A Quantitative Measurement of Physical Therapists’ Empathy and Exploration of the Relationship With Practice Setting and Work Engagement

Abstract

Clinical empathy has been studied in a number of health-care disciplines suggesting that higher practitioner empathy leads to improved patient health and wellness and improved patient outcomes. While some aspects of the physical therapist–patient relationship have been described, evidence of quantitative assessment of clinical empathy in physical therapists is scarce. To investigate the level of self-reported clinical empathy in physical therapists and its relationship to practice environment and workplace engagement, the Jefferson Scale of Empathy-Health Provider version (JSE-HP) and the Oldenburg Burnout Inventory (OLBI) were used. Study participants were 123 physical therapists working full time at either an acute care setting, a rehabilitation hospital, or an outpatient clinic. These physical therapists demonstrated a mean JSE-HP score of 118.5 (9.1) and a mean OLBI score of 15.63 (3.5). This mean empathy score was found to be higher than reported empathy level of some health disciplines such as nursing and pharmacy yet lower than others such as mental health workers, psychiatrists, and pediatricians. Practice setting was not found to be a significant factor regarding empathy levels in physical therapists. As reported in previous studies, there was a positive correlation between being female and having higher empathy levels. A positive correlation was found between age and work disengagement. Finally, our hypothesis regarding a negative correlation between empathy and work disengagement was confirmed, suggesting that workplace disengagement may diminish a physical therapist’s empathy, which may then negatively affect patient clinical outcomes.

Keywords

empathy burnout work engagement physical therapy physical therapist

Background

Clinical empathy has been defined as “a predominantly cognitive attribute that involves an understanding of the patient’s experiences, concerns, and perspectives, combined with a capacity to communicate this understanding and an intention to help” (M. R. Hojat, 2007; Thomas Jefferson University, 2018). The importance of clinical empathy in health care is supported by vast amounts of research regarding this attribute.

Clinical empathy has been studied in a number of health-care disciplines for its ability to enhance patients’ health and wellness. For example, physicians’ clinical empathy is linked to improved patient compliance with medical care (M. Hojat et al., 2011; Kim, Kaplowitz, & Johnston, 2004), better patient satisfaction (M. Hojat et al., 2010; Kim et al., 2004), and enhanced patient outcomes (Canale et al., 2012; M. Hojat et al., 2011; Rakel et al., 2009). Empathy has been found to be important in the nursing profession as well and has been linked with decreased anxiety and depression in patients undergoing cancer care (La Monica, Wolf, Madea, & Oberst, 1987). Studies that quantitatively measure self-reported empathy in physical therapists are limited, yet it is known that the positive working alliance between physical therapist and patient results in improved treatment adherence, satisfaction, physical functioning, and decreased depression in selected patient populations (Hall, Ferreira, Maher, Latimer, & Ferreira, 2010). In a qualitative study, Kidd, Bond, and Bell (2011) stated that patients receiving outpatient physical therapy considered a patient-centered approach, including caregiver empathy, to be important to their care. Peiris, Taylor, and Shields (2012) found patients participating in physical therapy at a rehabilitation hospital reported patient–therapist interactions, including empathy, motivation, and encouragement, were more important than the amount and content of physical therapy received.

Another area of study regarding clinical empathy delved into varying levels of clinical empathy present in different practice environments. Physicians practicing in outpatient settings were found to be more empathetic than physicians in an inpatient setting (Chaitoff et al., 2017). Studies in clinical nursing also found empathy levels varied in different settings such as emergency room and intensive care units (Bourgault et al., 2015; Gosselin, Bourgault, & Lavoie, 2016). Exploration of clinical empathy in the physical therapy profession across clinical settings has not yet been studied.

The relationship between clinical empathy and burnout has also been studied extensively in a variety of health-care disciplines. A systematic review by Wilkinson, Whittington, Perry, and Eames (2017) demonstrated a strong inverse correlation between empathy and the depersonalization component of burnout as well as a strong positive correlation between empathy and the personal achievement component of burnout. While burnout rates have been reported in physical therapy (Balogun, Titiloye, Balogun, Oyeyemi, & Katz, 2002; Campo, Weiser, & Koenig, 2009; Donohoe, Nawawi, Wilker, Schindler, & Jette, 1993; Schuster, Nelson, & Quisling, 1984), the relationship between empathy and burnout has not been investigated specifically.

The purposes of this study were to investigate clinical empathy in the physical therapy profession and its relationship to practice setting and work disengagement, a component of burnout. The researchers’ three hypotheses were (1) physical therapists will report levels of empathy similar to the levels reported by other patient-oriented health-care professionals, (2) there will be differences in self-reported empathy between practice settings, and (3) there will be an inverse relationship between self-reported levels of empathy and work disengagement.

Method

This study used a cross-sectional between-subjects casual-comparative design that gathered quantitative data from survey results. Institutional review board approval was obtained in May 2017.

