Effects of mindfulness-based stress reduction on employees' mental health : a systematic review

OBJECTIVES: The purpose of this exploratory study was to obtain greater insight into the effects of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) on the mental health of employees. METHODS: Using PsycINFO, PubMed, and CINAHL, we performed a systematic review in October 2015 of studies investigating the effects of MBSR and MBCT on various aspects of employees' mental health. Studies with a pre-post design (i.e. without a control group) were excluded. RESULTS: 24 articles were identified, describing 23 studies: 22 on the effects of MBSR and 1 on the effects of MBSR in combination with some aspects of MBCT. Since no study focused exclusively on MBCT, its effects are not described in this systematic review. Of the 23 studies, 2 were of high methodological quality, 15 were of medium quality and 6 were of low quality. A meta-analysis was not performed due to the emergent and relatively uncharted nature of the topic of investigation, the exploratory character of this study, and the diversity of outcomes in the studies reviewed. Based on our analysis, the strongest outcomes were reduced levels of emotional exhaustion (a dimension of burnout), stress, psychological distress, depression, anxiety, and occupational stress. Improvements were found in terms of mindfulness, personal accomplishment (a dimension of burnout), (occupational) self-compassion, quality of sleep, and relaxation. CONCLUSION: The results of this systematic review suggest that MBSR may help to improve psychological functioning in employees

Linking leadership development programs for physicians with organization-level outcomes:a realist review

Background: Hospitals invest in Leadership Development Programs (LDPs) for physicians, assuming they benefit the organization’s performance. Researchers have listed the advantages of LDPs, but knowledge of how and why organization-level outcomes are achieved is missing. Objective: To investigate how, why and under which circumstances LDPs for physicians can impact organization-level outcomes. Methods: We conducted a realist review, following the RAMESES guidelines. Scientific articles and grey literature published between January 2010 and March 2021 evaluating a leadership intervention for physicians in the hospital setting were considered for inclusion. The following databases were searched: Medline, PsycInfo, ERIC, Web of Science, and Academic Search Premier. Based on the included documents, we developed a LDP middle-range program theory (MRPT) consisting of Context-Mechanism-Outcome configurations (CMOs) describing how specific contexts (C) trigger certain mechanisms (M) to generate organization-level outcomes (O). Results: In total, 3904 titles and abstracts and, subsequently, 100 full-text documents were inspected; 38 documents with LDPs from multiple countries informed our MRPT. The MRPT includes five CMOs that describe how LDPs can impact the organization-level outcomes categories ‘culture’, ‘quality improvement’, and ‘the leadership pipeline’: 'Acquiring self-insight and people skills (CMO1)', 'Intentionally building professional networks (CMO2)', 'Supporting quality improvement projects (CMO3)', 'Tailored LDP content prepares physicians (CMO4)', and 'Valuing physician leaders and organizational commitment (CMO5)'. Culture was the outcome of CMO1 and CMO2, quality improvement of CMO2 and CMO3, and the leadership pipeline of CMO2, CMO4, and CMO5. These CMOs operated within an overarching context, the leadership ecosystem, that determined realizing and sustaining organization-level outcomes. Conclusions: LDPs benefit organization-level outcomes through multiple mechanisms. Creating the contexts to trigger these mechanisms depends on the resources invested in LDPs and adequately supporting physicians. LDP providers can use the presented MRPT to guide the development of LDPs when aiming for specific organization-level outcomes.</p

‘Practice what you preach’. Perspectives on the involvement of people with dementia and carers in community-based dementia friendly initiatives, a qualitative study

