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LORMA COLLEGES

COLLEGE OF PHYSICAL AND RESPIRATORY THERAPY

Carlatan, City of San Fernando, La Union

In Partial Fulfillment for the Requirements in Research

Levels of Satisfaction on Treatment, Facilities and Services Rendered to

Patients with Musculoskeletal Condition on Selected Hospitals in La Union

Submitted To:

Sir Bernard Tayaban Jr., PTRP, MDA

Submitted By:

Anin, Jerna C.

Bisquera, John Glenn D.

Campos, Bianca Joyce U.

Gurtiza, Joanna Eden A.

Imperial, Charmaine E.

Laureta, Chloei Ann D.


Chapter I

INTRODUCTION

I. Background Study

Patients are individuals who have disorders that require interventions to improve their

function. (Pagliarulo, M.) A patient is any recipient of health care services. The patient is most

often ill or injured and in need of treatment by an advanced practice registered nurse,

physiotherapist, physician, physician assistant, psychologist, podiatrist, veterinarian, or other

health care provider.

Patients have this certain health needs or necessities in which they consult health care

providers or services to attain satisfaction. Satisfaction is individuals feelings of pleasure or

disappointment resulting from comparing their perceptions of a product or services performance

to their expectation levels. It is the act of fulfilling a need, desire, or appetite, or the feeling gained

from such fulfillment.

Patient satisfaction is an important and commonly used indicator for measuring the

quality in health care. Patient satisfaction affects clinical outcomes, patient retention, and medical

malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality health

care. Patient satisfaction is thus a proxy but a very effective indicator to measure the success of

doctors and hospitals. Patient satisfaction is only an indirect or a proxy indicator of the quality of

doctor or hospital performance. Delivery of patient-focused care requires that we provide care in

a particular way, not just sometimes or usually, but always. It must be every patient every time.

(Wendy L, Scott G. USA: AHA company; 1994)

Almost all of the patients around the world seek medical attention by means of going to

the hospital. Hospital is an integral part of the medical and social organization which is to provide

for the population complete health care, both curative and preventive; and whose out-patient

services reach out into the family in its home environment. The hospital is also a center for the

training of health workers and for bio-social research.

Most of the hospitals around the world, patient complains of having problems about their

muscular system and skeletal system or basically the musculoskeletal system. The
Musculoskeletal System provides form, stability, and movement to the human body. It consists of

the body's bones, muscles, tendons, ligaments, joints, cartilage, and other connective tissue. The

term "connective tissue" is used to describe the tissue that supports and binds tissues and organs

together. Its chief components are collagen and elastic fibers, which are composed of different

proteins. The musculoskeletal system incorporates bones, muscles, and connective tissue

(your ligaments, tendons, and fascia). Collectively these body parts provide the

framework for your body, create your movements, and dictate your degree of flexibility.

They comprise approximately sixty percent of your body mass and expend most of your

energy. (Lipman, 2010).

Some patients undergoes rehabilitation in order to recover from a certain condition or

disorders. Rehabilitation is a treatment or treatments designed to facilitate the process of

recovery from injury, illness, or disease to as normal a condition as possible. The purpose of

rehabilitation is to restore some or all of the patient's physical, sensory, and mental capabilities

that were lost due to injury, illness, or disease. Rehabilitation includes assisting the patient to

compensate for deficits that cannot be reversed medically. Rehabilitation should be carried out

only by qualified therapists. Exercises and other physical interventions must take into account the

patient's deficit. (Medical Dictionary)

Most of the patients who are having injuries and disorders that affect the human bodys

movement or musculoskeletal system such as low back pain, sprain, strain, osteoarthritis,

rheumatoid arthritis undergoes physical therapy rehabilitation.