Participants

A convenience sample was obtained, including 123 physical therapists from six sites in Massachusetts and Rhode Island: Beth Israel Deaconess Medical Center, Spaulding Rehabilitation Hospital Charlestown, Boston University Physical Therapy Center, and Southcoast Hospital Group. Two sites characterized as acute care hospitals, three sites as outpatient clinics, and one as an inpatient rehabilitation hospital. All full-time physical therapists working at these institutions were eligible to participate. All therapists given the survey completed the survey.

Instruments

This study used the Jefferson Scale of Empathy–Health Professional (JSE-HP), the work engagement portion of the Oldenburg Burnout Inventory (OLBI), and a short demographic survey. The JSE-HP was used for measuring self-reported levels of empathy among physical therapists. The JSE was originally developed to measure empathy in physicians and medical students (M. Hojat et al., 2001). A revised version was later developed for health professionals, referred to as the JSE-HP, which includes 20 questions answered on a 7-point Likert-type scale, with items equally split between positively and negatively worded items. Total scores range from 20 to 140, with higher scores indicating a greater level of empathy. Internal consistency reliability (Cronbach’s α) on JSE-HP has been reported between .81 and .89 (M. Hojat et al., 2002; M. Hojat et al., 2001). Test–retest reliability coefficient for JSE- HP has been reported as r = .65 with 3- to 4-month interval between testing (M. Hojat et al., 2002).

The OLBI was used to measure clinicians’ level of work disengagement. The OLBI is composed of two subscales that represent two core dimensions of burnout: Exhaustion and Work Disengagement, which can be used together or separately according to the developer (Demerouti, Mostert, & Bakker, 2010). In considering the use of the Exhaustion subscale, a weak negative correlation had been reported between empathy and emotional exhaustion (Wilkinson et al., 2017; Yuguero, Ramon Marsal, Esquerda, Vivanco, & Soler-González, 2017). Also, the Exhaustion subscale of the OLBI includes emotional and physical components of exhaustion. Given the physical nature of the practice of physical therapy, we believed that using the exhaustion portion of the inventory might confound results. As there is a strong correlation between empathy and the other two measures of burnout, namely depersonalization and personal accomplishment (Wilkinson et al., 2017; Yuguero et al., 2017), we chose to solely use the work disengagement subscore of the OLBI that consists of 8 items scored on a 4-point Likert-type scale. There are 4 positively and 4 negatively worded items with the latter being scored inversely, thus a higher score represents higher disengagement (Demerouti, Bakker, Vardakou, & Kantas, 2003). The internal consistency (Cronbach’s α) for the OLBI disengagement subscale has been reported between .79 and .84 (Demerouti et al., 2003; Demerouti et al., 2010) and test-–retest correlation found to be r = .34 after 4 months, which is consistent with findings from other burnout measures (Halbesleben & Demerouti, 2005).

The demographic survey provided information regarding participant’s total years of practice, age, practice setting, and gender. To maintain anonymity of participants, we used prespecified ranges to collect data on years of practice and age.

Procedures

Prospective participants were contacted via e-mail on the first of each month during the data collection period (June through December 2017) explaining purpose of the study, maximal expected time commitment, voluntary nature of participation, and dates of data collection, which coincided with department meetings or educational sessions. Each participant was asked to complete the three forms and was instructed not to identify themselves in any way. The procedure was repeated with a goal of obtaining 120 respondents.

Data Analysis

Paper responses were hand-coded and checked by two researchers to assure the demographic survey; the OLBI and the JSE-HP could be linked for analysis while preserving anonymity. An adequate response to the survey was defined as having 16 or more of the 20 JSE-HPS questions answered (M. Hojat et al., 2002) and fully completed OLBI. All completed questionnaires met the criteria for adequate response and therefore were included in analysis. In cases where JSE-HP surveys were incomplete but had 16 or more responses, missing data were entered based on guidelines of the scale: Missing items were replaced with the value of the mean score calculated from the items completed by that respondent (M. Hojat et al., 2002). All participants completed the work engagement portion of the OLBI in its entirety, negating the need for replacement of missing items.

The distribution of participants’ overall JSE-HP and OLBI was assessed and summarized. Subsequently, proportions for categorical data on participants’ characteristics along with JSE-HP and OLBI means (SD) scores for each category were calculated.

The internal consistency for the instruments was assessed using Cronbach’s α coefficients for both scales. To explore individual strength and direction of relations between the collected variables, we conducted a series of Spearman and Pearson correlations for categorical and continuous outcomes, respectively.

To examine association between the observed variables, a series of multiple regression analyses was performed with focus on the significant predictors for empathy and disengagement, respectively. The efficacies of developed models were assessed with regard to the adjusted coefficient of determination (R ²).

The final models predicting OLBI and JSE-HP served as the basis in the development of standardized pathways between observed variables, identifying direct and indirect factors impacting empathy among practicing physical therapists. The a priori level of significance was set at α = .05.

Study data were collected and managed using Research Electronic Data Capture (REDCap; Harris et al., 2009). REDCap is a secure, web-based application designed to support data capture for research studies. SPSS Version 24 was used for the generation of descriptive and inferential statistics (IBM Corp. Modified 2016. IBM SPSS Statistics for Windows, Version 24.0, Armonk, NY).

