To the Editor: We write to comment on the article by Goldstein et al titled, “The Development of an Instrument to Measure Satisfaction With Physical Therapy” published in the September 2000 issue of Physical Therapy . Our concern is that we believe faulty procedures in that research quite likely led to incorrect conclusions. We contend that use of the instrument described in that article may perpetuate misconceptions and may mislead those who are interested in patient satisfaction. The introduction of the article professes an interest in the domains of patient satisfaction. The second paragraph on page 856 implies that no psychometric analyses have been conducted in the area of patient satisfaction in physical therapy. This is puzzling because the previous year we published an extensive study on outpatient satisfaction in this same journal.1 We reported on 3 samples with a total of 607 subjects from 21 different facilities. Our research was designed to cross-validate the Physical Therapy Outpatient Satisfaction Survey (PTOPS) across separate samples and by means of both exploratory and confirmatory factor analyses. We provided evidence to support cross-validation by replicating findings from phase 2 (model B) on a new sample in phase 3 through confirmatory factor analysis. We identified 4 domains of outpatient satisfaction: “Enhancers,” “Detractors,” “Location,” and “Cost.” We believe that there were several methodological flaws in the Goldstein et al study. First, the researchers used 20 items to assess 11 hypothesized satisfaction domains. The rationale for proposing several of these domains, in our view, was lacking. What is more important, however, is that there was no way to test the presence of 11 domains, because 6 of the hypothesized domains were assessed with only a single item. Therefore, we argue that it was impossible to develop any intra-domain variance. Because variance is a reflection of …