concurrent improvement of the quality of healthcare services is a major interest when 
 evaluating medical facilities1 , 2 . classically , an evaluation of medical services did not 
 consider patient preferences , but emphasised technical achievements3 . however , there has been growing interest in measuring 
 patient satisfaction in healthcare research , reflecting a move towards patient - centred 
 care2 , 4 . this trend to patient - centred care has been strengthened by the 
 increasingly competitive marketplace . patients who are highly satisfied with a medical 
 service are more likely to seek additional services and recommend a medical facility to 
 others4 . the department of rehabilitation provides physical , occupational , language , and therapeutic 
 assessments and treatments for outpatients . patient satisfaction with rehabilitation 
 services and the attitude of the therapist is as important for assessing therapy as 
 diagnostic procedures and the environment of the facility5 . generally included items are location and accessibility , cost , 
 payment , and facility5 , 6 . previous researchers who have reported on patient satisfaction 
 related to rehabilitation services have emphasised specific items to measure the therapist s 
 manner and successful rehabilitation4 . the usefulness of a questionnaire can not be evaluated with subjective criteria but rather 
 only with objective criteria such as validity and reliability , and most studies try to 
 ensure that the validity of an instrument is well founded7 . an uncertain questionnaire item will generate an uncertain reply 
 from a patient . a good questionnaire contains differentiated items for evaluating the 
 environment , therapeutic technique , therapist s manner , and appropriate rehabilitation 
 process4,5,6 . the 
 purpose of present study were to develop an outpatient satisfaction questionnaire to be used 
 in health system , from which the underlying dimensions could be derived and individual 
 patient scores could be calculated . the medline and science - direct databases for the years 20002014 were searched to find 
 instruments that had been devised to evaluate patient satisfaction at national and 
 international levels . the keywords used for the search were patient satisfaction , 
 questionnaires , rehabilitation , and validity . an agenda was developed for categorising 
 questions on therapeutic satisfaction , courtesy satisfaction , proceeding satisfaction , 
 environment satisfaction , revisits , and recommendations . the final questionnaire contained 
 29 positively and negatively worded statements that are scored using a five - point likert 
 scale ranging from  strongly disagree  to  strongly agree . all the patients coming for rehabilitation therapy who were willing to participate in the 
 study were included . in all , 40 outpatients with a mean age of 57.4  3.8 ( range 4262 ) 
 years completed questionnaire . all of the patients who were unwilling to participate in the 
 study were excluded . present study did not approved by ethics committee for just gaining 
 user s satisfaction about the medical service . all the patients gave written informed 
 consent when getting questionnaires so that returned envelop enclosed the consent about 
 joining this study . after their first visit to the rehabilitation therapy , each patient was given two 
 questionnaires and written informed consent for joining study with a prepaid return 
 envelope . one was the newly designed questionnaire and the other was the patient 
 satisfaction with outpatient physical therapy : instrument validation questionnaire of 
 beattie et al . a cover letter explained the reasons for conducting the survey , encouraged 
 participation , and guaranteed data confidentiality . follow - up letters with the same 
 questionnaires were sent to the patients 1 week later . if the patient still had not returned 
 the questionnaire 15 days after the first reminder , they received a third letter with a new 
 copy of the questionnaire . of the 80 
 patients who answered , 48 ( 60% ) responded to the first mailing , of whom 8 did not reply to 
 the second mailing to investigate reliability , so the final sample was 40 . the test - retest reliability and validity of the questionnaire were analysed using spss ver . 18.0 ( spss , chicago , il , usa ) . to quantify the statistical linear relationship between the 
 total score of the primary questionnaire and each agenda item and the total score of the 
 newly designed questionnaire , pearson correlation coefficients were used . the a 
 priori  level was set at 0.01 for the determination of statistical significance . a single - measure intra - class correlation ( icc ) was used to test the test - retest 
 reliability . the average satisfaction with the newly designed questionnaire was 18.87  1.65 for 
 therapeutic satisfaction , 19.02  1.52 for courtesy satisfaction , 18.00  2.18 for 
 processing satisfaction , 9.05  1.17 for environmental satisfaction , 9.22  1.12 for 
 hospital satisfaction , and 74.17  6.72 for the total satisfaction score . the average 
 satisfaction with the previous questionnaire was 55.35  5.39 , and the values were 
 significantly correlated with those of the newly designed questionnaire ( tables 1table 1.pearson correlation between newly designed questionnaire and previous 