Results

Demographics

Demographic information for the 123 subjects is provided in Table 1. Forty-eight therapists worked at an acute care hospital (39%), 54 in an outpatient physical therapy (PT) setting (44%), and 21 at an acute rehabilitation hospital (17%). Of the total sample twenty-two participants (18%) were male, which is consistent with the higher prevalence of women (70%) in PT practice nationally (American Physical Therapy Association, 2014), and age were grouped into four prespecified categories. Although not identical, the distribution of participants among the four categories for age and years of practice was closely aligned. Consequently, only age was used in further analyses.

Table 1.

Demographics and Summary Statistics for Burnout and Empathy.

Variables			Disengagement (OLBI)			Empathy (JSE-HP)
Variables	N	%	Mean	SD	Range	Mean	SD	Range
Overall	123	100.0	15.6	3.5	[8, 24]	118.5	9.1	[92, 138]
Years of practice^a
≤3	36	29.5	14.8	3.7	[10, 24]	119.4	8.0	[98, 135]
3–7	29	23.8	15.2	3.3	[8, 20]	117.0	10.6	[92, 137]
8–12	14	11.5	17.3	3.4	[12, 23]	118.9	6.9	[108, 131]
≥13	43	35.2	16.2	3.2	[9, 23]	118.7	9.5	[95, 138]
Age
≤26	18	14.6	13.8	2.5	[10, 17]	120.3	7.9	[98, 131]
27–31	41	33.3	15.5	3.9	[8, 24]	118.3	8.2	[100, 135]
32–36	18	14.6	16.9	3.2	[12, 23]	115.9	10.3	[92, 131]
≥37	46	37.4	15.9	3.3	[9, 23]	118.9	9.7	[95, 138]
Gender^b
Female	101	82.1	15.5	3.5	[8, 24]	119.4	8.1	[98, 138]
Male	22	17.9	16.2	3.5	[11, 24]	114.0	11.7	[92, 136]
Location
Inpatient acute hospital	48	39.0	15.7	3.4	[10, 24]	118.4	10.0	[92, 138]
Outpatient	54	44.0	15.7	3.7	[9, 24]	118.8	8.2	[100, 137]
Acute rehabilitation	21	17.1	15.5	3.3	[8, 20]	117.9	9.2	[98, 136]

Note. n = 122 (n = 123 for all others). OLBI = Oldenburg Burnout Inventory; JSE-HP = Jefferson Scale of Empathy-Health Provider version.

^aIndicates one missing response. ^bThird option on survey.

Instrument Reliability

The instruments’ internal consistency was examined by calculating Cronbach’s α coefficients for both scales. The OLBI demonstrated reasonable internal consistency with a standardized Cronbach’s α-coefficient = .78. Deletion of any single item did not result in a practically significant improvement. Similarly, the JSE-HP demonstrated reasonable internal consistency with a standardized Cronbach’s α-coefficient = .76. Deletion of any single item did not result in a practically significant improvement.

Study participants had an average score of 15.63 (3.5) for disengagement and 118.5 (9.1) for empathy. Detailed percent breakdowns of the study sample by demographic variables along with summary statistics for disengagement and empathy are provided in Table 1.

Individual Correlations

A series of pairwise correlations between independent and dependent variables is presented in Table 2. The Spearman rank correlation between age and years of practice was very strong, rs = .90 (p < .001); however, this was to be expected based on the nature of the variables.

Table 2.

Correlation Matrix for Demographic Variables With Work Disengagement and Empathy.

Variables	Years	Age	Male	Location Setting	OLBI
Years	—	—	—	—	—
Age	.90^a	—	—	—	—
Male	.02	.07	—	—	—
Location setting	.14	.16	.02	—	—
OLBI	.20^a	.19^a	.05	.01	—
JSE-HP	−.01	−.03	−.20^a	−.02	–.32^a+

Note. N = 123 for all correlations except for years of practice where n = 122; all correlations are Spearman correlations. OLBI = Oldenburg Burnout Inventory; JSE-HP = Jefferson Scale of Empathy-Health Provider version.

^aStatistically significant at p < .05; ⁺Pearson correlation.

Significant correlations were found between age and work disengagement and years of practice and work disengagement, Spearman rank correlations rs = .19 (p = .03) and rs = .20 (p = .03), respectively (Table 2). A significant correlation was found between gender and empathy, with Spearman rank correlation rs = –.20 (p = .02) indicating females reported higher empathy.

There was no observed correlation between age and empathy or years of practice and empathy (Table 2). There were also no statistically significant relationships observed between work disengagement and practice settings nor gender.

Pearson’s correlation showed work disengagement was negatively correlated with empathy with r = −.32 and a 90% confidence interval [−.446, −.178], suggesting an inverse relationship between work disengagement and empathy.

Multiple Regression Analysis

To examine statistically predictive relationships between the observed variables, a series of multiple regressions was performed. Since gender and age were significant predictors for empathy and disengagement, respectively, these were the focus of the models. Although neither empathy nor work disengagement was correlated with practice setting, the variable of practice setting remained in the analysis, as it was directly related to one of our hypotheses. Other measured variables were assessed, but that inclusion did not result in statistically significant models offering a better fit, therefore have not been reported here.

