Risk factors associated with physical therapist burnout: a systematic review

The Mediating Role of Physical Therapists' Satisfaction With Helping Patients in the Relationship Between Work Support and Intention to Leave Their Current Employment

IMPORTANCE

The wellbeing of physical therapists is crucial for retaining them at work as skilled professionals and ensuring high-quality patient care.

OBJECTIVE

The purpose of this study was to examine the effect of perceived organizational support and peer support on physical therapists' intention to leave their current employment, mediated by their satisfaction with helping patients (ie, compassion satisfaction).

DESIGN

The design for this study was an online survey that included the short version of the Perceived Organizational Support scale, the Peer Support Scale, the Compassion Satisfaction Scale, and the Intent to Leave scale. The research used statistical analysis to explore the direct and indirect relationships between these variables.

SETTING

The setting for this study was health care organizations and private practices.

PARTICIPANTS

Israeli registered physical therapists volunteered to participate.

MAIN OUTCOMES

Regression analysis indicated that greater perceived organizational support and peer support were associated with lower intention to leave the current employment. Compassion satisfaction levels mediated the relationships between physical therapists' perceived organizational support, peer support, and intention to leave their current employment.

RESULTS

Two hundred ninety-three physical therapists completed the survey. Participants reported a medium level of perceived organizational support (mean = 2.86; range = 1-5); a high level of peer support (mean = 4.15; range = 1-5); a high level of compassion satisfaction (mean = 40.85; range = 10-50); and a low level of intention to leave their current employment (mean = 2.38; range = 1-5).

CONCLUSIONS

The study shows the importance of fostering a supportive work environment and peer relationships to enhance physical therapists' satisfaction. The study attests to the contribution of the positive emotion physical therapists derive from helping patients as a protective factor against their intention to leave their current employment, contributing to the overall stability of the health care workforce.

RELEVANCE

Understanding the relations between perceived organizational support, peer support, and intention to leave current employment, as well as the role of compassion satisfaction, can help health care organizations and policymakers retain physical therapists.

Part II: Beyond Broken Histories: Reframing Professional Identity and the Historical Genesis of Manual Therapy. Interviews across professions

BACKGROUND

Perspectives on the historical genesis of manual therapy for chiropractic, manual medicine, osteopathy, and physiotherapy are limited.

OBJECTIVE

This study sought to identify themes and narratives related to the genesis of manual therapy; the potential of a common root for manual therapy in 19th century Northern Europe; and the potential impact of a current 'broken history' for manual therapy.

METHODS

An exploratory phenomenological approach was utilized, based upon structured one-hour interviews of 21 professionals across four professions who had previously completed a survey on the historical genesis of manual therapy.

RESULTS

Descriptive and hermeneutic themes were developed based upon the lived experience of individuals relating to interview questions and a presented historical narrative. Support for a common genesis in Northern Europe was present within physiotherapists, but for all other professions North America was primary. Multiple themes and quotes of significance were developed from the study, including the importance of history within professional identity. An archetypal analysis was completed to answer specific assumptions related to the historical genesis of manual therapy including points of genesis for manual therapy and scientific necessity within manual therapy.

CONCLUSION

The findings of this study provide new perspectives to consider on the value, criticality, and impact of manual therapy, and its history's for the four professions in practice, education, and regulations.

Burnout in physiotherapists and occupational therapists working in the Australian community disability sector under the national disability insurance scheme: a qualitative study

AIM(S)

This study aimed to explore the experience and perceptions of burnout in Physiotherapists (PTs) and Occupational Therapists (OTs) working with adults under the National Disability Insurance Scheme (NDIS) in the community disability sector in Australia.

MATERIALS AND METHODS

This study uses an exploratory qualitative design.

PARTICIPANTS

A total of ten clinicians: five OTs and five PTs working in the community disability sector who self-identified as having experienced burnout within the last two years.Semi-structured interviews were undertaken with ten clinicians via video conference lasting about 33 min, recorded, transcribed verbatim and analysed manually using thematic analysis. COREQ research reporting checklist followed.

