Intervenciones individuales para reducir el estrés laboral del personal sanitario
Referencias
Referencias de los estudios incluidos en esta revisión
Referencias de los estudios excluidos de esta revisión
Referencias de los estudios en espera de evaluación
Referencias de los estudios en curso
Referencias adicionales
Referencias de otras versiones publicadas de esta revisión
Characteristics of studies
Characteristics of included studies [ordered by study ID]
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Yoga
Control (No intervention)
Overall
Included criteria: no prior experience with yoga, willingness to complete eight weekly sessions and homework exercises, and willingness to be randomly assigned to the research or control group. Excluded criteria: serious illness or major orthopaedic diagnoses of the neck, back, pelvis, or lower extremities that could interfere with completion of the yoga intervention protocol. Pretreatment: NR Compliance rate: NR Response rate: NR Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention characteristics Yoga
Control (no intervention)
| |
| Outcomes | MBI
Health Promoting Lifestyle Profile II (HPLP II)
| |
| Identification | Sponsorship source: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Research and Creative Activities Fund of Texas Christian University. Country: USA Setting: Hospital Comments: NR Authors name: Gina K. Alexander Institution: Texas Christian University, Harris College of Nursing and Health Sciences Email: [email protected] Address: TCU Box 298620, Fort Worth, TX 76129, USA Time period: NR | |
| Notes | MBI‐EE included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Questionnaire, and core study questionnaires. After individuals completed consent forms and baseline assessments, they were enroled in the study and randomized to the intervention (yoga) or usual care control group. A total of 54 individuals Sequence generation process not mentioned |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported |
| Incomplete outcome data (attrition bias) | Unclear risk | Not reported. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or study protocol reported in the study and we did not find one online. No indication of selective reporting. |
| Other bias | Unclear risk | Compliance rate and response rate not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mindfulness training
Control (wait list)
Overall
Included criteria: willingness to complete the questionnaires and commitment to adhere to the programmes' attendance and dedication requirements. Excluded criteria: were being in psychiatric or psychological treatment, or not being actively practising at the time of the study. Pretreatment: no initial differences between groups were found for the main variables of our study (mindfulness, F = 2.51, P = 0.12; burnout, F = 1.11, P = 0.30; and emotional exhaustion, F = 2.87, P = 0.10), including demographic or professional characteristics (P > 0.05) Type of healthcare worker: exclusively physicians Response rate: NR Compliance rate: regarding acceptability of the intervention to participants, the attendance rates for the two phases of the program were 88% for weekly sessions and 72% for monthly sessions | |
| Interventions | Intervention characteristics Mindfulness training
Control (wait list)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
| |
| Identification | Sponsorship source: The authors report the University of the Basque Country (UPV/EHU)provided funding for the materials and travel expenses. The Official Medical College of Biscay in Spain provided the physical setting to conduct the sessions. Country: Spain Setting: all participants were actively used in public (42.9%) or private (52.4%) practice. Comments: NR Authors name: Alberto Amutio, PhD; Institution: Department of Social Psychology and Methodology of the BehavioralSciences, Faculty of Psychology, University of the Basque Country (UPV/EHU), Spain Email: [email protected] Address: Avda Tolosa, 70, Donostia‐San Sebastian, Gipuzko Time period: NR | |
| Notes | MBI‐EE included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Participants in the experimental group (n = 21) were randomly selected using the statistical program SPSS 20.0. The remaining subjects were included in the control group (n = 21)." |
| Allocation concealment (selection bias) | Unclear risk | Judgement Comment: Unable to judge whether participants and/or investigators could possibly foresee assignment |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "Each participant in the experimental group committed to attending the sessions, doing the exercises assigned as home‐work, and answering the evaluation questions at the end of each of the phases of the study. The waitlist control group was told that a similar course would be offered again." Judgement Comment: Participants not blinded |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported |
| Incomplete outcome data (attrition bias) | Unclear risk | not explicitly stated whether participants dropped out. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one online. |
| Other bias | Low risk | No indication of other sources of bias |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Control (no intervention)
Mindfulness and self‐compassion program
Overall
Included criteria: informed consent, committing to completing the pre‐ and post‐intervention questionnaires, attending at least 75% of the sessions and practising mindfulness and self‐compassion for 45 minutes a day. Excluded criteria: having completed a mindfulness and/or compassion program in the previous 6 months; having a psychiatric illness that did not make participation in the study advisable. Pretreatment: they were not significant in any of the characteristics considered. Type of healthcare worker: various healthcare staff but 46.7% nurses and physicians 53.3% Response rate: NR Compliance rate: Intervention group 92% and control group 92% | |
| Interventions | Intervention characteristics Control (no intervention)
Mindfulness and self‐compassion program
| |
| Outcomes | Perceived Stress Questionnaire (PSQ)
| |
| Identification | Sponsorship source: This work has been partially financed by the Department of Health of the Government of Navarra, by obtaining the first prize in the II Contest of Ideas for Health Research in Primary Care. Country: Spain Setting: NR Comments: NR Authors name: Aranda Auserón Institution: Subdirección de Farmacia, Servicio Navarro de Salud‐Osasunbidea (SNS‐O), Pamplona, Spain Email: [email protected] Address: NR | |
| Notes | PSS included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | The randomization of the groups was carried out by assigning correlative numbers to the 48 participants and selecting a total of 25 from a balloon with 48 numbered balls; these numbers were part of the intervention group, with the rest remaining in the control group. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants not blinded whereas outcomes are self‐reported |
| Incomplete outcome data (attrition bias) | Low risk | 3 of the 48 (16%) randomised participants were lost to follow‐up, which is below our pre‐defined cut‐off point. |
| Selective reporting (reporting bias) | Unclear risk | No trial protocol or registration mentioned in the study nor did we find one online. |
| Other bias | Unclear risk | Low participation rate in the study (48 of 1281; 3.75%) |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Evaluation of a well‐being workshop
Control (no intervention)
Overall
Included criteria: recruitment was restricted to physician trainees completing their RACP basic physician training in New South Wales (NSW) hospitals. Excluded criteria: NR Pretreatment: differences between groups at 3 and 6 months were assessed using linear regression models, with group as a covariate, and adjusted for the participants’ baseline value of the outcome measure. Compliance rate: not explicitly reported "Lack of control over work rosters, difficulty swapping shifts, being on call or studying for the RACP exams, were major factors influencing the intervention group participant attendance at workshops" Response rate: 88% Type of healthcare worker: exclusively physician trainees | |
| Interventions | Intervention characteristics Evaluation of a wellbeing workshop
Control (no intervention)
| |
| Outcomes | ProQOL ‐ Burnout
DASS ‐ stress
DASS ‐ Anxiety
DASS ‐ Depression
| |
| Identification | Sponsorship source: The authors received no financial support for the research, authorship, and/or publication of this article Country: Australian Setting: Several hospitals Comments: NR Authors name: Carmen Axisa Institution: University of Technology Sydney, Sydney, NSW, and; PhD Candidate, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Email: [email protected] Address: University of Technology Sydney, Building 10, Level 7, 235 Jones St, Ultimo, Sydney, NSW 2007, Australia. Time period: 2014‐105 | |
| Notes | DASS‐stress included in analysis 1.1 and 1.2 DASS‐Anxiety included in analysis 1.4 and 1.5 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Participants were randomly assigned to the intervention or control group using a web‐based True Random Number Generator service." |
| Allocation concealment (selection bias) | Unclear risk | Unable to judge whether participants and/or investigators could possibly foresee assignment |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported |
| Incomplete outcome data (attrition bias) | High risk | 46 of the 59 (78%) randomised participants included in the analyses. Not reported whether lost to follow‐up was at random. |
| Selective reporting (reporting bias) | Low risk | No trial registration or no study protocol reported. No indication of selective reporting. |
| Other bias | Unclear risk | Compliance difficult to assess. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Cognitive‐behavioural therapy + relaxation
Control (no intervention)
Overall
Included criteria: nurses of both sexes, undergraduate and postgraduate education, all age groups, more than one year experience of clinical work, and working in different wards. Excluded criteria: having a chronic physical and psychological illness, taking drugs that affected the mental system, and loss of a first‐degree relative (father, mother, spouse or child) less than six months beforehand. It was also announced that one of the admission requirements was the principle of confinement to educational materials and issues raised by the group members in each session. Pretreatment: age and the variable burnout and its subscales before intervention were not significantly different in the two groups. Compliance rate: NR Response rate: NR Type of healthcare worker: various healthcare professionals including nurses 44 (75%), head nurses 10 (17%) and supervisors 5 (9%) | |
