can influence satisfaction and to propose action plan to improve health services in developing countries.

Ethical considerations

Approval from the Ethics Committee of the Faculty of Medicine “Ibn El Jazzar” Sousse was obtained for this study (Ref: CEFMS 80/2019, date of approval: 22/12/2019).¹¹

Our study does not involve any risk for the participants. We respected anonymity and medical secrecy when collecting the data. Written consents were obtained from adult participants and legal guardians of minor participants.¹²

Authors’ contributions

The research idea was conceived by Sonia Jemni and Rihab Moncer. Data acquisition, draft preparation and writing was carried out by Leila Hamadou, Rihab Moncer and Rym Ghammam. The rest of the authors reviewed the article, revised the discussion critically and checked the references.

All authors have revised and approved the final version of the manuscript.

Data availability

• Satisfaction of patients treated in a physical medicine and rehabilitation department during the covid-19 pandemic: Dataset. DOI: 10.6084/m9.figshare.25904920.v2.¹³
available on the figshare repository under the license CC0

Extended data

This study contains the following extended data:

1. Satisfaction of patients treated in a physical medicine and rehabilitation department during the covid-19 pandemic: Monnin and Perneger questionnaire in arabic. DOI:10.6084/m9.figshare.25935001.v2.¹⁰
- • Satisfaction of patients treated in a physical medicine and rehabilitation department during the covid-19 pandemic: participants' consent forms (for adults and legal guardians) in arabic. DOI:10.6084/m9.figshare.25934776.v2.¹²
- • Satisfaction of patients treated in a physical medicine and rehabilitation department during the covid-19 pandemic: approval of the ethics committee for the study. DOI:10.6084/m9.figshare.25934413.v2.¹¹

available on the figshare repository under the license CC0

Reporting guidelines

DOI: 10.6084/m9.figshare.26026477

STROBE Statement—Checklist of items that should be included in reports of cross-sectional studies

Acknowledgements

The authors would like to thank the participants in this study and the medical staff in the PM&R department of Sahloul university hospital of Sousse, Tunisia.

References

1. Yamba MKY, Mashinda DK, Kayembe J-MN, et al.: Evaluation de la qualité des soins aux Cliniques Universitaires de Kinshasa: étude de satisfaction des patients hospitalisés Assessment of the quality of care at the Kinshasa University Hospital: perception of attending patients. Ann. Afr. Med. 2018; 11: e2926.
2. Zemni I, Safer M, Khelil M, et al.: Patient satisfaction in a tertiary care center (Tunisia, 2015-2016). Tunis. Med. 2018; 96: 737–745. PubMed Abstract
3. Midoun N, Boumansour N, Dali AA, et al.: Mesure de la satisfaction des patients hospitalisés dans un établissement hospitalier universitaire, vis-à-vis de la qualité des soins, de la restauration et de la relation avec le personnel. Rev d’Épidémiologie Santé Publique. 2016; 64: S243. Publisher Full Text
4. Seleznev I, Alibekova R, Clementi A: Patient satisfaction in Kazakhstan: Looking through the prism of patient healthcare experience. Patient Educ. Couns. 2020; 103: 2368–2372. PubMed Abstract | Publisher Full Text
5. Zhao M, Haley DR, Nolin JM, et al.: Utilization, cost, payment, and patient satisfaction of rehabilitative services in Shandong. China. Health Policy. 2009; 93: 21–26. PubMed Abstract | Publisher Full Text
6. De Paula DAG, Piatti NCTP, Costa LM, et al.: Satisfaction levels with physical therapy in hospitalized patients. Braz. J. Phys. Ther. 2020; 24: 118–123. PubMed Abstract | Publisher Full Text | Free Full Text
7. Gupta P, Parmar N, Mand G: Patient satisfaction in prosthetic rehabilitation programme. Med. J. Armed Forces India. 2001; 57: 95–98. PubMed Abstract | Publisher Full Text | Free Full Text
8. Devreux IC, Jacquerye A, Kittel F, et al.: Benchmarking of patient satisfaction with physical rehabilitation services in various hospitals of Jeddah. Life Sci. J. 2012; 9: 73–78.
9. Monnin D, Perneger TV: Scale to Measure Patient Satisfaction With Physical Therapy. Phys. Ther. 2002; 82: 682–691. Publisher Full Text
10. Hamadou L, Moncer R, Ghammam R, et al.: Satisfaction of patients treated in a physical medicine and rehabilitation department during the covid-19 pandemic: Monnin and Perneger questionnaire in arabic. figshare. Epub ahead of print 30 May 2024. Publisher Full Text
11. Hamadou L, Moncer R, Ghammam R, et al.: Satisfaction of patients treated in a physical medicine and rehabilitation department during the covid-19 pandemic: approval of the ethics committee for the study. Epub ahead of print 7 June 2024. Publisher Full Text
12. Hamadou L, Moncer R, Ghammam R, et al.: Satisfaction of patients treated in a physical medicine and rehabilitation department during the covid-19 pandemic: participants’ consent forms (for adults and legal guardians) in arabic. Epub ahead of print 7 June 2024. Publisher Full Text
13. Hamadou L, Moncer R, Ghammam R, et al.: Satisfaction of patients treated in a physical medicine and rehabilitation department during the covid-19 pandemic. Dataset. Epub ahead of print 26 May 2024. Publisher Full Text
14. Delanian Halsdorfer N, Blasquez J, Bensoussan L, et al.: An assessment of patient satisfaction for a short-stay program in a physical and rehabilitation medicine day hospital. Ann. Phys. Rehabil. Med. 2011; 54: 236–247. PubMed Abstract | Publisher Full Text
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Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 19 Jun 2024