RESULTS

Four themes and 11 sub-themes were identified including contributing factors, protective factors, consequences of burnout and proposed actions. There was consistency across all themes of a complex intersection between the individual Allied Health Professional (AHP), the workplace and the funding model of the National Disability Insurance Scheme (NDIS).

CONCLUSION

This study provides insight into the experience of burnout in AHPs in the community disability sector in Australia, offering perspectives on the dynamics of the unique roles of OT's and PT's while offering practical and actionable recommendations for both AHPs and workplaces.

Burnout in occupational therapy and physiotherapy students: a systematic review of the risk and protective factors

BACKGROUND AND PURPOSE

Studies consistently suggest that work as an occupational therapist or physiotherapist is associated with burnout, yet no review has been conducted on the risk and protective factors of burnout in physiotherapy and occupational therapy students (collectively termed allied health students). This systematic review identified and synthesized the risk and protective factors associated with burnout in allied health students.

METHODS

Eight databases, Google Scholar, and Connected Papers were searched in November 2024 systematically for mixed-method or quantitative studies containing primary data on the risk and protective factors of burnout. Titles, abstracts, and full-text articles were reviewed by two authors independently against the selection criteria. Risk of bias was evaluated in included studies, and the level of evidence was classified using National Health and Medical Research Council guidelines. Risk and protective factors were collated and summarized as modifiable or non-modifiable.

RESULTS

Eleven studies (10 physiotherapy, 1 occupational therapy) with 2,444 participants were included. The risk of bias was variable, and the level of evidence was satisfactory. Fifteen risk and protective factors were identified. Protective factors including higher grit and resilience, more physical activity and self-care, and more time spent supported by family, peers, faculty, and academic advisors, were consistently related to lower burnout. The relationships of other variables with burnout were unclear.

CONCLUSION

The factors identified in this study can be targeted in wellbeing, preventative, and intervention recommendations and strategies for students. Examples include increasing family and faculty support, and physical activity, to protect against burnout.

Current and Projected Future Supply and Demand for Physical Therapists From 2022 to 2037: A New Approach Using Microsimulation

IMPORTANCE

Projections of physical therapist supply and demand provide critical insights into workforce trends, including factors that may influence possible shortages.

OBJECTIVE

This study evaluates the current and forecasted adequacy of the physical therapist workforce in the United States to meet the evolving health care needs of the population.

DESIGN

This is a cross-sectional study that combines survey data, analysis of administrative databases, and microsimulation modeling.

SETTING

The study evaluates future demand for physical therapists across all employment and care delivery settings. Projections of supply and demand are compared to assess workforce adequacy nationally and by state through 2037.

PARTICIPANTS

Supply modeling incorporates a representative sample of physical therapists from each state, derived from the Federation of State Boards of Physical Therapy (FSBPT) counts and demographic data from the American Physical Therapy Association (APTA) member database. An online survey administered in April 2024 to APTA members (n = 1759 completed surveys, 18% response rate) collected data on demographics, practice characteristics, workload, hours worked, and retirement intentions.

INTERVENTION

The study examines key factors influencing the physical therapist workforce, including demographics, care delivery patterns, workload, hours worked, and provider retention.

MAIN OUTCOMES

The study forecasts annual full-time equivalent (FTE) physical therapist supply and demand through 2037, with state-level analysis and additional forecasts for alternative forecast scenarios.

RESULTS

In 2022, there were an estimated 233,890 FTE physical therapists in the workforce. A projected shortfall of 12,070 FTEs (5.2%) in 2022 was identified relative to population demand. Although projected supply growth from 2022 to 2037 (39,170 FTEs) exceeds demand growth (36,280 FTEs), a national shortfall remains in most forecast scenarios. By 2037, the physical therapist supply is expected to reach 273,070 FTEs, while demand will increase to 282,230 FTEs, resulting in a projected shortfall of 9120 FTEs (3.3%) in the main scenario.

