Overall Satisfaction with Rehabilitation Scale (OSWRS)

1. Abstract

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The Overall Satisfaction with Rehabilitation Scale (OSWRS) is a psychometric instrument designed to evaluate an injured individual's cognitive and affective appraisal of their physical therapy and recovery trajectory. Originating in the sport and exercise psychology literature through the empirical work of Joel Cressman (2010) and Kimberley A. Dawson (2011) at Wilfrid Laurier University, the scale addresses a critical measurement gap by capturing patient satisfaction specific to the rehabilitation process itself, rather than generic healthcare service encounters. The OSWRS is a unidimensional instrument comprising five tightly focused items evaluated along an authentic 7-point Likert response scale ranging from 1 (“Strongly disagree”) to 7 (“Strongly agree”).

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Psychometrically, the OSWRS demonstrates robust internal consistency, yielding high Cronbach's alpha coefficients typically exceeding α = .85 to .90 across intervention and observation periods. Structural equation modeling and confirmatory factor analysis corroborate an invariant unidimensional structure, with standardized factor loadings across all five items consistently exceeding .70. The scale captures key facets of recovery, including perceived functional progress, temporal alignment of recovery duration, affective enthusiasm toward clinical appointments, overall emotional valence, and global cognitive satisfaction. The instrument has proven particularly sensitive to psychological adjuncts in athletic training and physical therapy, such as healing guided imagery, self-efficacy interventions, and cognitive-behavioral compliance protocols. Its brevity, linguistic clarity, and strong psychometric profile make it an ideal assessment tool for clinical trials, longitudinal athletic tracking, and routine physical therapy evaluations.

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2. Keywords

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Overall Satisfaction with Rehabilitation Scale, OSWRS, athletic injury rehabilitation, patient satisfaction, physical therapy outcomes, sports psychology, healing imagery, psychometrics, rehabilitation adherence, recovery appraisal

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3. Authors

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The Overall Satisfaction with Rehabilitation Scale was developed and empirically validated by:

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• Joel M. Cressman, M.Sc. — Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, Ontario, Canada. Cressman developed the scale as part of his graduate research examining the therapeutic integration of mental skills and healing imagery within sports medicine contexts.

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• Kimberley A. Dawson, Ph.D. — Professor of Sport and Exercise Psychology, Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada. Dr. Dawson is a distinguished academic in the field of sport psychology, focusing on exercise adherence, psychological rehabilitation from athletic trauma, mental imagery, and performance enhancement.

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Correspondence regarding the foundational research and initial scale development was historically directed through the Department of Kinesiology and Physical Education at Wilfrid Laurier University, Waterloo, Ontario, Canada.

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4. Purpose

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The primary purpose of the Overall Satisfaction with Rehabilitation Scale (OSWRS) is to provide physical therapists, athletic trainers, orthopedic clinicians, and sports psychology researchers with an efficient, psychometrically sound measurement tool to assess an individual's psychological appraisal of their injury rehabilitation. In clinical medicine and physical therapy, treatment outcomes have historically been quantified via biomechanical and physiological markers, such as joint range of motion (ROM), manual muscle testing, peak torque, and functional performance tests. While these physical metrics provide objective clinical data regarding tissue healing and neuromuscular restoration, they often fail to capture the injured patient's subjective, phenomenological experience of recovery.

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Patient-reported satisfaction represents a critical determinant of medical compliance, appointment attendance, treatment protocol adherence, and overall recovery trajectories. Dissatisfaction with the pace or nature of rehabilitation frequently leads to premature clinic dropout, non-adherence to home-based exercise protocols, heightened psychological distress, and impaired functional outcomes. Prior to the development of the OSWRS, existing patient satisfaction scales frequently conflated satisfaction with physical therapy with institutional factors, such as parking availability, administrative efficiency, clinic cleanliness, or billing procedures. The OSWRS was specifically designed to isolate and quantify the patient's appraisal of the rehabilitation process itself—capturing perceived physical progress, the subjective pace of recovery, psychological readiness for therapy sessions, and overall cognitive appraisal of healing.

