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More Frequent Empathic Communication by Physical Therapists Is Associated With Improved Outcomes for Low-Impact Chronic Pain

Year: 2026

Type: article

Abstract: IMPORTANCE: Empathic communication is recommended in chronic pain management, yet few studies have examined the role of provider communication on treatment outcomes in pain rehabilitation. OBJECTIVE: The objective is to quantify associations between the frequency of empathic communication by physical therapists and patient-reported pain outcomes during routine clinical care for patients with chronic musculoskeletal pain. PARTICIPANTS AND DESIGN: Thirty-one physical therapist-patient dyads participated in a prospective cohort study in an outpatient physical therapy clinic. Evaluation and treatment sessions were audio-recorded over 6 weeks of routine physical therapy management of chronic musculoskeletal pain. MAIN OUTCOMES AND MEASURES: Empathic communication was quantified as a ratio of the frequency of empathic responses by physical therapists normalized to the frequency of empathic opportunities expressed by patients. Mixed-effects models assessed associations between physical therapist empathic communication and patient-reported pain intensity and interference over time. RESULTS: Across 99 recorded visits, physical therapists (n = 8) responded empathically 67% of the time. Empathic response rates for individual providers ranged from 27% to 84%. On average, more frequent empathic communication was associated with lower pain intensity (B = -1.29 [95% CI = -2.23 to -0.36) and pain interference (B = -1.07 [95% CI = -2.11 to -0.03]). More frequent empathic communication was also associated with a greater reduction in pain intensity over time (B = -0.78 [95% CI = -1.45 to -0.12]). CONCLUSIONS AND RELEVANCE: More frequent empathic communication is associated with lower patient-reported pain intensity and interference, along with larger and more rapid decreases in pain intensity over time. Future studies should investigate the efficacy of empathic communication skills training to improve outcomes of chronic pain management.

Source: Physical Therapy

DOI: 10.1093/ptj/pzag001