The effectiveness of early mobilization (compression and decompression with glide) in osteoarthritis of knee joint. DR.

Transcription

1 Abstract The effectiveness of early mobilization (compression and decompression with glide) in osteoarthritis of knee joint. DR. IMRAN RAFIQ BSPT, PP-DPT, ISRA UNIVERSITY, ISLAMABAD, DR. MUHAMMAD NAVEED BABUR PT. DPT, ISRA UNIVERSITY, ISLAMABAD Objective: Purpose of this study was to identify the effectiveness of mobilization (compression and decompression with glide) in patients of osteoarthritis of knee. Design: Case series Methods: A total of five patient s age between years and pain from mild to moderate in severity were treated using compression and decompression technique with glide for 9 minutes. All the patients were given 3-4 sessions per week and evaluated before and after treatment using visual analogue scale (VAS), 6 minute walk test and 8-feet up and go test. Results: After application of mobilization techniques there was decrease in knee joint pain, decrease in stiffness and improvement in functional capability of patients. Patients were pain free, with comfortable ROM and independent in performing activities of daily life. Conclusion: Study showed that compression and decompression technique with glide leads to significant improvement in symptoms in patients with mild pain but patients with moderate pain give satisfactory response. Functional capabilities of patients were also improved Key words: Mobilization, Osteoarthritis (OA), VAS (visual analogue scale), Anteroposterior (AP), Range of Motion (ROM) Introduction Osteoarthritis is a condition of synovial joints characterized by cartilage loss with an accompanying peri- articular response. Pathologically, there is an alteration in cartilage structure, radiologically there are osteophytes and joint space narrowing and clinically patient complains of pain and disability. [1] Osteoarthritis (OA) is the most common joint disorder, a prevalence that increases with age. Mobilization is a passive procedure performed to improve pain, increase range of motion and increase the functional capability of patient because optimal stimulus for the regeneration of joint cartilage is intermittent compressiondecompression with gliding. Mobilization of knee joint includes mobilization of tibiofemoral joint. Mobilization of tibiofemoral joint includes anterior and posterior glides with compression and decompression. [2] Objective of this study was to identify the effectiveness of early mobilization (compression and decompression with glide) in relieving pain, increase ROM of knee joint and functional capability in patients of osteoarthritis Study design was 252

2 case series. Patients were treated in Department of physical therapy Al- Raee hospital Gujranwala, Pakistan. Duration of study was two month. Five patients with inclusion criteria, age between years and pain from mild to moderate in severity were included and patients, age below 30 years or above 60 years and sever pain were excluded from study. Visual analogue scale was used to measure the severity of pain and functional capabilities were assessed with 6- minute walk test and 8- feet up and go test. Results Before treatment Case Pain ROM Functional capability Case 1 Case 2 Case 3 Case 4 Case5 Moderate pain at VAS during walk and sitting and rising from chair. Mild pain during walking at VAS Moderate at VAS during walk and sitting and rising from chair. Mild pain in NWB. Moderate pain at VAS during walk and sitting and rising from chair. No pain in NWB. Moderate pain at VAS during walk and sitting and rising from chair Difficult AROM& PROM in non weight bearing. Can easily perform PROM &AROM, NWB &WB Can perform PROM &AROM in NWB &WB with mild difficulty. Can perform PROM &AROM in NWB &WB with mild difficulty. Can easily perform PROM &AROM, NWB &WB Unable to walk more than 10 meter in 6 minute walk test. Moderate pain in sitting and rising from chair in 8- feet up and go test. Able to walk considerable distance with mild pain in 6 minute walk test but with mild pain in sitting and rising from chair in 8- feet up and go test. Able to walk considerable distance with moderate pain in 6 minute walk test but with moderate pain in sitting and rising from chair in 8- feet up and go test. Able to walk considerable distance with moderate pain in 6 minute walk test but with moderate pain in sitting and rising from chair in 8- feet up and go test. Able to walk considerable distance with moderate pain in 6 minute walk test but with moderate pain in sitting and rising from chair in 8- feet up and go test. 253