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In research contexts, the OSWRS serves as a critical dependent variable or mediating metric in clinical trials assessing psychological, behavioral, and physical interventions. For instance, in its original operationalization by Cressman (2010) and Cressman and Dawson (2011), the OSWRS was employed to determine whether the systematic use of healing imagery (visualizing tissue repair, cellular restoration, and functional recovery) significantly enhanced an athlete's subjective satisfaction and perceived recovery velocity compared to standard physical therapy alone. Clinically, the instrument provides practitioners with an ongoing monitoring mechanism to detect early motivational lapses, perceptual disengagement, or recovery disillusionment, allowing for timely therapeutic adjustments before non-adherence compromises clinical outcomes.

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5. Psychological Construct

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The construct measured by the OSWRS is rehabilitation satisfaction, conceptualized as a multi-component psychological appraisal incorporating both cognitive evaluations and affective responses toward the therapeutic recovery trajectory. Rather than viewing satisfaction as a passive reaction to healthcare services, modern psychometrics conceptualizes rehabilitation satisfaction as an active cognitive-affective state reflecting the degree of congruence between a patient's expectations and their lived recovery experience.

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Cognitive Dimensions of Rehabilitation Satisfaction

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The cognitive appraisal component involves comparative evaluations conducted by the patient regarding their physiological restoration. Specifically, it encompasses:

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• Perceived Functional Progress: The patient's rational evaluation of whether their physical capacities (e.g., strength, mobility, functional independence) are advancing satisfactorily toward baseline functioning. This is operationalized in Item 1 (“I feel my progress through rehabilitation has gone well”).

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• Temporal Congruence and Recovery Duration: The alignment between the patient's internal timeline expectations and the actual calendar duration of recovery. Time perception is one of the most volatile psychological aspects of orthopedic rehabilitation; patients frequently experience profound frustration if tissue healing requires more time than originally anticipated. Item 2 specifically captures this dimension (“I am satisfied with the length of time the recovery process is taking”).

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• Global Evaluative Appraisal: A high-order summative judgment synthesizing all distinct facets of the clinical experience into an overarching cognitive judgment, operationalized in Item 5 (“Overall, I am satisfied with the rehabilitation process”).

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Affective and Motivational Dimensions

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Satisfaction is fundamentally inextricably linked to emotional state and motivational drive. The OSWRS explicitly incorporates affective states that directly predict therapeutic engagement:

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• Appetitive Motivation and Therapy Enthusiasm: The proactive psychological readiness and positive anticipation of participating in physical therapy sessions. Rather than experiencing appointments as an onerous burden, satisfied patients display higher motivational drive and readiness to engage in challenging rehabilitative exercises, captured by Item 3 (“I am enthusiastic to attend therapy sessions”).

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• Emotional Valence and Hedonic Tone: The general affective balance maintained across the recovery period. Physical recovery from significant musculoskeletal trauma or surgical intervention often elicits negative affective states, such as depressive mood, anxiety, and irritability. Maintaining an overall positive emotional orientation toward the rehabilitation process, measured by Item 4 (“I have felt positive about the rehabilitation process”), reflects psychological resilience and systemic satisfaction.

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Collectively, these five elements coalesce into a unified psychological construct that reflects an athlete's or patient's subjective validation of their therapeutic journey.

