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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.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. IndependentWAI 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.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.

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.

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 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.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.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.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.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.