IntroductionPeople with dementia and their carers experience social stigma and often refrain from social participation. Significant improvement might be achieved by creating Dementia Friendly communities (DFCs) for which dementia friendly initiatives (DFIs) are needed. DFIs are developed by a variation of stakeholders. However, people with dementia and their carers are often unrepresented herein. This study aims to get insight into the perspectives of stakeholders (e.g., health- and social care professionals, volunteers, people with dementia and their carers) about the involvement of people with dementia and their carers during the development and sustainment of DFIs.MethodsDescriptive qualitative study, using a co-research design with a carer as co-researcher. Nineteen semi-structured interviews with stakeholders, including people with dementia and their carers, were performed. Inductive content analysis took place using Atlas Ti.ResultsFour themes were found: 1) the involvement of people with dementia and their carers is important for both people with dementia and their carers and other stakeholders; 2) personal character traits, life histories, and associated emotions evoke the need for involvement; 3) involvement requires an open, responsive stance and building relationships; and 4) the estimation of one’s own and others’ capacities influences perspectives on involvement. As such, practice what you preach means actively adopting an open, responsive approach and acknowledging the unique abilities and backgrounds of people with dementia and their carers. It emphasizes the importance of actually living by the values you advocate for.ConclusionCentral to perspectives on involving people with dementia and their carers is the emphasis on working relationally, differing from service-led and pre-structured patient and public involvement (PPI). Working relationally calls for organizational shifts aligned with a rights-based perspective to avoid tokenism, and promotion of user-led organizations with genuine partnerships. Creative methods, problem-solving, and communication skills are essential for the development and sustainment of inclusive, supportive, person-centered DFIs. Future studies should explore the long-term impact of the involvement and working relationally on the well-being of people with dementia and their carers

Professionals’ adaptive expertise and adaptive performance in educational and workplace settings.: An overview of reviews

Professionals will increasingly be confronted with new insights and changes. This raises questions as to what kind of expertise professionals need, and how development of this expertise can be influenced within the contexts of both education and work. The terms adaptive expertise and adaptive performance are well-known concepts in the domains of education and Human Resource Development respectively. The literature, however, lacks a conceptual overview. Our research seeks to provide an overview on how adaptive expertise and adaptive performance are conceptualized. In addition we looked for what individual, task and organizational characteristics relate to adaptive expertise. We mined information drawn from existing reviews in an overview of reviews. Nine reviews met the inclusion criteria. Adaptive performance is best referred to as the visible expression of an adaptive expert and this is triggered by ‘change’. The scope of this ‘change’ lies somewhere between change that is ‘new for the learner’ and change that is ‘new for everyone in the whole world’. The extent to and way in which a learner or professional is able to deal with this change depends on the maturity of the learner or professional. We found numerous individual, task and environmental characteristics related to adaptive expertise and adaptive performance. The nature and relation of these characteristics, and their specificity in relation to adaptive expertise and adaptive performance are visualized in a figure, but also provide several suggestions for future research

Symptom increase following a functional capacity evaluation in patients with chronic low back pain:An explorative study of safety

Introduction: This study was performed to study intensity and duration of symptom increase following an FCE and to explore safety of an FCE. Methods: Included were 92 patients with chronic low back pain (CLBP), mean age 38.5 years, mean self-reported disability 12.5 (Roland Morris Disability Questionnaire). All patients underwent an FCE. Symptom increase was measured with a 2-item questionnaire. Operational definition for safety: no formal complaint filed and symptom increase to occur only temporarily. Results: No formal complaints were filed (n=92). In total, 54 patients returned the questionnaire (59%; 'responders'). Of the responders, 76% reported increased symptom intensity after an FCE, ranging from 'little increase' to 'severe increase'. Symptoms of all responders returned to pre-FCE level. Duration of symptom increase of the responders ranged from 1 day to 3 weeks. Symptom increase resided to pre-FCE level within 1 week in 93% of the responders. Symptom increase was weakly related to self-reported disability (r=0.38, p <0.05). Except for gender, differences between responders and non-responders were non-significant. Conclusion: A temporary increase in symptom intensity following an FCE is common. Within the operational definitions of safety used in this study, assessment of functional capacity of patients with CLBP appears safe

Measuring disability in patients with chronic low back pain : the usefulness of different instruments

