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Rehabilitation for patients with burnout
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Stress-related diseases and burnout have increased in Sweden during the last decades. In 2006, the most common diagnoses for new cases of sickness compensation were mental and behavioural disorders in both women and men. In spite of the large group of people seeking care for and on long-term sickness absence due to stress-related diseases and burnout, there is no agreement on which treatment they should be offered. The overall aim of this thesis was to describe patients on longterm sick leave because of burnout and to evaluate rehabilitation programs for this patient group.

Two patient samples were recruited from the Stress Clinic at the University Hospital in Umeå, Sweden: REST (Rehabilitation for stressrelated disease and burnout; n=136) and QIST (Qigong for stress-related disease and burnout; n=82). A general population sample was from the 2004 Northern Sweden MONICA survey (n=573). Patients in REST were randomised into a 1-year rehabilitation program to either program A (Cognitively-oriented Behavioural Rehabilitation (CBR) and Qigong), or to program B (Qigong alone). In Paper I, baseline data were compared with data from the MONICA sample. In paper II, programs A and B were compared regarding effects on psychological variables and sick leave rates, and in Paper III, 18 patients from program A and B were interviewed to explore subjective experiences of the rehabilitation programs. Patients in QIST were allocated to an intervention with Qigong twice a week for 12 weeks or a control group. Psychological and physical measurements were assessed in QIST.

Data were collected by questionnaires, physical measurements, the register on sick leave, and interviews.

Patients with burnout reported a more restricted social network and higher work demands than the general population. In relation to women from a general population, women with burnout more often worked “with people”, reported high job strain, a more sedentary work situation and less emotional support.

A per-protocol analysis showed no significant differences in treatment effect between program A and B in REST or between the intervention and control group in QIST. All groups improved significantly over time with reduced levels of burnout, anxiety, depression, and fatigue. In REST, lower scores on obsessive-compulsive symptoms, stress behaviour, and sick leave rates were found in both programs and in QIST both groups increased dynamic balance and physical capacity. In an intention-to-treat analysis, patients in program A in REST had significantly fewer obsessive-compulsive symptoms, and larger effect sizes in stress behaviour and obsessive-compulsive symptoms compared to patients in program B. Patients in both REST programs perceived that the 1-year rehabilitation program gave them specific tools to use in secondary prevention. They also emphasised that the good encounters, affirmation and group cohesiveness they perceived during the 8 rehabilitation was a necessary basis for initiation of a behavioural change leading to recovery.

In conclusion, compared to a general population, patients with burnout perceived more demands at work and less social support. Lack of emotional support seemed to be more associated with burnout among women. There were no differences in effect between CBR and Qigong compared to Qigong alone, or between a 12 week Qigong intervention compared to a control condition. Improvements were found in all groups in the rehabilitation programs. CBR combined with Qigong have some advantages compared to Qigong alone. An environment with good encounters and affirmation of the patients was experiences as important by the patients and group rehabilitation had advantages as recognition and support from the group. Early rehabilitation measures are important to prevent long-term sickness absence. In future rehabilitation programs it might be necessary to have a more individualized approach and choose treatments preferred by the patient.

Place, publisher, year, edition, pages
Umeå: Arkitektkopia , 2009. , 70 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1237
Keyword [en]
burnout, social support, work demands, population surveillance, epidemiology, randomised controlled trials, cognitive therapy, sick leave, mind-body and relaxation techniques, anxiety, depression, grounded-theory analysis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-18434ISBN: 978-91-7264-711-4 (print)OAI: oai:DiVA.org:umu-18434DiVA: diva2:158989
Distributor:
Yrkes- och miljömedicin, 901 87, Umeå
Public defence
2009-02-27, Sal B plan 9, Tandläkarhögskolan By 1D, Norrlands Universitetssjukhus, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-02-11 Created: 2009-02-05 Last updated: 2012-01-27Bibliographically approved
List of papers
1. Patients with burnout in relation to gender and a general population
Open this publication in new window or tab >>Patients with burnout in relation to gender and a general population
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2007 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 35, no 5, 516-523 p.Article in journal (Refereed) Published
Abstract [en]

Aims: The aims of this study were to describe gender differences in patients with burnout and compare these patients with a general population with respect to physical, psychosocial and work variables. Methods: Data were collected from a total of 136 patients (96 women and 40 men, 41,6 ± 7,4 years), diagnosed with stress-related disease and burnout at the Stress Clinic, University Hospital of Umeå. Data on burnout, physical, psychosocial and work characteristics were compared with similar data from a geographical and age-matched population based survey, the 2004 Northern Sweden MONICA study. The survey sample included a total of 573 participants (283 women and 290 men, 40,7 ± 8,5 years). Results: Women with burnout reported a higher rate of impaired awakening, lower job control, greater proportion of unpaid work and worked to a greater extent ``with people'' compared to men. Men with burnout had a more restricted social network and reported working more overtime than women. Patients with burnout reported a higher rate of unemployment, a more restricted social network and higher work demands compared to a general population. Women with burnout reported less emotional support, a more sedentary work situation, high job strain and worked to a greater extent ``with people'' than women from the general population. Conclusions: There are some differences in working conditions and social network between women and men with burnout. Patients with burnout differ from a general population regarding individual and social factors as well as work-related factors.