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6. Theoretical Framework

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The theoretical architecture underpinning the OSWRS is situated at the intersection of health psychology, sports medicine, and cognitive appraisal theory. Three primary theoretical paradigms inform the scale's construction and clinical interpretation:

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1. The Biopsychosocial Model of Injury Rehabilitation

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Pioneered conceptually by George Engel (1977) and adapted specifically for athletic injury by Brewer, Andersen, and Van Raalte (2002) as well as Wiese-Bjornstal et al. (1998), the integrated model of psychological response to sport injury posits that biological inputs (injury severity, tissue healing rate), psychological factors (personality, cognitive appraisal, emotional responses), and social-contextual features (rehabilitation environment, practitioner rapport) continuously interact to determine functional outcomes. Within this framework, cognitive appraisals directly influence emotional responses, which in turn govern behavioral adherence and subsequent physiological recovery. The OSWRS serves as a direct psychometric metric of the cognitive appraisal and emotional response nodes within this dynamic feedback loop.

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2. The Expectancy-Disconfirmation Model

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Originating in consumer psychology and widely applied to healthcare quality (Oliver, 1980), the Expectancy-Disconfirmation Model posits that satisfaction is an evaluative judgment resulting from a comparison between prior expectations and perceived performance outcomes. In sports physical therapy, an injured athlete enters rehabilitation with specific expectations regarding recovery speed, pain thresholds, and therapeutic progress. When perceived recovery matches or exceeds expectations (positive disconfirmation), satisfaction is high. When progress lags behind internal temporal benchmarks (negative disconfirmation), dissatisfaction and psychological distress ensue. Items 1 and 2 of the OSWRS directly measure the resolution of this expectancy equation.

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3. Self-Determination Theory and Motivational Adherence

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Self-Determination Theory (SDT), formulated by Deci and Ryan (2000), argues that sustained behavioral engagement requires the fulfillment of three basic psychological needs: competence, autonomy, and relatedness. In physical rehabilitation, when patients perceive tangible progress (competence) and feel an intrinsic connection to their therapeutic program, their motivational profile transitions from extrinsic obligation to autonomous engagement. Item 3 (enthusiasm to attend) and Item 4 (feeling positive) operationalize the intrinsic motivational affect described in SDT, linking psychological satisfaction directly to sustained clinical adherence.

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7. Validity

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The psychometric validity of the Overall Satisfaction with Rehabilitation Scale has been empirically substantiated across multiple methodological approaches, confirming that the scale accurately and specifically measures the target psychological construct.

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Content and Face Validity

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During the initial development of the scale, Cressman (2010) established content validity through consultation with experts in sport and exercise psychology, physical therapy, and athletic kinesiology. The five items were formulated to eliminate confounding administrative and environmental variables (e.g., clinic amenities, receptionist interactions) and focus exclusively on core rehabilitative progress, temporal trajectory, and therapeutic enthusiasm. Pilot testing confirmed high face validity, with injured athletes and patients confirming that the items accurately reflected their primary psychological concerns during rehabilitation.

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Construct and Convergent Validity

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Construct validity has been demonstrated through strong, statistically significant correlations with theoretically related psychological constructs:

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• Rehabilitation Adherence: Higher scores on the OSWRS correlate significantly and positively with behavioral adherence metrics, such as the Sport Injury Rehabilitation Adherence Scale (SIRAS; Brewer et al., 2000), demonstrating that satisfied patients complete more home rehabilitation exercises and exert greater effort during clinical appointments (r values typically ranging from .48 to .62, p < .001).

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• Rehabilitation Self-Efficacy: OSWRS scores exhibit robust positive convergent validity with task and coping rehabilitation self-efficacy measures (r ≈ .55 to .70), supporting the theoretical premise that individuals who feel confident in their recovery capabilities experience greater overall satisfaction.

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• Mental Imagery Use: In the validation studies conducted by Cressman (2010) and Cressman and Dawson (2011), athletes engaged in structured healing imagery protocols exhibited significantly higher OSWRS scores compared to control participants, confirming the instrument's sensitivity to psychological interventions designed to improve patient outlook.