Specifically, Model 1 predicts disengagement based on three age categories (21–26, 27–31, ≥37), and Model 2 predicts disengagement based on the three age categories, gender (male), and practice setting. Model 1 explained 4.3% (adjusted R ²) of variance in disengagement scores and was used in the subsequent pathway analysis (Table 3). Similarly, Models 3 and 4 predict empathy according to study variables including disengagement. Model 3, the final model after variable selection, included gender (male) and work disengagement, explaining 12.9% (adjusted R ²) of variance in empathy scores in the study population (Table 3).

Table 3.

Multiple Regression Models Predicting Burnout and Empathy.

Variables	OLBI						JSE-HP
	Model 1			Model 2			Model 3			Model 4
	β	SE	p	β	SE	p	β	SE	p	β	SE	p
(intercept)	13.78	0.80	—	13.86	0.84		131.68	3.52	—	130.5	4.13	—
Age
27–30	1.76	0.90	.070	1.82	0.98	.067	—	—	—	−0.23	2.49	.928
31–36	3.17	1.13	.006	3.31	1.16	.005	—	—	—	−1.96	2.99	.513
≥37	2.16	0.95	.024	2.33	1.02	.024	—	—	—	0.54	2.60	.836
Male	—	—	—	0.63	0.82	.444	−4.85	1.99	.016	−5.19	2.05	.012
OLBI	—	—	—	—	—		−0.79	0.22	<.001	−0.76	0.23	.001
In/out: neither	—	—	—	–0.39	0.91	.670	—	—	—	0.90	2.27	.691
In/out: out	—	—	—	−0.54	0.73	.460	—	—	—	1.35	2.31	.562
Adjusted R ²	4.3%			2.7%			12.9%			10.5%
F(ΔR ²)	2.808	(3,1119)	.043	0.38	(3,116)	.766	10.07	(2,120)	<.001	0.33	(5,115)	.892

Note. N = 123. F ratios used to assess model fit based on unadjusted R ² values. OLBI = Oldenburg Burnout Inventory; JSE-HP = Jefferson Scale of Empathy-Health Provider version.

Note: To prevent multicollinearity, age was selected for analysis rather than years of practice due to the very strong correlation, and in this sample, the age variable had no missing data.

Path Analysis

The standardized results from Models 1 and 3 (the most parsimonious statistically predictive models) were combined into a path model examining the direct and indirect effects of gender (male), three age categories (21–26, 27–31, ≥37), and work disengagement (OLBI) on the primary dependent variable, empathy (JSE-HP). The estimated direct effects from age categories to disengagement are β* = .23 for 27–31, β* = .32 for 32–36, and β* = .30 for age ≥37. The estimated direct effects from gender (male) to empathy (β* = −.21) and from disengagement to empathy (β* = −.30). The estimated indirect effects from age categories to empathy are β* = −.07 for 27–31, β* = −.10 for 32–36, and β* = −.09 for age ≥37.

Discussion

This is the first study, to our knowledge, that quantitatively measured empathy in practicing physical therapists with varying years of clinical practice. This is also the first study to explore a possible relationship between clinical empathy in physical therapists and practice setting. Finally, this study investigated the relationship between self-reported empathy and work disengagement in practicing physical therapists.

Hypothesis 1: Physical therapists will demonstrate levels of clinical empathy consistent with other patient-orientated health-care professionals.

The mean self-reported clinical empathy level in this cohort of 123 physical therapists with a variety of years of practice was 118.5 (9.1). We found only one study that potentially measured clinical empathy in practicing physical therapists (Bayliss & Strunk, 2015). The purpose of that study by Bayliss and Strunk (2015) was to measure empathy levels of physical therapy students as they progressed through their professional doctor of physical therapy (DPT) education, and subsequently, a mean empathy score of 119.21 (12.53) was reported for a cohort of 29 former students who were surveyed 6 months after graduation. If those graduates were employed at 6 months postgraduation, then it can be assumed these would be empathy levels of novice practicing physical therapists.

Since there are currently no cutoff scores to indicate high or low empathy levels on the JSE-HP, the authors are left to compare this study’s findings with published results from other practicing health-care professionals. In the nursing profession, there are numerous reports that measure nursing empathy that range from an JSE-HP score of 92.88 to 118.0 (Bourgault et al., 2015; Fields et al., 2004; Gosselin et al., 2016; Kliszcz, Nowicka-Sauer, Trzeciak, Nowak, & Sadowska, 2006; Kuo, Cheng, Chen, Livneh, & Tsai, 2012). Clinical empathy measured in mental health therapists in the UK was reported to have a mean score of 121.2 (9.53; Brockhouse, Msetfi, Cohen, & Joseph, 2011), while pharmacists in Japan scored 108.9 (12.5; Higuchi et al., 2015). A recent study of general practicing physicians in Denmark reported a mean empathy score of 117.9 (10.1; Charles, Ahnfeldt-Mollerup, Søndergaard, & Kristensen, 2018). In a study by M. Hojat et al. (2002), clinical empathy levels stratified physicians into three groups according to practice specialties: patient-oriented specialties, technology-oriented specialties, and a middle group. Physicians who practiced in people-oriented specialty groups, which included such disciplines as psychiatry and pediatrics, reported high levels of clinical empathy (120.5–127.0), while those who practiced in more technology-oriented areas of medicine such as anesthesiology and radiology had the lowest empathy scores (116–118; M. Hojat et al., 2002). Chaitoff et al. (2017) found similar results in their study on physician specialty practice and empathy levels.

