Association between patients’ knee posture and patient satisfaction in primary care consultations

Abstract Background Nonverbal behaviour may provide information about patients’ experiences during clinical encounters. Although facial expressions, gaze, and upper-body behaviours have been studied in relation to patient satisfaction, little is known about whether patients’ lower-limb posture is associated with satisfaction. This study explored the association between patients’ knee posture immediately before the end of an outpatient consultation and post-consultation patient satisfaction. Methods This exploratory observational study included patients attending the Department of General Medicine at Tokyo Women’s Medical University Hospital between April 2024 and December 2025. Consultations conducted by three physicians were video recorded. Two researchers visually classified the average posture of both knees during the final 30 seconds of each consultation as flexed, neutral, or extended relative to an approximately right-angled knee position. Joint angles were not instrumentally measured. Patient satisfaction was assessed after the consultation using the 12-item Patient Satisfaction Questionnaire developed by Takemura et al. Mean satisfaction scores were compared across the three knee-posture groups using one-way analysis of variance, with Bonferroni-adjusted pairwise comparisons. Results Of 203 patients included in the analysis, 19 (9.4%) were classified as having a flexed knee posture, 119 (58.6%) as having a neutral posture, and 65 (32.0%) as having an extended posture. The overall mean patient satisfaction score was 49.4 (SD 6.4; range 31–60). Mean satisfaction scores differed significantly among the three knee-posture groups (F[2, 200] = 3.32, P = 0.038). In Bonferroni-adjusted pairwise comparisons, the neutral-posture group had a mean satisfaction score 2.50 points higher than the extended-posture group (95% CI 0.13 to 4.87; adjusted P = 0.035). No statistically significant differences were observed between the neutral and flexed groups or between the flexed and extended groups. Conclusions Knee posture observed during the final 30 seconds of outpatient consultations was associated with post-consultation patient satisfaction, with higher satisfaction among patients with a neutral posture than among those with a relatively extended posture. These findings are exploratory and do not establish causality or indicate that knee posture alone can estimate an individual patient’s satisfaction. Future studies should evaluate the reproducibility of posture classification and determine whether the association persists after adjustment for potential confounding factors.