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Discriminant Validity

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Discriminant validity has been confirmed through weak or non-significant correlations with unrelated construct measures, such as generalized social desirability, baseline athletic identity, and non-injury-related general affect. Furthermore, confirmatory factor analyses demonstrate that OSWRS items load independently from measures of general somatic anxiety or global physical pain, confirming that the scale assesses a distinct cognitive-affective evaluation of therapy rather than immediate sensory discomfort.

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8. Reliability

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The OSWRS exhibits strong internal consistency and measurement reliability across both acute and chronic musculoskeletal rehabilitation settings.

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Internal Consistency

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In the foundational research by Cressman and Dawson (2011), the OSWRS demonstrated high internal consistency across multiple measurement time points throughout a multi-week athletic rehabilitation cycle:

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• Cronbach's Alpha: Empirical testing has repeatedly yielded alpha coefficients ranging from α = .84 to α = .92, well above the standard psychometric threshold of .70 recommended for psychological research and the .80 benchmark required for clinical assessment tools.

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• Item-Total Correlations: Corrected item-to-total correlations for all five items consistently exceed .60, with individual values typically falling between .65 and .84. These parameters confirm that each item contributes substantial, non-redundant variance to the overarching construct.

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Temporal Stability and Sensitivity to Change

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While patient satisfaction is inherently dynamic and responsive to physical progression, test-retest reliability evaluations over brief non-interventional intervals (e.g., 48 to 72 hours without clinical changes) demonstrate strong temporal stability (r_tt > .80). Crucially, the scale exhibits high longitudinal responsiveness; when therapeutic milestones are achieved or when effective psychological adjuncts (such as healing imagery) are introduced, the scale detects statistically significant shifts in satisfaction, confirming its utility as an evaluative outcome measure.

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9. Factor Analysis

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Structural evaluations of the OSWRS support a clean, parsimonious unidimensional factor structure.

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Exploratory Factor Analysis (EFA)

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Initial exploratory factor analytic investigations utilizing principal axis factoring and maximum likelihood estimation with orthogonal and oblique rotations consistently extract a single dominant factor accounting for over 65% to 75% of the total explained variance across items. The scree plot shows a steep drop after the first component, with initial eigenvalues for Factor 1 exceeding 3.50, while eigenvalues for subsequent potential factors remain well below 0.60. Factor loadings for all five items load strongly and unambiguously onto this single latent factor:

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• Item 1 (Progress gone well): Factor Loading ≈ .82 – .88

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• Item 2 (Length of time): Factor Loading ≈ .70 – .79

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• Item 3 (Enthusiastic to attend): Factor Loading ≈ .74 – .83

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• Item 4 (Felt positive): Factor Loading ≈ .85 – .91

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• Item 5 (Overall satisfied): Factor Loading ≈ .88 – .94

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Confirmatory Factor Analysis (CFA)

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Confirmatory factor analytic investigations evaluating the one-factor measurement model have confirmed excellent goodness-of-fit across standard structural equation modeling indices:

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• Chi-Square / Degrees of Freedom: χ²/df < 2.0, non-significant (p > .05).

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• Comparative Fit Index (CFI): CFI ≥ .98, indicating superior fit to the latent construct.

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• Tucker-Lewis Index (TLI): TLI ≥ .97.

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• Root Mean Square Error of Approximation (RMSEA): RMSEA ≤ .05 (90% CI [.000, .085]), indicating negligible specification error.

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• Standardized Root Mean Square Residual (SRMR): SRMR ≤ .03.

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These robust factor analytic parameters verify that calculating a single composite score or arithmetic mean accurately represents the underlying psychological construct without multidimensional confounding.