Author details Author details

Leila Hamadou
Roles: Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing

Rihab Moncer
Roles: Conceptualization, Methodology, Project Administration, Supervision, Validation

Rim Ghammam
Roles: Formal Analysis, Methodology, Software, Supervision, Validation

Walid Ouanes
Roles: Supervision, Validation, Visualization

Sonia Jemni
Roles: Supervision, Validation, Visualization

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

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Hamadou L, Moncer R, Ghammam R et al. Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study [version 1; peer review: 1 not approved]. F1000Research 2024, 13:662 (https://doi.org/10.12688/f1000research.152248.1)

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Reviewer Report 16 Sep 2024

Oliver O'Sullivan, University of Nottingham, Nottingham, UK

Not Approved

https://doi.org/10.5256/f1000research.166984.r320460

Dear Colleagues,

Thank you for inviting me to Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study [version 1], which is a cross-sectional survey performed in 240 patients or their care-givers in 2020.

I have several concerns with the manuscript, starting with the timing and purpose.

I do not understand why this work was performed when it was. To be more precise, throughout Jan - Dec 2020, the entire world was gripped by the COVID-19 pandemic, with lockdown restrictions intermittently implemented globally, hospitals were constantly fighting to avoid being overwhelmed and keep people alive, rehabilitation services were de-prioritised, and their focus was mainly on ITU survivors and those with prolonged COVID-19 symptoms - your manuscript reflects none of this, which makes it hard be convinced by the data. In addition, I struggle to understand why anyone would choose *that* time to perform a study of patient satisfaction. Unless this is sufficiently explained and articulated in the article, I will continue to have doubts about the validity of the data.

I have also struggled to understand why this has been submitted four years later as a full length manuscript. When distilled down, you have performed a review of a single department using a single questionnaire, and have found very little of significance, with any findings only directly applicable to the department in question and, in my view, not of interest to the general medical audience. At very best, given the minimal data presented, this should be a 'letter to the editor' style article, but even then, I don't believe this would add value to the medical canon.

In addition, I have found the repeated use of the male pronoun when referring to your participants inappropriate, especially as there were more females in your study, the fact that only 15.4% of questionnaires were provided by family members but 22.3% of participants were illiterate, the rather erratic style of referencing, and the, at times, irrelevant discussion, not in keeping with good academic work.

I appreciate that this review may appear overly-critical, but as a peer-reviewer we must ensure that potential future additions to the published literature are of a high enough standard and add valuable findings. In my opinion, I am afraid this is neither, and I wanted to be honest with you to avoid you wasting your time further.

Good luck with your future endeavours

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

No
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

No

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Rehabilitation (including physical, medical and neurological)

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Author Response 19 Sep 2024

Leila Hamadou, Department of Physical Medicine and Rehabilitation, Sahloul University Hospital, Sousse, Tunisia

19 Sep 2024

Author Response

Dear Reviewer,

Thank you for accepting to review our paper entitled “Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study ... Continue reading Dear Reviewer,

Thank you for accepting to review our paper entitled “Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study [version 1]”.
In response to your comments, we want to clarify many points:

First comment “I do not understand why this work was performed when it was. To be more precise, throughout Jan - Dec 2020, the entire world was gripped by the COVID-19 pandemic, with lockdown restrictions intermittently implemented globally, hospitals were constantly fighting to avoid being overwhelmed and keep people alive, rehabilitation services were de-prioritised, and their focus was mainly on ITU survivors and those with prolonged COVID-19 symptoms - your manuscript reflects none of this, which makes it hard be convinced by the data. In addition, I struggle to understand why anyone would choose *that* time to perform a study of patient satisfaction. Unless this is sufficiently explained and articulated in the article, I will continue to have doubts about the validity of the data.”