CONCLUSIONS

Unless measures are implemented to boost the number of physical therapists entering or re-entering the workforce, or policies are enacted to improve retention, the national shortfall is likely to persist, further exacerbating access to care challenges.

RELEVANCE

This study underscores the need for targeted policy interventions to address workforce shortages and additional research into health care workforce forecasting.

The Experiences and Perceptions of First Contact Practitioners in Primary Care-A Qualitative Systematic Review

BACKGROUND

First Contact Practitioners (FCP) have developed as a more advanced physiotherapy clinical role delivering specialist MSK services in GP practice settings. They aim to support GPs in effectively managing increasing patient workloads. As FCPs are now a more established NHS role, it is important to understand how these clinicians perceive their roles to guide and support future service development.

AIMS

To review the current evidence regarding the experience of FCPs in the UK. To understand how FCPs perceive their role. To gain an insight into FCP practice which can inform future primary research studies.

METHOD

A systematic review of FCP primary qualitative research studies. Multiple database and grey literature search with screening following PRISMA guidelines. Qualitative critical appraisal and analysis used tools and frameworks from the Joanna Briggs Institute.

RESULTS

The review reports on 11 included studies which informed the creation of six key concepts impacting upon FCP role experience and perceptions. These were complexity, competency and role development, role understanding, job satisfaction, wellbeing and burnout and service delivery.

CONCLUSION

FCP clinicians feel broadly positive about their roles, although they report a clear risk of burnout and associated negative impact on their wellbeing. Job satisfaction is linked to adequate training and developing the competencies required to manage patients in an environment of clinical uncertainty. Having access to regular clinical mentorship is a key requirement and FCPs must adapt to the specific demands of work in a GP practice environment.

Emergency Services During the SARS-CoV-2 Pandemic: A Gender Comparison of Burnout Risk and Personality Traits in the Kharkiv City Sample

Introduction: The SARS-CoV-2 pandemic presented unique challenges to the health-care system and prehospital emergency medical services. An increasing prevalence of burnout has been described, which in turn is associated with mental illness. The aim of this paper was to evaluate burnout through a sex comparison and to analyze associations of burnout with personality traits during the SARS-CoV-2 pandemic. Methods: Eighty-eight emergency physicians and field shearers of Kharkiv City (Ukraine) emergency medical services (52% women) participated in the quantitative cross-sectional study. In addition to sociodemographic and occupational data, the Maslach Burnout Inventory (MBI) and the Freiburg Personality Inventory (FPI) were applied and analyzed in the sex comparison. Correlation analyses were performed to describe the relationships between the MBI dimensions and FPI traits. Results: The average age of the respondents was 35.1 ± 13.5 years. The prevalence of burnout during the pandemic was 6.5% in women and 2.4% in men. Only the scores on the MBI dimension cynicism were significantly (p = 0.027) higher in women than in men. Two personality traits differed between sexes: inhibition and male/female self-reports. Predominantly moderate correlations were found between the FPI traits and the MBI dimensions. Conclusions: Although the prevalence of burnout in this occupational group during the pandemic was similar to prepandemic figures reported in the literature, more than half of the male and female paramedics showed average-to-high scores on the three MBI dimensions. Because burnout is associated with other mental illnesses and prolonged incapacity, workplace-based interventions should be implemented.

A Narrative Review of Burnout Syndrome in Medical Personnel

Burnout among healthcare workers has been extensively studied since its initial recognition in 1960, with its defining characteristics established by Maslach in 1982. The syndrome, characterized by emotional exhaustion, depersonalization, and low personal accomplishment, is exacerbated by work-related stress and has profound implications for individual and societal well-being.

METHODS

A review of the literature, including PubMed searches and analyses of risk factors and protective measures, was conducted to assess the prevalence, impacts, and biomarkers associated with burnout among healthcare workers. Various instruments for evaluating burnout were examined, including the widely used Maslach Burnout Inventory, alongside specific tools tailored to different occupational populations.

