Structural equation modeling for association between patient satisfaction and quality of life after implant surgery

Sun-Young Chung; Jin-Hyun Cho; Kyu-Bok Lee; Youn-Hee Choi; Keun-Bae Song

doi:10.4047/jkap.2011.49.4.291

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Chung, Cho, Lee, Choi, and Song: Structural equation modeling for association between patient satisfaction and quality of life after implant surgery

ORIGINAL ARTICLE

J Korean Acad Prosthodont 2011;49(4):291-299.

Published online: 18 December 2011

DOI: https://doi.org/10.4047/jkap.2011.49.4.291

Structural equation modeling for association between patient satisfaction and quality of life after implant surgery

Sun-Young Chung, MS¹, Jin-Hyun Cho, DDS, PhD², Kyu-Bok Lee, DDS, PhD², Youn-Hee Choi, DDS, PhD¹, Keun-Bae Song, DDS, PhD^1,^∗

^¹Department of Preventive Dentistry

^²Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Korea

∗Corresponding Author: Keun-Bae Song Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, 2-188-1, Samduk-dong, Jung-gu, Daegu, 700-412, Korea +82 53 660 6870: e-mail, kbsong@knu.ac.kr

Received 26 August 20116 October 2011 Accepted 10 October 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was designed to measure patient satisfaction and oral health-related quality of life and to assess an association between patients’ satisfaction and oral health-related quality of life after implant surgery by using structural equation modeling.

Materials and methods

A total of 257 participants who visited 6 dental clinics located in Daegu city for the purpose of implant treatment participated in this study. Six months after completion of implant surgery, the patients’ satisfaction and oral health-related quality of life were surveyed. The effect of factors associated with patients’ satisfaction such as functions and aesthetics, maintenance and cost on oral health-related quality of life after implant surgery was analyzed using AMOS 4.0.

Results

Oral health-related quality of life was improved in all dimensions of OHIP-14 after implant surgery. Functions and aesthetics as well as maintenance had a significant effect on oral health-related quality of life (P<.05), while cost was not a critical factor influencing oral health-related quality of life.

Conclusion

High satisfaction with functional aspects and maintenance aspects significantly affected good quality of life. The result of this study supported the fact that education and management for patients after implant therapy were positively related to good quality of life based on a theoretical model. (J Korean Acad Prosthodont 2011;49:291-9)

Keywords: Implant, OHIP-14, Oral health-related quality of life, Patient satisfaction, Structural equation modeling

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Fig. 1.

Study model (OHRQoL: Oral health-related quality of life).

Fig. 2.

Patients Satisfaction on five categories related to function, aesthetic, maintenance, cost, and general satisfaction after implant surgery (each item was recorded by 5-point Likert scale and of the 12 items, 5 ones were excluded).

Fig. 3.

Oral health-related quality of life on seven categories related to functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap before and after implant surgery (The numerical values in brackets were differences of OHIP-14 score between before and after implant surgery).

Table 1.

Questionnaires for measurement of treatment satisfaction given to patients 6 months after implant surgery

No.	Question
Q1	My implant functions very well, and I can chew on it very well
Q2	To speak, I can use my implant very well
Q3	I am pleased with the aesthetic results
Q4	I can clean my implants very well
Q5	It is easier for me to clean my implants than to clean my teeth
Q6	The tissues around the implants bleed less than around the teeth
Q7	I got exactly what I expected
Q8	I would like this treatment again, if needed
Q9	I would recommend this treatment to friends or relatives, if indicated
Q10	I found that the cost of the treatment was justified
Q11	I feel more secure biting on implant/my teeth/no difference
Q12	I need more time to clean implant/my teeth/no difference

Table 2.

Questionnaires for measurement of oral health-related quality of life given to patients at the baseline and 6 months after implant surgery

No.	Dimension	Question
Q1	Functional limitation	Have you had trouble pronouncing any words because of problems with your teeth, mouth or dentures?
Q2	Functional limitation	Have you felt that your sense of taste has worsened because of problems with your teeth, mouth or dentures?
Q3	Physical pain	Have you had painful aching in your mouth?
Q4	Physical pain	Have you found it uncomfortable to eat any foods because of problems with your teeth, mouth or dentures?
Q5	Psychological discomfort	Have you been self-conscious because of your teeth, mouth or dentures?
Q6	Psychological discomfort	Have you felt tense because of problems with your teeth, mouth or dentures?
Q7	Physical disability	Has your diet been unsatisfactory because of problems with your teeth, mouth or dentures?
Q8	Physical disability	Have you had to interrupt meals because of problems with your teeth, mouth or dentures?
Q9	Psychological disability	Have you found it difficult to relax because of problems with your teeth, mouth or dentures?
Q10	Psychological disability	Have you been a bit embarrassed because of problems with your teeth, mouth or dentures?

Table 3.

Confirmatory factor analysis for patients’ satisfaction

Factors	Items (Number)	Regression weights	Standardized regression weights	P<
Function and aesthetics	Chewing (Q1)	1.471	0.885	.001
	Speaking (Q2)	1.477	0.929	.001
	Aesthetics (Q3)	1.000	0.597	-
Maintenance	Cleaning (Q4)	0.512	0.532	.001
	Easiness (Q5)	1.099	0.903	.001
	Bleeding (Q6)	1.000	0.727	-
Cost	Costs (Q10)	1.000	0.432	-

X²= 51.766, df = 12, P=.000, RMR = 0.048, GFI = 0.947, AGFI = 0.875, IFI = 0.940, CFI = 0.939

Table 4.

Confirmatory factor analysis for oral health-related quality of life

Factors	Items (Number)	Regression weights	Standardized regression weights	P<
	Functional limitation (Q1-Q2)	1.000	0.694	-
	Physical pain (Q3-Q4)	1.232	0.750	.001
	Psychological discomfort (Q5-Q6)	1.404	0.836	.001
OHRQoL	Physical disability (Q7-Q8)	1.000	0.780	.001
	Psychological disability (Q9-Q10)	1.180	0.862	.001
	Social disability (Q11-Q12)	0.663	0.667	.001
	Handicap (Q13-Q14)	0.959	0.680	.001

X²= 107.901, df = 14, P=.000, RMR = 0.086, GFI = 0.884, AGFI = 0.767, IFI = 0.907, CFI = 0.906

Table 5.

Correlation matrix of components

	Function and aesthetics (FA)	Maintenance (MA)	Cost (CO)	OHRQoL (OQ)
Function and aesthetics (FA)	1
Maintenance (MA)	0.461^∗	1
Cost (CO)	0.053	0.115	1
OHRQoL (OQ)	0.320^∗	0.271^∗	0.005	1

^∗ Correlation is significant at the 0.01 level (2-tailed).

Table 6.

Estimation of structural equation models and hypothesis testing between patient satisfaction and OHRQoL after implant surgery

Hypothesis	Path	Direction		Regression weights	Standardized regression weights	P<
H1	FA (ξ 1) → OQ (η 1)	+	(gamma) 11	0.438	0.225	.004
H2	MA (ξ 2) → OQ (η 1)	+	(gamma) 12	0.220	0.216	.007
H3	CO (ξ 3) → OQ (η 1)	-	(gamma) 13	-0.031	-0.039	.587

X²= 243.124, df = 72, P=.000, RMR = 0.067, GFI = 0.876, AGFI = 0.820, IFI = 0.901, CFI = 0.900

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