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Completing the Patient Specific-Complaint Questionnaire in Physical Therapy Practice is Problematic for High and Low Literate Patients: A Qualitative Study

Marlies Welbie, H Wittink, M J Westerman, W L J M Deville


Objective: to get insight into the perspectives of physical therapy patients with different levels of health literacy on ‘ease of use’ and ‘usefulness’ of the most frequently used questionnaire in Dutch physical therapy: the Patient Specific-Complaint questionnaire (PSC).

Methods: Cognitive interviews were conducted with twenty-five Dutch and twenty-five Turkish physical therapy patients with variable health literacy levels after they completed the Dutch PSC. A thematic content analysis approach was used to analyze the data.

Results: Nineteen respondents did not complete the PSC fully and ten were not able to complete the questionnaire at all. All respondents but one experienced difficulties completing the PSC. Most problems were experienced in understanding and interpreting the instructions and questions. Low educated and low health literate respondents experienced more difficulties than high educated and adequate health literate respondents did. Due to these difficulties in twenty-four cases the PSC generated other information than was intended by its developers. Almost half of the respondents were positive about the usefulness of the PSC in relation to their treatment process.

Conclusions: Completing questionnaires is more difficult for patients than care providers might realize. The results of this study confirm the necessity to collaborate with patients in all stages of questionnaire development. The ease of use of questionnaires should be tested and if necessary improved. To stimulate questionnaire developers to take usability and face and content validity into account, it is recommended to incorporate assessment of these criteria in quality evaluation tools like the COSMIN checklist.


Questionnaires, literacy, health literacy, ease of use, usefulness, physical therapy, qualitative research, patient complaints

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