A survey on the current status of rehabilitation services and burnout of rehabilitation professionals in Shanghai

2.1 Study design

Twenty-four hospitals located in three districts of Shanghai were selected for this study. All the tertiary and secondary hospitals and 50% of the community health centers in these three districts were selected in the study. The districts included: A (downtown), district B (urban fringe), and district C (suburb of the city). These three districts have different social and economic levels in Shanghai and together they represent the overall social and economic status in Shanghai.

In the surveyed hospitals, the medical professionals were recruited in this survey, including all the physicians, therapists and nurses from the rehabilitation-related departments and the same number of physicians and nurses from other medical departments. The study was conducted in February and March of 2012.

2.2 Questionnaire

Questionnaires were sent to 24 surveyed hospitals to collect the data on rehabilitation departments (such as types of rehabilitation services, number of rehabilitation professionals, and number of beds) and other hospital data.

Questionnaires were sent to the medical professionals in the surveyed hospitals. The questionnaires included information about characteristics (gender, age, educational level, monthly income, and professional title), working conditions, and job stress of medical professionals, and included a burnoutmeasure.

2.3 Measurement of burnout

Burnout was measured with Maslach Burnout Inventory-General Survey (MBI-GS), developed by Maslach and Jackson [5]. The MBI-GS consists of 16 items grouped into three dimensions including emotional exhaustion, cynicism, and low professional efficacy. The emotional exhaustion dimension was measured by 5 items, cynicism dimension was measured by 5 items, and low professional efficacy was measured by 6 items. All items were scored on a 7-point frequency rating scale ranging from “0” (never) to “6” (every day) [6].

The consistencies of the scale and each subscales in the Chinese version of the MBI-GS [7, 8] were analyzed by Cronbach’s alpha coefficient and split-half reliability coefficient. In this study, Cronbach’s alpha coefficients for the scale overall were 0.897 for rehabilitation professionals and 0.916 for other medical professionals. Cronbach’s alpha coefficients for the subscales of emotional exhaustion, cynicism and low professional efficacy were 0.937, 0.870, and 0.947 respectively for rehabilitation professionals and 0.955, 0.906, and 0.935 respectively for other medical professionals.

2.4 Statistical analyses

Fisher exact tests were used to compare the differences in the characteristics of surveyed rehabilitation professionals. One-way ANOVAs and multivariate mixed models were adopted respectively to compare the extent of burnout among different levels of hospitals and to explore the factors that associated with burnout in rehabilitationprofessionals.

3.1 Rehabilitation services

Among the 24 hospitals sampled in this study, 15 (62.5%) have rehabilitation departments. The percentage of the hospitals that had a rehabilitation department in tertiary general hospitals, secondary general hospitals, and community health centers was 100%, 80%, and 50%, respectively. This percentage was the highest (88.9%) in district A and the lowest (25.0%) in district C (Table 1). All the surveyed hospitals could provide physical therapy, massage, and acupuncture services. Out of 24 hospitals, only one tertiary hospital (1/24, 4.17%) had beds for inpatient rehabilitation.

3.2 Characteristics of the participants

Questionnaires were sent to 250 rehabilitation professionals and 250 medical professionals from other departments. The response rates for them were 88.40% (221/250) for rehabilitation professionals and 94.00% (235/250) for other medicalprofessionals.

For surveyed rehabilitation professionals, 55.20% were male, 58.37% were below 35 years old, and 53.39% and 10.86% had undergraduate and graduate education respectively. The surveyed rehabilitation professionals who had monthly income of 5000 yuans or above accounted for 11.98%. The surveyed rehabilitation professionals in tertiary hospitals had higher education and higher monthly income, while those in community health centers were the opposite (Table 2).

In our survey, the surveyed rehabilitation professionals included nurses (15.84%), physical or occupational therapists (33.03%), and physicians (51.13%). The percentage of the surveyed rehabilitation physicians and therapists with high education (both undergraduates and graduates) was 64.90%, with a higher percentage in physicians than in therapists (75.23% vs 53.53%), and with the higher percentage in tertiary general hospitals than in secondary general hospitals and community health centers (77.48% vs 66.67% and 49.32% respectively) (Table 3).