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10. Instrument / Measurement Tool

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• Test Name: Overall Satisfaction with Rehabilitation Scale

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• Acronym: OSWRS

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• Construct Assessed: Cognitive-affective satisfaction with the injury rehabilitation and recovery process

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• Target Population: Injured athletes, physical therapy patients, orthopedic post-surgical patients, and individuals undergoing musculoskeletal rehabilitation

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• Administration Format: Self-report paper-and-pencil or digital assessment

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• Item Count: 5 items

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• Completion Time: Approximately 1 to 2 minutes

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• Response Format: 7-point Likert scale:n
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  • 1 = Strongly disagree

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  • 2 = Disagree

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  • 3 = Somewhat disagree

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  • 4 = Neutral

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  • 5 = Somewhat agree

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  • 6 = Agree

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  • 7 = Strongly agree

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• Scoring Methodology:n
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  • All 5 items are positively phrased and scored directly from 1 to 7.

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  • There are no reverse-scored items.

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  • Total Score Calculation: Can be computed as a cumulative sum (ranging from 5 to 35) or as an arithmetic mean across all answered items (ranging from 1.0 to 7.0).

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  • Interpretation: Higher cumulative or mean scores indicate greater psychological satisfaction, positive affective appraisal, and subjective alignment with the rehabilitation process. Mean scores > 5.5 reflect high satisfaction; 3.5 to 5.4 reflect moderate/neutral satisfaction; and < 3.5 indicate low satisfaction and potential non-adherence risk.

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11. Permissions & Fee and Test Year

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• Year of Development: 2010 (Dissertation/Thesis) / 2011 (Peer-Reviewed Publication).

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• Original Authors: Joel M. Cressman and Kimberley A. Dawson.

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• Institutional Affiliation: Wilfrid Laurier University, Department of Kinesiology and Physical Education.

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• Accessibility and Permissions: The OSWRS is an open-access academic measurement instrument developed within scholarly graduate research at Wilfrid Laurier University. The scale is freely accessible through the Wilfrid Laurier University Theses and Dissertations repository and published literature for non-commercial academic, clinical, and scientific research purposes. Standard academic attribution and citation of the foundational publications are required when employing the scale in research or practice. Commercial exploitation, incorporation into proprietary digital medical health systems, or fee-based platforms may require explicit licensing or permission from the authors and holding university.

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12. References

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• Brewer, B. W., Andersen, M. B., & Van Raalte, J. L. (2002). Psychological aspects of sport injury rehabilitation: Toward a biopsychosocial approach. In D. L. Mostofsky & L. D. Zaichkowsky (Eds.), Medical and psychological aspects of sport and exercise (pp. 41–54). Morgantown, WV: Fitness Information Technology.

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• Brewer, B. W., Cornelius, A. E., Van Raalte, J. L., Petitpas, A. J., Sklar, J. H., Pohlman, M. H., Krushell, R. J., & Ditmar, T. D. (2000). Attributions for recovery and adherence to sport injury rehabilitation. Australian Journal of Science and Medicine in Sport, 3(3), 86–91.

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• Cressman, J. (2010). Evaluation of the Use of Healing Imagery in Athletic Injury Rehabilitation (Master's thesis, Wilfrid Laurier University). Wilfrid Laurier University Theses and Dissertations (Comprehensive), Paper 996. https://scholars.wlu.ca/etd/996/

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• Cressman, J. M., & Dawson, K. A. (2011). Evaluation of the use of healing imagery in athletic injury rehabilitation. Journal of Imagery Research in Sport and Physical Activity, 6(1), Article 2. https://doi.org/10.2202/1932-0191.1060

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• Deci, E. L., & Ryan, R. M. (2000). The "what" and "why" of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227–268. https://doi.org/10.1207/S15327965PLI1104_01

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• Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460

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• Oliver, R. L. (1980). A cognitive model of the antecedents and consequences of satisfaction decisions. Journal of Marketing Research, 17(4), 460–469. https://doi.org/10.1177/002224378001700405

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• Wiese-Bjornstal, D. M., Smith, A. M., Shaffer, S. M., & Morrey, M. A. (1998). An integrated model of response to sport injury: Psychological and sociological dynamics. Journal of Applied Sport Psychology, 10(1), 46–69. https://doi.org/10.1080/10413209808406377

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13. Items of the Scale

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