3 After treatment Case no Case 1 Case 2 Case 3 Case 4 Case5 Pain ROM Functional capability Mild pain at VAS during walk and sitting and rising from chair. No pain during walking at VAS No pain at VAS during walk and sitting and rising from chair. No pain in NWB. Mild on off pain at VAS during walk and sitting and rising from chair. No pain at VAS during walk and sitting and rising from chair Easy AROM& PROM in NWB &WB Can perform PROM &AROM in NWB &WB Can perform PROM &AROM in NWB &WB without pain. Can perform PROM &AROM in NWB &WB. Can easily perform PROM &AROM, NWB &WB Distance increased in 6 minute walk test. Mild pain in sitting and rising from chair in 8- feet up and go test. Able to walk considerable distance without pain in 6 minute walk test but with mild pain in rising from chair after prolong sitting Able to walk considerable distance without pain in 6 minute walk test but with mild pain in sitting and rising from chair in 8- feet up and go test. Able to walk considerable distance with mild pain on off in 6 minute walk test, sitting and rising from chair in 8- feet up and go test. Able to walk considerable distance without pain in 6 minute walk test without pain in sitting and rising from chair in 8- feet up and go test. Discussion Study revealed that early mobilization (compression and decompression with glide ) in patients of osteoarthritis of knee, result in significant improvement of the symptoms of the patient which, support the results of study, The initial effects of knee joint mobilization on osteoarthritic hyperalgesia.by Mossa, P., Slukab, k., & Wrighta, A. (2007) [3]. The purpose of study was to investigate the initial effects of accessory knee joint mobilization on measures of pain and function in individuals with knee osteoarthritis. The effects of a 9-min, nonnoxious, AP mobilization of the tibio-femoral joint were compared with manual contact and no-contact interventions. The effectiveness of early mobilization (compression and decompression with glide) in osteoarthritis of knee to see the effects of mobilization to reduce pain and functional capability of the patient. There was decrease or no pain in patients and improved functional capability of patients. This shows the reliability and validity of this study. Results provide new evidences that mobilization of an osteoarthritic knee joint immediately could be an effective means of reducing pain and improving functional capability in this population. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee by Deyle, G, D., Henderson, N, E., & Matekel, R. L. et al (2000).[4] Clinically and statistically significant improvements in 6-minute walk distance. A combination of manual physical 254

4 therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention. Effectiveness of early mobilization (compression and decompression with glide) in osteoarthritis of knee also increase in distance walked by patient in 6- minute walk test and decrease in pain and improved functional capability. These techniques also delay or prevent the need for surgical procedures. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Therapeutic Exercises and Manual Therapy in the Management of Osteoarthritis (2005) [5].The purpose was to create guidelines for the use of therapeutic exercises and manual therapy in the management of adult. The Ottawa Panel recommended the use of therapeutic exercises alone, or combined with manual therapy, for managing patients with OA. This study also suggested the use of mobilization techniques in management of the patients suffering from OA. This suggests to investigate effects of a 9-min, non-noxious, AP mobilization of the tibio-femoral joint were compared with manual contact and no-contact interventions, which provides new experimental evidence that accessory mobilization of an osteoarthritic knee joint immediately produces both local and widespread hypoalgesic effects. It may therefore be an effective means of reducing pain in this population. Conclusion A large elderly population is suffering from osteoarthritis of knee resulting in psychological, social and functional limitations of this population. This prevents them from their participation as an active member of the society. Mobilization is an effective mean of reducing their disability and keeps them pain free and functional. This also helps delaying or preventing need for surgical procedures. But further research and evidences are necessary for efficacy of mobilization techniques in osteoarthritis of knee. In last, mobilization helps a lot to manage pain, increase ROM and improve the functional capability of the patient. 255

5 References Parveen, K & Michael, C (Eds.). (1999). Clinical Medicine. China : W.B.Saunders Kisner, C& Colby, L (1996) Therapeutic Exercises Foundation and Techniques.New Jaypee Brothers Dehli. Mossa, P., Slukab, k., & Wrighta, A. (2007). The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Manual therapy, 12(2), Deyle, G, D., Henderson, N, E., & Matekel, R. L. et al (2000). Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Annals of Internal Medicine, 132(3), Ottawa Panel Evidence-Based Clinical Practice Guidelines for Therapeutic Exercises and Manual Therapy in the Management of Osteoarthritis. Physical Therapy (2005). 85(9),