 questionnairenewly designed questionnaireprevious questionnairepearson correlationtherapeutic satisfaction0.699*courtesy satisfaction0.718*processing satisfaction0.725*environmental satisfaction0.641*hospital satisfaction0.772*total satisfaction0.811**correlation is significant at the 0.01 level . and 2table 2.intraclass correlation coefficient ( icc ) and 95% coefficient interval ( 95%ci ) 
 between pre and post questionnaire measurementitemtest and retest measurementicc95% cicronbach s therapeutic satisfaction0.719 * 0.5310.8410.838courtesy satisfaction0.785 * 0.6310.8800.880processing satisfaction0.683 * 0.4760.8190.810environmental satisfaction0.672 * 0.4570.8120.800hospital satisfaction0.740 * 0.5620.8530.854total satisfaction 0.772 * 0.6110.8720.872previous questionnaire0.622 * 0.3910.7800.768*correlation is significant at the 0.01 level . ) . the test - retest reliability of all items in the newly designed questionnaire 
 was strong ( icc=0.772 , 95% ci 0.610.87 ) . the cronbach s alpha for the newly designed 
 questionnaire score showed acceptable inter - item reliability ( =0.87 ) . this study examined the validity of a newly designed satisfaction questionnaire based on 
 questionnaires used in previous research and assessed the reliability of the questionnaire 
 in outpatients . this type of investigation is used not only to confirm the present state of 
 a medical service but also to find a way to improve the quality of a medical service to 
 maximise patient satisfaction and visits7,8,9 . rehabilitation service makes use of diverse therapist techniques and sophisticated 
 instruments10 . in a team approach , 
 physical , occupational , and speech therapists have to cooperate to improve patient status , 
 and cooperation among the therapists is one of the most important factors leading to patient 
 satisfaction , as well as courtesy and therapeutic techniques . present results showed that 
 satisfaction related to processing was relatively lower than for the other items . the correlation between the previous and newly developed questionnaires was significant 
 only for the total score because using a cronbach s alpha of 0.8 at the minimum value for 
 regarding statistical means . the previous questionnaire gives a unified score rather than 
 differentiating diverse agendas , and it has the advantage of providing a representative 
 simple value . however , this makes it difficult to clarify the item characteristics , unlike 
 questionnaire in which each agenda item was moderately correlated with the total patient 
 satisfaction score . the aim of this study was not to devalue the previously developed 
 questionnaire but rather to develop a specific questionnaire for examining the state of 
 medical services . recently , mas et al.9 
 reported positive relationships between the level of patient satisfaction and levels of 
 professional competence , interpersonal manner of healthcare staff , and information . this study confirmed the test - retest reliability of the new and previous questionnaires . in 
 each dimension , cronbach s alpha was > 0.8 for all of the dimensions and the 
 inter - subscale correlation was between 0.731 and 0.883 . a previous study analysed the 
 internal consistency of the questionnaire dimensions using cronbach s alpha , and reported 
 results above the recommended minimum of 0.78 . however , the icc exceeded 0.7 in the therapeutic and courtesy and 
 hospital dimensions only . second , it was almost 
 impossible to determine satisfaction with other hospital departments because this study 
 could not collect information on the presence or absence of other diseases or surgical 
 history . the outpatient satisfaction questionnaire developed in this study had suitable validity , 
 reliability , and acceptability . outpatient satisfaction with the rehabilitation service in 
 busan , korea , was relatively high in terms of the therapeutic procedure and courtesy , and 
 relatively low in terms of the environment and processing .
[ purpose ] the purpose of present study were to develop an out - patient satisfaction 
 questionnaire to be used in health care system , from which the underlying dimensions could 
 be derived and individual patient scores calculated , and to evaluate some of the 
 questionnaire s psychometric properties . 
 [ subjects and methods ] forty out - patient of local 
 hospital reply both the questionnaire used in previous study and newly designed 
 questionnaire . to identifying validity 
 , the statistical linear relationship between the 
 total score of the primary questionnaire and newly designed questionnaire , which were 
 analyzed . 
 the test - retest reliability has been investigated by using a single measure 
 intra class correlation . 
 [ results ] the average satisfaction of the previous questionnaire 
 were significantly correlated with newly designed questionnaire . 
 the intra - lass 
 correlation coefficient of the each items of newly designed questionnaire were strong . 
 total score of the previous questionnaire had the lowest test - retest reliability , 
 cronbach s alpha coefficient for the newly designed questionnaire score showed acceptable 
 inter - item reliability . 
 [ conclusion ] the out - patients satisfaction questionnaire 
 developed in present study , which had appropriate validity , reliability , and 
 acceptability .