Open Access Research article

Cross-cultural adaptation and validation of the Physical Therapy Outpatient Satisfaction Survey in an Italian musculoskeletal population

Carla Vanti1, Francesca Bonetti2, Daniele Ceron3, Raffaella Piccarreta4, Francesco Saverio Violante5, Andrew Guccione6 and Paolo Pillastrini7*

Author Affiliations

1 Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna 40138, Italy

2 Associazione Italiana Riabilitazione Inserimento Invalidi, Rehabilitation Center, Via Novacella 40, Rome 00142, Italy

3 Riabilita Physical Therapy, Masters in Manual Therapy and Musculoskeletal Rehabilitation, University of Padova, Padova 35121, Italy

4 Department of Decision Sciences, L.Bocconi University, Milan 20100, Italy

5 Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna 40138, Italy

6 Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA 22030, USA

7 Department of Biomedical and Neuromotor Sciences (DIBINEM) Alma Mater Studiorum, University of Bologna, Via Pelagio Palagi 9, Bologna 40138, Italy

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BMC Musculoskeletal Disorders 2013, 14:125  doi:10.1186/1471-2474-14-125

Published: 5 April 2013



Although patient satisfaction is a relevant outcome measure for health care providers, few satisfaction questionnaires have been generally available to physical therapists or have been validated in an Italian population for use in the outpatient setting. The aim of this study was to translate, culturally adapt, and validate the Italian version of the Physical Therapy Outpatient Satisfaction Survey (PTOPS).


The Italian version of the PTOPS (PTOPS-I) was developed through forward-backward translation, review, and field-testing a pre-final version. The reliability of the final questionnaire was measured by internal consistency and test-retest stability at 7 days. Factor analysis was also used to explore construct validity. Concurrent validity was measured by comparing PTOPS-I with a 5-point Likert-type scale measure assessing the Global Perceived Effect (GPE) of the treatment and with a Visual Analogue Scale (VAS).


354 outpatients completed the PTOPS-I, and 56 took the re-test. The internal consistency (Cronbach’s alpha) of the original domains (Enhancers, Detractors, Location, and Cost) was 0.758 for Enhancers, 0.847 for Detractors, 0.885 for Location, and 0.706 for Cost. The test-retest stability (Intra-class Correlation Coefficients) was 0.769 for Enhancers, 0.893 for Detractors, 0.862 for Location, and 0.862 for Cost. The factor analysis of the Italian version revealed a structure into four domains, named Depersonalization, Inaccessibility, Ambience, and Cost. Concurrent validity with GPE was significantly demonstrated for all domains except Inaccessibility. Irrelevant or non-significant correlations were observed with VAS.


The PTOPS-I showed good psychometric properties. Its use can be suggested for Italian-speaking outpatients who receive physical therapy.

Health care administration; Measurement; Outcome measures