6 Factors Influencing on Customers E-Satisfaction: a case Study from Iran Bahram Ranjbarian Professor of Marketing, University of Isfahan Saeed Fathi Assistant Professor of Management Department, University of Isfahan Zeynab Rezaei MBA Candidate, University of Isfahan Abstract: Understanding of what creates a satisfying customer experience becomes crucial for online-stores success in attracting more customers to purchase through on line. This study is an empirical investigation which proposes and tests an "e-satisfaction" model. The adopted model, identifies five dimensions representing satisfaction with internet purchase experience and analyzes online-customers attitudes toward internet shopping based on their perception about the rule of convenience, the kind of merchandising, website design, security of transaction, serviceability in e-satisfaction. The statistical population of this research study was internet users and consumers of some Iranian internet shopping centers. The data was obtained through a field survey. The results revealed that four factors of convenience, merchandising, security and serviceability have influence on customer e-satisfaction but the influence of website design on e-satisfaction was not supported despite its indirect effect on security and serviceability. Finally, some strategic recommendations are proposed for customers e-satisfaction enhancement and also for further investigation. Key words: E-satisfaction, Internet shopping, Electronic commerce, Merchandising, Iran 1- Introduction: The collapse of large numbers of dot-com companies has required managers, who felt that the Internet had changed everything, to relearn that profits indeed do matter (Rosenbloom, 2002) and that the traditional laws of marketing were not rescinded with the arrival of the e- commerce era. Additionally, it has been reinforced that organizations not only need to attract new customers, but also must retain them to ensure profitable repeat business. [Anderson, 2003]. An increasing number and variety of firms and organizations are exploiting and creating business opportunities on the internet. Companies spend a lot of money on their websites to provide their customers with traditional functionality and a more integrated marketing stream with the hopes of entering customers to purchase goods on line. The key determinants of success or failure for e-commerce companies are not merely web presence or low price but delivering right quality of e-service that causes sophisticated online customers pay a higher 257

7 price. The service quality has a significant impact on customer satisfaction. Based upon the problematic and investigation relevance of internet shopping, the propose of this research study is developed and test a model of better understanding the factors that are most important in predicting consumers' behavioral intention to purchase over the internet. Although research on cognitive computing for insights into making the websites of internet shops more competitive is very important and highly needed, the field is in its infancy and many important research topics like e-satisfaction have not yet been studied conceptually and empirically enough well. Shoppers are very often of the "touch and feel" type, who prefer to handle and compare goods before deciding to buy. Under these circumstances, it was important to discover whether consumers perceived at the outset that virtual shopping over the internet would engender a comparable experience, and how significantly life content considerations tended to affect decisions to shop in this way. [Liao & Cheung, 2001] Our objective is to provide the initial evidence for the determinants of e-satisfaction. We examine and document the role of convenience, merchandising, site design, security, serviceability in customer e-satisfaction assessments by rely on qualitative evidence gathered through focus group tested to develop the conceptual model for the investigation and then tested the model across a broader groups of online shoppers. We close the study by discussing implications of the findings and directions for future research. 2- Literature Review While considerable research has investigated the drivers of service quality and satisfaction in the offline environment (Zeithaml,2000), a small, but growing body of research has examined the drivers in the environment in the online environment (Francis,2002 ; Donthu,2001; Loiacono & et al,2002 ; Srinivasan & Ponnavolu,2002 ; Zeithaml & et al,2000). Research on the basic questions - what drives online satisfaction and retention - is still in the exploratory stage as both theory and empirical investigations are emerging. From a broad perspective, the Internet is a new technology and Web site satisfaction will be driven by ease of use and usefulness (Davis, 1989). Davis argued that these two concepts are predominant in predicting how much consumers will be using computer technologies. The ability to easily navigate a Web site and its perceived value (e.g. entertainment, convenience, community) will influence both usage level and satisfaction. By extension, satisfaction in the online environment may also be driven by consumer benefits in using self-service technologies. As noted by Van Riel (Van Riel, and et al, 2001) these benefits include convenience], saving time and money, avoiding interpersonal interaction and being in control. This implies that the drivers of Web satisfaction may include Web site characteristics (e.g. ease of use), the specific Web site's value (e.g. useful information) and its relative value (e.g. more convenient than offline 258