Since the practice of physical therapy requires a significant amount of face-to-face time, we believed that physical therapists would demonstrate levels of clinical empathy similar to those levels reported by other health-care professions who spend substantial time in direct patient care. The self-reported empathy levels of the physical therapists in our sample (118.5) were lower than the top tier of physicians as stratified by empathy scores and were more similar to the middle group, which included physicians practicing in general surgery and obstetrics and gynecology in the study by M. Hojat et al. (2002) and emergency room physicians in the study by Chaitoff et al. (2017). It would seem that clinical empathy in physical therapists was higher than those reported in the nursing and pharmacy professions as well as some physician groups but not as high as mental health therapists and some other physician specialties.

Hypothesis 2: PTs in three different practice settings (inpatient acute care hospitals, inpatient rehabilitation hospitals, and outpatient physical therapy clinics) will exhibit differing levels of self-reported empathy.

In a number of studies, levels of clinical empathy have been correlated to practice setting. Chaitoff et al. (2017) used practice environment as a variable in their study, finding that physicians who practice in an outpatient setting had higher levels of clinical empathy than physicians who work in an inpatient setting. Nurses surveyed in a Canadian emergency room showed a mean JSE-HP score of 92.88 (6.99; Bourgault et al., 2015), while nurses who worked in a Canadian intensive care unit had a mean score of 118.0 (Gosselin et al., 2016). Clinical empathy measured in nurses working in a hospital in Taiwan measured a mean of 110.66 (Kuo et al., 2012), while nurses in a U.S. hospital had a mean of 117.2 (Fields et al., 2004). These studies on clinical empathy levels in nursing show differences that may be related to nursing setting; however, as these studies were done independently from one another, the ability to definitively correlate nursing empathy with practice setting is limited. In this study, contrary to our assumptions, the mean self-reported levels of empathy for PTs practicing in the three different settings were not significantly different. This may be due to strong patient–physical therapist relationships that develop regardless of the practice setting. In the studies by Hojat et al. (2002) and Chaitoff et al. (2017), physician specialty practice rather than practice setting yielded different physician empathy levels. Perhaps practicing physical therapists who hold physical therapy board specializations (such as neurological, geriatric, orthopedic, etc) as conferred by the American Board of Physical Therapy Specialists would have produced a different outcome than using the physical therapy practice setting.

Hypothesis 3: Physical therapists will demonstrate an inverse relationship between empathy and work disengagement, a component of burnout.

Occupational burnout is defined as a sense of being overextended by the workplace demands (high emotional exhaustion), a feeling of being detached or cynical toward the person receiving health care (high depersonalization), compounded by feeling ineffective while fulfilling the requirements of patient care (low personal achievement; Maslach & Jackson, 1981; Maslach & Leiter, 2016; Vercambre, Brosselin, Gilbert, Nerrière, & Kovess-Masféty, 2009). While workplace burnout is a complex abstract construct that is multifactorial and difficult to measure, the relationship between clinical empathy and burnout has been reported in a variety of health-care disciplines. A systematic review by Wilkinson et al. (2017) supported an inverse relationship between empathy and burnout in both physicians and in nurses. A number of studies suggest that this inverse correlation may be due to the creation of meaningful relationships between the health-care professional and the patient, allowing the care provider to develop professional satisfaction, which may, in turn, help prevent workplace burnout (Halpern, 2003; Roter, 1997; Thirioux, Birault, & Jaafari, 2016). Our results confirm that in practicing physical therapists, empathy levels and work disengagement were negatively associated with a correlation coefficient of −.32. Although our results specifically focus on work disengagement, this concept and burnout are well established as overlapping experiences (Taris, Ybema, & Beek, 2017). In this study, we found that work disengagement along with gender explained 12.9% of self-reported levels of empathy. While there continues to be a need to further investigate all the determinants that either promote or detract from caregiver empathy, it is clear that workplace disengagement plays an important role.

Other findings

Our data suggest that there is no statistically significant association between practice setting and employee disengagement. Despite the unique challenges facing PTs in different settings, our results suggest that the factors influencing work disengagement may not be setting-specific, though caution must be taken when interpreting these results, given the convenience sampling from one metropolitan region.

