Correlation between physical therapy and burnout in Saudi Arabia: a national cross-sectional studyAbstract
Introduction: Burnout is as a multidimensional syndrome of physical, emotional, and mental exhaustion from prolonged exposure to stressful and demanding work environments, and it has been linked to a wide range of psychological and physical health problems.
Objective: To explore the prevalence of burnout among Saudi physicaltherapists working in private and governmental healthcare facilities and to examine its association with various professional and environmental variables.
Methods: A crosssectional study was conducted among 375 Saudi physical therapists practicing in Saudi Arabia using validated English version of the Maslach Burnout Inventory. Descriptive statistics, ttests, ANOVA, and multivariate linear regression were used for data analysis.
Results: The findings revealed a higher prevalence of burnout among female compared to male physical therapists. Specifically, 41.6% of the participants reported high emotional exhaustion, 84.8% reported depersonalization, and 86.9% reported reduced personal accomplishment. A significant positive correlation was also found between daily working hours and burnout dimensions (emotional exhaustion, depersonalization, personal accomplishment).
Conclusion: This study identified a high prevalence of burnout among physical therapists in Saudi Arabia. Female gender, longer daily working hours, and regional differences were significantly associated with higher burnout dimensions. Due to the crosssectional design, causal relationships cannot be inferred. These findings may assist policymakers and healthcare administrators in developing strategies to support therapists' mental health and well-being.
Keywords:
Burnout; Physical therapy; Saudi Arabia
Resumo
Introdução: A síndrome de burnout é uma síndrome multidimensional de exaustão física, emocional e mental resultante da exposição prolongada a ambientes de trabalho estressantes e exigentes, e tem sido associada a uma ampla gama de problemas de saúde física e psicológica.
Objetivo: Explorar a prevalência de burnout entre fisioterapeutas sauditas que atuam em instituições de saúde privadas e governamentais e examinar sua associação com diversas variáveis profissionais e ambientais.
Métodos: Realizouse um estudo transversal com 375 fisioterapeutas sauditas atuantes na Arábia Saudita, utilizando a versão validada em inglês do Inventário de Burnout de Maslach. Estatísticas descritivas, testes t, ANOVA e regressão linear multivariada foram utilizados para a análise dos dados.
Resultados: Os resultados revelaram uma maior prevalência de burnout entre fisioterapeutas do sexo feminino em comparação com os do sexo masculino. Especificamente, 41,6% dos participantes relataram alta exaustão emocional, 84,8% relataram despersonalização e 86,9% relataram redução da realização pessoal. Uma correlação positiva significativa também foi encontrada entre a carga horária diária de trabalho e as dimensões do burnout (exaustão emocional, despersonalização e realização pessoal).
Conclusão: Identificouse uma alta prevalência de burnout entre fisioterapeutas na Arábia Saudita. O sexo feminino, a maior jornada de trabalho diária e as diferenças regionais estiveram significativamente associados a maiores níveis de burnout. Devido ao delineamento transversal do estudo, não é possível inferir relações causais. Esses achados podem auxiliar formuladores de políticas públicas e gestores de saúde no desenvolvimento de estratégias para apoiar a saúde mental e o bemestar dos fisioterapeutas.