8 shopping). A variety of independent and dependent constructs and measures have been employed to identify the drivers of e-satisfaction. In short, there is no consensus on what drives online service quality and e-satisfaction (Zeithaml & et al, 2002). While ease of use has various labels (e.g. site design, Web store functionality, ease of understanding, ease of navigation) and different measures (e.g. easy to use, easy to locate information, user friendly site) the underlying construct reflects the ease with which an individual can navigate the Web site. Similarly, Website content has various labels (e.g. product information, product attribute description, product selection, product uniqueness, informational fit-to- task) and different measures (e.g. product information meets my needs, extensive product selection, clearly describes products), and the underlying construct reflects the depth of and information on the products offered. A majority of the studies suggest a third driver, customer security (e.g. financial security, security/privacy) which reflects the Web site's information regarding its security policies. Beyond these three, there were fewer consensuses on the remaining drivers either discussed or tested. These included customer service, convenience, ease of ordering, and efficiency. Of interest to this study was the role of customer service (e.g.care, responsiveness) which reflects the ability to respond to questions, problems and after sale service. [Anand, 2007] The Internet literature review (i.e. consumers reactions to Internet use about information search and purchase experience) permits to identify and analyze the relevant elements of e- satisfaction structure, needed to include as explanatory variables in regression models developed in this study. Convenience is the most important factor of consumers satisfaction with Internet using and is related to speed, easy access to information at low cost (i.e. time, effort and displacement) where everything can be found in a minute without time or geographical restraints. In the consumers perception, Internet shopping convenience is related to an easy way of shopping and reducing total time spent on purchase (Szymanski & Hise; 2000; Kim & Lim, 2001), a pleasant way of shopping and delivery time (Jarvenpaa & Todd, 1997; Alba et al, 1997) and the perceived relation - cost / delivery time (Shim et al, 2001). Additionally, the human interaction loss in electronics services and retail has different effects on consumers satisfaction (Meuter et al, 2000; Forman & Sriram, 1991). Site design quality depends on functional and attractive elements as: ease of browsing, a standard language use, interface design, information search engine in virtual stores, pages actualization, clear information contents, the largest number of clickable items (Jarvenpaa & Todd, 1997), an organized presentation (Szymanski & Hise, 2000), interactivity tools available, a good reality simulation and product s virtual experimentation possibility (Shim et al, 2001; Alba et al, 1997). Attractive web pages presentation should contain animated gifts, 259

9 sound, video and entertainment contents like advertisement (Kim & Lim, 2001). However, some consumers react negatively to web banners, because they interrupt and slow down a web page (Szymanski & Hise; 2000). Reliability on Internet information search elements reveals a perceptual dichotomy between consumer s reliability of the information content and reliability in control and use of technology. Information reliability is related with diversity, depth and actuality of information contents (Szymanski & Hise, 2000; Kim & Lim, 2001). The capacity to compare product s information and the information search result depends on individual capacity of Internet use and affects consumer s satisfaction (Alba et al, 1997). Entertainment is basically related to amusement and pleasure contents in Internet. Kim & Lim (2001) concludes that entertainment is an important factor of consumers satisfaction with Internet shopping, and is associated to pleasure of browsing, advertising and bonus offer in web sites. Entertainment is also associated to interesting places to visit and shopping (Shim et al, 2001), and the possibility of animation through virtual environments, minimizing the absence of human contact and amusement associated to shopping (Jarvenpaa & Todd, 1997). Security perception and privacy assurance with Internet shopping demonstrates to have the biggest impact on e-satisfaction (Szymanski & Hise, 2000). Most researchers also agree that the security problems (i.e. personal data transmission and payments with credit cards) are the major risks affecting online transactions, acting as the principal barriers to electronic commerce. Internet product offer is generally satisfactory for consumers, concerning product diversity and available brands (Jarvenpaa & Todd, 1997) but doesn t demonstrate a significant impact on e-satisfaction (Szymanski & Hise, 2000). Other major critical elements are related to risks inherent to catalog purchase: product performance (i.e. guaranty, possibility of sensorial experimentation or product return) and supplier confidence (i.e. unknown supplier with no physical address, non-fulfillment of delivery promises) (Shim et al., 2001; Jarvenpaa & Todd, 1997). Other consumer s expectations, concern lower price products or a perceptual price/convenience relation (Jarvenpaa & Todd, 1997; Bakos, 1997), transaction costs reduction and a higher delivery speed (Shim et al, 2001; Alba et al, 1997). [Torres & Martins, 2004] Analyzing consumers level of satisfaction has been of special interest to many business people and academics, especially in the marketing field. Traditionally, the level of consumer satisfaction is determined by the quality of services, the price level, and the purchasing process. Consequently, the level of e-satisfaction is also determined by the quality of e- services, the price level and the purchase process. Wang and Huarng (2002) identified nine service quality factors that affect e-satisfaction through content analysis of online customer 260

