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MedRisk is one of the several available measurement tools developed to assess patient satisfaction with outpatient physical therapy services and has been adapted to different countries, including Brazil. However, the literature shows conflicting results regarding its dimensional structure. To evaluate the Brazilian version of MedRisk for semantic equivalence to the original English version, followed by an assessment of its dimensional structure. The original 18-item version was first submitted to translation and back-translation, followed by a pre-test on 55 patients (semantic equivalence phase). Another 326 patients were interviewed to assess the dimensional structure. An initial confirmatory factor analysis (CFA) was followed by exploratory structural equation modelling (ESEM). CFA was performed on the 16-item version agreed upon in the first phase, and indicated poor fit (RMSEA = 0.10, 90% CI: 0.08–0.12; CFI = 0.84; TLI = 0.79). The ensuing ESEM pointed to a four-factor structure, but five cross-loadings emerged, suggesting violation of the item factor specificity. High residual variances were also found in 3 items (≥0.70), which is indicative of poor item reliability. Although semantic equivalence was achieved, several uncovered psychometric (configural and metric) shortcomings show that MedRisk still requires refinements before recommending its use in Brazilian health services. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Measurement properties of the Brazilian Portuguese version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care," by Costa Oliveira N. de Fátima and colleagues in the 2014 issue.