Palavras-chave:
Burnout; Fisioterapia; Arábia Saudita
Introduction
Burnout is defined as a multidimensional syndrome of physical, emotional, and mental exhaustion resulting from prolonged exposure to stressful and emotionally demanding work environments. It is characterized by fatigue, diminished motivation, and decreased job satisfaction, and has been linked to a wide range of psychological and physical health problems.1 While most research has traditionally focused on human service professionals, physical therapists are equally vulnerable, what may be partly explained by the intensity of patient interaction and workload demands. Burnout is increasingly regarded not as an interpersonal breakdown, but as a crisis in the individual's relationship with their work.2
The Maslach Burnout Inventory (MBI) conceptualizes burnout across three domains: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA), which manifest as chronic emotional fatigue, cynical disengagement from work, and feelings of professional inefficacy, respectively.1 Prevalence among physical therapists has been reported to range between 45-71%, though methodological inconsistencies across studies associated with variability in these estimates.3 In the United States, burnout research in physical therapy remains limited, with much of the available literature either dated or restricted to acute care settings.4
Multiple factors show an association with burnout risk, including excessive administrative duties, limited autonomy, and misalignment of personal and organizational values.4 Personality traits such as perfectionism, selfcriticism, and overcommitment also increase susceptibility. Furthermore, insufficient organizational support, lack of recognition, and restricted career advancement opportunities intensify the problem.5
The COVID-19 pandemic introduced additional stressors for physical therapists, including infection control duties, expanded documentation, and educational responsibilities, which diverted time and energy from direct patient care.6 These challenges heightened both emotional strain and physical fatigue. Studies further highlight that therapists in rural areas face unique risks may be partly explained by staffing shortages, professional isolation, and limited continuing education, resulting in heavier workloads and resource constraints.7
Although workplace relationships and professional development opportunities have been shown to mitigate burnout,8 inconsistencies remain regarding demographic factors associated with age, salary, or patient load. However, less experienced therapists, particularly those with fewer than five years of practice, appear to be more vulnerable.9 Burnout among physical therapists threatens not only practitioner well-being but also patient safety, as it is associated with reduced care quality, higher error rates, and lower patient satisfaction.10 Moreover, it associates with professional attrition, further straining healthcare systems.
Despite extensive international literature, research addressing burnout among physical therapists in the Gulf and broader Middle Eastern contexts remains scarce. The limited studies available often rely on the MBI, but inconsistencies in administration and interpretation, as well as narrow geographic focus, hinder generalizability. These gaps highlight the need for comprehensive, largescale studies to better understand burnout prevalence and its associated factors in these regions. Therefore, this study aimed to conduct a national crosssectional survey using convenience sampling investigation to determine the prevalence of burnout among physical therapists in Saudi Arabia and to explore its associations with sociodemographic and professional variables. Specifically, the study examined the prevalence of burnout among Saudi physical therapists, the sociodemographic characteristics most strongly associated with burnout, and the relationship between years of continuous practice and burnout dimensions, particularly emotional exhaustion and personal accomplishment.
Methods
This multiregional crosssectional survey using convenience sampling was conducted to assess burnout among Saudi physical therapists working across different healthcare facilities in Saudi Arabia. Data was collected over a sixmonth period, from March to August 2025. The study protocol was reviewed and approved by the Research Ethics Committee of Taif University, Saudi Arabia (Approval No. 46-207, dated February 26, 2025). Written informed consent was obtained electronically from all participants prior to survey completion. Participation was voluntary, responses were anonymized, and all data were stored securely for research purposes only.
Participants
The study targeted licensed Saudi physical therapists employed in either public hospitals or private clinics. Both male and female therapists were eligible. Inclusion criteria were: holding a valid Saudi physical therapy license; currently employed in governmental or private healthcare facilities; and willingness to provide informed consent. Exclusion criteria included: non-Saudi therapists, nurses, physicians, interns, students, unlicensed practitioners, and incomplete survey responses. Participants were recruited through multiple channels to maximize reach across Saudi Arabia.
The survey link was distributed via professional networks, email invitations, and social media platforms (such as WhatsApp and X). Due to the nature of convenience sampling and the use of multiple distribution channels (e.g., forwarded links through personal and professional contacts), a precise response rate could not be calculated, as the exact number of individuals who received the survey invitation could not be determined. There were 12,544 licensed physical therapists in Saudi Arabiaat the time of the study. Using a 95% confidence level and a 5% margin of error, the minimum required sample size was calculated to be 373 participants.
Survey instrument
Data was collected using a self-administered questionnaire distributed via Google Forms. The cover page explained the study objectives, estimated completion time, and confidentiality assurances. The questionnaire comprised two sections: collection of sociodemographic and professional characteristics (age, gender, marital status, region, type of institution, educational level, years of professional experience, job role, daily working hours, and shift schedule); and burnout assessment using the validated English version of the MBI – Human Services Survey (MBI-HSS).2 The tool includes 22 items across the three subscales: EE (9 items), measuring emotional strain and fatigue; DP (5 items), assessing detached or impersonal attitudes toward patients; and PA (8 items), evaluating perceptions of competence and achievement in work. Each item was rated on a 7-point Likert scale ranging from 0 ("never") to 6 ("every day"). Subscale scores were summed and categorized as low, moderate, or high based on standardized thresholds (Table 1).