10 comments in their research. 1. General feedback on the web site design, 2. Competitive price of the product 3. Merchandise availability 4. Merchandise condition 5. On-time delivery 6. Merchandise return policy 7. Customer support 8. confirmation on customer order 9. Promotion activities [Wang, 2002] 3- Conceptual Model: A qualitative phase of research was initiated to identify possible antecedents to e- satisfaction. Qualitative research for model formulation is advocated for areas such as e- satisfaction that are ill-defined, under-researched, or relatively new (Miles and Huber-man, 1994). The conceptual model of the study which presented in Figure 1 is one outcome of this qualitative phase of research. E-satisfaction is depicted in Figure 1 as the outcome of consumer perceptions of online convenience, merchandising, site design, and security. Focus group members were later contacted and asked to review the model. All agreed that the model adequately captured their sentiments regarding e-satisfaction. Interestingly, the elements captured in the model also tend to be the ones discussed in the academic literature as representing advantages or disadvantages of e-retailing (e.g., Alba et al., 1997; Ernst and Young, 1999; Balasubramanian, 1997). Table 1.Conseptual Model Convenience Shopping time Convenience Ease of browsing Merchandising Number of offering Variety of offering Quality of info Quantity of info Less searching cost Site design Navigation structure Web Design and interface Fast Presentation 261

11 Convenience E-retailing is promoted widely as a convenient avenue for shopping. Shopping online can economize on time and effort by making it easy to locate merchants, find items, and procure offerings (Balasubramanian, 1997). Consumers do not have to leave their home nor travel to find and obtain merchandise online. They can also browse for items by category or online store. These time and browsing benefits of online shopping are likely to be manifested in more positive perceptions of convenience and e-satisfaction. H1: Shopping Convenience has influence on e-satisfaction of Internet shops customers Merchandising Positive perceptions of online merchandising represent another set of elements that could positively impact e-satisfaction levels. Merchandising is defined here as factors associated with selling offerings online separate from site design and shopping convenience. This includes the product offerings and product information available online. It seems reasonable to expect that e-satisfaction would be more positive when consumers perceive online stores to offer superior product assortments. For one, superior assortments can increase the probability that consumer needs will be met and satisfied. This is especially likely when consumers desire items not widely distributed (e.g., specialty goods), produced in limited quantities, or unavailable at brick-and-mortar stores because shelf space is limited. For example, a traditional book superstore may carry 150,000 titles (Bianco, 1997), but an Amazon.com carries millions of titles. The probability of locating any one title, therefore, would be higher at the online store. The probability of consumers satisfying needs online would also be higher. Second, the wider assortment of products can include items of better quality that may be attractive to consumers. The lower search costs traditionally associated with online shopping are thought to result in consumers buying better quality items (Bakos, 1997). Buying better quality items, in turn, can improve satisfaction by delimiting the costs of failed products. These costs include the costs of returning merchandise, losing face when items fail, failure in one item causing failure in a related item (e.g., failed tires and accidents), or failure creating an impediment to task completion (e.g., malfunctioning computer and uncompleted tasks). Finally, we expect richer information (more extensive and higher quality) available online to lead to better buying decisions and higher levels of e-satisfaction (Peterson, Balasubramanian, and Bronnenberg, 1997). 262