Response 1: Patient satisfaction is a critical factor in assessing the quality of healthcare services especially since our university hospital was preparing the accreditation procedure. And as it is known, patient satisfaction is one of the essential health care quality indicators.
According to the literature and the Rehabilitation 2030 project [1], researchers encourage studies that evaluate both the needs and satisfaction of patients with conditions requiring rehabilitation, as patient satisfaction is a key component of quality of care. This study assessed various domains that may affect this quality indicator, taking into account the specific needs of patients with restricted participation using a validated tool.
So this work is aligned with our hospital's accreditation process, as patient satisfaction is a reflection of care quality. Additionally, our study is part of a broader investigation into patient satisfaction during the COVID-19 pandemic for those in rehabilitation. Many researchers have explored barriers faced by rehabilitation patients during this period, with numerous studies continuing to be published in 2024 on the topic which testifies to the interest and relevance of the subject [2] [3]. If needed, we can include those studies as references in our paper.
It is also important to remember that the study was conducted in a country with limited resources (studies often come from developing countries, which is sometimes limiting) and that the physical medicine department is the only one in the center and southern regions of the country (there are only two department with hospitalization sector in the whole country), it hospitalizes patients who are difficult to manage and it was important to evaluate their satisfaction to draw up improvement actions. In fact, this work served as a basis for some improvement actions carried out in the department.
In addition, the study, was my medical thesis subject and my first research work under the supervision of a physical medicine specialist and an epidemiologist. The study protocol was ready before the “non-expected” COVID 19 pandemic. Data collection started in January 2020, in this period no restrictions of care in our country have been taken yet. The first case of COVID19 in the country was recorded in March 2020. So, we were obliged to continue the work especially that the department activity was not really affected. In fact, another University hospital in the region managed COVID 19 cases during this period and admissions for post-trauma and neurological rehabilitation were not suspended during the data collection period. Certainly, we observed some challenges in accessibility, as highlighted in our paper. Furthermore, every research work has its limitations and the limitations of our work were mentioned in the discussion part.

Second comment “I have also struggled to understand why this has been submitted four years later as a full length manuscript. When distilled down, you have performed a review of a single department using a single questionnaire, and have found very little of significance, with any findings only directly applicable to the department in question and, in my view, not of interest to the general medical audience. At very best, given the minimal data presented, this should be a 'letter to the editor' style article, but even then, I don't believe this would add value to the medical canon.”
In addition, I have found the repeated use of the male pronoun when referring to your participants inappropriate, especially as there were more females in your study, the fact that only 15.4% of questionnaires were provided by family members but 22.3% of participants were illiterate, the rather erratic style of referencing, and the, at times, irrelevant discussion, not in keeping with good academic work.

Response 2:
Thank you for you valuable time to review this manuscript.
I want to emphasize that, I’m a residency trainee, my thesis was presented in 2022, and the article was drafted and completed in December 2022. We revised it several times, and it is normal that this process takes time especially since in our country we lack funds for research and that in the meantime I should validate my medical internships. This work is an original paper that we revised using the strobe grid and is not a letter to the editor.

Regarding your comment concerning the use of gender pronouns, the representation of illiterate participants, and the referencing style, 15.4% of the questionnaires were completed by family members due to the patient's age (in the case of children) or cognitive limitations. For illiterate patients, the investigator read the questionnaire aloud to them. For gender pronouns, it was used only six times in the tables and do not refer to all participants.
In the discussion section, we cited references related to quality of care and patient satisfaction, and we compared our results with those findings in each instance.

Last comment:
“I appreciate that this review may appear overly-critical, but as a peer-reviewer we must ensure that potential future additions to the published literature are of a high enough standard and add valuable findings. In my opinion, I am afraid this is neither, and I wanted to be honest with you to avoid you wasting your time further.”

Response 3:
We appreciate your comments and your valuable time. But we think that this review is really overly-critical specially that many papers were recently published in the subject and that we followed a methodology appropriate to a cross-sectional study.
Assessing and re-evaluating patient satisfaction, during and outside of crises, is crucial. This work has been appreciated by professors specialized in quality of care and it served as an element of advocacy with the hospital administration. Regarding the evaluation of rehabilitation needs, studies and reviews have shown the need of studies investigating the need of patients and many reviews have shown that rehabilitation research doesn’t focus on such investigation especially in our region [4]. So, based in this work, we implemented several improvement actions in our department, such as streamlining registration for individuals with special needs. This study did not include intervention results, but it highlighted the challenges faced by our patients.
Best Regards

References
[1]       Rehabilitation 2030: A call for action, https://www.who.int/publications/m/item/rehabilitation-2030-a-call-for-action (accessed 3 August 2023).
[2]       Disabled people’s experiences of accessing reasonable adjustments in hospitals: a qualitative study | BMC Health Services Research | Full Text, https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3757-7 (accessed 17 September 2024).
[3]       Hickey EJ, Caudill A, Laufenberg H, et al. Quality of life, satisfaction with care, and the experiences of adults with intellectual and developmental disabilities before and during COVID-19. Disabil Health J 2024; 17: 101545.
[4]       Geberemichael SG, Tannor AY, Asegahegn TB, et al. Rehabilitation in Africa. Phys Med Rehabil Clin N Am 2019; 30: 757–768.
Dear Reviewer,

Thank you for accepting to review our paper entitled “Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study [version 1]”.
In response to your comments, we want to clarify many points:

First comment “I do not understand why this work was performed when it was. To be more precise, throughout Jan - Dec 2020, the entire world was gripped by the COVID-19 pandemic, with lockdown restrictions intermittently implemented globally, hospitals were constantly fighting to avoid being overwhelmed and keep people alive, rehabilitation services were de-prioritised, and their focus was mainly on ITU survivors and those with prolonged COVID-19 symptoms - your manuscript reflects none of this, which makes it hard be convinced by the data. In addition, I struggle to understand why anyone would choose *that* time to perform a study of patient satisfaction. Unless this is sufficiently explained and articulated in the article, I will continue to have doubts about the validity of the data.”