RESULTS

Healthcare workers, particularly physicians, exhibit significantly higher rates of burnout compared to the general population. Factors such as night shifts, workload, and exposure to biohazards contribute to elevated burnout risk. Biomarkers like cortisol, melatonin, and thyroid hormones have been linked to burnout, highlighting physiological implications.

CONCLUSIONS

Burnout poses significant challenges to healthcare systems globally, impacting patient care, worker retention, and overall well-being. Identifying and addressing risk factors while promoting protective factors such as resilience and social support are crucial in mitigating burnout. Further research into prevention strategies and biomarker monitoring is warranted to support the mental and physical health of healthcare workers.

Prevalence of burnout among physiotherapists: a systematic review and meta-analysis

BACKGROUND

Work-related burnout is a significant concern amongst healthcare professionals, including physiotherapists. It can negatively impact on both staff well-being and the quality of care delivered to patients.

OBJECTIVES

To estimate the prevalence of burnout among physiotherapists.

DATA SOURCES

PubMed, CINAHL, Web of Science, Embase, Scopus and PsycINFO, from inception to February 1st, 2022.

STUDY SELECTION OR ELIGIBILITY CRITERIA

Studies reporting burnout prevalence among physiotherapists.

DATA EXTRACTION AND DATA SYNTHESIS

Prevalence of burnout. Sub-analyses were performed grouping studies based on countries where surveys were conducted, classified as developed or developing countries. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale.

RESULTS

32 studies were included in the systematic review and 31 in the meta-analysis, enrolling a total of 5984 physiotherapists from 17 countries. Pooled prevalence (95% confidence interval) of burnout was 8% (4-15). Prevalence figures for Maslach Burnout Inventory dimensions were: (i) emotional exhaustion, 27% (21-34) (ii) depersonalization, 23% (15-32) (iii) low personal accomplishment, 25% (15-40). Both overall and single components prevalence was higher, although not significantly, in studies from developing than in developed countries.

LIMITATIONS

Tools used to assess burnout and cut-off scores chosen to identify the burnout prevalence differed across studies.

CONCLUSION AND IMPLICATIONS OF KEY FINDINGS

Prevalence of burnout reported by physiotherapists appears high worldwide, in particular in developing countries, and compares with that reported by nurses and physicians. Substantial heterogeneity in the prevalence of burnout, in its definition and assessment methods across studies, and limited quality of most studies precludes drawing definitive conclusions.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42022307876 CONTRIBUTION OF THE PAPER.

Career intentions and satisfaction influences in early career Australian physiotherapists

BACKGROUND

The current workforce does not meet the demand for physiotherapy services in Australia. Future demand is predicted to expand driven primarily by the aging population. Previous research describes significant attrition and short career intentions of junior physiotherapists.

OBJECTIVE

This study explored factors associated with physiotherapy graduates' early career intentions and satisfaction.

METHOD

Four cohorts of student physiotherapists completed two online surveys designed specifically for this study assessing their immediate and future career intentions and satisfaction. Surveys were completed after undergraduate training (Student Survey) and 2 years later (Practitioner Survey). Question formats included single or multiple select, Likert scale, and free-text responses. Responses were analyzed via descriptive statistics and content and relational analysis.

RESULTS

Despite most early career practitioners (83%) reporting career satisfaction, 27% intended to pursue long-term physiotherapy careers (>20 years) and 15% intended to work for 5 years or less. Fewer (11%) reported a longer career intention and 26% a shorter career intention compared to their student survey. Extrinsic occupational factors, such as support, were mentioned as influential in increasing intended future career length since course completion.

CONCLUSION

This study found some evidence of factors contributing to shorter career intentions of early career physiotherapists. Specific support of early career physiotherapists may encourage longer career intentions and help build future workforce capacity.

