OBJECTIVE: To investigate the discrepancy between ratings of pain intensity and patient satisfaction by evaluating a questionnaire item that assesses patient satisfaction with treatment effect. DESIGN: Inception cohort. SETTING: Ambulatory care. PARTICIPANTS: Sixty-six consecutive patients referred to outpatient physical therapy (PT) with acute low back pain (LBP). INTERVENTION: PT using treatment-based classification guidelines. MAIN OUTCOME MEASURE: Patient satisfaction 6 months after receiving PT for LBP. RESULTS: Patient satisfaction with symptoms was considerably lower than the other patient satisfaction items. Patient satisfaction with symptoms was responsive to measures of treatment effect (Spearman rho range, .36-.44, P < .01) and with whether expectations were met (Spearman rho = .45, P < .01). Patients who were satisfied with symptoms reported higher physical function, lower pain intensity, and less symptom bothersomeness (P < .01) at 6 months. The 2 strongest absolute and unique predictors of patient satisfaction with symptoms at 6 months were whether treatment expectations were met and change in symptom bothersomeness. CONCLUSIONS: This study suggested that a questionnaire item assessing patient satisfaction with symptoms allows patients to distinguish between satisfaction with treatment effect and treatment delivery.