| Interventions | Intervention characteristics Cognitive‐behavioural therapy + relaxation
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
| |
| Identification | Sponsorship source: NR Country: Iran Setting: Hospital Comments: NR Authors name: Bagheri T Institution: Burn Research Centre, Iran University of Medical Sciences, Tehran, Email: [email protected], [email protected] Address: Burn Research Centre, Motahari Hospital, Rashid Yasami St, Vali‐e‐asr Ave, Tehran, Iran Time period: 2014 | |
| Notes | MBI‐EE included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "They were assigned by the block randomization method to two groups of 30 subjects." Unclear how randomization took place. |
| Allocation concealment (selection bias) | Unclear risk | Quote: "Participants in the study included all nurses, head nurses and supervisors who met the inclusion criteria. They were assigned by the block randomization method to two groups of 30 subjects." Unable to judge whether participants or researchers could foresee the outcome of block randomization. |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Not described. |
| Selective reporting (reporting bias) | High risk | Quote: "their annual evaluation. Outcome measures: A demographic questionnaire was used to collect personal, social and occupational data including age, sex, marital status, educational level, work experience, overtime worked per month, work area, work shift, number of children and economic status. Burnout in all participants in the study was determined by the Maslach Burnout Questionnaire. Maslach Burnout Questionnaire (MBQ). The Maslach Burnout Questionnaire has 22 items which measure burnout in the three dimensions of emotional exhaustion (9 questions), personality depersonalization (5 questions), and individual performance (8 questions). In order to determine the total burnout score, questions 1, 2, 3, 5, 6, 9, 10, 12, 13, 14, 15, 19, 21 and 22 are considered (+) and questions 4, 7, 8, 11, 16, 17, 18 and 20 (‐), and then aggregated. Results for burnout frequency will be 35 to 84 (high), ‐15 to 34 (average), ‐16 to ‐66 (low) and for burnout severity 40 to 98 (high), ‐18 to 39 (average) and ‐19 to ‐77 (low). The validity of the questionnaire was verified by Maslach and Jackson and its reliability was calculated through Cronbach’s alpha, which was reported between ‐0.60 and 0.08. In Sedghi’s research, the reliability was determined to be 0.78. 20 The Cronbach’s alpha was reported as 0.8 in the present study. Data collection. In the second stage, the nurses in the intervention group received group cognitive therapy. In the third stage, immediately after and one month after training completion, the burnout level of all participants in the study was determined and evaluated by the Maslach burnout inventory. Data analysis. Data were extracted" In the trial register it is mentioned that the primary outcome is the Job Stress Questionnaire and the General Health questionnaire a secondary outcome while those have not been reported. https://en.irct.ir/trial/8633 |
| Other bias | Unclear risk | The response rate nor the compliance rate have been reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mindfulness‐Based IARA Model®
Control (no intervention)
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: χ2 analyses revealed no differences between groups for any of the demographic and work characteristics: Gender, age education, marital state, and organisational seniority. t‐test analyses highlighted that training and control groups were almost overlapping at baseline on outcome measures. Compliance rate: NR Response rate: 98% Type of healthcare worker: various healthcare workers including doctors, nurses, and healthcare assistants | |
| Interventions | Intervention characteristics Mindfulness‐Based IARA Model®
Control (no intervention)
| |
| Outcomes | Zung Self‐Rating Anxiety Scale (SAS)
Perceived Stress Scale (PSS)
| |
| Identification | Sponsorship source: this research received no external funding. Country: Italy Setting: public hospitals Comments: NR Authors name: Massimiliano Barattucci Institution: eCampus University, 22060 Novedrate, Italy Email: [email protected] Address: 22060 Novedrate, Italy Time period: 2018‐2019 | |
| Notes | Author M.Barattucci kindly provided clarification on table 5. PSS included in analysis 1.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "All HCPs belonging to these wards—doctors, nurses, and healthcare assistants—were randomly assigned to a control group (N = 301) or to an IARA training program (N = 301)." Sequence generation process insufficiently described |
| Allocation concealment (selection bias) | Unclear risk | Quote: "Material and Methods The research was configured as a randomized pre‐post evaluation with a comparison group, which included the completion of a questionnaire at the beginning (T0) and at the end of the training (T1). Baseline assessment was managed in November 2018, while Follow‐up in May 2019. All procedures performed in present study were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All participants gave their signed consent to participate in the study. The study was approved by the local ethics committee. From different Italian public hospitals, 602 HCP volunteer participants were recruited. The research involved many wards, such as oncology, general medicine, neurology, general surgery, gastroenterology, orthopedics, traumatology, urology, otolaryngology, pulmonology, and home care professionals. All HCPs belonging to these wards—doctors, nurses, and healthcare assistants—were randomly assigned to a control group (N = 301) or to an IARA training program (N = 301). Overall,</b> 497 workers participated in filling" Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | Quote: "and of 202 HCPs for the control group (response rate = 68%; Figure 1)." High lost to follow‐up in the control group, reasons not provided. Unclear whether this was a random. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or study protocol reported nor did we find one online. |
| Other bias | Unclear risk | Compliance not reported. |
| Study characteristics | ||
| Methods | ‐Study design: cluster‐randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Psychoeducational intervention
Education‐only (active control)
Overall
Included criteria: to be included in the study, DCWs had to be employed for at least two months (so adjustments to the residents and facility had been achieved) and provide morning personal care (i.e. period of time between 7AM and 12AM that involved activities related to bathing, grooming, dressing and toileting) to people with a diagnosis of moderate to severe dementia. Excluded criteria: temporary DCWs and trainees were excluded as it was not possible to ensure their participation until the end of the study. Pretreatment: None of the measured socio‐demographic variables were statistically significantly different at baseline. At baseline, there were no significant differences between the groups in perceived stress, burnout, or job satisfaction. Compliance rate: NR Response rate: 100% Type of healthcare worker: Exclusively direct care workers (DCWs) | |
| Interventions | Psychoeducational intervention Type of the intervention: Intervention type 4 ‐ Combination of two or more of the above Description of the intervention: the supportive component aimed to provide DCWs with coping strategies to manage work‐related stress and prevent burnout (e.g. time‐management, assertiveness, and problem‐solving). At the end of each supportive component, relaxation techniques, stretching, and strengthening exercises were practised. The number of sessions: 8 Duration of each session on average: 90 min Duration of the entire intervention: 8 weeks Duration of the entire intervention short vs long: short Intervention deliverer: by a gerontologist and a physical therapist with training and experience in PCC approaches and psycho‐educational groups Intervention form: group
Education‐only (active control) Type of the intervention: education‐only Description of the intervention: the control facilities received an education‐only intervention.The coordination, length, order, and content of the sessions were the same as the educational component of the PE intervention. It was the absence of the supportive component that distinguished both interventions. Each participant was assisted during morning care by the same professionals who helped DCWs to deliver a more PCC and clarified doubts that emerged from sessions. The number of sessions: 8 Duration of each session on average: 90 min Duration of the entire intervention: 8 weeks Duration of the entire intervention short vs long: short Intervention deliverer: by a gerontologist and a physical therapist with training and experience in PCC approaches and psycho‐educational groups Intervention form: Group | |
| Outcomes | The Perceived Stress Scale (PSS)
Maslach Burnout Inventory ‐ Emotional exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment
| |
| Identification | Sponsorship source: This work was supported by grants (grant numbers SFRH/BD/72460/2010 and RIPD/CIF/109464/2009) from the Foundation for Science and Technology (FCT) Country: Portugal Setting: 4 aged‐care facilities Comments: NR Authors name: Ana Barbosa Institution: Department of Health Sciences, University of Aveiro, Campus Universita ́rio de Santiago, Email: [email protected] Address: Agra do Crastoedifıcio 30, Aveiro, Portugal. Time period: NR | |
| Notes | PSS included in analysis 7.1 and 7.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | All four facilities agreed to participate and were randomly allocated to the experimental group—PE intervention—or control group— education‐only intervention, using a random number generator. |
| Allocation concealment (selection bias) | Low risk | After recruitment, the facilities within each pair were randomly assigned to the experimental group–PE intervention—or control group— education‐only intervention—using a random number generator. This decision was supported by the fact that education has become the most widely used approach with DCWs. Randomization occurred at the facility level because of possible contamination. No indication of allocation concealment |
| Blinding of participants and personnel (performance bias) | Low risk | Participants were blinded to the experimental or the control group. |
| Blinding of outcome assessment (detection bias) | Low risk | Researchers were not blinded to the intervention or assessments, however outcomes were PROs. |
| Incomplete outcome data (attrition bias) | Low risk | Lost to follow‐up not at random (due to sick leave, dismissal, vacation) but relatively small (13%) |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or study protocol reported, nor did we find one online. No indication of selective reporting. |