Physical therapy provides services to individuals and populations to develop, maintain

and restore maximum movement and functional ability throughout the lifespan. This includes

providing services in circumstances where movement and function are threatened by ageing,

injury, disease or environmental factors. Functional movement is central to what it means to be

healthy. Physical therapy is concerned with identifying and maximizing quality of life and

movement potential within the spheres of promotion, prevention, treatment/intervention,

habilitation and rehabilitation. This encompasses physical, psychological, emotional, and social

well- being. Physical therapy involves the interaction between physical therapist, patients/clients,
other health professionals, families, care givers, and communities in a process where movement

potential is assessed and goals are agreed upon, using knowledge and skills unique to physical

therapists. (Bernice Krumhansl)

Treatments are provided by physical therapist. Physical therapists are health care

professionals who maintain, restore, and improve movement, activity, and health enabling

individuals of all ages to have optimal functioning and quality of life, while ensuring patient safety

and applying evidence to provide efficient and effective care. In addition, physical therapists are

involved in promoting health, wellness, and fitness through risk factor identification and the

implementation of services to reduce risk, slow the progression of or prevent functional decline

and disability, and enhance participation in chosen life situations. (PPTA)

Physical Therapist in La Union provides treatments like stretching and strengthening

exercises, using of heating modalities like hot moist pack, ultrasound, paraffin wax bath, infrared

radiation, and microwave diathermy, cryotherapy, spinal and lumbar traction, use of different

types of electrical stimulators such as functional electrical stimulator, transcutaneous electrical

stimulators, neuromuscular electrical stimulation, joint mobilization in managing musculoskeletal

disorders.

Conceptual framework

Physical therapist , treat a number of musculoskeletal conditions a broad term that

encompasses injuries affecting the connective tissues of the body such as muscles, nerves, tendons,

joints, cartilage, or spinal discs (Bureau of Labor Statistics, 2008). Musculoskeletal disorders may occur

when muscles or tendons are stretched or over-used beyond their capabilities.

Many patients recover their strength and ability to return to normal function as well as becoming

pain free again through physiotherapy treatment. The overriding symptom of most conditions we see as

physiotherapists is pain. Pain can occur from infection such as in osteomyelitis where a bone becomes

infected. Pain can also be caused through injury to muscles, ligaments and tendons.
Physiotherapist in the treatment of musculoskeletal conditions aim is to have pain free again as

soon as possible, Physical Therapist have many ways of treating pain depending on the injury or illness

and these techniques may include joint mobilisation, muscle stretching, massage, heating modalities like

hot moist pack, ultrasound, paraffin wax bath, infrared radiation, and microwave diathermy, cryotherapy,

spinal and lumbar traction, use of different types of electrical stimulators such as functional electrical

stimulator, transcutaneous electrical stimulators, neuromuscular electrical stimulation and a host of other

scientifically-based treatment techniques.

Passive joint mobilization is a technique commonly used by physiotherapists to address the

problems of pain and joint stiffness, in order to allow an earlier return to activities. It involves the

physiotherapist manually gliding the articular surfaces of a joint to produce oscillatory movements

(Maitland GD 1991). It has been proposed that manual therapy such as joint mobilization produces

analgesic effects and increases elasticity of joint structures through interactions at the local, central

nervous system and psychological levels (Lederman E. 1997)

Stretching is a form of physical exercise in which a specific skeletal muscle is deliberately

elongated to its fullest length in order to improve the muscles felt elasticity. Benefits of stretching may

include increased flexibility, improved range of motion within joints, improved circulation improved

posture, and stress relief. It is commonly believed that stretching before or after physical activity can

reduce the chance of a strain or sprain injury by increasing the flexibility of muscles, tendons and

ligaments, which in turn increases the range of motion in a joint or group of joints. (Hess and Hecker,

2003). There are three common types of stretches; proprioceptive neuromuscular facilitation (PNF), static

and isometric. (Sharman et al, 2006).

Massage therapy can relieve symptoms and promote complete healing by increasing local

circulation, reducing muscle tension, and relieving muscle spasm and pain. Massage therapy can address

issues by reducing muscle tension and pain, releasing fascial restrictions and excess scar tissue, and

helping patients avoid dysfunctional patterns of compensation. ( Thrash, 1981)


Cryotherapie (ice application) as an effective treatment for soft tissue injuries. It reduces the

swelling, and it will improve the range of motion. However, there are still some doubts if it is actually

effective for pain relief. So the application of ice may be useful for a variety of musculoskeletal pains, yet

the evidence for its efficacy should be established more convincingly. (Nadler, 2004)

Exercise in warm water, usually called hydrotherapy or balneotherapy, is a popular and effective

treatment with a pain relief effect for many patients with painful neurologic or musculoskeletal conditions.