12 H2: Merchandising has influence on e-satisfaction of Internet shops customers Site Design In addition to possible convenience and merchandising effects, the ambience associated with the site itself and how it functions could play a role in whether consumers are satisfied or dissatisfied with their online shopping experiences. Manes (1997), for example, reports that good Web-site design is about good organization and easy search. This includes offering consumers uncluttered screens, simple search paths, and fast presentations. Moreover, each of these elements of site design could impact e-satisfaction levels in the genre of a more pleasurable shopping experience being a more satisfying one. Shopping is thought to be pleasurable and satisfying to consumers when the retailing sites are fast, uncluttered, and easy-to-navigate (Pastrick 1997). Fast, uncluttered, and easy-tonavigate sites economize on shopping time. Uncluttered and easy-to-navigate sites also economize on the cognitive effort consumers expend figuring out how to shop effectively online H3: Site Design has influence on e-satisfaction of Internet shops customers Security The security of online transactions continues to dominate discussions on Internet commerce and perhaps with good reason. Bruskin/Goldberg Research, for example, reports that 75% of Internet shoppers emphasize credit-card security as a major consideration when deciding whether or not to buy items online. [Szymanski & Hise, 2000] George (2002) examined whether privacy and internet trustworthiness helped deter-mine attitudes towards the Internet. He hypothesized that the more experienced an individual is with the internet, the more positive the individual s beliefs about inter-net trustworthiness. George also hypothesized that the more positive an individual s attitudes toward internet purchasing, the stronger the individual s intent to make consumer purchases over the internet. Lack of trust is one of the most frequently cited reasons for customers not shopping on the internet. Security and privacy have an impact on customers trust in shopping on the internet. The apprehensions of the customers regarding the security for online transactions and authenticity of goods are curtailing the success of the e-shopping model. More and more sophisticated customers would rather pay higher price to e-shoppers who provide high quality services. Bruskin / Goldberg research, for example, reports 75% of internet shoppers emphasize credit card security as a major consideration when deciding whether or not to buy items online.[ Amoroso & Hunsinger,2008] 263

13 H4: Security has influence on e-satisfaction of Internet shops customers Serviceability General feedback on the web site design, competitive price of the product, merchandise availability, merchandise condition, on-time delivery, merchandise return policy, customer support, confirmation on customer order, promotion activities are the factors affecting the e-satisfaction and thereby the overall success of the e-tailing site. the level of e- satisfaction is also determined by the quality of e-services, the price level and the purchase process. Product delivery has the strongest influence on customers' satisfaction and future purchase intentions. H5: Serviceability has influence on e-satisfaction of Internet shops customers 4- Research Methodology: With the qualitative findings as a foundation, the quantitative phase of research reported next focused on surveyed data which empirically test the conceptual model of the study. The customer s e-satisfaction and its related variables have been measured on a five point Likert - scale ranging from 1 to 5 with the following equivalences,'' 1'' : '' strongly disagree '' ; ''2'' : '' slightly disagree'' ; ''3'' : '' neutral '' ; ''4'' : '' agree '' ; and ''5'' : '' strongly agree ''. The samples were confined to e-shoppers in Esfahan, Iran. A questionnaire was designed and pre-tested on 40 participants according to the standard approach and subsequently was dispatched to 195 such individuals of different jobs and locations. Usable responses to the survey were obtained from 181 shoppers (93%). SPSS 17 and AMOS Graphics 18 were employed in data analysis. Sample Characteristics In its majority, the sample is composed by males and females, aged 20 to 40, with academic education and occupation of college students and employees. All respondents have a few years of e-shopping experience at least. The items which mostly purchased by our subjects are internet and telecom services, educational materials, digital and electronic components which also tend to be items purchased most frequently by online shoppers. (See table 2) % F Characteristics Under 1 1 to 3 Table 2.Sample principal characteristics Demographic E-Shopping Experience % F Characteristics Male Female Demographic Gender 264

14 to 6 year)( Under Above to 35 Age Movies 8 31 Above Digital & Electronics Educational materials Make Up Decorative Mobile & Laptop Stock Internet and telecom ser. 1 to 3 4 to 6 7 to 9 Above 10 Total Preferred Items to purchase on-line number of website visited Associate degree & lower Bachelor Degree Master degree PhD Low level jobs High level jobs Student Self-employed Under 5 6 to to 14 Above 15 Education Profession Working experience with Computer (years) 265

15 Reliability and Validity All indicators significantly loaded to a respective construct, proving unidimensionality.the reliability of the research construct has been examined by Cronbach Alpha coefficients; we found strong support for construct reliability. The validity of the construct also has been examined by means of factor analysis. Total scale showed relatively high Cronbach Alpha coefficients at α > 0.88 and all values ranged from 0.70 for security to 0.83 for e-satisfaction. 5- Data Analysis: Confirmatory factor analysis was conducted to determine the indicators (i.e. measurement item) for each construct loaded as predicted on the respective construct (i.e. e-satisfaction). We refined the scales by deleting items, that did not highly correlate with other items measuring the same constrict. Through a series of scales purification process, final acceptable CFA results were achieved for: CMIN/DF=2.371(Ρ-value=0/000), CFI=0.95, AGFI=0.92, NFI=0.93, GFI=0.93, RMR=0.06, RMSEA= Through CFA, we could confirm the presence of the construct (e-satisfaction) and the five dimensions of e-satisfaction (i.e. convenience, merchandising, website design, security and serviceability. (See table 3) 266