Response 1: Patient satisfaction is a critical factor in assessing the quality of healthcare services especially since our university hospital was preparing the accreditation procedure. And as it is known, patient satisfaction is one of the essential health care quality indicators.
According to the literature and the Rehabilitation 2030 project [1], researchers encourage studies that evaluate both the needs and satisfaction of patients with conditions requiring rehabilitation, as patient satisfaction is a key component of quality of care. This study assessed various domains that may affect this quality indicator, taking into account the specific needs of patients with restricted participation using a validated tool.
So this work is aligned with our hospital's accreditation process, as patient satisfaction is a reflection of care quality. Additionally, our study is part of a broader investigation into patient satisfaction during the COVID-19 pandemic for those in rehabilitation. Many researchers have explored barriers faced by rehabilitation patients during this period, with numerous studies continuing to be published in 2024 on the topic which testifies to the interest and relevance of the subject [2] [3]. If needed, we can include those studies as references in our paper.
It is also important to remember that the study was conducted in a country with limited resources (studies often come from developing countries, which is sometimes limiting) and that the physical medicine department is the only one in the center and southern regions of the country (there are only two department with hospitalization sector in the whole country), it hospitalizes patients who are difficult to manage and it was important to evaluate their satisfaction to draw up improvement actions. In fact, this work served as a basis for some improvement actions carried out in the department.
In addition, the study, was my medical thesis subject and my first research work under the supervision of a physical medicine specialist and an epidemiologist. The study protocol was ready before the “non-expected” COVID 19 pandemic. Data collection started in January 2020, in this period no restrictions of care in our country have been taken yet. The first case of COVID19 in the country was recorded in March 2020. So, we were obliged to continue the work especially that the department activity was not really affected. In fact, another University hospital in the region managed COVID 19 cases during this period and admissions for post-trauma and neurological rehabilitation were not suspended during the data collection period. Certainly, we observed some challenges in accessibility, as highlighted in our paper. Furthermore, every research work has its limitations and the limitations of our work were mentioned in the discussion part.

Second comment “I have also struggled to understand why this has been submitted four years later as a full length manuscript. When distilled down, you have performed a review of a single department using a single questionnaire, and have found very little of significance, with any findings only directly applicable to the department in question and, in my view, not of interest to the general medical audience. At very best, given the minimal data presented, this should be a 'letter to the editor' style article, but even then, I don't believe this would add value to the medical canon.”
In addition, I have found the repeated use of the male pronoun when referring to your participants inappropriate, especially as there were more females in your study, the fact that only 15.4% of questionnaires were provided by family members but 22.3% of participants were illiterate, the rather erratic style of referencing, and the, at times, irrelevant discussion, not in keeping with good academic work.

Response 2:
Thank you for you valuable time to review this manuscript.
I want to emphasize that, I’m a residency trainee, my thesis was presented in 2022, and the article was drafted and completed in December 2022. We revised it several times, and it is normal that this process takes time especially since in our country we lack funds for research and that in the meantime I should validate my medical internships. This work is an original paper that we revised using the strobe grid and is not a letter to the editor.

Regarding your comment concerning the use of gender pronouns, the representation of illiterate participants, and the referencing style, 15.4% of the questionnaires were completed by family members due to the patient's age (in the case of children) or cognitive limitations. For illiterate patients, the investigator read the questionnaire aloud to them. For gender pronouns, it was used only six times in the tables and do not refer to all participants.
In the discussion section, we cited references related to quality of care and patient satisfaction, and we compared our results with those findings in each instance.

Last comment:
“I appreciate that this review may appear overly-critical, but as a peer-reviewer we must ensure that potential future additions to the published literature are of a high enough standard and add valuable findings. In my opinion, I am afraid this is neither, and I wanted to be honest with you to avoid you wasting your time further.”

Response 3:
We appreciate your comments and your valuable time. But we think that this review is really overly-critical specially that many papers were recently published in the subject and that we followed a methodology appropriate to a cross-sectional study.
Assessing and re-evaluating patient satisfaction, during and outside of crises, is crucial. This work has been appreciated by professors specialized in quality of care and it served as an element of advocacy with the hospital administration. Regarding the evaluation of rehabilitation needs, studies and reviews have shown the need of studies investigating the need of patients and many reviews have shown that rehabilitation research doesn’t focus on such investigation especially in our region [4]. So, based in this work, we implemented several improvement actions in our department, such as streamlining registration for individuals with special needs. This study did not include intervention results, but it highlighted the challenges faced by our patients.
Best Regards

References
[1]       Rehabilitation 2030: A call for action, https://www.who.int/publications/m/item/rehabilitation-2030-a-call-for-action (accessed 3 August 2023).
[2]       Disabled people’s experiences of accessing reasonable adjustments in hospitals: a qualitative study | BMC Health Services Research | Full Text, https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3757-7 (accessed 17 September 2024).
[3]       Hickey EJ, Caudill A, Laufenberg H, et al. Quality of life, satisfaction with care, and the experiences of adults with intellectual and developmental disabilities before and during COVID-19. Disabil Health J 2024; 17: 101545.
[4]       Geberemichael SG, Tannor AY, Asegahegn TB, et al. Rehabilitation in Africa. Phys Med Rehabil Clin N Am 2019; 30: 757–768.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 19 Sep 2024

