Abstract
Background Patient satisfaction measures how pleased someone is with their care, is broadly made up of human and system attributes and is importantly an indicator of healthcare quality. Advanced practice physiotherapy (APP) is a higher level of practice and a model-of-care growing in healthcare systems worldwide. The purpose of this review was to evaluate patient satisfaction with advanced practice physiotherapy (APP) internationally.
Approach A systematic mixed studies review using a parallel-results convergent synthesis design was conducted and reported in line with PRISMA guidelines. The review followed a registered (CRD42023443612) and published protocol, informed by CANSpine patient partner advisory group engagement. MEDLINE (Ovid), Embase, CINAHL, Cochrane, Web of Science, and PEDro databases, and the grey literature were searched from inception to 29/7/2024 for studies measuring patient satisfaction with APP. Screening, data-extraction, and quality appraisal using the mixed methods appraisal tool were completed independently and in parallel by two reviewers. Narrative (quantitative) and thematic (qualitative) syntheses were completed, and findings were integrated in the discussion. GRADE and GRADE-CERQual were used to assess evidence certainty and confidence.
Results Thirty-two studies were included (8 high, 14 moderate, 10 low quality). Narrative synthesis identified high overall satisfaction with APP internationally. Human attributes of patient satisfaction with APP were high, and mostly high for system attributes of patient satisfaction with APP (very low certainty evidence). Themes pertaining to human attributes of patient satisfaction with APP included proficient communication and interpersonal skills, credible and competent experts, patient empowerment and self-management, and thorough assessments (moderate-high confidence evidence).
“The APP actually listened to what I was saying, I find that a lot of the time, particularly if you’re older … that people don’t really listen” (theme: proficient communication and interpersonal skills)
“That therapeutic alliance was there, right, so you kind of feel like you’re in charge but the APP is there to support you” (theme: patient empowerment and self-management)
Themes pertaining to system attributes of patient satisfaction with APP included fast access to specialist care, convenient location and amenities, and integrated care (moderate confidence evidence).
“It’s been excellent, it’s had me in and out of here way quicker than it would have done if I’d have had to wait for the General Practitioner” (theme: fast access to specialist care)
“Patient participants described how this model of care allowed the physiotherapist and primary care team to easily share information and provide more integrated primary care for low back pain” (theme: integrated care)
Implications Moderate to high confidence evidence suggests AP Physiotherapists themselves are integral to driving high patient satisfaction (e.g., through patient empowerment) with APP. Moderate confidence evidence suggests the systems in which APP is delivered (e.g., through integrated care) also contribute to high patient satisfaction. These findings align with research of advanced practice across other professions, strengthening its credibility. The certainty of quantitative evidence however is very low, and therefore future high-quality primary research is needed. This future research should explore how satisfaction relates to patient experience, and thus how it may contribute to healthcare quality.