Patient satisfaction with hospital rehabilitation: validation of the SAT-16 questionnaire through Rasch analysis.

Aim: The SAT-16 is a 16-item self-administered questionnaire measuring patient satisfaction with the quality of care during stay in a rehabilitation unit. A comprehensive psychometric analysis of SAT-16 was performed using both classical test theory and Rasch analysis (RA) to examine its validity and metric properties, and provide further insights for its clinical use in rehabilitation settings.

Methods: A sample of 9458 patients, consecutively admitted to two Rehabilitation Centres, was examined with SAT-16. Factor (both explorative and confirmatory) analysis and RA were used to process the data in order to examine validity and metric properties of SAT-16. Dimensionality, item fit to the model, response category performance and internal construct validity were assessed.

Results: Two subscales were identified by factor analysis and expert review, respectively related to satisfaction with clinical care (items 1-9), and satisfaction with hospital organization and facilities ("hotel" aspects of care, items 10-16). Each subscale underwent a separate RA. Response categories were revised in both subscales of SAT-16, obtaining a new 3-level rating scale. Both subscales showed high internal consistency and internal validity.

Conclusion: RA confirmed the appropriateness of SAT-16 and its usefulness in identifying areas for quality improvement. Overall, the questionnaire allows to assess patient satisfaction with the services through: 1) two sub-scores respectively specific for satisfaction with "clinical care" and "hotel aspects of care"; 2) additional information gathered in the optional open-ended questions.