16 Cronbach's Alpha Table 3: The result of the CFA on e-satisfaction Regression Rate Description Item 0.73 Familiarity satisfaction with e-shops 0.8 Satisfied with purchase from e-shops 0.82 Willingness to repeat the purchase from e-shops 0.72 Increase the frequency of visiting the e-shops e-satisfaction 0.76 Recommend others to buy from internet e-shops 0.57 Satisfied with all facilities and services of e- shops 0.76 Purchasing from e-shops is highly time saving 0.95 Purchasing from e-shops is easier convenience 0.61 Searching the needed products in e-shops is easy 0.52 E-shops products is enough to answer the customers E-shops products diversity is more than normal 0.52 shops merchandising 0.8 Info quantity for website products is enough 0.81 The given info about website products is qualified 0.51 Cost of searching products in e-shops is low 0.68 E-shoppers are guided while searching products 0.51 Websites view and design is suitable and beautiful 0.54 Exploring speed of e-shops website on screen is good site design 0.52 E-shops website design is changeable by applicants 0.65 The information presented by e-shops is up to date 0.6 The financial security exists in e-shops 0.88 No need to worry for personal privacy in e- security shopping 0.58 The customers claim in e-shops will be investigated serviceability 0.68 Special services are given in e-shopping 0.58 E-shops concern about packaging and quality 0.77 Delivery of products in e-shops is fast and on time 0.52 E-shops products are sent by prof. post services 0.55 Price of e-shops products is cheaper 0.53 E-shops products is always available to supply 0.63 The reimbursement of product is easy in e-shops 267

17 E-shops send approval to customers Purchasing process is e-shops is easy and pleasing E-shops let customers comment about website design 268

18 6- Result and Conclusion: The hypothesized model is tested employing structural equation modeling using AMOS. The overall fit of the model is acceptable. All the hypothesized paths are supported except one path (i.e. website design e-satisfaction). As shown in Table 4 and Figure.1, e-satisfaction is influenced by convenience (β =0.38) supporting H1, merchandising (β = 0.41) supporting H2, security (β = 0.22) supporting H4 and serviceability (β = 0.85) supporting H5 which compiles with most previous researches. The findings doesn t support H3,indicating that the website design (β = ) has not a significant influence on e-satisfaction, which is opposing our initial expectation and other researches that website design has influence on e-satisfaction, e.g. Kim et al (2009 ), Cai and Xu (2006) and Shankar et al (2003). This purpose of the study was to develop and test an integrative model of e-satisfaction by conceptualizing that e-satisfaction is influenced by convenience, merchandising, security and serviceability aspects of e-shopping among which serviceability considered to be the strongest predictor. The study supports mainly by previous studies. Table 4.Standardized parameter estimates of the hypothesized paths Coefficient Result Item Hypothesizes (t-value) Supported 0/38 (4/80) Convenience E- H1 satisfaction Supported 0/41 (2/75) Merchandising E- satisfaction H2 Rejected 0/22 (1/69) Site Design E- satisfaction H3 Supported 0/22 (1/98) Security E- satisfaction H4 Supported 0/85 (2/15) Serviceability E- satisfaction H5 CMIN/DF=2.371(Ρ-value=0/000), CFI=0.95, AGFI=0.92, NFI=0.93, GFI=0.93, RMR=0.06, RMSEA=