| Other bias | Unclear risk | Unit of analysis error (i.e. when a study ignored the clustering of the data in their analysis). Compliance not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Eye movement desensitisation and reprocessing (EMDR)
Control (no intervention)
Overall
Included criteria: employed as one of the technician classes (rescuer, basic, middle, or senior technician) at pre‐hospital medical emergency services, age range 18–55 years, working at pre‐hospital medical emergency services as their main job, not employed in administrative departments or communication centre of pre‐hospital medical emergency services, no drug addiction, no hearing or vision impairment, and concurrently, getting scores above 19 in the Alken stress scale, and provided written informed consent to participate in the study. Excluded criteria: no motivation to cooperate, intolerance to the treatment, absent for more than one therapeutic session, imprecise completion of data collection instruments, transfer or death of the technician. Pretreatment: there were no significant differences between the two groups for age, years of experience and stress at baseline. Compliance rate: not able to assess as participants absent for more than one therapeutic session were excluded Response rate: not able to assess Type of healthcare worker: exclusively emergency medical technicians | |
| Interventions | Intervention characteristics Eye movement densensitization and reprocessing (EMDR)
Control (no intervention)
| |
| Outcomes | Elkin stress symptoms scale
| |
| Identification | Sponsorship source: NR Country: Iran Setting: Medical Emergency Services, urban and road stations Comments: NR Authors name: Sharif Shahini Institution: University of Medical Sciences, Next to Imam Sajad Hospital Email: [email protected] Address: PO Box: 2591994 Yasuj, Iran Time period: 2017 | |
| Notes | Elkin stress symptoms scale included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "A number was assigned to the subjects who concurrently got a score of above 19 in the SSS, and by matching that number with the block random allocation list, the technicians were assigned to the intervention or control group, and the process was continued until the completion of the estimated sample size." |
| Allocation concealment (selection bias) | Unclear risk | Quote: "25 people for each group. During random block assignment, the order of the participants in the intervention and control groups was determined as follows. By multiplying the number of study groups (two groups) by 2, the number of samples per block was calculated as 4; then, by calculating the factorial of each block sample size (4!=4×3×2×1=24), the number of blocks generated from all possible orders was obtained as 24; since the number of people in each block was 4 and the estimated sample size was 50 based on the following description, by matching 13 random numbers generated by Sample Randomizer with the mentioned block numbers, the order of 50 research subjects was determined, numbers 1–50 were allocated to the subject and control groups, and the random allocation list was edited." Difficult to judge whether participants and/or investigators could possibly foresee assignment |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up |
| Selective reporting (reporting bias) | Low risk | Quote: "Iranian Clinical Trial Registry Website (code: IRCT20180102038191N1)." Trial registration in which the stress scale is not specified. No indication of selective reporting. |
| Other bias | Unclear risk | Not able to assess compliance/as participants absent for more than one therapeutic session were excluded. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mental Health Promotion Intervention
Control (wait list)
Overall
Included criteria: formal inclusion criteria were: (1) employment as a full time working nurse in a psychiatric hospital department, (2) time to take part in the study over the whole time period, (3) written consent to finish the surveys (baseline and three follow‐ups) Excluded criteria: not being on sick‐leave (Due to sickness absence, six nurses were excluded) Pretreatment: we found no significant differences between intervention and WCG with regard to gender, age, and working experience. Not recorded whether groups differed at baseline on the primary outcome perceived stress. Compliance rate: NR Response rate: not able to assess Type of healthcare worker: exclusively nurses working in psychiatry | |
| Interventions | Intervention characteristics Mental Health Promotion Intervention
Control (wait list)
| |
| Outcomes | Perceived Stress Questionnaire
| |
| Identification | Sponsorship source: NR Country: Germany Setting: Psychiatric Hospital Comments: NR Authors name: Monika Bernburg Institution: Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe‐University, Frankfurt am Main, Germany Email: [email protected] Address: CONTACT Stefanie Maches. Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg‐Eppendorf, Seewartenstrasse 10, 20459 Hamburg, Germany Time period: NR | |
| Notes | PSQ included in analysis 4.1 and 4.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "generated algorithm." Quote: "participate in this intervention study. Afterwards, these nurses were randomised into two study groups through a computer‐generated algorithm." |
| Allocation concealment (selection bias) | Unclear risk | Quote: "The researchers invited 140 nurses via email and/or direct communication to participate in the intervention. In sum, 86 nurses confirmed and gave their consent to participate in this intervention study. Afterwards, these nurses were randomized into two study groups through a computer‐generated algorithm." Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "So in the end, 44 nurses were included in the intervention group (IG) and 42 nurses took part in waitlist control group (CG)." Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Attrition was not reported. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or study protocol reported, nor did we find one online |
| Other bias | Unclear risk | Compliance rate not reported and response rate not able to assess. Not recorded whether groups differed at baseline on the primary outcome perceived stress. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Psychosocial competence training combined with cognitive behavioural and solution‐focused counselling
Control (no intervention)
Overall
Included criteria: Inclusion criteria were: (1) regular access to the Internet, (2) full‐time employment in a clinic, (3) a maximum of two years of work experience (junior nurse), (4) availability and willingness to participate during the 36 weeks, (5) agree to complete the questionnaires, (6) no previous knowledge or experience with mental health promotion training. Excluded criteria: NR Pretreatment: Baseline data on socio‐demographic differences indicated only small, insignificant differences between intervention and control group (P > 0.05). Not recorded whether groups differed at baseline on the primary outcome perceived stress. Compliance rate: NR Response rate: difficult to assess as figure 1 is mentioned but not included in the article. Type of healthcare worker: exclusively junior nurses | |
| Interventions | Intervention characteristics Psychosocial competence training combined with cognitive behavioural and solution‐focused counselling
Control (no intervention)
| |
| Outcomes | Perceived Stress Questionnaire (PSQ)
Maslach Burnout Inventory ‐ Emotional Exhaustion
| |
| Identification | Sponsorship source: NR Country: Germany Setting: Hospitals Comments: NA Authors name: Monika Bernburg Institution: Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Germany Email: [email protected] Address: Address for correspondence: Stefanie Mache, Institute for Occupational Medicine and Maritime Medicine (ZfAM), University Medical Center Hamburg‐Eppendorf, Martinistraße 52, 20251Hamburg, Germany. Time period: NR | |
| Notes | MBI‐EE included in analysis 4.1 and 4.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "After answering the baseline questionnaire (t0) participants were randomized with the ratio 50%: 50% to the two study groups (IG or CG). The randomization process was accomplished with a computer generated list of numbers." |
| Allocation concealment (selection bias) | Low risk | Quote: "This list was created by an independent research assistant; another assistant was blinded to the list, securing covered distribution to research conditions." |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "The CG group was asked to complete all surveys. The CG group received no intervention on mental health and did not undertake anything comparable to the intervention, e.g. any other training in psychosocial skills, counselling or therapy." Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "Dropout attrition: There was an overall drop‐out rate (from randomization to analysis) of 12%. 10 participants decided to terminate the study (reasons included illness, non‐appearance of participants) and did not answer the questionnaires. Overall, four of the 94 participants at T1, 6/94 of participants at T2 and 4/94 of participants at T3 did not provide all follow‐up data on the results. The participants who did not provide all follow‐up data did not differ in any meaningful way, either in the primary outcome or in other baseline outcomes (P > 0.05), from those who provided data. " Low loss to follow‐up and follow‐up seems to be at random. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one online |
| Other bias | Unclear risk | Compliance rate not reported and response rate difficult to assess. Not recorded whether groups differed at baseline on the primary outcome perceived stress. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Dear Doctor
Control (no intervention)
Overall
Included criteria: trainees were invited to participate if they were registered as being in Core Training Year 2 (CT2), or Speciality Training Years 3 or 4 (ST3 or ST4) of the UK training programme at the time of recruitment. Excluded criteria: no exclusion criteria were applied. Pretreatment: randomisation was well‐balanced in the final sample: participants in the two trial groups did not differ in terms of profile or covariates. Compliance rate: 1 of the 139 opted out (99%) Response rate: 18% Type of healthcare worker: exclusively trainee anaesthetists | |
| Interventions | Intervention characteristics Dear Doctor
Control (no intervention)
| |
| Outcomes | Copenhagen Burnout Inventory ‐ work‐related subscale
| |