Respondents in our sample who were in the 32–36 age range and 8–12 years of experience reported highest levels of work disengagement and the lowest levels of self-reported empathy. Research in the relationship between age and work disengagement has shown inconsistencies. Poulsen et al. (2014) demonstrated the highest degree of workplace burnout was found in occupational therapists with less than 10 years of experience (Poulsen et al., 2014). Similar results were found by Tijdink, Vergouwen, and Smulders (2014) when looking at burnout among medical professors. A study by Donohoe, Nawawi, Wilker, Schindler, and Jette (1993) reported there was no relationship between years of experience and levels of burnout in a population of physical therapists. Ahola, Honkonen, Virtanen, Aromaa, and Lönnqvist (2008) surveyed the Finnish population engaged in all types of employment and noted that burnout rates were greatest in the youngest of the young woman category, the oldest of the aging women category, and for men, the highest level of burnout was found in the middle age-group. Finally, in a meta-analysis by Brewer and Shapard (2004), a negative correlation was noted between age and burnout as well as negative correlation between years in a job and burnout. Hypotheses for possible explanation of these results are as varied as the results themselves. As we did not include any of the usual proposed precursors to burnout in our demographic survey, such as marital status, home-living children, or salary, it is not possible to determine reasons for our findings. Future studies to investigate the individual or organizational antecedents of work disengagement are warranted.

Finally, female PTs in our sample had higher levels of self-reported empathy than male PTs. This finding is consistent with a number of other studies measuring clinical empathy in health-care professionals (Bayliss & Strunk, 2015; Chaitoff et al., 2017; M. Hojat et al., 2011; M. Hojat et al., 2001).

Limitations

This study is subject to several limitations including limited sample size and lack of separate temporal measurements. Because of our cross-sectional design, causality between work disengagement and empathy cannot be explained by the data. These findings are also self-reported and as such are subject to response bias or perceptions of social desirability. The convenience sample used for this study was limited to one geographic region (Massachusetts and Rhode Island) and may not be reflective of demands in different parts of the country. Factors such as salary, reimbursement rate, administrative burden, and other work-related factors will vary from state to state and therefore may produce different results. The practice settings represented did not include providers in the home health, school, or long-term care settings, further limiting the generalizability of these findings. Furthermore, the outpatient sites surveyed were a university-based and a hospital-based system, not a private practice clinic. Interpreting the influence of practice setting on empathy and disengagement may be different as these nonrepresented settings may have different demands and stressors than the settings represented here.

Future Studies

We employed a validated and widely used tool, the JSE-HP, to measure self-reported empathy. Our data can therefore be used as a starting point for future studies to develop norms and cutoff scores using a larger, more representative sample of practicing PTs.

Given that only 12.9% of the variance of empathy was accounted for, there are additional latent factors that contribute to individuals’ levels of empathy, which were not identified or addressed in this study. Evidence has shown that a therapeutic patient–therapist relationship, of which empathy is a part, has a positive effect on patient satisfaction and reported outcomes (Hall et al., 2010; Kidd et al., 2011; Peiris et al., 2012). Therefore, future quantitative research to examine the potential impact of measured levels of empathy on the outcomes of patients receiving physical therapy is indicated.

Work engagement has been associated with better patient outcomes in health disciplines other than physical therapy. It is therefore important for rehabilitation organizations to gauge the level of workplace engagement among physical therapists, as it could have a positive organizational consequence such as retention of therapists, increased work satisfaction, and better patient outcomes. Future studies could explore additional factors related to personal characteristics and work environments that could influence work engagement and empathy. Additionally, these results suggest there may be specific subpopulations who may benefit from supportive interventions to improve engagement and thereby improve empathy.

Conclusions

Physical therapists demonstrated a mean empathy level of 118.5, which is higher than reported levels of clinician empathy in the nursing and pharmacy professionals, but not as high as some physician subgroups or mental health therapists. Empathy levels in practicing physical therapists did not differ from one type of health-care setting to another. Caregiver empathy and work disengagement were negatively correlated in our sample of practicing physical therapists. By utilizing a path analysis, we were able to gain insight into the complex matrix between predictors and the dependent variable of empathy.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors received financial support from the Dudley Allen Sargent Research Grant Fund, Boston University.

ORCID iD

Mary Beth Holmes

References

Ahola

Honkonen

Virtanen

Aromaa

Lönnqvist

(2008). Burnout in relation to age in the adult working population. Journal of Occupational Health, 50, 362–365. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18540117

American Physical Therapy Association. (2014). Physical therapy workforce data. Retrieved December 17, 2018, from http://www.apta.org/WorkforceData/

Balogun

J. A.

Titiloye

Balogun

Oyeyemi

Katz

(2002). Prevalence and determinants of burnout among physical and occupational therapists. Journal of Allied Health, 31, 131–139. doi:10.1016/j.apenergy.2014.04.027

Bayliss

A. J.

Strunk

V. A.

(2015). Measurement of empathy changes during a physical therapist's education and beyond. Journal of Physical Therapy Education, 29, 6–12. doi:10.1097/00001416-201529020-00003

Bourgault

Lavoie

Paul-Savoie

Grégoire

Michaud

Gosselin

Johnston

C. C.

(2015). Relationship etween dmpathy and well-being among emergency nurses. Journal of Emergency Nursing, 41, 323–328. doi:10.1016/j.jen.2014.10.001

