Psychometric Testing of a Rehabilitative Care Patient Experience Instrument

Abstract

Objective: To evaluate the internal consistency and test-retest reliability, construct validity, and feasibility of the WatLX, a measure of the experience of patients in rehabilitative care.

Design: Multisite, cross-sectional, and test-retest self-report study.

Setting: Outpatient rehabilitative care settings.

Participants: The WatLX was administered to English-speaking, cognitively intact outpatients (N=1174) over 18 years old who had completed a program of cardiac, musculoskeletal, neurologic, stroke, pulmonary, or speech language rehabilitative care, at 2 separate time points: (1) immediately following completion of their rehabilitation program, and (2) 2 weeks later (n=29). A subsequent feasibility study was conducted with 1013 patients from 19 clinics.

Interventions: Not applicable.

Main outcome measures: The WatLX measures 6 concepts, previously identified as key to outpatient rehabilitative care patients' experience: (1) ecosystem issues, (2) client and informal caregiver engagement, (3) patient and health care provider relations, (4) pain and functional status, (5) group and individual identity, and (6) open-ended feedback.

Results: Reliability analyses were conducted on 2 versions of the WatLX. Using a 7-point versus a 5-point Likert scale resulted in higher internal consistency and reliability scores. Cronbach's alpha coefficients were .863 and .957 for the 5- and 7-point scale, respectively, and the ICC scores were .827 and .880, respectively. The proof of concept study recruited 1013 patients with little interruption of workflow; results displayed strong internal consistency (Cronbach's alpha coefficient =.906). There is evidence of ceiling effects.

Conclusions: The WatLX is a parsimonious question set that is feasible for administration in ambulatory rehabilitative care settings, and which shows promising psychometric properties.

Keywords: Clinical notes, case report; Patient reported outcome measures; Quality indicators, health care; Rehabilitation; Reproducibility of results.