MBI-HSS has demonstrated strong psychometric properties, with Cronbach's alpha coefficients of 0.90 (EE), 0.79 (DP), and 0.71 (PA).1 Burnout was not treated as a single composite score. Instead, the three MBI-HSS subscales (EE, DP, PA) were analyzed separately, as recommended in the literature. Each subscale was calculated by summing its respective items and interpreted independently using established cut-off values.1
Statistical analysis
Data were analyzed using IBM SPSS Statistics (version XX, IBM Corp., Armonk, NY, USA). Descriptive statistics were computed to summarize participant characteristics and burnout dimensions. Continuous variables were reported as means ± standard deviations, while categorical variables were expressed as frequencies and percentages. The MBI-HSS subscales (EE, DP and PA) were scored according to established cut-off values, and participants were classified into low, moderate, or high burnout levels. Comparisons between burnout levels and sociodemographic/professional variables were conducted using the chisquare test (χ²) for categorical variables and the independent samples ttest or oneway ANOVA for continuous variables, as appropriate. Posthoc analyses with Bonferroni correction were applied for multiple group comparisons. Associations between burnout subscale scores and independent variables were examined using multiple linear regression analysis. Regression assumptions, including normality, linearity, homoscedasticity, and absence of multicollinearity, were assessed priorto analysis. adjusting for potential confounders. Statistical significance was set at p < 0.05.
Results
A total of 375 physical therapists participated in this study. The mean age was 30.47 ± 5.60 years, with overhalf of the participants (51.2%) aged 20-29 years. Females constituted 55.5% of the sample, and 61.3% were single. Participants were recruited from multiple regions of Saudi Arabia; however, the sample was not evenly distributed, with the majority residing in the Western region (55.2%). Regarding workplace type, 44.8% worked in private hospitals, while 39.2% were employed in Ministry of Health facilities. Most participants held a bachelor's degree (81.6%) and had less than 10 years of experience (73.6%). The majority were outpatient physical therapists (74.1%), working an average of 8.02 ± 1.13 hours per day and 5.17 ± 0.68 days per week, predominantly during day shifts (73.3%) (Table 2).
Burnout dimensions among physical therapists
Burnout was assessed using the three subscales of the MBI-HSS. The mean scores were 25.86 ± 9.56 for EE, 17.52 ± 5.36 for DP, and 22.11 ± 8.14 for PA. High levels of emotional exhaustion and depersonalization were observed in 41.6% and 84.8% of participants, respectively, while 86.9% reported low personal accomplishment.
These findings indicate a high burden across multiple burnout dimensions rather than a single composite outcome (Table 3).
Burnout according to sociodemographic and workrelated factors
Differences in burnout dimensions were examined across sociodemographic and work-related characteristics. Female physical therapists reported significantly higher EE (p = 0.05) and DP (p = 0.03), along with lower PA scores (p = 0.05), compared to males. These findings suggest genderbased differences in burnout dimensions. Regional differences were also observed. Participants from the Central Region reported higher EE (p = 0.034) and lower PA (p = 0.019) compared to other regions. However, these findings should be interpreted cautiously may be partly explained by unequal regional representation. Working more than 8 hours per day was significantly associated with lower PA scores (p = 0.010). No statistically significant differences were found for EEor DP in relation to working hours. Other variables, including age, marital status, type of hospital, educational level, years of experience, role, working days per week, and shift pattern, were not significantly associated with EE, DP, or PA (Table 4).
Differences in burnout subscales by sociodemographic and work-related characteristics (n = 375)
Multivariable analysis of burnout dimensions
Separate multivariable analyses were conducted to examine factors associated with burnout dimensions. Gender (B = 7.010; p = 0.002), region (B = -1.582; p = 0.028), and daily working hours (B = 2.739; p = 0.006) were significantly associated with higher levels of emotional exhaustion. Age showed a weak but statistically significant association (B = 1.162; p = 0.031).
No consistent associations were observed across all three burnout dimensions, indicating that different factors may relate differently to EE, DP, and PA. Other variables, including marital status, type of hospital, education level, years of experience, role, working days per week, and shift, were not significantly associated with burnout dimensions (Table 5).
