Factors Associated With Patient Satisfaction Measured Using an Iterative Scale

Yvonne Versluijs, Amirreza Fatehi, Amanda I. Gonzalez, Lee Reichel, David Laverty, David Ring

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND AND OBJECTIVES: Patient experience measures tend to have notable ceiling effects that make it difficult to learn from gradations of satisfaction to improve care. This study tested 2 different iterative satisfaction measures after a musculoskeletal specialty care visit in the hope that they might have less ceiling effect. We measured floor effects, ceilings effects, skewness, and kurtosis of both questionnaires. We also assessed patient factors independently associated with the questionnaires and the top 2 possible scores.

METHODS: In this cross-sectional study, 186 patients completed questionnaires while seeing 1 of 11 participating orthopedic surgeons in July and August 2019; the questionnaire measured: (1) demographics, (2) symptoms of depression, (3) catastrophic thinking in response to nociception, (4) heightened illness concerns, and (5) satisfaction with the visit on 2 iterative satisfaction scales. Bivariate and multivariable analyses sought associations of the explanatory variable with the satisfaction scales.

RESULTS: There is a small correlation between the 2 scales ( r = 0.27; P < .001). Neither scale had a floor effect and both had a ceiling effect of 45%. There is a very small correlation between greater health anxiety and lower satisfaction measured with one of the scales ( r = -0.16; P = .05).

CONCLUSION: An iterative satisfaction questionnaire created some spread in patient experience data, but could not limit ceiling effects. Additional strategies are needed to remove ceiling effects from satisfaction measures.

Original languageEnglish (US)
Pages (from-to)69-74
Number of pages6
JournalQuality Management in Health Care
Issue number2
StatePublished - Apr 1 2023


  • ceiling effects
  • Guttman-style questionnaire
  • patient experience
  • satisfaction
  • Cross-Sectional Studies
  • Humans
  • Surveys and Questionnaires
  • Catastrophization
  • Patient Satisfaction

ASJC Scopus subject areas

  • Health(social science)
  • Care Planning
  • Health Policy
  • Leadership and Management


Dive into the research topics of 'Factors Associated With Patient Satisfaction Measured Using an Iterative Scale'. Together they form a unique fingerprint.

Cite this