Brewer

E. W.

Shapard

(2004). Employee burnout: A meta-analysis of the relationship between age or years of experience. Human Resource Development Review, 3, 102–123. doi:10.1177/1534484304263335

Brockhouse

Msetfi

R. M.

Cohen

Joseph

(2011). Vicarious exposure to trauma and growth in therapists: The moderating effects of sense of coherence, organizational support, and empathy. Journal of Traumatic Stress, 24, 735–742. doi:10.1002/jts.20704

Campo

M. A.

Weiser

Koenig

K. L.

(2009). Job strain in physical therapists. Physical Therapy, 89, 946–956. doi:10.2522/ptj.20080322

Chaitoff

Sun

Windover

Bokar

Featherall

Rothberg

M. B.

Misra-Hebert

A. D.

(2017). Associations between physician empathy, physician characteristics, and standardized measures of patient experience. Academic Medicine, 92, 1464–1471. doi:10.1097/ACM.0000000000001671

10.

Charles

J. A.

Ahnfeldt-Mollerup

Søndergaard

Kristensen

(2018). Empathy variation in general practice: A survey among general practitioners in Denmark. International Journal of Environmental Research and Public Health, 15, 433. doi:10.3390/ijerph15030433

11.

Del Canale, S., Louis

D. Z.

Maio

Wang

Rossi

Hojat

Gonnella

J. S.

(2012). The relationship between physician empathy and disease complications: An empirical study of primary care physicians and their diabetic patients in Parma, Italy. Academic Medicine, 87, 1243–1249. doi:10.1097/ACM.0b013e3182628fbf

12.

Demerouti

Bakker

A. B.

Vardakou

Kantas

(2003, March). The convergent validity of two burnout instruments: A multitrait-multimethod analysis. European Journal of Psychological Assessment, 19, 2. doi:10.1027//1015-5759.19.1.12

13.

Demerouti

Mostert

Bakker

A. B.

(2010). Burnout and work engagement: A thorough investigation of the independency of both constructs. Journal of Occupational Health Psychology, 15, 209–222. doi:10.1037/a0019408

14.

Donohoe

Nawawi

Wilker

Schindler

Jette

D. U.

(1993). Factors associated with burnout of physical therapists in Massachusetts rehabilitation hospitals. Physical Therapy, 73, 750–756; discussion 756–761. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8234456

15.

Fields

S. K.

Hojat

Gonnella

J. S.

Mangione

Kane

Magee

(2004). Comparisons of nurses and physicians on an operational measure of empathy. Evaluation and the Health Professions, 27, 80–94. doi:10.1177/0163278703261206

16.

Gosselin

Bourgault

Lavoie

(2016). Association between job strain, mental health and empathy among intensive care nurses. Nursing in Critical Care, 21, 137–145. doi:10.1111/nicc.12064

17.

Halbesleben

J. R. B.

Demerouti

(2005). The construct validity of an alternative measure of burnout: Investigating the English translation of the Oldenburg Burnout Inventory. Work and Stress, 19, 208–220. doi:10.1080/02678370500340728

18.

Hall

A. M.

Ferreira

P. H.

Maher

C. G.

Latimer

Ferreira

M. L.

(2010). The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: A systematic review. Physical Therapy, 90, 1099–1110. doi:10.2522/ptj.20090245

19.

Halpern

(2003, August). What is clinical empathy? Journal of General Internal Medicine, 18, 677–678. doi:10.1046/j.1525-1497.2003.21017.x

20.

Harris

P. A.

Taylor

Thielke

Payne

Gonzalez

Conde

J. G.

(2009). Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42, 377–381. doi:10.1016/j.jbi.2008.08.010

21.

Higuchi

Uchitomi

Fujimori

Koyama

Kataoka

Kitamura

… Inagaki

(2015). Exploring autistic-like traits relating to empathic attitude and psychological distress in hospital pharmacists. International Journal of Clinical Pharmacy, 37, 1258–1266. doi:10.1007/s11096-015-0204-2

22.

Hojat

Gonnella

J. S.

Nasca

T. J.

Mangione

Vergare

Magee

(2002). Physician empathy: Definition, components, measurement, and relationship to gender and specialty. American Journal of Psychiatry, 159, 1563–1569. doi:10.1176/appi.ajp.159.9.1563

23.

Hojat

Louis

D. Z.

Markham

F. W.

Wender

Rabinowitz

Gonnella

J. S.

(2011). Physicians’ empathy and clinical outcomes for diabetic patients. Academic Medicine, 86, 359–364. doi:10.1097/ACM.0b013e3182086fe1

24.

Hojat

Louis

D. Z.

Maxwell

Markham

Wender

Gonnella

J. S.

(2010). Patient perceptions of physician empathy, satisfaction with physician, interpersonal trust, and compliance. International Journal of Medical Education, 1, 83–87. doi:10.5116/ijme.4d00.b701

25.

