TITLE:
Understanding Effort-Reward Imbalance among Kinshasa’s Physiotherapists—A Mixed-Methods Cross-Sectional Study
AUTHORS:
Philippe Lubanzadio-Mengi, Serge Mayaka, Jean Muzembo, Jean-Jacques Moraine, Jennifer Foucart, Vitalie Faoro
KEYWORDS:
Psychosocial Risk, Occupational Health, Stress, Musculoskeletal Disorders, Physical Therapy, Physiotherapy, Health at Work, Psychological Disorders
JOURNAL NAME:
Occupational Diseases and Environmental Medicine,
Vol.13 No.3,
July
7,
2025
ABSTRACT: Background: The issue of psychosocial risks at work has gained significant attention due to an improved recognition of the professional environmental cause of physical and psychological symptoms. Objective: To establish the typical profile of the Kinshasa physiotherapist most exposed to the Effort-Reward imbalance (ERI) using the Siegrist model, which evaluates both efforts, rewards and overinvestment. Method: A total of 174 physiotherapists practicing in Kinshasa were included in the study. The Siegrist model was administered to all participants, and 40 physiotherapists were selected to respond to an open questionnaire in the form of interviews, but after 17 interviews, semantic and theoretical saturation had been reached. Quantitative data were analyzed using ANOVA and principal component analysis (PCA), while qualitative insights enriched the interpretation of these findings by providing contextual depth. Results: The average ERI score was 0.43 ± 0.19 with 3% of physiotherapists having a score > 1. The ANOVA shows that working at patients’ homes and aiming for a high salary were significantly related with the ERI score and the sub-score “Efforts” (p Conclusion: Despite precarious working conditions and a difficult socio-economic context, only 3% of Kinshasa physiotherapists are subject to ERI. This surprising contrast may reflect high resilience, adaptive coping strategies, or a normalization of adversity that lowers reward expectations. The typical profile of the most exposed physiotherapist to the ERI in Kinshasa is a male physiotherapist who invest high effort, seeks high remuneration and provide home-based care. Both individual factors (such as education, experience, and self-esteem) and contextual elements (including workplace, workload, and perceived rewards) play a key role in shaping ERI in this population. Clinical Implications: Working at the patient’s home allows physiotherapists to have work, and therefore a salary or a supplement to their salary; but this way could also expose them to imbalance and stress.