Leila Hamadou, Department of Physical Medicine and Rehabilitation, Sahloul University Hospital, Sousse, Tunisia

19 Sep 2024

Author Response

Dear Reviewer,

Thank you for accepting to review our paper entitled “Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study ... Continue reading Dear Reviewer,

Thank you for accepting to review our paper entitled “Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study [version 1]”.
In response to your comments, we want to clarify many points:

First comment “I do not understand why this work was performed when it was. To be more precise, throughout Jan - Dec 2020, the entire world was gripped by the COVID-19 pandemic, with lockdown restrictions intermittently implemented globally, hospitals were constantly fighting to avoid being overwhelmed and keep people alive, rehabilitation services were de-prioritised, and their focus was mainly on ITU survivors and those with prolonged COVID-19 symptoms - your manuscript reflects none of this, which makes it hard be convinced by the data. In addition, I struggle to understand why anyone would choose *that* time to perform a study of patient satisfaction. Unless this is sufficiently explained and articulated in the article, I will continue to have doubts about the validity of the data.”

Response 1: Patient satisfaction is a critical factor in assessing the quality of healthcare services especially since our university hospital was preparing the accreditation procedure. And as it is known, patient satisfaction is one of the essential health care quality indicators.
According to the literature and the Rehabilitation 2030 project [1], researchers encourage studies that evaluate both the needs and satisfaction of patients with conditions requiring rehabilitation, as patient satisfaction is a key component of quality of care. This study assessed various domains that may affect this quality indicator, taking into account the specific needs of patients with restricted participation using a validated tool.
So this work is aligned with our hospital's accreditation process, as patient satisfaction is a reflection of care quality. Additionally, our study is part of a broader investigation into patient satisfaction during the COVID-19 pandemic for those in rehabilitation. Many researchers have explored barriers faced by rehabilitation patients during this period, with numerous studies continuing to be published in 2024 on the topic which testifies to the interest and relevance of the subject [2] [3]. If needed, we can include those studies as references in our paper.
It is also important to remember that the study was conducted in a country with limited resources (studies often come from developing countries, which is sometimes limiting) and that the physical medicine department is the only one in the center and southern regions of the country (there are only two department with hospitalization sector in the whole country), it hospitalizes patients who are difficult to manage and it was important to evaluate their satisfaction to draw up improvement actions. In fact, this work served as a basis for some improvement actions carried out in the department.
In addition, the study, was my medical thesis subject and my first research work under the supervision of a physical medicine specialist and an epidemiologist. The study protocol was ready before the “non-expected” COVID 19 pandemic. Data collection started in January 2020, in this period no restrictions of care in our country have been taken yet. The first case of COVID19 in the country was recorded in March 2020. So, we were obliged to continue the work especially that the department activity was not really affected. In fact, another University hospital in the region managed COVID 19 cases during this period and admissions for post-trauma and neurological rehabilitation were not suspended during the data collection period. Certainly, we observed some challenges in accessibility, as highlighted in our paper. Furthermore, every research work has its limitations and the limitations of our work were mentioned in the discussion part.

Second comment “I have also struggled to understand why this has been submitted four years later as a full length manuscript. When distilled down, you have performed a review of a single department using a single questionnaire, and have found very little of significance, with any findings only directly applicable to the department in question and, in my view, not of interest to the general medical audience. At very best, given the minimal data presented, this should be a 'letter to the editor' style article, but even then, I don't believe this would add value to the medical canon.”
In addition, I have found the repeated use of the male pronoun when referring to your participants inappropriate, especially as there were more females in your study, the fact that only 15.4% of questionnaires were provided by family members but 22.3% of participants were illiterate, the rather erratic style of referencing, and the, at times, irrelevant discussion, not in keeping with good academic work.

Response 2:
Thank you for you valuable time to review this manuscript.
I want to emphasize that, I’m a residency trainee, my thesis was presented in 2022, and the article was drafted and completed in December 2022. We revised it several times, and it is normal that this process takes time especially since in our country we lack funds for research and that in the meantime I should validate my medical internships. This work is an original paper that we revised using the strobe grid and is not a letter to the editor.

Regarding your comment concerning the use of gender pronouns, the representation of illiterate participants, and the referencing style, 15.4% of the questionnaires were completed by family members due to the patient's age (in the case of children) or cognitive limitations. For illiterate patients, the investigator read the questionnaire aloud to them. For gender pronouns, it was used only six times in the tables and do not refer to all participants.
In the discussion section, we cited references related to quality of care and patient satisfaction, and we compared our results with those findings in each instance.

Last comment:
“I appreciate that this review may appear overly-critical, but as a peer-reviewer we must ensure that potential future additions to the published literature are of a high enough standard and add valuable findings. In my opinion, I am afraid this is neither, and I wanted to be honest with you to avoid you wasting your time further.”