Keyword
Burnout professional, fatigue syndrome, social support, workload, population surveillance, epidemiology
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-18207 (URN)10.1080/14034940701271874 (DOI)17852977 (PubMedID)
Available from: 2007-11-29 Created: 2007-11-29 Last updated: 2017-08-21Bibliographically approved
2. Cognitively oriented behavioral rehabilitation in combination with Qigong for patients on long-term sick leave because of burnout: REST - a randomized clinical trial
Open this publication in new window or tab >>Cognitively oriented behavioral rehabilitation in combination with Qigong for patients on long-term sick leave because of burnout: REST - a randomized clinical trial
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2009 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 16, no 3, 294-303 p.Article in journal (Refereed) Published
Abstract [en]

Background

Despite an increase in the occurrence of burnout, there is no agreement on what kind of rehabilitation these patients should be offered.

Purpose

Primary aim of this study was to evaluate effects on psychological variables and sick leave rates by two different group rehabilitation programs for patients on long-term sick leave because of burnout. Rehabilitation program A (Cognitively oriented Behavioral Rehabilitation (CBR) and Qigong) was compared with rehabilitation program B (Qigong only).

Method

In a randomized clinical trial, 96 women and 40 men with a mean age of 41.6 ± 7.4 years were allocated to one of the two rehabilitation programs.

Results

A per-protocol analysis showed no significant difference in treatment efficacy between the groups. Both groups improved significantly over time with reduced levels of burnout, self-rated stress behavior, fatigue, depression, anxiety, obsessive–compulsive symptoms, and sick leave rates. In an intention-to-treat analysis, patients in program A had fewer obsessive–compulsive symptoms and larger effect sizes in self-rated stress behavior and obsessive–compulsive symptoms compared to patients in program B.

Conclusion

This study showed no differences in effect between CBR and Qigong compared with Qigong only in a per-protocol analysis. Both rehabilitation programs showed positive effect for patients with burnout.

Keyword
randomized controlled trials, burnout, cognitive therapy, sick leave
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-18430 (URN)10.1007/s12529-008-9011-7 (DOI)
Available from: 2009-02-05 Created: 2009-02-05 Last updated: 2017-08-21Bibliographically approved
3. Take charge: Patients' experiences during participation in a rehabilitation programme for burnout
Open this publication in new window or tab >>Take charge: Patients' experiences during participation in a rehabilitation programme for burnout
2010 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 42, no 5, 475-481 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to explore the experiences of patients with burnout during a rehabilitation programme.

Patients and methods: Eighteen patients with burnout were interviewed at the end of a one-year rehabilitation programme. The programme consisted of 2 groups, one with a focus on cognitively-oriented behavioural rehabilitation and Qigong and 1 with a focus on Qigong alone. The interviews were analysed using the grounded theory method.

Results: One core category, Take Charge, and 6 categories emerged. The core category represents a beneficial recovery process that helped the patients to take control of their lives. The common starting point for the process is presented in the 3 categories of Good encounters, Affirmation and Group cohesiveness. The categories were basic conditions for continuing development during rehabilitation. In the categories Get to know myself, How can I be the one I want to be? and Choice of track, the more group-specific tools are included, through which the patients adopted a new way of behaving.

Conclusion: Patients in both groups experienced group participation as being beneficial for recovery and regaining control of their lives, although in somewhat different way. An experience of affirmation and support from health professionals and group participants is of importance for behavioural change

Keyword
cognitive therapy, interviews, mind-bofy and relaxation techniques, qigong, qualitative research, stress.
National Category
Nursing Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-18432 (URN)000278821500010 ()20544160 (PubMedID)
Available from: 2009-02-05 Created: 2009-02-05 Last updated: 2017-08-21Bibliographically approved
4. Effects of qigong in patients with burnout: a randomized controlled trial
Open this publication in new window or tab >>Effects of qigong in patients with burnout: a randomized controlled trial
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2009 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, no 9, 761-767 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate the efficacy of Qigong in rehabilitation for patients with burnout. DESIGN: Prospective, randomized controlled trial. SUBJECTS: Eighty-two patients (68 women and 14 men, mean age 44.3 (standard deviation 9.1) years) diagnosed with burnout.

METHODS: Basic care was offered to both the intervention and the control group. Patients in the intervention group received basic care and, in addition, performed Qigong twice a week for 12 weeks. Psychological variables, health-related quality of life, perceived relaxation and physical measurements were assessed at baseline and after the intervention period.

RESULTS: No significant difference in treatment efficacy between the groups was found by either intention-to-treat or per-protocol analyses. Both groups improved significantly over time, with reduced levels of burnout, fatigue, anxiety and depression, and increased dynamic balance and physical capacity. CONCLUSION: In this study, a Qigong intervention twice a week for 12 weeks had no additional effect beyond basic care for patients with burnout.

Keyword
mind-body therapies; burnout; anxiety; depression; randomized controlled trial
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-30750 (URN)10.2340/16501977-0417 (DOI)19774311 (PubMedID)
Available from: 2010-01-14 Created: 2010-01-14 Last updated: 2017-12-12Bibliographically approved

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