19 Fig.1. Summary results in the model of e-satisfaction process 270

20 References [1] Alba, J., Lynch, J., Weitz, B, and Janiszewski, C. (1997), Interactive home shopping: consumer, retailer, and manufacturer incentives to participate in electronic marketplace, Journal of Marketing, Vol.61 No.3, pp [2] Amoroso, Donald L. and Hunsinger D.Scott, (2008), Analysis of the factors that influence online purchasing, Proc CONISAR, Vol.1. [3] Anand, Akshay, (2007), E-Satisfaction- A comprehensive framework, International Marketing Conference on Marketing & Society, IIMK. [4] Anderson, Rolph and Srinivasan, Srini S. (2003), E-satisfaction and e-loyalty: A contingency framework, Psychology & Marketing, Vol.20 (2): pp [5] Bakos, J.Yannis, (1997), Reducing Buyer Search Costs: Implications for Electronic Marketplace. Management Science, Vol.43, No. 12, pp [6] Balasubramanian, Sridar, (1997), Two Essays in Direct Marketing, Ph.D. Dissertation University, New Havent, CT. [7] Bianco, Anthony, (1997), Virtual Bookstores Start to Get Real, Business Week (October, 27), pp [8] Cai.S., Xu. (2006). Effects of outcome, process and shopping enjoyment on online consumer behavior. Electronic Commerce Research and Applications 5. pp [9] Davis, F.D. (1989), Perceived usefulness, perceived ease of use and user acceptance of information technology, MIS Quarterly, September, pp [10] Donthu, N. (2001), does your web site measure up?, Marketing Management, November /December, pp [11] Ernst and Young (1999), Internet Shopping: An Ernst and Young Special Report, Eanst and Young LLP, Forrester Research, Inc, (2000). [12] Forman, A.M. and V.Sriram, The Depersonalization of Retailing; Its Impact on The "loyalty" Consumer. In Journal of Retailing, Vol.67 No. 2, pp [13] Francis, J.E. and White, L. (2002), PIRQUAL : a scale for measuring customer expectations and perceptions for quality in internet retailing, In Proceeding of the Winter Education's Conference, American Marketing Association, Chicago, IL, pp [14] Kim, Jiyoung, Jin, Byonugho, and Swinney L., Jane, (2009), the role of etail quality, e-satisfaction and e-trust in online loyalty development process, Journal of Retailing and Consumer Service 16, pp [15] Kim, J., Lee, J., Han, K. and Lee, M. (2002), Businesses as buildings: metrics for the architectural quality of internet business, Information System Research, Vol.13 No.3, pp [16] Liao, Ziqy & Cheung, Michael Tow, (2001). Internet based Shopping and Customer attitude: An empirical study, Information and Management, Vol.38: pp [17] Loiacono, E.T., Watson, RT, and Goodhue, Dl. (2002), WebQual: a measure of web site quality, in, Proceedings of the Winter Educator's Conference, American Marketing Association, Chicago, IL, pp

21 [18] Meuter M. et al, (2000), Self Services Technologies: Understanding Customer Satisfaction with Technology-Based Services Encounters, In Journal of Marketing, Vol.64, No.3, pp [19] Peterson, Robert A., Sridhar Balasubramanian and Bart J.Bronnenberg, (1997), exploring the Implications of the Internet for Consumer Marketing, Journal of the Academy of Marketing Science, 25 (fall): pp [20] Rosenbloom, B., (2002), Ten deadly myths of e-commerce, Business Horizons, No.45, pp.1-6. [21] Shankar.V.S., Smith, A.K., Rangaswamy, A (2003), Consumer satisfaction and loyalty in online and offline environments. International Journal of Research in Marketing 20(2), pp [22] Shim, S. and Eastlick, M.A. (1998), The Hierarchical influence of personal values on mall shopping attitude and behavior, Journal of Retailing, Vol.47 No.1, pp [23] Srinivasan, S.S., Anderson, R. and Ponnavolu, K. (2002), Customer loyalty in e- commerce: an exploration of its antecedents and consequences, Journal of Retailing, Vol.78, pp [24] Szymanski, David M. and Hise, Richard T. (2000), E-satisfaction: Initial examination, Journal of Retailing, Vol.76 (3), pp [25] Torres, Anna Isabel and Martins, Francisco Vitorino (2004), An e-satisfaction model Application to internet information search and purchase, IADIS International Conference E-commerce [26] Van Riel, A.C.R., Liljander, V.and Jurriens, P.(2001), Exploring consumer evaluations of e-services : a portal site, International Journal of service Industry Management, Vol.12 No.4, pp [27] Wang, Ming (2003), Assessment of e-service quality via e-satisfaction in e-commerce globalization, EJISDC, Vol.11, No.10, pp [28] Zeithaml, V.A., Parasuraman, A. and Malhotra, A. (2002), Service quality delivery through Web sites: a critical review of extent knowledge, Journal of the academy of Marketing Science, Vol.30 No.4, pp