Clinimetric Properties of the Working Alliance Inventory and Credibility Expectancy Questionnaire: Screening Options for Musculoskeletal Pain.

OBJECTIVE: To investigate clinimetric properties of 2 surveys used to evaluate common factors in the patient-provider relation and present screener options for the assessment of common factors and report their correlation with pain and functional outcomes. DESIGN: Observational cohort. SETTING: Outpatient physical therapy. PARTICIPANTS: 100 individuals (58% women, mean age=34, SD=15; N=100) presenting to physical therapy with musculoskeletal pain in the following regions: 44% lower extremity, 36% spine, 19% upper extremity, 1% undetermined. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Participants completed the Working Alliance Inventory (WAI) and the Credibility and Expectancy Questionnaire (CEQ). Exploratory factor analysis (EFA) explored factor structure of the WAI and CEQ. Internal consistency was evaluated for scales derived from items retained based on factor loadings. Finally, options for screener tools were proposed and assessed based on their correlation to original surveys as well as pain and functional outcomes. RESULTS: The data supported a 4-factor structure for the surveys. Some WAI items were excluded due to cross-loading. The derived four-factor scales demonstrated strong correlations with the original surveys (r=.89-.99) and exhibited good internal consistency (α=.824-.875). Two screening options were suggested: 1 retaining 11 of the original 18 items and the other comprising just 3 items. Both screening tools correlated with the original surveys and showed associations with improvements in pain and functional outcomes (r=-.21-.34). CONCLUSION: The proposed screeners provide concise measurement options to facilitate use in clinical practice. These tools can aid in facilitating patient communication specifically addressing patient expectation and understanding the tasks required to enact behavior change.

Working Alliance Inventory (WAI) and its relationship to patient-reported outcomes in painful musculoskeletal conditions.

PURPOSE: Therapeutic alliance (TA) has been positively correlated to improvements in patient outcomes. This study examined the Working Alliance Inventory (WAI) relationship with changes in disability and pain intensity for patients receiving physical therapy (PT) treatment for acute and chronic musculoskeletal pain conditions. METHODS: Fifty participants were dichotomized into success or failure by the minimal clinically important difference (MCID) on region-specific patient-reported outcome measures (PROM) and Numeric Pain Rating Scale (NPRS). Regression and correlation statistics examined the relationship between WAI with change scores and quantity of PT. Independent t-tests compared WAI scores across categorical variables. RESULTS: WAI scores were higher for those meeting MCIDs on PROM and NPRS compared to those who did not. WAI scores were significantly correlated with improvement on region-specific outcome measures and NPRS. Regression analysis found the patient rating of the TA to be a positive predictor for improvement on regions specific outcome measures and NPRS. CONCLUSIONS: Patients who rated the TA higher were more likely to meet the MCID for region-specific disability and pain intensity. Patient ratings of the TA were associated with improved change scores on pain rating and standardized outcome measures during a course of treatment for musculoskeletal pain conditions.Implications for rehabilitationPatients' early rating of the therapeutic alliance (TA) is associated with improvements seen on pain and functional outcomes.Physical therapists should assess the TA and use strategies to enhance the alliance to optimize patient's experiences with physical therapy.

A Comparison of Doctor of Physical Therapy Students' Self-Reported Empathy With Standardized Patients Perceptions of Empathy During a Simulated Telehealth Encounter.

Empathy is an important factor in developing a positive patient-provider relationship. It has been shown to lead to improved patient outcomes, well-being, and satisfaction. This study examines the relationship between first-year physical therapy students' self-reported empathy levels and a patient's perceptions of caregiver empathy during a standardized patient interview via telehealth. Forty-five students completed a self-reported empathy survey before the standardized patient encounter using telehealth. Following the experience, standardized patients rated the perceived empathy demonstrated by the students during that patient-provider encounter using 2 validated measures. The mean student self-reported empathy using the Jefferson Scale of Empathy-Health Care Provider Student (JSE-HPS) version was 123.93 (range 95-135 SD 7.328). The standardized Jefferson Scale of Patient Perception of Provider Empathy (JSPPPE) scores showed a mean of 23.8 (range 11-32 SD 3.951) and a mean of 3.16 (range 1-5 SD.85) on the Global Rating of Empathy (GRE). There was no significant correlation found between the JSE-HPS and the JSPPPE, r = -.47, P = .760, or the GRE r = -.166, P = .276. The artificial nature of a standardized patient interaction using the telehealth format for this encounter may have contributed to the students' inability to communicate empathy to the patient and may explain this discrepancy.

Participant Outcomes of a Student-Run, Intensive, Short-Term, Task-Specific Rehabilitation Program for Individuals Post-Stroke.

Empathy, when demonstrated by health care providers, results in improved patient compliance and enhanced patient outcomes. Yet, self-reported empathy has been shown to decrease in health care professional students during their course of study. Possible reasons for this decrease in empathy have included the type of curriculum of the professional program, participation in clinical experiences, the movement from idealism to realism, and student distress. This current study using the Jefferson Scale of Empathy-Health Professions Student Version (JSE-HPS) demonstrated that Doctor of Physical Therapy (DPT) students, from two DPT programs, showed an increase in their self-reported levels of empathy over the course of their professional education. These students were surveyed before and after clinical experiences and represented two pedagogically different DPT programs. These data suggest that DPT students may differ from the trends found in other healthcare domains. Instead of developing interventions to improve student empathy, as has been suggested, educational time may be better spent helping these DPT students protect and utilize their current levels of empathy.

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

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.

A Cross-Sectional Study of Empathy Among Students at Two Doctor of Physical Therapy Programs in Boston.

BACKGROUND: A decline in empathy has been demonstrated in college students over a 30-year period. While higher empathy levels have been measured in healthcare students vs non-healthcare students, reports show a disheartening decrease in student empathy scores over the course of professional healthcare education. OBJECTIVE: The purpose of this study was to assess self-reported empathy in students at two Doctor of Physical Therapy (DPT) programs, one of which used problem-based learning pedagogy while the other used a more traditional didactic teaching method. METHODS: This was a cross-sectional study of cohorts of students enrolled at two DPT programs between June 2016 and January 2017. Empathy levels were measured using the Jefferson Scale of Empathy-Health Professions Student version (JSE-HPS) at the start of each year in their DPT education. Demographic factors of gender and age were also examined. RESULTS: The majority of respondents were female (243/304) with an even distribution of respondents per year of educational experience. There was no significant difference in levels of empathy when comparing the cohorts of students from the two pedagogically different DPT programs. Females demonstrated higher levels of empathy than males. There was a greater level of empathy in third-year students than first-year students in both programs. CONCLUSION: No differences were found in empathy levels between students from two pedagogically different institutions. As empathy is correlated with improved patient outcomes and patient satisfaction, endeavors to understand, document, and increase students' empathy levels should be investigated.