Response 3:
We appreciate your comments and your valuable time. But we think that this review is really overly-critical specially that many papers were recently published in the subject and that we followed a methodology appropriate to a cross-sectional study.
Assessing and re-evaluating patient satisfaction, during and outside of crises, is crucial. This work has been appreciated by professors specialized in quality of care and it served as an element of advocacy with the hospital administration. Regarding the evaluation of rehabilitation needs, studies and reviews have shown the need of studies investigating the need of patients and many reviews have shown that rehabilitation research doesn’t focus on such investigation especially in our region [4]. So, based in this work, we implemented several improvement actions in our department, such as streamlining registration for individuals with special needs. This study did not include intervention results, but it highlighted the challenges faced by our patients.
Best Regards

References
[1]       Rehabilitation 2030: A call for action, https://www.who.int/publications/m/item/rehabilitation-2030-a-call-for-action (accessed 3 August 2023).
[2]       Disabled people’s experiences of accessing reasonable adjustments in hospitals: a qualitative study | BMC Health Services Research | Full Text, https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3757-7 (accessed 17 September 2024).
[3]       Hickey EJ, Caudill A, Laufenberg H, et al. Quality of life, satisfaction with care, and the experiences of adults with intellectual and developmental disabilities before and during COVID-19. Disabil Health J 2024; 17: 101545.
[4]       Geberemichael SG, Tannor AY, Asegahegn TB, et al. Rehabilitation in Africa. Phys Med Rehabil Clin N Am 2019; 30: 757–768.
Dear Reviewer,

Thank you for accepting to review our paper entitled “Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study [version 1]”.
In response to your comments, we want to clarify many points:

First comment “I do not understand why this work was performed when it was. To be more precise, throughout Jan - Dec 2020, the entire world was gripped by the COVID-19 pandemic, with lockdown restrictions intermittently implemented globally, hospitals were constantly fighting to avoid being overwhelmed and keep people alive, rehabilitation services were de-prioritised, and their focus was mainly on ITU survivors and those with prolonged COVID-19 symptoms - your manuscript reflects none of this, which makes it hard be convinced by the data. In addition, I struggle to understand why anyone would choose *that* time to perform a study of patient satisfaction. Unless this is sufficiently explained and articulated in the article, I will continue to have doubts about the validity of the data.”

Response 1: Patient satisfaction is a critical factor in assessing the quality of healthcare services especially since our university hospital was preparing the accreditation procedure. And as it is known, patient satisfaction is one of the essential health care quality indicators.
According to the literature and the Rehabilitation 2030 project [1], researchers encourage studies that evaluate both the needs and satisfaction of patients with conditions requiring rehabilitation, as patient satisfaction is a key component of quality of care. This study assessed various domains that may affect this quality indicator, taking into account the specific needs of patients with restricted participation using a validated tool.
So this work is aligned with our hospital's accreditation process, as patient satisfaction is a reflection of care quality. Additionally, our study is part of a broader investigation into patient satisfaction during the COVID-19 pandemic for those in rehabilitation. Many researchers have explored barriers faced by rehabilitation patients during this period, with numerous studies continuing to be published in 2024 on the topic which testifies to the interest and relevance of the subject [2] [3]. If needed, we can include those studies as references in our paper.
It is also important to remember that the study was conducted in a country with limited resources (studies often come from developing countries, which is sometimes limiting) and that the physical medicine department is the only one in the center and southern regions of the country (there are only two department with hospitalization sector in the whole country), it hospitalizes patients who are difficult to manage and it was important to evaluate their satisfaction to draw up improvement actions. In fact, this work served as a basis for some improvement actions carried out in the department.
In addition, the study, was my medical thesis subject and my first research work under the supervision of a physical medicine specialist and an epidemiologist. The study protocol was ready before the “non-expected” COVID 19 pandemic. Data collection started in January 2020, in this period no restrictions of care in our country have been taken yet. The first case of COVID19 in the country was recorded in March 2020. So, we were obliged to continue the work especially that the department activity was not really affected. In fact, another University hospital in the region managed COVID 19 cases during this period and admissions for post-trauma and neurological rehabilitation were not suspended during the data collection period. Certainly, we observed some challenges in accessibility, as highlighted in our paper. Furthermore, every research work has its limitations and the limitations of our work were mentioned in the discussion part.

Second comment “I have also struggled to understand why this has been submitted four years later as a full length manuscript. When distilled down, you have performed a review of a single department using a single questionnaire, and have found very little of significance, with any findings only directly applicable to the department in question and, in my view, not of interest to the general medical audience. At very best, given the minimal data presented, this should be a 'letter to the editor' style article, but even then, I don't believe this would add value to the medical canon.”
In addition, I have found the repeated use of the male pronoun when referring to your participants inappropriate, especially as there were more females in your study, the fact that only 15.4% of questionnaires were provided by family members but 22.3% of participants were illiterate, the rather erratic style of referencing, and the, at times, irrelevant discussion, not in keeping with good academic work.

Response 2:
Thank you for you valuable time to review this manuscript.
I want to emphasize that, I’m a residency trainee, my thesis was presented in 2022, and the article was drafted and completed in December 2022. We revised it several times, and it is normal that this process takes time especially since in our country we lack funds for research and that in the meantime I should validate my medical internships. This work is an original paper that we revised using the strobe grid and is not a letter to the editor.