| Identification | Sponsorship source: The study was funded by the National Institute for Health Research Imperial Patient Safety Translational Research Centre and registered (ISRCTN11418903) Country: UK Setting: Royal College of Anaesthetists Comments: NR Authors name: A Brazier Institution: National Institute for Health Research Imperial Patient Safety Translational Research Centre, Faculty of Medicine, Imperial College London, London, UK Email: [email protected] Address: NR Time period: 2019‐2020 | |
| Notes | CBI included in analysis 4.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Participants were randomly assigned to intervention or control conditions with a 1:1 allocation ratio using a random number generator (Stata â, StataCorp, College Station, TX, USA). Randomisation was stratified by training year and across five broad training regions. " |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "Participants were not blinded to their condition assignment: intervention group participants received the intervention; control participants did not." Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Quote: "Despite the high attrition, there were no significant differences in participant characteristics (v 2 s < 3.80, ps > 0.15) or baseline outcomes measures (ts < 0.81, ps > 0.42) between those who did and did not complete the final survey (see also online Supporting Information Table S4)." High attrition, reasons other than did not complete survey not given. Lost to follow‐up appears to be at random. |
| Selective reporting (reporting bias) | Unclear risk | Quote: "The following exploratory findings should be regarded as indicative as they were not pre‐specified in the trial registry or protocol (the relevant outcomes were added after the start of the trial)." Trial registration number not provided, Difficult to assess whether there is selective outcome reporting. |
| Other bias | Unclear risk | Quote: "The RCoA identified and invited 1549 trainees to participate via email. Of the 647 (response rate 42%) who completed the baseline survey, 274 trainees (18% of the original cohort) consented to participate and remained in the trial throughout the trial period." Quote: "Female participants (v 2 = 8.07, p = 0.018), those with lower burnout (t = ‐2.42, p = 0.016), higher ‘meaningful’ score (t = 3.29, P = 0.001) and ‘valued’ score (t = 2.97, p = 0.003) were more likely to sign up for the trial after completing the baseline survey." Low selective response rate. |
| Study characteristics | ||
| Methods | RCT, USA | |
| Participants | Nurses with at least 6 months full‐time bedside nursing in a hospital setting. Those who regularly receive massage therapy on their own as well as anyone with medical reasons for not being able to have chair massage were excluded. | |
| Interventions | 1) Experimental: massage: application to the back, neck, shoulders, arms and hands. Techniques used were effleurage, petrissage, friction, vibration and compression. One 30‐minute session per person over 4 days | |
| Outcomes | The Perceived Stress Scale | |
| Identification | ||
| Notes | PSS included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported. |
| Allocation concealment (selection bias) | Low risk | "Sample size was 82 participants, randomly assigned to the massage group or the control group per a randomization schedule developed by a biostatistician who worked for the hospital but was not on the study team" (p. 337) |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | "A total of 60 follow‐up surveys were completed, a 73% return rate" (p.339) |
| Selective reporting (reporting bias) | Low risk | There was only one outcome measured and reported. |
| Other bias | Unclear risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Stretching exercise
Control (no intervention)
Overall
Included criteria: to participate in the research, NPs could not present any medical impediment to performing physical exercises and not participating in any kind of physical activity oriented during the research. Those individuals who were absent from classes for three consecutive sessions for any reason were excluded. Excluded criteria: NR Pretreatment: NR Compliance rate: the frequency of the students was recorded in all classes. The participant who missed three or more consecutive classes was excluded from the investigation; however, the only person excluded from the study was even allowed participating in the classes Response rate: NR Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention characteristics Stretching exercise
Control (no intervention)
| |
| Outcomes | Occupational Stress Scale (OSS)
| |
| Identification | Sponsorship source: Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ Country: Brasil Setting: The State Institute of the Brain Paulo Niemeyer (IEC). Comments: NR Authors name: Flávia Porto Institution: Instituto de Educação Física e Desportos, Universidade do Estado do Rio de Janeiro Email: [email protected] Address: Rua São Francisco Xavier, 524, Sala 9122F, Maracanã, CEP 20550‐900, Rio de Janeiro, RJ, Brasil Time period: NR | |
| Notes | OSS included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "They were chosen from a list of random numbers generated in software (Microsoft Excel 2010, São Paulo, Brazil)." |
| Allocation concealment (selection bias) | Unclear risk | Quote: "The volunteers were randomly assigned to the experimental group (EG: n = 20, 35.5 ± 9.5 years old, 69.9 ± 13.7 kg and 1.62±0.5m) and the control group (CG: n = 19, 37.8±8.9 years old, 81.8±15.4 kg and 1.68±0.9m). They were chosen from a list of random numbers generated in software (Microsoft Excel 2010, São Paulo, Brazil). The CG was submitted to the same evaluation as the EG. However, they did not participate in the classes of muscle stretching (MS). There was no blinding of participants and evaluators; however, it was considered that it did not influence the outcome of the study." Difficult to judge whether participants and/or investigators could possibly foresee assignment |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "There was no blinding of participants and evaluators; however, it was considered that it did not influence the outcome of the study." Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Quote: "(MS). There was no blinding of participants and evaluators; however, it was considered that it did not influence the outcome of the study." Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "The participant who missed three or more consecutive classes was excluded from the investigation; however, the only person excluded from the study was even allowed participating in the classes." |
| Selective reporting (reporting bias) | Low risk | Trial registration. No indication of selective reporting. |
| Other bias | Unclear risk | Response rate not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Aromatherapy
Control (no intervention)
Overall
Included criteria: female nursing staff, participants were chosen by applying the following criteria: displaying more symptoms of stress than the average of 4.6, scheduled to work over seven consecutive days, ages and working years. The criteria possessed by the experimental group included: able to communicate with researchers, willing to participate in the project, not allergic to lavender, not suffering from any form of liver or kidney dysfunction, and with normal olfactory functions. Excluded criteria: NR Pretreatment: comparisons of control variables (ages, work experiences, working years, levels of education and promotion potentials) between the experimental and the control group showed no significant statistical distribution variance. Differences in the number of the stress symptoms on the pre‐test day between the experimental group and the control group did not have a statistical significance. Compliance rate: NR Response rate: not able to assess. Purposive sampling. Type of healthcare worker: exclusively female nurses. | |
| Interventions | Intervention characteristics Aromatherapy
Control (no intervention)
| |
| Outcomes | Number of Job stress‐related symptoms
| |
| Identification | Sponsorship source: NR Country: Taiwan Setting: Teaching hospital Comments: NR Authors name: Li Fang Institution: Department of Nursing, Meiho University, Email: [email protected] Address: 23 Pingguang Road, Neipu Shiang, Pingtung County 912, Taiwan. Time period: NR | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Subsequently, the 110 nurses were randomly separated into two groups, one experimental group of 53 and one control group of 57." |
| Allocation concealment (selection bias) | Unclear risk | Difficult to judge whether participants and/or investigators could possibly foresee assignment, but the outcomes are not likely to be influenced. |
| Blinding of participants and personnel (performance bias) | Low risk | Quote: "Participants of the control group pinned small empty bottles on their clothes on the right chest. Some participants of the control group might note that the small bottle would not decrease stress because it had no odour. When participants in the experimental group received small bottles containing lavender oil and experienced the smells, they might know there was something in the bottle that might make differences." Placebo control group. |
| Blinding of outcome assessment (detection bias) | Low risk | Participants were blinded and outcomes are PROs. |
| Incomplete outcome data (attrition bias) | Unclear risk | Not mentioned explicitly, but it appears that there is no loss to follow‐up. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or study protocol reported, nor did we find one online No indication of selective reporting. |
| Other bias | Unclear risk | Compliance rate not reported. Response rate not able to assess.‘Loosely’ validated outcome measure. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Gratitude
Hassle
Control (no intervention)
Overall
Included criteria: full‐time Chinese professional workers Excluded criteria: exclusion criterion was scheduled long leave in the next 4 months. Pretreatment: age, education and years of experience differed statistically significant at baseline. Compliance rate: the compliance rate was excellent, with 99% of the diary days having valid returns. There were no significant differences between the two groups on number of diaries completed, as well as total number of events reported in the 4‐week period. Response rate: 82% Type of healthcare worker: various health care professionals including physicians (33%), nurses (55%) and physical/occupational therapists (12%). | |
| Interventions | Intervention characteristics Gratitude
Hassle
Control (no intervention)
| |
| Outcomes | Perceived Stress Scale
Center for Epidemiologic Studies‐Depression Scale (CES‐D)
| |
