Abstract Background. Burnout, recognised in the ICD-11 as an occupational phenomenon, is a significant concern for healthcare organisations, with consequences for both professionals' well-being and the quality and safety of care. Mindfulness-based interventions (MBIs) have received growing attention, but existing systematic reviews focus almost exclusively on physicians and nurses and suggest more consistent effects on stress than on burnout. Rehabilitation professionals, despite being exposed to specific risk factors, remain under-investigated. Objective. To evaluate the effects of MBIs on burnout and work-related stress among rehabilitation professionals, compared with other interventions or no intervention, and to propose a pilot study designed to overcome the methodological limitations identified by the review. Methods. Following a theoretical framework on burnout (Chapter 1) and on mindfulness as a coping strategy, from the MBSR and MBCT protocols to its mechanisms of action (Chapter 2), a systematic review was conducted according to the PRISMA 2020 guidelines (Chapter 3). PubMed, Scopus, Web of Science, CINAHL, the Cochrane Library and PEDro were searched for primary studies published since 2016 that tested a stand-alone mindfulness intervention in rehabilitation professionals. Methodological quality was assessed with the Mixed Methods Appraisal Tool (MMAT) and with design-specific tools (QuADS, ROBINS-I, JBI checklists). Given the heterogeneity of the studies, a narrative synthesis was performed. Results. Of the 127 records identified, 6 studies (2018–2025) were included. Samples ranged from 8 to 40 participants, mostly physiotherapists, and no study was a randomised trial or included a follow-up. Three of the six studies reported a statistically significant improvement in at least one burnout dimension, particularly emotional exhaustion. Neither of the two studies measuring work-related stress reached statistical significance, although qualitative findings consistently pointed to improved emotional regulation and a greater sense of calm. Two studies were at critical risk of bias due to confounding in group allocation. Findings specific to rehabilitation work also emerged, such as the physical demands of manual practice and patient non-adherence. Six of the eight professions considered were not represented in any study. Proposed intervention. Chapter 4 proposes a multicentre, two-arm, randomised controlled pilot study. It would involve a multiprofessional sample of 90–150 professionals with at least moderate burnout (Oldenburg Burnout Inventory ≥ 44). The intervention would include six weekly 90-minute sessions in a hybrid format, daily informal practice anchored to three moments of the working day, and an app to monitor adherence. The primary outcome would be feasibility, assessed against pre-specified "traffic-light" progression criteria. Burnout, stress, dispositional mindfulness and productivity would be exploratory secondary outcomes, with follow-up at three and six months. Conclusions. The evidence suggests a possible benefit on burnout, particularly on emotional exhaustion, but does not allow definitive conclusions. This reflects the limitations of the included studies and of the review itself: data extraction and critical appraisal were performed by a single reviewer, and the protocol was not registered. The main contribution of this thesis is to have documented this gap and to have proposed a protocol built on the limitations identified. If confirmed by stronger evidence, MBIs could become a secondary prevention tool for work-related stress; for now, their use should be accompanied by careful outcome monitoring.
Background. Il burnout, riconosciuto dall'ICD-11 come fenomeno occupazionale, rappresenta una criticità rilevante per le organizzazioni sanitarie, con ricadute sul benessere dei professionisti e sulla qualità e sicurezza delle cure. Gli interventi basati sulla mindfulness (MBI) hanno ricevuto crescente attenzione, ma le revisioni sistematiche disponibili riguardano quasi esclusivamente medici e infermieri e suggeriscono effetti più consistenti sullo stress che sul burnout. I professionisti della riabilitazione, pur esposti a fattori di rischio specifici, restano poco indagati. Obiettivo. Valutare gli effetti degli MBI su burnout e stress lavoro-correlato nei professionisti della riabilitazione, rispetto ad altri interventi o all'assenza di intervento, e proporre uno studio pilota che superi i limiti metodologici emersi dalla revisione. Materiali e metodi. Dopo l'inquadramento teorico del burnout (Capitolo 1) e della mindfulness come strategia di coping, dai protocolli MBSR e MBCT ai meccanismi d'azione (Capitolo 2), è stata condotta una revisione sistematica secondo le linee guida PRISMA 2020 (Capitolo 3) su PubMed, Scopus, Web of Science, CINAHL, Cochrane Library e PEDro, includendo studi primari pubblicati dal 2016 che testassero un intervento mindfulness puro su professionisti della riabilitazione. La qualità metodologica è stata valutata con il Mixed Methods Appraisal Tool (MMAT) e con strumenti disegno-specifici (QuADS, ROBINS-I, checklist JBI); l'eterogeneità degli studi ha imposto una sintesi narrativa. Risultati. Dei 127 record identificati sono stati inclusi 6 studi (2018–2025), con campioni di 8–40 partecipanti, prevalentemente fisioterapisti; nessuno era un trial randomizzato né prevedeva un follow-up. Tre studi su sei hanno riportato un miglioramento significativo su almeno una dimensione del burnout, in particolare sull'esaurimento emotivo; sullo stress lavoro-correlato, nessuno dei due studi che lo misuravano ha