Development and validation of questionnaire to measure patients’ satisfaction with removable partial denture

INTRODUCTION

Tooth loss remains a significant global health concern, impacting not only oral function but also an individual’s quality of life, self-esteem, and social interaction. The rehabilitation of partially edentulous patients with removable partial dentures (RPDs) remains a cornerstone in prosthodontic practice, offering a balance between functionality, esthetics, and cost-effectiveness among the treatment options available to replace missing teeth. RPDs continue to play a vital role, particularly in populations with limited access to advanced fixed or implant-supported prostheses. RPDs are favored for their affordability, reversibility, and ability to restore function and esthetics in a relatively non-invasive manner.^[1-3]

However, the success of RPD therapy is not solely determined by clinical parameters such as retention and stability; patient satisfaction plays a pivotal role in assessing the overall effectiveness of the treatment and encompasses a broad spectrum of subjective experiences.

Despite the availability of RPDs as a longstanding treatment modality, evaluating their impact from the patient’s perspective is still a challenge in both clinical practice and research. Many existing assessments focus primarily on clinical criteria, neglecting the nuanced and personal aspects of patient experiences that are crucial for comprehensive outcome evaluation. Patients’ satisfaction encompasses various domains, including comfort, esthetics, masticatory function, speech, and psychological well-being, all of which significantly influence the patient’s acceptance and continued use of the prosthesis.^[4]

At present, there is no universally accepted, validated questionnaire in English, Hindi, and Marathi languages that holistically measures patient satisfaction with RPDs in a structured and standardized manner. Available tools are often either too generic, lacking specificity for RPDs, or failing to encompass key psychosocial dimensions. This gap limits our ability to compare treatment outcomes across studies, assess the effectiveness of prosthodontic interventions, and, most importantly, provide patient-centered care. Furthermore, without reliable instruments, clinicians may overlook important concerns that could affect prosthesis use, adaptation, or long-term compliance.^[5-8]

To address this gap, several studies have undertaken the development and validation of satisfaction questionnaires tailored for RPD wearers. Al Jaghsi et al. developed and tested self-administered satisfaction questionnaires for patients with removable dental prostheses in the German language, demonstrating excellent internal consistency and high repeatability. Similarly, an Arabic version of satisfaction questionnaires was developed, with factor analyses revealing a one-factor model for both upper and lower jaw questionnaires, indicating robust construct validity.^[9,10]

These studies underscore the feasibility and importance of developing culturally and linguistically appropriate instruments to assess patient satisfaction with RPDs. However, there is a need to develop a questionnaire in English, Hindi, and Marathi languages to ensure their reliability and applicability in various clinical settings.

The objective of this study is to develop and validate a comprehensive questionnaire in all three languages that accurately measures patient satisfaction with RPDs. The tool aims to address key domains including comfort, function, esthetics, and psychosocial impact, ensuring a holistic assessment of patient experiences. By establishing the reliability and validity of this instrument, we aim to provide clinicians and researchers with a practical tool for monitoring outcomes and enhancing patient-centered care in removable prosthodontics.

MATERIAL AND METHODS

An English, Hindi, and Marathi language postal questionnaire to measure patients’ satisfaction with RPDs was developed based on evidence from the literature and expert input, followed by translation, cultural adaptation, and validation to establish its validity and reliability.

RESULTS

The reliability of the questionnaire was evaluated through measures of internal consistency and test–retest stability. The Cronbach’s alpha value of 0.800 indicates good internal consistency, demonstrating that the items included in the scale are homogenous and effectively measure the same underlying construct. Test–retest reliability, assessed using Kappa statistics, yielded a value of 0.786, which corresponds to substantial agreement between the two administrations of the instrument. This result confirms that the responses remained stable over time, supporting the reproducibility of the tool [Table 2].

DISCUSSION

The present study aimed to develop and validate a questionnaire to assess patient satisfaction with RPDs, addressing the need for a standardized and reliable patient-reported outcome measure (PROM) specific to RPD users. The psychometric evaluation of the instrument demonstrated strong reliability and excellent content validity, indicating that the questionnaire is both methodologically sound and clinically applicable.

The internal consistency reliability analysis yielded a Cronbach’s alpha value of 0.800, which is widely recognized as the benchmark for good reliability in social and health sciences. This suggests that the items included in the questionnaire are cohesively aligned and collectively measure the intended construct of patient satisfaction with RPDs. The high internal consistency is comparable to or exceeds that of other prosthodontic PROMs, such as the Oral Health Impact Profile and the Patient’s Denture Assessment, which typically report alpha values within the 0.70–0.85 range. This finding reinforces that the newly developed tool is robust in measuring satisfaction across multiple domains relevant to RPD users, such as comfort, stability, esthetics, mastication, and overall function.^[11-13]

In addition to internal consistency, the questionnaire demonstrated excellent test–retest reliability, with a Kappa value of 0.786, indicating substantial agreement between repeated administrations. This level of temporal stability confirms that respondent answers are not influenced by external variability or random fluctuations but rather consistently reflect their true perceptions. Such reproducibility is essential for any outcome measure intended for clinical use, longitudinal evaluation, or intervention-based studies. Comparable prosthodontic questionnaires have reported test–retest reliability in the moderate to substantial range, suggesting that the instrument developed in this study meets or surpasses established standards in the field.^[14,15]

The content validity analysis further supports the rigor of the questionnaire construction process. Expert panel evaluations yielded exceptionally high S-CVI/Ave values (0.99–1.00) and S-CVI/UA values (0.90–1.00) across all assessed domains – relevance, simplicity, clarity, and ambiguity. These results indicate near-unanimous expert agreement on item adequacy, confirming that all components of the questionnaire are conceptually appropriate, clearly worded, and free of ambiguity. The overall S-CVI/Ave of 0.998 and S-CVI/UA of 0.975 reflect exemplary content validity, far exceeding commonly accepted thresholds (>0.80), and align with best-practice standards in questionnaire development methodology.

Collectively, the high reliability and validity indices attest to the methodological quality of the instrument and indicate that the questionnaire is well-structured to capture patient-centered outcomes relevant to RPD therapy. Given the known limitations of traditional clinical indicators – such as retention or occlusion – in predicting patient acceptance, the availability of a validated PROM designed specifically for RPD wearers is crucial. This tool can provide clinicians with deeper insights into the functional and psychosocial dimensions of prosthesis use, ultimately enhancing treatment planning, communication, follow-up, and evidence-based decision making.

Moreover, the strong psychometric properties demonstrated in this study position the questionnaire as a valuable instrument for future clinical research, including comparative studies of prosthetic designs, materials, treatment protocols, and long-term patient satisfaction outcomes. By addressing a gap in existing prosthodontic assessment tools, this validated questionnaire contributes significantly to the broader movement toward patient-centered care and quality-of-life evaluation in prosthodontics.

CONCLUSION

The newly developed questionnaire demonstrates excellent reliability, strong content validity, and robust psychometric performance, establishing it as a valuable instrument for assessing patient satisfaction with RPDs. Its high internal consistency, substantial test–retest stability, and strong expert agreement indicate that the tool accurately captures the multifaceted patient experience associated with RPD use. This questionnaire fills a critical gap in prosthodontic assessment, offering clinicians and researchers a standardized and patient-centered method for evaluating treatment outcomes, guiding clinical improvements, and supporting evidence-based practice.