| Identification | Sponsorship source: This study was supported by Research Grants Council of Hong Kong Strategic Public Policy Research Grant No. HKIEd1001‐SPPR‐08 awarded to Sheung‐Tak Cheng. Country: Hong Kong Setting: 5 public hospitals Comments: NR Authors name: Sheung‐Tak Cheng Institution: Department of Health and Physical Education, Hong Kong Email: [email protected] Address: Institute of Education, 10 Lo Ping Road, Tai Po, N.T. Time period: NR | |
| Notes | PSS included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "control. Method Design and Randomization This was a double‐blind randomized controlled trial with follow‐up to 3 months posttreatment. Participants were randomly assigned into one of three experimental conditions— gratitude, hassle, and nil‐treatment control. 3 Block‐restricted randomization was performed by the second author using a true random number generator to create groups of" Quote: "generator to create groups of equal size (n = 34 per group). Participants were told that this was a study about the well‐being of health care workers, without further details about the research objective or hypothesis. Data collection consisted purely of self‐ administered questionnaires. The research assistants were blind to experimental assignment and were not involved in obtaining diaries or answers to the questionnaires. Participants were debriefed at the conclusion of the study." |
| Allocation concealment (selection bias) | Low risk | No indication of selection bias |
| Blinding of participants and personnel (performance bias) | Unclear risk | Quote: "All questionnaires and diaries were filled out by the participants themselves, who were told not to disclose details of the experiment to others." Although this was a double‐blind randomised‐controlled trial it is questionable whether the blinding was effective as participants randomised to the gratitude or hassle group were asked to keep a diary and could have informed colleagues. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Participants were blinded to group assignment and outcomes are PROs. It is questionable whether the blinding was effective as participants randomised to the gratitude or hassle group were asked to keep a diary and could have informed colleagues. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "One hassle and two gratitude participants did not have data at the 3‐month follow‐up (see Figure 1). Little’s (1988) missing completely at random test yielded a nonsignificant result, 2 (6) 7.14, p.308. Therefore, the data were missing completely at random, and all available data could be used. |
| Selective reporting (reporting bias) | Low risk | Quote: "The trial protocol is available from the first author." No public trial protocol nor trial registration. No identification of selective outcome reporting. |
| Other bias | Low risk | Quote: "Although age, years of experience, and education were significantly different among groups at baseline, and were related to perceived stress, only the latter two were included as covariates, as age and years of experience were highly correlated (r .89, p.001) and experience was theoretically more closely related to stress." Quote: "total of 125 practitioners were approached, and 102 physicians, nurses, physiotherapists, and occupational therapists provided consent to participate (success rate 82%)." Quote: "Owing partly to reminders sent by the research team, the compliance rate was excellent, with 99% of the diary days having valid returns. There were no significant differences between the two groups on number of diaries completed" |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Authentic Connections Groups
Control (no intervention)
Overall
Included criteria: inclusion criteria included being: (a) a nursing education specialist or clinical nurse specialist, and (b) a mother to at least one child or adult child. Excluded criteria: exclusion criteria included: (a) being actively suicidal or (b) meeting criteria for psychoses. Pretreatment: NR Compliance rate: 1/18 allocated to the intervention group dropped out. Session attendance rates among the intervention group averaged 92% across the study (not including the participant who dropped out) Response rate: NR Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention characteristics Authentic Connections Groups
Control (no intervention)
| |
| Outcomes | The Perceived Stress Scale
Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
Self‐Rating Depression Scale ‐ Depression
Self‐Rating Depression Scale ‐ Anxiety
| |
| Identification | Sponsorship source: Funding Sources: Elizabeth C. Bonner Endowment Fund; Authentic Connections Country: USA Setting: Hospital Comments: NA Authors name: Sherry S. Chesak Institution: Department of Nursing, Division of Nursing Research, Mayo Clinic Email: [email protected] Address: 200 First St. SW, Rochester, MN 55905 Time period: NR | |
| Notes | PSS included in analysis 1.1 and 1.2 Self‐Rating Depression Scale ‐ Depression included in analysis 1.4 and 1.5 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Participants who agreed and consented were randomly assigned to the intervention group (n = 18) or control group (n = 18)." Sequence generation process not mentioned |
| Allocation concealment (selection bias) | Unclear risk | Quote: "Participants who agreed and consented were randomly assigned to the intervention group (n = 18) or control group (n = 18). " Unable to judge whether participants and/or investigators could possibly foresee assignment |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | 13/15 of the 18 participants (72%/83%) allocated to the intervention group completed respectively post‐intervention and 3‐month follow‐up assessment. 17/14 of the 18 participants (78%/94%) allocated to the intervention group completed respectively post‐intervention and 3‐month follow‐up assessment. Reasons not provided. Not mentioned whether lost to follow‐up at random. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or study protocol reported, nor did we find one online |
| Other bias | Unclear risk | Not able to assess response rate. Authors mention that they have corrected for baseline differences. However, the baseline characteristics have not been reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Meridian acupressure
Control (wait list)
Overall
Included criteria: the inclusion criteria for participants were daytime shift work nurses who voluntarily agreed to participate, without cognitive disorder, with clear consciousness, ability to communicate in verbal and non‐verbal language, and ability to understand the objectives of the study. Three participants who reported a poor state of health state without a doctor’s diagnosis and prescription were included. Excluded criteria: the exclusion criteria were persons diagnosed with acute or chronic illness by a doctor, those who have taken a prescription with skin lesions at the intervention site, and pregnant and lactating women. Pretreatment: the analysis of the homogeneity between the intervention and control groups showed that they were homogeneous, with a significance level of P < 0.05 Compliance rate: NR Response rate: NR convenience sample Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention characteristics Meridian acupressure
Control (wait list)
| |
| Outcomes | The stress scale ‐ psychological stress
The stress scale ‐ physical stress
The State Anxiety Inventory (SAI)
The stress scale ‐ total
| |
| Identification | Sponsorship source: The author(s) received no financial support for the research, authorship, and/or publication of this article Country: Korea Setting: Hospital Comments: NR Authors name: Youngmi Cho Institution: Department of Nursing, Sun Moon University Email: [email protected] Address: Chungcheongnam‐do, Asan‐si 31460 Korea Time period: 2018 | |
| Notes | The stress scale included in analysis 2.1 STAI included in analysis 2.3 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The participants were recruited through convenience sampling. During the coin toss, heads meant the subject became a participant in the intervention group in this study." |
| Allocation concealment (selection bias) | Unclear risk | Quote: "The participants were recruited through convenience sampling. During the coin toss, heads meant the subject became a participant in the intervention group in this study. " Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one. |
| Other bias | Unclear risk | Compliance and response rate not recorded. |
| Study characteristics | ||
| Methods | RCT, USA | |
| Participants | 25 nurses, pastoral care, respiratory therapy and social work personnel | |
| Interventions | 1) Experimental: mindfulness‐based stress reduction programme: 8‐week program with approximately 2.5 hours teaching per week and homework practice with audiotapes for six days a week. Group sessions included teaching on topics such as communication skills, stress reactivity and self‐compassion and experiential exercises to help participants integrate these concepts. | |
| Outcomes | MBI, Brief Symptom Inventory | |
| Identification | We kindly received data from the author. | |
| Notes | MBI‐EE included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "Participants were then randomly assigned to the treatment group or the wait‐list control group." (p.27) |
| Allocation concealment (selection bias) | Unclear risk | Not reported. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 2/14 (14%) in the treatment group did not return completed inventories and were not taken into consideration in the analyses, which is below our pre‐defined cut‐off value. |
| Selective reporting (reporting bias) | Low risk | All outcomes reported. |
| Other bias | Unclear risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Text messaging (Social Support Behavioral Code)
Control (text messaging ‐ medical facts)
Overall
Included criteria: eligibility criteria were: (a) NLGNs employed as RNs for the first time, (b) ages 19 to 37 years (millennials and post‐millennials) as the majority joining the workforce (NursingLicensure.org, 2020), (c) proficient in English, (d) working in an acute care facility as an RN during the first year of hire, (e) had a working personal smartphone, (f) had the ability to send and receive text messages, (g) had an active and working personal email account, (h) were willing to participate for 6 weeks, (i) completed survey instruments at baseline, week 3, and week 6, (j) agreed to not use or carry their smartphone while performing direct patient care, and (k) assumed any data charges for text messages Excluded criteria: exclusion criteria were NLGNs who had worked as an RN on another floor or at another organisation Pretreatment: NR Compliance rate: Response rate: 100% Type of healthcare worker: exclusively nurses who were in their first year of hire. | |