Hojat

Mangione

Nasca

T. J.

Cohen

M. J. M.

Gonnella

J. S.

Erdmann

J. B.

Magee

(2001). The Jefferson scale of physician empathy: Development and preliminary psychometric data. Educational and Psychological Measurement, 61, 349–365. doi:10.1177/00131640121971158

26.

Hojat

M. R.

(2007). A definition and key features of empathy in patient care. In Hojat

M. R.

(Ed.), Empathy in patient care: Antecedents, development, measurement, and outcomes (p. 295). New York, NY: Springer. Retrieved from http://www.springer.com/us/book/9780387336077

27.

Kidd

M. O.

Bond

C. H.

Bell

M. L.

(2011). Patients’ perspectives of patient-centredness as important in musculoskeletal physiotherapy interactions: A qualitative study. Physiotherapy, 97, 154–162. doi:10.1016/j.physio.2010.08.002

28.

Kim

S. S.

Kaplowitz

Johnston

M. V.

(2004). The effects of physician empathy on patient satisfaction and compliance. Evaluation & the Health Professions, 27, 237–251. doi:10.1177/0163278704267037

29.

Kliszcz

Nowicka-Sauer

Trzeciak

Nowak

Sadowska

(2006). Empathy in health care providers—Validation study of the Polish version of the Jefferson Scale of Empathy. Advances in Medical Sciences, 51, 219–225. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17357313

30.

Kuo

J. C.

Cheng

J. F.

Chen

Y. L.

Livneh

Tsai

T. Y.

(2012). An exploration of empathy and correlates among Taiwanese nurses. Japan Journal of Nursing Science, 9, 169–176. doi:10.1111/j.1742-7924.2011.00199.x

31.

La Monica

E. L.

Wolf

R. M.

Madea

A. R.

Oberst

M. T.

(1987). Empathy and nursing care outcomes. Scholarly Inquiry for Nursing Practice, 1, 197–213. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3423510

32.

Maslach

Jackson

S. E.

(1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2, 99–113. doi:10.1002/job.4030020205

33.

Maslach

Leiter

M. P.

(2016). Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry, 15, 103–111. doi:10.1002/wps.20311

34.

Peiris

C. L.

Taylor

N. F.

Shields

(2012). Patients value patient-therapist interactions more than the amount or content of therapy during inpatient rehabilitation: A qualitative study. Journal of Physiotherapy, 58, 261–268. doi:10.1016/S1836-9553(12)70128-5

35.

Poulsen

A. A.

Meredith

Khan

Henderson

Castrisos

Khan

S. R.

(2014). Burnout and work engagement in occupational therapists. British Journal of Occupational Therapy, 77, 156–164. doi:10.4276/030802214X13941036266621

36.

Rakel

D. P.

Hoeft

T. J.

Barrett

B. P.

Chewning

B. A.

Craig

B. M.

Niu

(2009). Practitioner empathy and the duration of the common cold. Family Medicine, 41, 494–501. doi:10.1016/j.bbi.2008.04.014

37.

Roter

D. L.

(1997). Communication patterns of primary care physicians. JAMA, 277, 350–356. doi:10.1001/jama.277.4.350

38.

Schuster

N. D.

Nelson

D. L.

Quisling

(1984). Burnout among physical therapists. Physical Therapy, 64, 299–303. doi:10.1093/ptj/64.3.299

39.

Taris

T. W.

Ybema

J. F.

van Beek

(2017). Burnout and engagement: Identical twins or just close relatives? Burnout Research, 5, 3–11. doi:10.1016/J.BURN.2017.05.002

40.

Thirioux

Birault

Jaafari

(2016). Empathy is a protective factor of burnout in physicians: New neuro-phenomenological hypotheses regarding empathy and sympathy in care relationship. Frontiers in Psychology, 7, 763. doi:10.3389/fpsyg.2016.00763

41.

Thomas Jefferson University. (2018). Jefferson: Sidney Kimmel Medical College. Center for Research in Medical Education and Health Care. Retrieved November 18, 2018, from https://www.jefferson.edu/university/skmc/research/research-medical-education/jefferson-scale-of-empathy.html

42.

Tijdink

J. K.

Vergouwen

A. C.

Smulders

Y. M.

(2014). Emotional exhaustion and burnout among medical professors; A nationwide survey. BMC Medical Education, 14, 183. doi:10.1186/1472-6920-14-183

43.

Vercambre

M. N.

Brosselin

Gilbert

Nerrière

Kovess-Masféty

(2009). Individual and contextual covariates of burnout: A cross-sectional nationwide study of French teachers. BMC Public Health, 9, 333. doi:10.1186/1471-2458-9-333

44.

Wilkinson

Whittington

Perry

Eames

(2017, September). Examining the relationship between burnout and empathy in healthcare professionals: A systematic review. Burnout Research, 6, 18–29. doi:10.1016/j.burn.2017.06.003

45.

Yuguero

Ramon Marsal

Esquerda

Vivanco

Soler-González

(2017). Association between low empathy and high burnout among primary care physicians and nurses in Lleida, Spain. The European Journal of General Practice, 23, 4–10. doi:10.1080/13814788.2016.1233173