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.