| Interventions | Intervention characteristics Text messaging (Social Support Behavioral Code)
Control (text messaging ‐ medical facts)
| |
| Outcomes | Perceived Sense of Stress (PSS)
| |
| Identification | Sponsorship source: NR Country: USA Setting: two urban health care systems located in western Pennsylvania and southern California. Comments: NR Authors name: Lisa Concil Institution: Lecturer and Clinical Instructor, San Diego State University Email: 10006 Maya Linda Road, #5207, San Diego, CA 92126 Address: [email protected] Time period: NR | |
| Notes | PSS included in analysis 3.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Randomization was conducted using an online random sequence generator (Random.org, 2019)." |
| Allocation concealment (selection bias) | Unclear risk | Quote: "A $20 gift card was sent to participants who completed the study requirements. Additionally, the first four participants who completed the study at the end of week 6 were awarded another $50 gift card." We assume that consecutive nurses were randomised. Difficult to judge whether nurses or the investigator could possibly foresee assignment. |
| Blinding of participants and personnel (performance bias) | Unclear risk | Unclear whether participants were blinded. The control group received 'placebo' text messages. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Unclear whether participants were blinded whereas outcomes were self‐reported. The control group received 'placebo' text messages. |
| Incomplete outcome data (attrition bias) | Low risk | Attrition rate is low. (21/22 were included in the analysis). Reason provided. Not reported whether the participant that was lost to follow‐up differed from the other participants. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one online. No indication of selective reporting. |
| Other bias | Unclear risk | Not reported whether there were any baseline differences between groups on stress, gender, age. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Meditation
Journal
Outside
Gratitude
Control (no intervention)
Overall
Included criteria: Full and part‐time nurses and nurse aides working any shift at a suburban, 225 bed, Level 1 trauma centre were eligible to participate. Excluded criteria: NR Pretreatment: NR Compliance rate: 3 of the 18 nurses assigned to an intervention group did not complete the six‐week intervention (17%) Response rate: NR Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention characteristics Meditation
Journal
Outside
Gratitude
Control (no intervention)
| |
| Outcomes | ProQOL ‐ Burnout
ProQOL ‐ Compassion Satisfaction
ProQOL ‐ Secondary Trauma
| |
| Identification | Sponsorship source: The author(s) received no financial support for the research, authorship, and/or publication of this article. Country: United States of America Setting: 1 trauma center Comments: NR Authors name: Darcy Copeland Institution: College of Natural and Health Sciences, University of Northern Colorado Email: [email protected] Address: Gunter Hall 3080, Campus Box 125, Greeley, CO 80639, USA Time period: NR | |
| Notes | Pro_QOL_BO included in analysis 2.1.Intervention groups combined to create a single pair‐wise comparison | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "As participants were enrolled, they were randomized, using a list of random numbers generated from an online random number generator, into one of five groups: meditation, outside, gratitude, journal, or control." |
| Allocation concealment (selection bias) | Unclear risk | Quote: "Upon receipt of IRB approval, nurses and nurse aids were invited to participate via organizational email. As interested participants contacted the PI, they were screened for eligibility and a time was arranged to complete informed written consent procedures, the pre‐intervention assessment, and receive intervention instructions. As participants were enroled, they were randomized, using a list of random numbers generated from an online random number generator, into one of five groups: meditation, outside, gratitude, journal, or control." As a list of random numbers was used it is assumed that the person who randomised patients could foresee allocation it is however unclear who performed randomisation. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not asked to change any other practise while at work; participants assigned to one intervention were not expressly discouraged from engaging in the other interventions. Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes were self‐reported |
| Incomplete outcome data (attrition bias) | Low risk | 2 of the 22 participants were not included in the analysis (9%). Reasons were provided. Participants who did not complete the study were more often male however loss to follow‐up is below our pre‐defined cut‐off point. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one. |
| Other bias | Unclear risk | Not recorded whether there were differences at baseline between groups. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Proactive recovery programme
Control (no intervention)
Overall
Included criteria: RNs with less than 12 months’ work experience were eligible to participate. Excluded criteria: NR Pretreatment: no significant differences were observed between the two groups at baseline for any of the background variables or any of the outcome measures at baseline. Compliance rate: 36 of the 99 (36%) participants randomised to the intervention group participated in two of the three sessions. Response rate: 45% (207/461) Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention characteristics Proactive recovery programme
Control (no intervention)
| |
| Outcomes | Perceived Stress Scale (PSS)
Shirom‐Melamed Burn‐out Questionnaire (SMBQ) ‐ Global
| |
| Identification | Sponsorship source: This study was funded by AFA Försäkring (150024) Country: Sweden Setting: Eight Swedish hospitals Comments: NR Authors name: Anna Dahlgren Institution: Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Solna, Sweden Email: [email protected] Address: NR Time period: 2017‐2018 | |
| Notes | PSS included in analysis 2.1 and 2.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Excel generator for random allocation to groups was used by the research team. Based on a previous feasibility study, adjustments to the process of random group allocation were made if many nurses from the same ward were initially allocated to one group. Twenty adjustments were also made for participants who were randomised to the intervention group but knew that they could not attend the group sessions. They were moved to the control group and replaced by a random participant from the control group. |
| Allocation concealment (selection bias) | High risk | Quote: "parallel randomised control trial was designed to include 100 participants in each group (intervention and wait list control) to detect moderate effect sizes (Cohen’s d = 0.5) resulting in a power of 0.94. Excel generator for random allocation to groups was used by the research team. Based on a previous feasibility study, adjustments to the process of random group allocation were made if many nurses from the same ward were initially allocated to one group. Twenty adjustments were also made for participants who were randomised to the intervention group but knew that they could not attend the group sessions. They were moved to the control group and replaced by a random participant from the control group. Adjustments were made for 24 participants. Masking was not applicable. After the follow‐up measure the control group received the intervention." |
| Blinding of participants and personnel (performance bias) | High risk | 'Masking was not possible'. Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | 130 of the 207 randomised participants (63%) completed 6 months follow‐up. Reasons not provided as well as whether it was at random. |
| Selective reporting (reporting bias) | High risk | Trial registration (https://clinicaltrials.gov/ct2/show/NCT04246736). In the trial registration many other stress outcomes were mentioned, which were not mentioned in this study, i.e.
|
| Other bias | Unclear risk | Judgement Comment: Low response rate 207/461 (45%) |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Massage
Control (no intervention)
Overall
Included criteria: The inclusion criteria were the following: woman age 20 to 45; working in day‐time shift (morning, afternoon, 12‐hour shift), LSS score ≥ 40, time working in the hospital at least one year, a 30‐day interval between returning from vacation or medical level. Excluded criteria: The exclusion criteria were: smokers, hypertensive individuals, use of glucocorticoids, beta‐blockers, psychoactive drugs in the last three months, pregnant, or hysterectomised woman, use of integrative practises (acupuncture, massage, herbal therapy, Reiki, or floral therapy amongst others) for at least two months. Pretreatment: the groups were homogenous regarding the qualitative variables used to describe the population ‐ age, BMI, LSS, and BPI ‐ except for the pain interference component in enjoyment of life (P = 0.037). Compliance rate: two of the 30 missed a massage session (6.7%) Response rate: 60 of the 91 eligible patients participated (66%) Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention Characteristics Massage
Control (no intervention)
| |
| Outcomes | The List of Stress Symptoms (LSS)
| |
| Identification | Sponsorship source: The study was funded by the Research Support Foundation of the State São Paulo (Process No 2017/19, 645‐2) Country: Brazil Setting: Two teaching cancer hospitals Comments: NR Authors name: Borges de Souza Institution: Nursing course of the Santa Casa de São Paulo school of medicine sciences Email: [email protected] Address: Rua dr. Cesario Motta 3r, 61, 01221‐020 Time period: 2017‐2018 | |
| Notes | LSS included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | The volunteers who met the inclusion criteria were numbered for the two‐group simple randomization (http://www.randomizer.org). After this, one of the researchers created a sequential numerical list: the first participant was randomly chosen and the rest were included in the list as they met the eligibility criteria and according to the groups of the randomized list. |
| Allocation concealment (selection bias) | Unclear risk | The volunteers who met the inclusion criteria were numbered for the two‐group simple randomization (http://www.randomizer.org). After this, one of the researchers created a sequential numerical list: the first participant was randomly chosen and the rest were included in the list as they met the eligibility criteria and according to the groups of the randomized list. Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | Low risk | Participants were blinded. |