Cohen's d values ranged from 0.20 to 0.31 for significant ttest comparisons (gender, working hours), indicating small to small moderate effects. Eta squared (η2) for regional differences ranged from 0.028 to 0.031, and the regression model's adjusted R² was 0.089. These effect sizes suggest that while statistically significant, the identified factors explain a limited proportion of the variance in burnout dimensions, highlighting the multifactorial nature of burnout.
Discussion
We observed a high prevalence of burnout among physical therapists in Saudi Arabia, with 41.6% experiencing high EE, 84.8% showing high DP, and 86.9% reporting low PA. These findings indicate that burnout is widespread and pervasive across this professional group. Comparable results have been reported internationally, with studies estimating burnout prevalence among physiotherapists ranging from 45 to 71%, though variations exist depending on setting and methodology.3,11 In Saudi Arabia, high burnout levels have also been documented among other allied health professionals, including respiratory therapists and nurses. Primarily, it may be partly explained by high workloads, long working hours, andlimited support structures.12,13 Collectively, these findings emphasize that Saudi physical therapists are similarly vulnerable to occupational stressors associated with burnout.
Gender was significantly associated with burnout dimensions, with female physical therapists reporting higher EE and DP, and lower PA compared to their male counterparts. This is consistent with previous research suggesting that female healthcare workers may be more vulnerable to stress and workrelated emotional demands, what may be partly explained by both professional and social role expectations.8,11 Age also demonstrated a weak but significant association with burnout dimensions (EE, DP, PA), although years of experience were not significant factor, aligning with earlier findings that younger professionals or those earlier in their careers often face increased susceptibility to burnout. This may be partly explained by high workloads and limited coping strategies.9
Regional variation was observed, with physical therapists the Central Region reporting significantly higher EE and lower PA compared to other regions. This finding may be attributed to differences in caseloads, healthcare infrastructure, or organizational resources across Saudi regions, consistent with evidence highlighting the association with of workplace context on burnout levels.7
Work hours per day were strongly associated with burnout. Physical therapists working more than eight hours daily had significantly lower PA scores, indicating diminished professional efficacy. Regression analysis further confirmed that daily working hours were an independently associated factor of burnout dimensions (EE, DP, PA), underscoring the role of workload intensity. These results support prior studies showing that long working hours, administrative overload, and insufficient recovery time exacerbate stress and burnout in healthcare workers.10
Interestingly, other variables such as type of hospital, marital status, education level, and years of experience were not significantly associated with burnout. This suggests that, while systemic and personal characteristics associated with burnout, immediate job demands such as workload and genderrelated vulnerabilities may play a more critical role in shaping burnout risk.
Implications for practice and policy
The high prevalence of burnout among physical therapists highlights an urgent need for institutional and national-level interventions. Organizational measures could include workload redistribution, flexible scheduling, and adequate staffing to reduce daily work hours. Providing structured psychological support, mentorship programs, and stress management training may enhance resilience and coping among physical therapists.8 Moreover, policies promoting work-life balance and professional development opportunities could mitigate burnout and improve retention rates. International evidence supports that enhancing organizational support and aligning job demands with personal resources are effective strategies to reduce burnout and enhance job satisfaction.2,5
Limitations and future directions
This study has several limitations. First, the crosssectional design precludes causal inference; therefore, the observed relationships should be interpreted as associations only, not as causal effects between burnout dimensions and sociodemographic, as well as work-related variables should be interpreted as associations rather than causal effects. Second, participants were recruited using non-probabilistic convenience sampling, which may introduce selection bias and limit the representativeness of the sample. Although participants were drawn from multiple regions of Saudi Arabia, more than half were from the Western region, which may have shown an association with regional comparisons and restricts the generalizability of the findings. Third, the sample size was calculated based on assumptions for estimating burnout prevalence. While appropriate for descriptive purposes, no priori power analysis was conducted for the regression models; therefore, the results of inferential analyses should be interpreted with caution. Finally, several potentially important variables were not assessed, including workload indicators (e.g., number of patients per day), job satisfaction, income level, and mental health status. The omission of these factors may have introduced residual confounding and limits the ability to fully explain the observed associations.
Future research using longitudinal designs is recommended to better establish temporal relationships and track burnout over time. In addition, qualitative studies may provide deeper insights into the lived experiences of physical therapists and the organizational factors influencing burnout. Expanding research to include comparisons with other allied health professionals may further contextualize professionspecific risks and inform targeted, multidisciplinary interventions.