raggiunto la significatività, a fronte di temi qualitativi convergenti di migliore regolazione emotiva e maggiore calma. Due studi presentavano un rischio di bias critico per confondimento nell'allocazione ai gruppi. Sono emersi inoltre elementi specifici del lavoro riabilitativo, come l'impegno fisico della pratica manuale e la non aderenza dei pazienti, mentre sei delle otto professioni considerate non erano rappresentate in alcuno studio. Proposta di intervento. Il Capitolo 4 propone uno studio pilota randomizzato controllato, multicentrico, a due bracci, su un campione multiprofessionale di 90–150 professionisti con burnout almeno moderato (Oldenburg Burnout Inventory ≥ 44). L'intervento prevedrebbe sei incontri settimanali di 90 minuti in formato ibrido, una pratica informale quotidiana ancorata a tre momenti della giornata lavorativa e un'applicazione per il monitoraggio dell'aderenza. L'outcome primario sarebbe la fattibilità, valutata con criteri di progressione "a semaforo" definiti a priori; burnout, stress, mindfulness disposizionale e produttività costituirebbero outcome secondari esplorativi, con follow-up a tre e sei mesi. Conclusioni. Le evidenze suggeriscono un possibile beneficio sul burnout, soprattutto sull'esaurimento emotivo, ma non consentono conclusioni definitive, per i limiti del corpus e della revisione (estrazione e valutazione critica affidate a un unico revisore, protocollo non registrato). Il principale contributo della tesi è aver documentato questa lacuna e proposto un protocollo basato sui limiti individuati. Se confermati da evidenze più solide, gli MBI potrebbero rappresentare uno strumento di prevenzione secondaria dello stress lavoro-correlato, oggi da impiegare con un attento monitoraggio degli esiti.
Mindfulness e burnout nei professionisti della riabilitazione: revisione sistematica e proposta di intervento
RICCI, FABIO
2025/2026
Abstract
Abstract Background. Burnout, recognised in the ICD-11 as an occupational phenomenon, is a significant concern for healthcare organisations, with consequences for both professionals' well-being and the quality and safety of care. Mindfulness-based interventions (MBIs) have received growing attention, but existing systematic reviews focus almost exclusively on physicians and nurses and suggest more consistent effects on stress than on burnout. Rehabilitation professionals, despite being exposed to specific risk factors, remain under-investigated. Objective. To evaluate the effects of MBIs on burnout and work-related stress among rehabilitation professionals, compared with other interventions or no intervention, and to propose a pilot study designed to overcome the methodological limitations identified by the review. Methods. Following a theoretical framework on burnout (Chapter 1) and on mindfulness as a coping strategy, from the MBSR and MBCT protocols to its mechanisms of action (Chapter 2), a systematic review was conducted according to the PRISMA 2020 guidelines (Chapter 3). PubMed, Scopus, Web of Science, CINAHL, the Cochrane Library and PEDro were searched for primary studies published since 2016 that tested a stand-alone mindfulness intervention in rehabilitation professionals. Methodological quality was assessed with the Mixed Methods Appraisal Tool (MMAT) and with design-specific tools (QuADS, ROBINS-I, JBI checklists). Given the heterogeneity of the studies, a narrative synthesis was performed. Results. Of the 127 records identified, 6 studies (2018–2025) were included. Samples ranged from 8 to 40 participants, mostly physiotherapists, and no study was a randomised trial or included a follow-up. Three of the six studies reported a statistically significant improvement in at least one burnout dimension, particularly emotional exhaustion. Neither of the two studies measuring work-related stress reached statistical significance, although qualitative findings consistently pointed to improved emotional regulation and a greater sense of calm. Two studies were at critical risk of bias due to confounding in group allocation. Findings specific to rehabilitation work also emerged, such as the physical demands of manual practice and patient non-adherence. Six of the eight professions considered were not represented in any study. Proposed intervention. Chapter 4 proposes a multicentre, two-arm, randomised controlled pilot study. It would involve a multiprofessional sample of 90–150 professionals with at least moderate burnout (Oldenburg Burnout Inventory ≥ 44). The intervention would include six weekly 90-minute sessions in a hybrid format, daily informal practice anchored to three moments of the working day, and an app to monitor adherence. The primary outcome would be feasibility, assessed against pre-specified "traffic-light" progression criteria. Burnout, stress, dispositional mindfulness and productivity would be exploratory secondary outcomes, with follow-up at three and six months. Conclusions. The evidence suggests a possible benefit on burnout, particularly on emotional exhaustion, but does not allow definitive conclusions. This reflects the limitations of the included studies and of the review itself: data extraction and critical appraisal were performed by a single reviewer, and the protocol was not registered. The main contribution of this thesis is to have documented this gap and to have proposed a protocol built on the limitations identified. If confirmed by stronger evidence, MBIs could become a secondary prevention tool for work-related stress; for now, their use should be accompanied by careful outcome monitoring.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/29341