Patient satisfaction in the cervical spine research society outcomes study: relationship to improved clinical outcome

Background and context: Satisfaction is a key indicator of how health care has met patient expectations. Purpose: To examine relationship between clinical and functional outcome and patient satisfaction. Study design/setting: Prospective analysis of outcomes. Patient sample: A total of 428 patients undergoing cervical spine surgery consecutively enrolled at 23 nationwide sites. Outcome measures: Cervical Spine Outcomes Questionnaire (CSOQ). Methods: We used the CSOQ to evaluate 428 patients undergoing cervical spine surgery at 23 nationwide sites. Satisfaction was assessed at 3 months by self-report. Clinical improvement was defined at 3 months as decreased postoperative CSOQ domain scores. Principal components analysis (PCA) was used to demonstrate adherence of the CSOQ to domains of clinical and functional recovery and to identify items measuring patient satisfaction. Psychometric properties of items measuring patient satisfaction were examined. The association between patient satisfaction and 3 month clinical and functional outcome was tested. Results: On repeat administration in a subset of 50 patients, these four items demonstrated good test-retest reliability (Cronbach's α=0.784). PCA extracted factors adhering to the domain structure of the CSOQ. A unique factor was characterized by the following: recommend to friend (loading=0.658), compare favorably with others (loading=0.525) and with expectations (loading=0.701), and show overall satisfaction (loading=0.513). Structural equation models revealed influence of CSOQ domain scores and socioeconomic status on patient satisfaction. All reported comparisons were significant at p<.001. Conclusions: Satisfaction is unobservable, but can be assessed through self-report. Clinical improvement, especially in neck pain, after surgery is associated with improved patient satisfaction.