Conclusion
This study identified a high prevalence of burnout among Saudi physical therapists, with female gender, longer daily working hours, and regional differences significantly associated with burnout dimensions. Due to the crosssectional design, causal relationships cannot be inferred. These findings highlight the need for organizational and policy interventions to address work-related factors associated with burnout. Longitudinal and qualitative studies are recommended to further explore these associations.
Data availability statement
The data that support the findings of this study are available upon reasonable request.
References
-
1 Maslach C, Jackson SE. The measurement of experienced burnout. J Organiz Behav. 1981;2(2):99-113. https://doi.org/10.1002/job.4030020205
» https://doi.org/10.1002/job.4030020205 -
2 Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397-422. https://doi.org/10.1146/annurev.psych.52.1.397
» https://doi.org/10.1146/annurev.psych.52.1.397 -
3 Burri SD, Smyrk KM, Melegy MS, Kessler MM, Hussein NI, Tuttle BD, et al. Risk factors associated with physical therapist burnout: a systematic review. Physiotherapy. 2022;116:9-24. https://doi.org/10.1016/j.physio.2022.01.005
» https://doi.org/10.1016/j.physio.2022.01.005 -
4 Vedamuttu M, Hood M, Eastgate L, Bialocerkowski A. Burnout in occupational therapy and physiotherapy students: a systematic review of the risk and protective factors. Physiother Theory Pract. 2025;41(9):1986-2001. https://doi.org/10.1080/0-9593985.2025.2478091
» https://doi.org/10.1080/0-9593985.2025.2478091 - 5 Pines A, Aronson E. Career burnout: Causes and cures. New York: Free Press; 1988.
-
6 Muaidi QI, Shanb AA. Effects of work demands on physical therapists in the KSA. J Taibah Univ Med Sci. 2016;11(1):56-62. https://doi.org/10.1016/j.jtumed.2015.12.004
» https://doi.org/10.1016/j.jtumed.2015.12.004 -
7 Harvey SB, Modini M, Joyce S, Milligan-Saville JS, Tan L, Mykletun A, et al. Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems. Occup Environ Med. 2017;74(4):301-10. https://doi.org/10.1136/oemed-2016-104015
» https://doi.org/10.1136/oemed-2016-104015 -
8 Kim JH, Kim AR, Kim MG, Kim CH, Lee KH, Park D, et al. Burnout syndrome and work-related stress in physical and occupational therapists working in different types of hospitals: which group is the most vulnerable? Int J Environ Res Public Health. 2020;17(14):5001. https://doi.org/10.3390/ijerph1714-5001
» https://doi.org/10.3390/ijerph1714-5001 -
9 Wandling BJ, Smith BS. Burnout in orthopaedic physical therapists. J Orthop Sports Phys Ther. 1997;26(3):124-30. https://doi.org/10.2519/jospt.1997.26.3.124
» https://doi.org/10.2519/jospt.1997.26.3.124 -
10 Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PLoS One. 2016;11(7):e0159015. https://doi.org/10.1371/journal.pone.0159015
» https://doi.org/10.1371/journal.pone.0159015 -
11 Venturini E, Ugolini A, Bianchi L, Di Bari M, Paci M. Prevalence of burnout among physiotherapists: a systematic review and meta-analysis. Physiotherapy. 2024;124:164-79. https://doi.org/10.1016/j.physio.2024.01.007
» https://doi.org/10.1016/j.physio.2024.01.007 -
12 Algarni SS, Algihab AA, Dahmash HAB, Alomaireni AS, Alzahrani RA, Alruwaili AH, et al. Burnout among respiratory therapists in a tertiary hospital in Saudi Arabia. Respir Care. 2023;68(2):228-33. https://doi.org/10.4187/respcare.10140
» https://doi.org/10.4187/respcare.10140 -
13 Al-Anazi S, Habib SS, Al-Khlaiwi T, Alodhayani AA, Alotaibi A, Aldulejan S, et al. Association of burnout and working environment conditions in respiratory care professionals in Saudi Arabia: a cross-sectional study. Front Public Health. 2024;12: 1434472. https://doi.org/10.3389/fpubh.2024.1434472
» https://doi.org/10.3389/fpubh.2024.1434472