The warmth of water may block nociception by acting on thermal receptors and mechanoreceptors, thus

influencing spinal segmental mechanisms. It gives positive effects on cutaneous barrier homeostasis and

a anti-inflammatory activity. In addition, the warmth may enhance blood flow and muscle relaxation. The

hydrostatic effect may also relieve pain by reducing peripheral edema and by dampening sympathetic

nervous system activity. ( Kiichiro T, 2010)

Ultrasound therapy uses sound waves to impart mechanical vibrations to the tissues to create

heat. Ultrasound waves penetrate homogeneous tissues readily and are absorbed primarily by tissues

with high protein content, such as muscle and connective tissue (Frizzell LA, 1982). The heat produced

by ultrasound elevates the temperature in joint structures 4 to 6C [Lehmann JF 1968). Since ultrasound

was developed in the early 1950s, it has been used to relieve pain and joint immobility in a variety of

musculoskeletal conditions.

Paraffin wax bath is a heat modality (mixture of paraffin wax and mineral oil) that delivers heat

through superficial conduction to relieve pain and inflammation, increase superficial blood flow, and may

increase extensibility of collagen tissue. (Hecox B,2006) Parts of the body are submerged in warm melted

wax to coat the skin in a thick layer, which is then wrapped securely and left for a period of time to "soak".

The heat from paraffin wax treatments is both warming and healing, and the nourishing wax helps to

moisturise dry and cracked skin. (http://www.jill-lusk.co.uk/treatments/paraffin-wax-treatments)

Physical Therapist not only treat pain, but also deal with the accompanying muscle weakness,

loss of muscle balance and stability and decrease in range of movement and functional use of the body
part. Physical Therapist do this is through the prescription and management of individual exercise

programs for patients.

The importance of exercise in dealing with musculoskeletal conditions can never be overstated.

Exercise improves flexibility, promotes movement, and increases blood flow to the area which all help to

reduce pain and increase function. Strengthening exercises are just as important in restoring function and

condition to weak muscles.

Statement of the problems

This study aims to determine the Levels of Satisfaction among Musculoskeletal Condition

on Selected Hospitals in La Union.

1. What is the profile respondent as to:

a. Age

b. Civil status

c. Gender

d. Educational attainment

e. Occupation

f. Length of service

2. What is the level of satisfaction as to:

a. Treatment

b. Facilities

c. Services

3. What is the significant Relationship between the profiles?

4. What do patients prefer?

a. Public Hospital

b. Private Hospital

Hypotheses

The following were the research hypotheses that were formulated in the study:
1. In old age on Ireland they are satisfied to the Treatment done

Significant of the Study

The study will benefit the Rehabilitation Center of the different hospitals in La Union in promoting

excellent rehabilitation services among the patients with musculoskeletal conditions. This study aims to

determine the patients rating of their care experienced based on what they did or did not experience in

their interaction in obtaining health care. Patient satisfaction surveys can help gauge patients perceptions

of practice services and functions. These study are invaluable means for improving communication

between providers and patients and engaging patients in their care.

The study will benefit the Physical Therapist in helping the patient to understand the treatment

and procedures given by them and their role in providing a care to prevent the condition of the patient with

musculoskeletal problems. This study also helps the physical therapist in expanding their roles in different

aspects of health care.

The purpose of this study is to survey the patient level of satisfaction in rehabilitation services in

public and private hospitals in La Union. This study measures the quality of care in patients with

musculoskeletal condition wherein it helps the patient to overlook on the costs of services, the quality of

care delivered and the impact of the treatment facilities on improving their quality of life.

The result of the study focus on achieving high or excellent ratings of patient satisfaction to

improve the quality of service delivery among the patient, therefore physical therapist need to

characterize the factors influencing patient satisfaction which are used as a means to assess the quality

of healthcare delivery.

Scope and Delimitation

The study focused on the reaction of the Musculoskeletal patients from the three selected

hospitals in La Union regarding on the levels of their satisfaction within treatments, facilities and services.
This study is interested on how the musculoskeletal patients reacts on the treatments and

services given by the hospital they chose and also the hospital facilities. It aims to recognize the patients

reactions.