Measuring disability is an important topic in rehabilitation research in patients with chronic low back pain (CLBP). Due to the major impact of CLBP on functioning in both daily living and work, measuring disability in patients with CLBP is best described in terms of limitations in activities and restrictions in participation in daily living and work. A frequently used measurement instrument in rehabilitation medicine to measure self-reported limitations in activities of daily living (ADL) in patients with CLBP, is the Roland Morris Disability Questionnaire (RMDQ). A validated Dutch language version is available (RMDQ-Dv), but test-retest reliability and limits of agreement have not been investigated previously in the RMDQ-Dv. Previous studies found different responsiveness statistics, dependent on the external criterion used to measure change. A frequently used measurement instrument in rehabilitation medicine to measure performance of work-related activities is the Isernhagen Work Systems Functional Capacity Evaluation (IWS FCE). The IWS FCE consists of 28 work-related tasks based on the Dictionary of Occupational Titles, including lifting, carrying, pushing, pulling, forward bending, squatting, crouching, etc. Several subtests of the IWS FCE have proven good reliability in patients with CLBP. In this thesis, the RMDQ-Dv and the IWS FCE are examined on their usefulness to assess, evaluate and predict disability and functioning in patients with CLBP. The thesis mainly focuses on limitations in ADL and limitations in work-related activities. Furthermore, physical and psychosocial factors are studied on their ability to assess and predict restrictions in work participation in patients with CLBP. In chapter 1, the design and outline of the thesis, used measurement instruments and research questions are described. In chapter 2, the reliability and stability of the RMDQ-Dv is presented. Thirty patients with CLBP filled out the RMDQ-Dv with a two-week interval and before starting the rehabilitation program. Intra Class Correlation (ICC) was used as a measure for reliability and the limits of agreement were calculated for quantifying the stability (natural variation over time) of the RMDQ-Dv. The RMDQ-Dv showed good reliability to assess limitations in ADL in patients with CLBP (ICC=0.91). A natural variation of 6 points was found to the total scoring range of 0 to 24. In chapter 3, the consequences of using different external criteria on the responsiveness of the RMDQ-Dv is presented. Eighty-three patients with CLBP filled out the RMDQ-Dv. Four different external criteria were used: 1. Global perceived change in complaints. 2. Global perceived change in ability to take care of oneself. 3. Change in rating of pain intensity. 4. Smallest Real Difference. Standardised response means ranged from 1.33 to 3.45, pooled effect sizes ranged from 1.50 to 2.81 and areas under curves ranged from 0.76 to 1.00. Responsiveness of the RMDQ-Dv ranges from good to very good, dependent on the used external criterion. Chapter 4 describes to what extent self-reporting can replace performance based testing. Seventy-two healthy subjects were tested. Three different self-reports and a performance test were used to measure lifting high. The construct of the self-reports and performance tests covered the same components to enable an adequate comparison. Results showed that all lifting tasks could be predicted, though not solely via self-reports. Performance testing can be predicted with a margin of error of +/- 5-kg for at least 79% of the healthy subjects on the basis gender, self-reports and subject’s participation in fitness. In chapter 5, the performance on the lifting task of the IWS FCE is compared with RWL of the NIOSH lifting guideline for this task. Ninety-two patients with CLBP performed the FCE lifting task. RWL was calculated for this task. Mean difference between performance and RWL was 15.0 kg (SD 14.7; range –8.8 to 59.2). Performance on the FCE lifting task and RWL of the NIOSH for this task produced different safe lifting weights in individual patients with CLBP. This finding may result in contradictory recommendations about need for rehabilitation and return to work. In chapter 6 a systematic review is presented, performed to provide an overview of predictors for sickness absence divided into predictors for the decision to report sick and predictors for the decision to return to work in patients with CLBP. Medical and psychological databases were searched, as well as citations from relevant reviews. In– and exclusion criteria were applied. Two reviewers assessed independently the methodological quality of the papers. The only consistent evidence found was that patients with higher expectations had less sickness absence at the moment of follow-up measurement. Predictors varied with the decision to report sick or to return to work, the used measurement instruments, timing of follow-up measurements and definitions of outcomes. No core set of predictors exists for sickness absence in general in patients with CLBP. Chapter 7 describes results of a cross sectional study about factors related to work status in patients with CLBP, classified according to the international classification of functioning, disability and health (ICF). Ninety-two patients with CLBP filled out questionnaires and performed tests to assess factors related to different ICF domains. Results showed that non-working patients had a lower self-reported physical and mental health, lower physical fitness, more self-reported limitations in ADL, lower education, more depressive symptoms and higher psycho neuroticism than working patients (univariate analyses). Patients with a low educational level, a low self-reported physical or mental health were more likely to be non-working (logistic linear regression analysis). The relation between work status and CLBP is multidimensional, as was illustrated by using the bio-psychosocial model of the ICF. Self-reported limitations and physical and mental health are more strongly related to work status than objective measurements of performance. In chapter 8, an explorative prognostic cohort study with a one-year follow-up (4, 8 and 12 months after baseline) is presented (n=18). The aim of this study was to explore to what extent the standardized IWS FCE could be matched with observed work demands in workers with CLBP and secondly, to what extent this match could predict sick leave one year after rehabilitation treatment. Seven out of eleven analysed FCE activities could be directly matched with work demands (carrying, pushing, pulling, crouching, kneeling, forward bending static, and dynamic bending and rotating). For some workers, difficulties existed in matching of three activities (pushing, pulling and crouching). One activity (lifting) could be indirectly matched with work demands. One activity (walking) could not be matched with WPA data. Two activities (sitting, standing) were excluded from analyses due to practical limitations. No relation was found between performance on FCE activities, work demands, and sick leave during follow-up. It was concluded that seven FCE activities could be directly matched with work demands in the 18 occupations studied. It was however not possible to match all observed work demands with FCE activities. In the general discussion in chapter 9, the main findings about the usefulness of the RMDQ-Dv and IWS FCE to measure disability and functioning in patients with CLBP are discussed. Measuring disability is much more complicated than just measuring limitations in ADL, work-related activities or restrictions in work participation. The difficulty in measuring disability and clinical implications for Occupational and Social Insurance medicine are discussed. Recommendations for further research are presented. The RMDQ-Dv is a useful and valuable instrument when determining need for rehabilitation and evaluation of change in self-reported limitations in ADL. However, the large natural variation of the instrument should be taken into account when using this instrument in individual patients. Prospective research is needed to support of refute the hypothesis that the RMDQ-Dv can be used in predicting disability and functioning in work. The IWS FCE can be used for the assessment of performance of work-related activities and to assess whether the performance of work-related activities is sufficient to perform those activities at work. Because of the large natural variation and the unknown responsiveness, this instrument is less suitable to measure change in performance of work-related activities. In addition, the current standardized IWS FCE protocol is less suitable to predict work ability, and to predict sickness absence by matching work ability and work demands. Instead of using the IWS FCE as outcome measure instrument, the IWS FCE can be used as a tool in treatment programs, to improve limitations reported by the patients, by showing them that they can perform more than thought.

