Objective: To evaluate the impact of patient-perceived physician empathy on health-related quality of life (HRQoL), treatment satisfaction, and clinical outcomes in patients receiving Botulinum Neurotoxin A (BoNT-A) therapy.
Background: While physician empathy is known to improve outcomes in general medicine, its specific impact on HRQoL and treatment success in BoNT-A therapy for chronic neurological conditions remains underexplored.
Method: This cohort analysis evaluated data from 636 adults receiving quarterly BoNT-A for cervical dystonia (CD), chronic migraine (CM), blepharospasm, hemifacial spasm, and spasticity. Empathy was quantified using the Consultation and Relational Empathy (CARE) measure. Outcomes at baseline and 3-month follow-up included the EQ-5D-5L index, treatment satisfaction, clinician-rated severity, CDQ-24, MIDAS, TSUI, and Goal Attainment Scaling (GAS). Multivariable Generalized Estimating Equations (GEE) evaluated empathy’s predictive value. Model criterion analysis compared the predictive fit of empathy versus clinical severity, and mediation analysis explored if empathy improves HRQoL by mitigating emotional distress.
Results: The cohort (mean age 55.2±14.7 years; 71.7% female) was primarily treated for CD (41.2%) and CM (29.6%). Multivariable GEE showed higher baseline empathy independently predicted improved EQ-5D-5L index (β=0.045, p=0.004) and greater patient satisfaction (β=4.85, p=0.048) at follow-up across diagnoses. In the CD subgroup, empathy predicted subjective improvements on the CDQ-24 total score (β=-4.68, p=0.010) and ADL subscale (β=-4.69, p=0.010). Empathy did not significantly alter objective severity (TSUI), headache frequency, or GAS scores. Crucially, model comparisons demonstrated empathy was a superior predictor of general HRQoL compared to physician-rated severity. Mediation analysis indicated empathy influences HRQoL primarily by reducing disease-related emotional distress.
Conclusion: Physician empathy is not merely a secondary skill but a primary determinant of HRQoL in BoNT-A therapy. While objective markers track disease progression, the therapeutic alliance acts as a relational shield, outperforming clinical severity in predicting long-term patient well-being and treatment satisfaction.
To cite this abstract in AMA style:
T. Kölsche, R. Jansen, M. Ringelstein, S. Meuth, J. Lee, P. Albrecht. Beyond Symptom Relief: Physician Empathy Outperforms Clinical Severity in Predicting Quality of Life for Patients Undergoing Botulinum Toxin Therapy [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/beyond-symptom-relief-physician-empathy-outperforms-clinical-severity-in-predicting-quality-of-life-for-patients-undergoing-botulinum-toxin-therapy/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/beyond-symptom-relief-physician-empathy-outperforms-clinical-severity-in-predicting-quality-of-life-for-patients-undergoing-botulinum-toxin-therapy/