Regarding your comment concerning the use of gender pronouns, the representation of illiterate participants, and the referencing style, 15.4% of the questionnaires were completed by family members due to the patient's age (in the case of children) or cognitive limitations. For illiterate patients, the investigator read the questionnaire aloud to them. For gender pronouns, it was used only six times in the tables and do not refer to all participants.
In the discussion section, we cited references related to quality of care and patient satisfaction, and we compared our results with those findings in each instance.

Last comment:
“I appreciate that this review may appear overly-critical, but as a peer-reviewer we must ensure that potential future additions to the published literature are of a high enough standard and add valuable findings. In my opinion, I am afraid this is neither, and I wanted to be honest with you to avoid you wasting your time further.”

Response 3:
We appreciate your comments and your valuable time. But we think that this review is really overly-critical specially that many papers were recently published in the subject and that we followed a methodology appropriate to a cross-sectional study.
Assessing and re-evaluating patient satisfaction, during and outside of crises, is crucial. This work has been appreciated by professors specialized in quality of care and it served as an element of advocacy with the hospital administration. Regarding the evaluation of rehabilitation needs, studies and reviews have shown the need of studies investigating the need of patients and many reviews have shown that rehabilitation research doesn’t focus on such investigation especially in our region [4]. So, based in this work, we implemented several improvement actions in our department, such as streamlining registration for individuals with special needs. This study did not include intervention results, but it highlighted the challenges faced by our patients.
Best Regards

References
[1]       Rehabilitation 2030: A call for action, https://www.who.int/publications/m/item/rehabilitation-2030-a-call-for-action (accessed 3 August 2023).
[2]       Disabled people’s experiences of accessing reasonable adjustments in hospitals: a qualitative study | BMC Health Services Research | Full Text, https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3757-7 (accessed 17 September 2024).
[3]       Hickey EJ, Caudill A, Laufenberg H, et al. Quality of life, satisfaction with care, and the experiences of adults with intellectual and developmental disabilities before and during COVID-19. Disabil Health J 2024; 17: 101545.
[4]       Geberemichael SG, Tannor AY, Asegahegn TB, et al. Rehabilitation in Africa. Phys Med Rehabil Clin N Am 2019; 30: 757–768.
Competing Interests: No competing interests were disclosed. Close
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VERSION 1 PUBLISHED 19 Jun 2024

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Oliver O'Sullivan, University of Nottingham, Nottingham, UK

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16 Sep 2024 | for Version 1

Oliver O'Sullivan, University of Nottingham, Nottingham, UK

17 Views Cite this report Responses(1)

Not Approved

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

No
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

No

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Rehabilitation (including physical, medical and neurological)

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Responses (1)

Author Response

19 Sep 2024

Leila Hamadou, Department of Physical Medicine and Rehabilitation, Sahloul University Hospital, Sousse, Tunisia

Dear Reviewer,

Thank you for accepting to review our paper entitled “Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study [version 1]”.
In response to your comments, we want to clarify many points:

First comment “I do not understand why this work was performed when it was. To be more precise, throughout Jan - Dec 2020, the entire world was gripped by the COVID-19 pandemic, with lockdown restrictions intermittently implemented globally, hospitals were constantly fighting to avoid being overwhelmed and keep people alive, rehabilitation services were de-prioritised, and their focus was mainly on ITU survivors and those with prolonged COVID-19 symptoms - your manuscript reflects none of this, which makes it hard be convinced by the data. In addition, I struggle to understand why anyone would choose *that* time to perform a study of patient satisfaction. Unless this is sufficiently explained and articulated in the article, I will continue to have doubts about the validity of the data.”

Response 1: Patient satisfaction is a critical factor in assessing the quality of healthcare services especially since our university hospital was preparing the accreditation procedure. And as it is known, patient satisfaction is one of the essential health care quality indicators.
According to the literature and the Rehabilitation 2030 project [1], researchers encourage studies that evaluate both the needs and satisfaction of patients with conditions requiring rehabilitation, as patient satisfaction is a key component of quality of care. This study assessed various domains that may affect this quality indicator, taking into account the specific needs of patients with restricted participation using a validated tool.
So this work is aligned with our hospital's accreditation process, as patient satisfaction is a reflection of care quality. Additionally, our study is part of a broader investigation into patient satisfaction during the COVID-19 pandemic for those in rehabilitation. Many researchers have explored barriers faced by rehabilitation patients during this period, with numerous studies continuing to be published in 2024 on the topic which testifies to the interest and relevance of the subject [2] [3]. If needed, we can include those studies as references in our paper.
It is also important to remember that the study was conducted in a country with limited resources (studies often come from developing countries, which is sometimes limiting) and that the physical medicine department is the only one in the center and southern regions of the country (there are only two department with hospitalization sector in the whole country), it hospitalizes patients who are difficult to manage and it was important to evaluate their satisfaction to draw up improvement actions. In fact, this work served as a basis for some improvement actions carried out in the department.
In addition, the study, was my medical thesis subject and my first research work under the supervision of a physical medicine specialist and an epidemiologist. The study protocol was ready before the “non-expected” COVID 19 pandemic. Data collection started in January 2020, in this period no restrictions of care in our country have been taken yet. The first case of COVID19 in the country was recorded in March 2020. So, we were obliged to continue the work especially that the department activity was not really affected. In fact, another University hospital in the region managed COVID 19 cases during this period and admissions for post-trauma and neurological rehabilitation were not suspended during the data collection period. Certainly, we observed some challenges in accessibility, as highlighted in our paper. Furthermore, every research work has its limitations and the limitations of our work were mentioned in the discussion part.