| Blinding of outcome assessment (detection bias) | Low risk | The study was blinded to researchers, participants and statistician. |
| Incomplete outcome data (attrition bias) | Unclear risk | 12 of the initial 60 participants discontinued the study (20%), reasons provided but not whether they differed with responders. After that another 12 participants was randomized and included in the analysis. The baseline characteristics are provided for 30 participants, but it is unclear which participants are included here. |
| Selective reporting (reporting bias) | Low risk | In the trial protocol, the authors mention that salivary cortisol is, alongside the LSS, the primary outcome. Salivary not reported in this article. https://ensaiosclinicos.gov.br/rg/RBR-3bjjf4 but is not one our outcome measures so no selective reporting on outcomes that we are interested in. |
| Other bias | Low risk | Judgement Comment: No indication of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Emotional Freedom Techniques
Control (wait list)
Overall
Included criteria: nurses caring for COVID‐19 patients. Inclusion criteria were: a) not having any psychiatric diagnoses, b) not taking any courses about coping with anxiety and stress, and c) volunteering to participate in the study Excluded criteria: NR Pretreatment: no statistically significant pre‐intervention differences were found between the groups on demographic variables. The pre‐test stress level, anxiety level and the burn‐out score did not differ significantly between the groups. Compliance rate: five of the 40 participants did not attend the EFT sessions (13%) Response rate: 100% Type of healthcare worker: exclusively nurses caring for COVID‐19 patients | |
| Interventions | Intervention characteristics Emotional Freedom Techniques
Control (wait list)
| |
| Outcomes | State Anxiety Scale
The Burnout Scale
Subjective Units of Distress Scale
| |
| Identification | Sponsorship source: This research was not funded. Country: Turkey Setting: A university hospital Comments: NR Authors name: Berna Dincer Institution: Department of Internal Medicine Nursing, Faculty of Health Science, Istanbul Medeniyet University, Istanbul, Turkey Email: [email protected] Address: 38, Tıbbiye Street, Istanbul, Uskudar 34668, Istanbul, Turkey Time period: 2020 | |
| Notes | Subjective Units of Distress Scale included in analysis 2.1 STAI included in analysis 2.3 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Eighty nurses who met the inclusion criteria were assigned to groups using an online random number generator. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "After completing the Descriptive Characteristics Form online, a time for the meeting was determined in collaboration with the participants in each subgroup. They were also asked to stay comfortable in as calm and tranquil an environment as possible during the session. The EFT treatment was provided by the first author, who was certified in EFT. Each 5‐person group began by having the participants complete the pre‐test SUD, the STAI‐I, and the burnout scale via SurveyMonkey." Participants were not blinded. Baseline questionnaire filled in after randomisation. |
| Blinding of outcome assessment (detection bias) | High risk | Quote: "The analysis was conducted by a researcher who was blind to group assignment." Participants were not blinded whereas outcomes were self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 10% lost‐to‐follow‐up however unknown whether this was at random however loss to follow‐up is below our pre‐defined cut‐off point. |
| Selective reporting (reporting bias) | High risk | No intention to tread analysis. Participants randomised to the intervention group that did not attend the EFT session (n = 5) were excluded. |
| Other bias | Low risk | No indication of other sources of bias |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline Characteristics Mindfulness‐based intervention
Control (wait list)
Overall
Included criteria: participants were personnel, 18 or older, from the surgical intensive care unit (SICU) of a large academic medical center. Eligibility criteria included any personnel working in the SICU and having contact with the patients or their families. Excluded criteria: individuals practising mindfulness, yoga, or exercising more than 30 minutes a day were excluded, as were individuals with third trimester pregnancy or a history of recent surgery if it limited ability to perform the gentle yoga movement Pretreatment: there were no significant differences between the two groups for age (P = 0.9496, t = 0.0638), years of experience (P = 0.9485, t = 0.06512), or years working in the SICU (P = 0.8702, t = 0.1648). Compliance rate: NR Response rate: not able to assess as the exact number of eligible individuals is not reported. More than 200 individuals working in the SICU were eligible to participate and were informed about the study through flyers and information provided at staff meetings. Thirty‐two individuals were interested in participating and all were eligible to participate because of minimal exclusion criteria to reflect real workplace conditions. Type of healthcare worker: various healthcare staff but 69% nurses | |
| Interventions | Intervention characteristics Mindfulness‐based intervention
Control (wait list)
| |
| Outcomes | DASS ‐ stress
Perceived Stress Scale
Maslach Burnout Inventory ‐ emotional exhaustion
Maslach Burnout Inventory ‐ depersonalization
Maslach Burnout Inventory ‐ Personal accomplishment
Professional Quality of Life (ProQOF)
| |
| Identification | Sponsorship source: Funding: Funded in part by the OSU Harding Behavioral Health Stress, Trauma and Resilience program Country: Unites States Setting: A large academic medical center Comments: NR Authors name: Anne‐Marie Duchemin Institution: Department of Psychiatry, The Ohio State University, Email: anne‐[email protected] Address: 1670 Upham Drive, Columbus, OH 43210, USA. Time period: NR | |
| Notes | Not able to include in analysis due to missing data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Eligible participants were randomized 1:1 using Graphpad software to intervention group or waiting list control group, with stratification by gender and type of work. Assessments were performed for all" |
| Allocation concealment (selection bias) | Unclear risk | Quote: "Eligible participants were randomized 1:1 using Graphpad software to intervention group or waiting list control group, with stratification by gender and type of work. Assessments were performed for all participants," Difficult to judge whether participants and/or investigators could possibly foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Quote: "Questionnaires and samples were coded." Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "There was no drop‐out and all participants completed the 2 sets of assessments." |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or study protocol reported, nor did we find one online |
| Other bias | Unclear risk | Quote: "was considered statistically significant. RESULTS More than 200 individuals working in the SICU were eligible to participate and were informed about the study through flyers and information provided at staff meetings. Thirty‐two individuals were interested in participating and all were eligible to participate due to minimal exclusion criteria to reflect real workplace conditions. Participants (n = 32) were" Not able to assess the response rate as the exact number of eligible individuals is not reported. Compliance not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Attention‐based training (ABT)
Control (wait list)
Overall
Included criteria: a current staff member of the emergency department of St. James’ Hospital; preference to participate in the study and to be over 18 years of age Excluded criteria: alcohol or substance abuse within the past 6 months; more than four consecutive classes of meditation or other mind–body practises (including yoga and Tai‐chi) in the past two years; a diagnosis of schizophrenia; currently using (at time of enrolment) anti‐psychotic medication or recently started on anti‐depressant meditation (less than three months at the time of enrolment). Participants on a stable dose of anti‐depressant medication (for more than three months) were permitted but advised to consult with their general practitioner or psychiatrist prior to enrolment. Pretreatment: NR Type of healthcare worker: exclusively emergency department healthcare worker Response rate: 100% Compliance rate: 16 of the 29 followed at least two sessions > 55% | |
| Interventions | Intervention characteristics Attention‐based training (ABT)
Control (wait list)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment
DASS ‐ stress
DASS ‐ anxiety
| |
| Identification | Sponsorship source: NR Country: Ireland Setting: Hospital Comments: NR Authors name: PJ Dunne Institution: Trinity Translational Medicine Institute, Trinity College Email: [email protected] Address: Dublin D08 W9RT, Ireland Time period: NR | |
| Notes | The authors kindly referred to the supplementary file. MBI‐EE included in analysis 2.1 DASS anxiety included in analysis 2.3 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Emergency MDT participants were stratified by role and gender and allocated to intervention or no‐treatment control group using an online randomization tool [17]. Volunteers" |
| Allocation concealment (selection bias) | Unclear risk | Quote: "Emergency MDT participants were stratified by role and gender and allocated to intervention or no‐treatment control group using an online randomization tool [17]." Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "There was no significant difference between study completers and withdrawers." 42 of the 58 participants were analysed. Response rate 72%. However, missing at random according to the authors. |
| Selective reporting (reporting bias) | Unclear risk | The authors report a trial registration, nor did we find one online |
| Other bias | Unclear risk | Unclear whether participants differ on baseline characteristics. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Intervention
Control (no intervention)
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: Reported socio demographic baseline characteristics of participants randomised to the intervention group were similar to socio demographic baseline characteristics of participants randomised to the control group Compliance rate: We could not determine if participants in the intervention arm actually completed their chosen weekly micro‐tasks Response rate: NR Type of healthcare worker: physicians from various disciplines | |
| Interventions | Intervention characteristics Intervention
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional exhaustion