Occupational Burnout and Psychological Resilience Levels Among Physiotherapists

This study sets out to determine those factors that may increase the risk of occupational burnout among physiotherapists. Fifty-six physiotherapists (39 women and 14 men aged 25-69) with various specializations (paediatric, adult, or both), work models (individual, team, or both), and workplaces (public or private) completed the Oldenburg Burnout Inventory (OLBI) to assess their burnout levels and the Resilience Scale (SPP-25) in order to have their psychological resilience evaluated. Pearson correlation coefficients showed a significant inverse relationship between psychological resilience and the risk of burnout. Among environmental factors, private clinical practice had a protective effect against burnout. Regression analysis revealed that tolerance for failure and viewing life as a challenge (a subscale of SPP-25) were key predictors of burnout. Higher tolerance for failure and viewing life as a challenge corresponded with lower scores on the exhaustion and disengagement scales. The study showed that the higher the psychological resilience, regardless of specialization, work model, or workplace, the lower the risk of burnout. This indicates the need for greater attention to employees’ personality traits, which can significantly impact work quality.

The first year of private practice - new graduate physiotherapists are highly engaged and satisfied but edging toward burnout

BACKGROUND

A greater understanding of physiotherapists' work-life during their first year of work in private practice, and whether their experiences are mediated by personal traits, may provide valuable information to support their transition and retention.

OBJECTIVES

Describe the first year of practice for graduate physiotherapists in terms of employee engagement, job satisfaction, performance, and burnout, and evaluate the relationship between these measures and personal traits (resilience, grit, mind-set).

DESIGN

One-year longitudinal mixed-methods study.

METHODS

Twenty new graduate physiotherapists completed questionnaires evaluating resilience, grit, and mind-set within 1-week of commencing employment. Engagement and job satisfaction were evaluated at 3, 6 and 12-months, and burnout evaluated at 12-months. Performance data (number of patients seen, revenue) were collected throughout the year. Individual semi-structured interviews were conducted at baseline, 3, 9 and 12-months.

RESULTS

Engagement and satisfaction were high at all time points. At 12-months, burnout was at a medium level. Resilience was positively associated with job satisfaction at 6 (ρ = 0.56, p = .019) and 12-months (ρ = 0.54, p = .027). Engagement (ρ = -0.57, p = .04) and job satisfaction (ρ = -0.56, p = .03) were negatively associated with burnout at 12-months. All participants remained passionate about their work although increasing administrative burden and patient complexity contributed to feelings of burnout.

CONCLUSIONS

Resilience was positively associated with job satisfaction suggesting those with capacity to 'bounce back' were more satisfied and engaged with their job. Although moderate levels of burnout were reported at 12-months, those with higher job satisfaction and employee engagement had lower levels of burnout. Participants proposed practical strategies to help mitigate burnout.

"It's easy to be burned out in this line of work": Experiences of burnout among Black women pelvic floor therapists in the United States

BACKGROUND

Burnout disproportionately affects professionals who spend much of their time in direct patient care. The physical and emotional demands of pelvic floor therapists, coupled with identity-based stressors, may place Black women pelvic floor therapists at an increased risk for experiencing burnout.

OBJECTIVE

The purpose of this study was to explore the experiences of burnout among Black women pelvic floor therapists in the United States.

DESIGN

This is a short-form qualitative study with data collected from an online survey.

METHODS

We recruited Black women pelvic floor therapists from November 2023 to February 2024 to complete an online survey comprised of open-ended questions about their experiences of burnout. The coding team analyzed the short-form qualitative data using inductive structural tabular thematic analysis.

RESULTS

Of the 59 participants in the total sample, 37 reported experiencing professional burnout. Main themes were: (1) contributors to burnout, (2) signs of burnout, and (3) consequences of burnout. Notably, contributors to burnout were predominantly structural and included workplace factors, such as unrealistic productivity standards and experiences of discrimination and microaggressions. Signs of burnout were primarily emotional. Consequences of burnout included leaving the current work setting, a strong desire to transition to a different setting, or taking a break from the profession overall.

CONCLUSION

This study revealed that it is not only the intensity of Black women pelvic floor therapists' workload but also the nature of their tasks and the contexts within which they operate that contribute to burnout.

The relationship between burnout and work engagement levels of nurses and physiotherapists working during the COVID-19 pandemic period

BACKGROUND

The COVID-19 pandemic has affected all health professionals worldwide. This has also influenced their working lives, affecting burnout and work engagement.