Second comment “I have also struggled to understand why this has been submitted four years later as a full length manuscript. When distilled down, you have performed a review of a single department using a single questionnaire, and have found very little of significance, with any findings only directly applicable to the department in question and, in my view, not of interest to the general medical audience. At very best, given the minimal data presented, this should be a 'letter to the editor' style article, but even then, I don't believe this would add value to the medical canon.”
In addition, I have found the repeated use of the male pronoun when referring to your participants inappropriate, especially as there were more females in your study, the fact that only 15.4% of questionnaires were provided by family members but 22.3% of participants were illiterate, the rather erratic style of referencing, and the, at times, irrelevant discussion, not in keeping with good academic work.

Response 2:
Thank you for you valuable time to review this manuscript.
I want to emphasize that, I’m a residency trainee, my thesis was presented in 2022, and the article was drafted and completed in December 2022. We revised it several times, and it is normal that this process takes time especially since in our country we lack funds for research and that in the meantime I should validate my medical internships. This work is an original paper that we revised using the strobe grid and is not a letter to the editor.

Regarding your comment concerning the use of gender pronouns, the representation of illiterate participants, and the referencing style, 15.4% of the questionnaires were completed by family members due to the patient's age (in the case of children) or cognitive limitations. For illiterate patients, the investigator read the questionnaire aloud to them. For gender pronouns, it was used only six times in the tables and do not refer to all participants.
In the discussion section, we cited references related to quality of care and patient satisfaction, and we compared our results with those findings in each instance.

Last comment:
“I appreciate that this review may appear overly-critical, but as a peer-reviewer we must ensure that potential future additions to the published literature are of a high enough standard and add valuable findings. In my opinion, I am afraid this is neither, and I wanted to be honest with you to avoid you wasting your time further.”

Response 3:
We appreciate your comments and your valuable time. But we think that this review is really overly-critical specially that many papers were recently published in the subject and that we followed a methodology appropriate to a cross-sectional study.
Assessing and re-evaluating patient satisfaction, during and outside of crises, is crucial. This work has been appreciated by professors specialized in quality of care and it served as an element of advocacy with the hospital administration. Regarding the evaluation of rehabilitation needs, studies and reviews have shown the need of studies investigating the need of patients and many reviews have shown that rehabilitation research doesn’t focus on such investigation especially in our region [4]. So, based in this work, we implemented several improvement actions in our department, such as streamlining registration for individuals with special needs. This study did not include intervention results, but it highlighted the challenges faced by our patients.
Best Regards

References
[1]       Rehabilitation 2030: A call for action, https://www.who.int/publications/m/item/rehabilitation-2030-a-call-for-action (accessed 3 August 2023).
[2]       Disabled people’s experiences of accessing reasonable adjustments in hospitals: a qualitative study | BMC Health Services Research | Full Text, https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3757-7 (accessed 17 September 2024).
[3]       Hickey EJ, Caudill A, Laufenberg H, et al. Quality of life, satisfaction with care, and the experiences of adults with intellectual and developmental disabilities before and during COVID-19. Disabil Health J 2024; 17: 101545.
[4]       Geberemichael SG, Tannor AY, Asegahegn TB, et al. Rehabilitation in Africa. Phys Med Rehabil Clin N Am 2019; 30: 757–768.

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Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study

Abstract

Background

Methods

Results

Conclusion

Keywords

Introduction

Methods

Study design

Data collection

Data analysis

Ethical considerations

Results

Table 1. Characteristics of patients of the PM&R department, Sahloul University Hospital, Sousse 2020.

Patients’ satisfaction in the PM&R department

Figure 1. Patients’ satisfaction according to the dimensions explored by the Monnin and Perneger questionnaire in the PM&R department, Sahloul University Hospital, Sousse 2020.

Table 2. Description of the items of the Monnin and Perneger satisfaction questionnaire, Sahloul University Hospital, Sousse 2020.

Patients’ satisfaction in the PM&R department and associated factors

Figure 2. Satisfaction of the population studied according to the period of physical therapy, PM&R department, Sahloul University Hospital, Sousse 2020.

Table 3. Satisfaction of the population studied according to the associated factors, Sahloul University Hospital, Sousse 2020.

Multivariate analysis of satisfaction’s factors of patients treated in physical medicine

Table 4. Factors associated with patient satisfaction in relation to studied dimensions in the PM&R department, Sahloul University Hospital, Sousse 2020.

Discussion

Conclusion

Ethical considerations

Authors’ contributions

Data availability

Extended data

Reporting guidelines

Acknowledgements

References

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