Flow chart showing the review process and results.

<p>* Once we had compiled a set of eligible studies, we searched their reference lists for additional studies (‘snowballing’ or ‘snowball’ method).</p

Effects of Mindfulness-Based Stress Reduction on employees’ mental health: A systematic review

<div><p>Objectives</p><p>The purpose of this exploratory study was to obtain greater insight into the effects of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) on the mental health of employees.</p><p>Methods</p><p>Using PsycINFO, PubMed, and CINAHL, we performed a systematic review in October 2015 of studies investigating the effects of MBSR and MBCT on various aspects of employees’ mental health. Studies with a pre-post design (i.e. without a control group) were excluded.</p><p>Results</p><p>24 articles were identified, describing 23 studies: 22 on the effects of MBSR and 1 on the effects of MBSR in combination with some aspects of MBCT. Since no study focused exclusively on MBCT, its effects are not described in this systematic review. Of the 23 studies, 2 were of high methodological quality, 15 were of medium quality and 6 were of low quality. A meta-analysis was not performed due to the emergent and relatively uncharted nature of the topic of investigation, the exploratory character of this study, and the diversity of outcomes in the studies reviewed. Based on our analysis, the strongest outcomes were reduced levels of emotional exhaustion (a dimension of burnout), stress, psychological distress, depression, anxiety, and occupational stress. Improvements were found in terms of mindfulness, personal accomplishment (a dimension of burnout), (occupational) self-compassion, quality of sleep, and relaxation.</p><p>Conclusion</p><p>The results of this systematic review suggest that MBSR may help to improve psychological functioning in employees.</p></div

Summary of studies that examined the impact of Mindfulness-Based Stress Reduction (MBSR).

<p>Summary of studies that examined the impact of Mindfulness-Based Stress Reduction (MBSR).</p