OBJECTIVE

This study aims to investigate the relationship between burnout and work engagement among nurses and physiotherapists during the COVID-19 pandemic.

METHODS

This cross-sectional study was conducted with total 509 nurses and physiotherapists who were working at any of the private, public, or university hospitals from two large and one small cities. A Personal Introduction Form, the Maslach Burnout Scale, and the Work Engagement Scale were used in the study. Frequency, percentage, mean, and Pearson correlation analysis were used for statistical analysis. Necessary ethical approvals were taken for the research.

RESULTS

There was a significant, moderate, negative relationship between the average scores of the nurses on the vigor and devotion dimensions and the Work Engagement Scale and their average scores on emotional exhaustion, personal accomplishment, depersonalization dimensions and their average score on the Maslach Burnout Scale (p < 0.05). There was a significant, moderate, negative relationship between the scores of the physiotherapists on the Work Engagement Scale and its dimensions and their average scores on the Maslach Burnout Scale and its dimensions (p < 0.05).

CONCLUSION

In our study, it was found that the burnout levels of nurses and physiotherapists had an effect on their work engagement during the COVID-19 pandemic. During and after the COVID-19 process, managers should take measures to reduce the burnout levels of health professionals and increase their level of work engagement.

Second Victims among Austrian Pediatricians (SeViD-A1 Study)

(1) Background: The second victim phenomenon (SVP) plays a critical role in workplace and patient safety. So far, there are limited epidemiological data on the SVP in German-speaking countries. Some studies have been carried out in Germany, but so far, no quantitative studies have been carried out in Austria examining the prevalence, symptom load and preferred support measures for second victims (SVs). This study therefore examines the SVP among Austrian pediatricians. (2) Methods: A nationwide, cross-sectional and anonymous online study was conducted using the SeViD questionnaire (Second Victims in Deutschland) including the Big Five Inventory-10 (BFI-10). Statistical analysis included binary-logistic and multiple linear regression with the bootstrapping, bias-corrected and accelerated (BCa) method based on 1000 bootstrap samples. (3) Results: Of 414 Austrian pediatricians, 89% self-identified as SVs. The main cause of becoming an SV was the unexpected death or suicide of a patient. High neuroticism and extraversion values as well as working in outpatient care positively correlated with having experienced the SVP. A preferred support strategy was access to legal counseling. (4) Conclusions: Austrian pediatricians have the highest SVP prevalence measured with the SeViD questionnaire. Further research should focus on prevention strategies and intervention programs.

Feeling exhausted: How outpatient physical therapists perceive and manage job stressors

PURPOSE

Burnout is identified as a workplace problem rather than a worker problem. However, it remains unclear what job stressors are associated with burnout among outpatient physical therapists. Thus, the primary objective of this study was to understand the burnout experiences of outpatient physical therapists. The secondary aim was to identify the relationship between physical therapist burnout and the work setting.

METHODS

One-on-one interviews based on hermeneutics were used for qualitative analysis. Quantitative data was collected using the Maslach Burnout Inventory-Health Services Survey (MBI-HSS) and the Areas of Worklife Survey (AWS).

RESULTS

Qualitative analysis found participants interpreted an increased workload with no increase in wages, loss of control, and a mismatch between organizational culture and values as the main drivers of organizational stress. Professional issues such as high debt burden, low salaries, and declining reimbursement emerged as stressors. Participants showed moderate to high emotional exhaustion per the MBI-HSS. There was a statistically significant association between emotional exhaustion and workload and control (p < 0.001). For every one-point increase in workload, emotional exhaustion increased by 6.49 while for every one-point increase in control, emotional exhaustion decreased by 4.17.

CONCLUSION

Outpatient physical therapists in this study felt that increased workload with a lack of incentives and inequity, coupled with a loss of control, and a mismatch between personal and organizational values were significant job stressors. Creating awareness of outpatient physical therapist's perceived stressors may play an important role in developing strategies to diminish or prevent burnout.