3.3 Burnout analysis

Professional burnout analyses indicated that the mean values of rehabilitation professionals in MBI-GS for emotional exhaustion, cynicism, and low professional efficacy were 11.66, 7.48, and 10.36, which were significantly lower than those of other medical professionals (14.37, 9.88, and 13.66 respectively) (Table 4). However, the rehabilitation professionals in tertiary general hospitals had less cynicism than those in secondary general hospitals or community health centers. The rehabilitation professionals in secondary general hospitals had higher emotional exhaustion than those in tertiary general hospitals and community health centers (Table 5).

3.4 Factors that influencing burnout

Multivariate generalized linear mixed analysis indicated that among rehabilitation professionals, significantly higher emotional exhaustion was observed in those in secondary general hospitals, as well as those who worked for 10–14 years in the rehabilitation department. The rehabilitation professionals with low monthly income were more likely to have cynicism. The rehabilitation professionals who were young, with lower income or with higher professional titles showed lower professional efficacy (Table 6).

4.1 Shortage of rehabilitation resources

As one of the developing countries, China has an increasing demand for rehabilitation services. According to the national survey, about 1 billion people, including the disabled, chronic patients, and the elderly, need rehabilitation therapy [9]. In contrast, only 19.0% of the disabled received rehabilitation services in 2007, and the percentage of the disabled who get rehabilitation services was 29.5% in urban areas whereas only 15.7% in the rural regions [10]. Shanghai is the most densely populated city in China and with a rapidly aging population. According to the estimations from World Report on Disability and from China, 15% ∼18% of the world population and 6.34% of the population in China had disabilities [2, 11]. So there is a great demand for rehabilitation therapy in Shanghai. However, most rehabilitation centers face the problems of a shortage of rehabilitation therapists. This shortage can lead to difficulties in delivering quality rehabilitation programs for patients. Although the rehabilitation sector has been quickly developing since 1990, the year when the government put nine kinds of rehabilitation services into medical insurance coverage, the rehabilitation service is not meeting the fast-growing demand.

In this study, all 24 hospitals responded to the survey. The responding hospitals involved three different hospital levels and were geographically distributed in three districts at different social and economic levels in Shanghai. Their data on rehabilitation reflect the situation in the city. The results showed that the percentage of the hospitals with a rehabilitation department was different among different districts and positively associated with social and economic level and with hospital level. Although every hospital surveyed had other departments related to rehabilitation therapy, such as department of massage, physical therapy and acupuncture, the percentage of the hospitals that had a rehabilitation department ranged from 25.0% to 88.9%. Only one tertiary general hospital had 12 beds for inpatient rehabilitation. These reflected the uneven distribution of and the shortage of rehabilitation resources in Shanghai.

In addition, the percentage of the rehabilitation professionals with graduate and undergraduate degrees in Shanghai may be higher than that in other studies in China [12, 13], however, it was relatively lower in community health centers. Similar to other studies, the components of the rehabilitation team in Shanghai were physicians, therapists, and nurses [14]. However the education level of therapists surveyed in the study was much lower than that of physicians. The rehabilitation resources in Shanghai should be enhanced to meet the futuredemands.

4.2 Less burnout of rehabilitation professionals

Although many studies have discussed the stress and burnout of physicians and nurses [15–17], there has been limited research on rehabilitation professionals [18]. Forty-six percent of the respondents scored high on the emotional exhaustion subscale of the MBI-GS for the burnout study in rehabilitation hospitals in Massachusetts [19]. Emotional exhaustion was more prevalent among physiotherapists in the study of healthcare professionals working in the physical and rehabilitative medicine ward in northern Italy [20]. However, our study found that rehabilitation professionals in Shanghai did not have high emotional exhaustion, high cynicism, or low professional efficacy in general. Furthermore, rehabilitation professionals in Shanghai were significantly lower in burnout scales than those from other medical specialties in the hospitals of Shanghai. It might be due to lower workloads in rehabilitation departments caused by a lack of awareness of rehabilitation needs from other physicians and patients.

4.3 Factors that affected burnout of rehabilitation professionals

In the study, we found that the characteristics of rehabilitation professionals (such as age, monthly income, professional title, years working in rehabilitation) affected their rating scales on emotional exhaustion, cynicism, and/or low professional efficacy. These characteristics may influence their expectation on the job and therefore affect their perception on the burnout. After controlling the characteristics of rehabilitation professionals, those who worked in the secondary general hospitals had higher emotional exhaustion. The demands for rehabilitative care and the capability for providing rehabilitative care in secondary general hospitals of Shanghai deserve more attention by the managers in those hospitals and by the local governments.