This study would also like to know the patients perception about the treatments, services and

hospital facility.

This research study is limited or focuses only on the musculoskeletal patients from the three

selected hospitals in La Union.

Definition of Terms

1. Care - Level of active concern, or lack of negligence, towards avoidance of possible dangers,

mistakes, pitfalls, and risks, demanded of a party as a duty or legal obligation.

2. Effective - is the capability of producing a desired result. When something is deemed effective, it

means it has an intended or expected outcome, or produces a deep, vivid impression

3. Efficient - performing or functioning in the best possible manner with the least waste of time and

effort

4. Facility - a place, amenity, or piece of equipment provided for a particular purpose.

5. Fulfillment - is a feeling of satisfaction that you get from doing or achieving

something, especially something useful.

6. Health - As defined by World Health Organization (WHO), it is a "State of complete physical, mental,

and social well-being, and not merely the absence of disease or infirmity." Health is a dynamic

condition resulting from a body's constant adjustment and adaptation in response to stresses and

changes in the environment for maintaining an inner equilibrium called homeostasis.

7. Health Care - The treatment and management of illness and the preservation of health, dental,

complementary and alternative medicine, pharmaceutical, clinical sciences, nursing, and allied health

professions. Health care embraces all the goods and services designed to promote health including

preventive, curative, and palliative, interventions whether directed to individuals or to populations.

8. Health Care Service - the furnishing of medicine,medical or surgical treatment,

nursing, hospital service, dental service, optometrical service, complementary health services or any
or all of the enumerated services or any other necessary services of like character, whether or not

contingent upon sickness or personal injury, as well as the furnishing to any person of any and

all other services and goods for the purpose of preventing, alleviating, curing or healing human

illness, physical disability or injury.

9. Low back pain - Low back pain is pain, muscle tension, or stiffness localized below the costal margin

and above the inferior gluteal folds, with or without sciatica, and is defined as chronic when it persists

for 12 weeks or more.

10. Maslows Hierarchy of Needs - is a motivational theory in psychology comprising a five tier model of

human needs, often depicted as hierarchical levels within a pyramid.

11. Need - A motivating force that compels action for its satisfaction. Needs range from basic survival

needs (common to all human beings) satisfied by necessities, to cultural, intellectual, and social

needs (varying from place to place and age group to age group) satisfied by necessaries. Needs are

finite but, in contrast, wants (which spring from desires or wishes) are boundless.

12. Osteoarthritis- is the most common form of arthritis, affecting millions of people worldwide. It occurs

when the protective cartilage on the ends of your bones wears down over time.

13. Rheumatoid arthritis- is the most common type of autoimmune arthritis. It is triggered by a faulty

immune system (the bodys defense system) and affects the wrist and small joints of the hand,

including the knuckles and the middle joints of the fingers.

14. Sprain - Severe stress, stretch, or tear of soft tissues such as the joint capsule, ligament, tendon, or

muscle

15. Strain - Overstretching, overexertion, overuse of soft tissue; tends to be less severe than a sprain;

results from slight trauma or unaccustomed repeated trauma of a minor degree. It also refers to the

amount of deformation that occurs in tissues when a stress is applied

The Paradigm of the Study

Input Process Output


Extent of the patients I. Interview with the patients Level of satisfaction on

having problems about II. Extent of patients treatment, facilities and

their muscular system a. Age services rendered to patients


and skeletel system or b. Civil status with musculoskeletal

basically musculoskeletal c. Gender conditions on selected

system d. Educational attainment hospitals in La Union

e. Occupation

f. Length of service

Bureau of Labor Statistics (2008). Nonfatal occupational injuries and illnesses requiring

days away from work, 2007. Washington, D.C., U.S. Department of Labor, Retrieved on

March 1, 2009 from http://www.bls.gov/iif/oshwc/osh/case/osnr0031.pdf.


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Sharman, M., Cresswell, A., & Riek, S. (2006). Proprioceptive neuromuscular facilitation

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(http://www.jill-lusk.co.uk/treatments/paraffin-wax-treatments)