Year of Publication

2012

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Health Sciences

Department

Rehabilitation Sciences

First Advisor

Dr. Ruth A. Huebner

Abstract

Client satisfaction is an important outcome indicator because it measures multiple domains of the quality of healthcare and rehabilitation service delivery. It is especially important in occupational therapy because it is also client-centered. There are multiple domains of satisfaction and findings described in previous research; however, there is no single standard of measuring client satisfaction or any single working model describing the relationship among variables influencing satisfaction. This research was designed to apply a measure of satisfaction in rehabilitation and to develop a working model of satisfaction.

This study was an exploratory and predictive study using a large existing dataset to test a working logic model of client satisfaction, determine the best predictors of satisfaction, and then to revise the model for future research. After developing the Satisfaction with a Continuum of Care (SCC) in a pilot study, the SCC was completed by 1104 clients from a large Midwest rehabilitation hospital. The SCC results were paired with administrative data with client demographics, functional status, and measures of the` rehabilitation process. Six research questions on the predictors of satisfaction with client-centeredness and clinical quality were answered using logistic regression.

Significant predictors of satisfaction were having a neurological disorder, total rehabilitation hours, and admission to rehabilitation within 15 days of onset. The most robust and consistent predictors of satisfaction in this study were aspects of functional status as measured by the Functional Independence Measure especially improvement in overall and self-care functioning.

The results in the study were consistent with some previous research and inconsistent with others. The finding that improvements in functional status were highly predictive of satisfaction supports the worth that clients place on rehabilitation results including the self-care improvements focused on by occupational therapy.

This study was a partnership involving occupational therapy and a rehabilitation hospital. The finding that changes in self-care function were predictive of satisfaction was intended to isolate the effects of OT. There is a need to demonstrate outcomes and link these to occupational therapy and other rehabilitation disciplines to continue to identify best practices and contribute to the rehabilitation literature.

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