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
Maslach Burnout Inventory ‐ Depersonalisation
| |
| Identification | Sponsorship source: NR Country: USA Setting: Mayo Clinic Departments of Medicine in Minnesota and Arizona and Mayo Clinic Department of Surgery in Minnesota Comments: NR Authors name: Dyrbye LN, West CP, Richards ML, Ross HJ, Satele D, Shanafelt TS Institution: Mayo Clinic Email: [email protected] Address: 200 Second Street SW, Rochester, Minnesota, 55905, United States Time period: NR | |
| Notes | MBI‐EE included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Participants were randomized to an intervention group or a control group using a computer‐generated algorithm. Randomization was stratified by speciality (Internal Medicine or Surgery), campus (Rochester or Arizona), and baseline response to the single item, “The work I do is meaningful to me” (from the Empowerment at Work Scale (Spreitzer, 1995)). All participants were asked to complete baseline and end‐of‐study (three month) survey. For both surveys consented participants received an e‐mailed cover letter with a link to a web‐based survey." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Over 90% of participants in each arm completed both the baseline and end‐of‐study surveys. |
| Selective reporting (reporting bias) | Unclear risk | No protocol registration, nor did we find one online. |
| Other bias | Unclear risk | Response rate not reported. Quote: We could not determine if participants in the intervention arm actually completed their chosen weekly micro‐tasks |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Coaching
Control (wait list)
Overall
Included criteria: Individuals who had been in practice for 5 to 30 years were eligible Excluded criteria: NR Pretreatment: no group differences reported Type of healthcare worker: exclusively physician Response rate: 12% Compliance rate: Participants randomised to the intervention group had a mean of 5.5 coaching sessions (range, 0‐6 coaching sessions). | |
| Interventions | Intervention characteristics Coaching
Control (wait list)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional exhaustion
Maslach Burnout Inventory ‐ Depersonalization
Maslach Burnout Inventory ‐ Personal accomplishment
| |
| Identification | Sponsorship source: Funding for this study was provided by the Mayo Clinic Department ofMedicine Program on Physician Well‐Being and thePhysician Foundation Country: USA Setting: Mixed healthcare settings including the department of medicine, family medicine and pediatric Comments: NR Authors name: Liselotte N.Dyrbye Institution: Department of Medicine, Program on Physician Well‐Being, Mayo Clinic Email: [email protected] Address: 200 First StSW, Rochester, MN 55905 Time period: 2017‐2018 | |
| Notes | We kindly received the mean and SD of the MBI‐EE for both groups from author C. West. MBI‐EE included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "We used a computer‐generated dynamic allocation algorithm to randomize participants into a coaching group and a control group. Randomization" |
| Allocation concealment (selection bias) | Unclear risk | Quote: "We used a computer‐generated dynamic allocation algorithm to randomize participants into a coaching group and a control group. Randomization was stratified by years in practice, work site (Arizona, Florida, Minnesota, or Mayo Clinic Health System), and primary care (family medicine, general pediatrics, or general internal medicine) vs sub‐specialty practice." Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 82 of the 88 completed follow‐up >93% |
| Selective reporting (reporting bias) | Low risk | The authors report a trial register. For the outcomes that we are interested in, there is no selective outcome reporting. |
| Other bias | Unclear risk | Low participation rate (88 of the 764 eligible physicians participated) |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Multimodel intervention
Control (no intervention)
Overall
Included criteria: (1) actively working in an adult ICU, (2) held a registered nurse license, and (3) had at least 6 months’ work experience in the current ICU. Excluded criteria: (1) current placement outside ICU, (2) on maternity or sick leave, (3) planning to leave ICU, or (4) already completed the simulation intervention prior to the beginning of the trial. Pretreatment: the only major between‐group difference was in marital status (46% were single in the intervention group vs 62% in the control group). Compliance rate: 100% Response rate: 100% Type of healthcare worker: nurses | |
| Interventions | Intervention characteristics Multi‐model intervention
Control (no intervention)
| |
| Outcomes | Job stress questionnaire (JSQ) ‐ psychological demand
Job stress questionnaire (JSQ) ‐ decision latitude
Job stress questionnaire (JSQ) ‐ Social support
The Copenhagen Psychosocial Questionnaire ‐ (COPSOQ) ‐ stress
The Copenhagen Psychosocial Questionnaire ‐ (COPSOQ) ‐ burnout
| |
| Identification | Sponsorship source: NR Country: France Setting: Hospital Comments: NR Authors name: Radia El Khamali Institution: Assistance Publique‐Hôpitaux de Marseille, Hôpital Nord, Réanimation des Détresses Respiratoires et des Infections Sévères, Marseille, Franc Email: laurent.papazian@ap‐hm.fr Address: Laurent Papazian, MD, PhD, Médecine Intensive‐Réanimation, Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France Time period: 2016‐2019 | |
| Notes | COPSOQ stress included in analysis 4.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Briefly, ICU nurses meeting the inclusion criteria were selected by lots drawn by the clinical research unit at the Assistance Publique‐Hôpitaux de Marseille, which was not involved with the ICU. At each planned session, the chief nurse provided the clinical research unit with a list of nurses to participate in the program (each nurse chose an identification number). The clinical research unit selected 2, 4, 6, 8, 10, or 12 nurses to participate in the trial. Half of the selected nurses (1, 2, 3, 4, 5, or 6) were randomized to the intervention group and the other half were randomized to the control group. |
| Allocation concealment (selection bias) | Unclear risk | Participants were randomly assigned using a computer‐generated randomization list (allocation ratio of 1:1) and a permuted block design (block size range, 4‐8). Participants from 1 to 3 ICUs were randomized to 1 of 2 equal‐sized groups: (1) the 5‐day intervention simulation training group or (2) the control group (nurses did not participate in simulation training but answered questionnaires). Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Almost no loss to follow‐up, those lost reasons were reported |
| Selective reporting (reporting bias) | High risk | Registration protocol: https://clinicaltrials.gov/ct2/show/NCT02672072 Did not report on the outcomes of Maslach Burnout inventory |
| Other bias | Low risk | No indication for other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Chromotherapy‐based intervention
Control (no intervention)
Overall
Included criteria: inclusion criteria: interested in attending chromotherapy educational and consultation sessions at least three times per month for a period of 3 months, age range between 25 and 45 years Excluded criteria: exclusion criteria included existing comorbid clinical conditions that could have any effect on fatigue such as depression, thyroid disease or severe infection, surgery operation from three months ago, or participants who were suffering from malnutrition and iron deficiency anaemia, and participants who were unable for other reasons to continue their participation in this research. Pretreatment: there were no significant differences between the two groups for age, years of experience, or years working Compliance rate: of 96 nurses 80 participated in all sessions > 83% Response rate: NR Type of healthcare worker: nurses | |
| Interventions | Intervention characteristics Chromotherapy‐based intervention
Control (no intervention)
| |
| Outcomes | Professional Quality of Life (ProQol) ‐ Compassion satisfaction
Profesional Quality of Life (ProQol) ‐ Burn out
Professional Quality of Life (ProQOL) ‐ Secondary traumatic stress
| |
| Identification | Sponsorship source: NR Country: Iran Setting: Hospital Comments: NR Authors name: Roghiye Emani Institution: Nursing and Midwifery Faculty of Urmia University of Medical Sciences, Urmia, Iran; Email: [email protected] Address: Nursing and Midwifery Faculty of Urmia University of Medical Sciences, Pardis–e‐Nazlou, 11 km of Nazlou Road, Urmia, Iran Time period: NR | |
| Notes | PRO‐QOl_BO included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "A total of 96 ICU nurses assessed for eligibility; among them 80 nurses (according to inclusion and exclusion criteria of the study) were randomized to the experimental group or to the control group." "For randomization in this study, an independent researcher‐made random allocation cards using computer‐generated the random numbers. The allocator kept the original random allocation sequences in an inaccessible third place and worked with a copy. " |
| Allocation concealment (selection bias) | Low risk | Quote: "For randomization in this study, an independent researcher‐made random allocation cards using computer‐generated the random numbers. The allocator kept the original random allocation sequences in an inaccessible third place and worked with a copy." |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Lost to follow‐up not reported. |
| Selective reporting (reporting bias) | Low risk | IRCT registration number: IRCT2017101431588N3. No indication of selective reporting. |
| Other bias | Unclear risk | Response rate not able to assess. Compliance not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mindfulness‐based stress reduction (MSBR)
Psychoeducational stress management (SMC)
Wait list
Overall
Included criteria: (i) non‐physician healthcare workers; (ii) aged ≥ 18 years; (iii) with a permanent work contract; and (iv) in direct contact with patients. Excluded criteria: participants were excluded if they reported suicidal ideation or problematic alcohol consumption at enrolment as measured in items 8 and 11 of the 45‐item Outcome Questionnaire Pretreatment: the three groups did not differ significantly in any of the collected baseline characteristics, except for levels of ’rewards’ at work and scores in the mindfulness ‘describing’ facet Compliance rate: NR Response rate: NR Type of healthcare worker: various healthcare workers | |
| Interventions | Intervention characteristics Mindfulness‐based stress reduction (MSBR)
Psychoeducational stress management (SMC)
Wait list
| |
| Outcomes | General Health Questionnaire (GHQ‐12)
45‐item Outcome Questionnaire (OQ‐45)
Perceived Stress Scale (PSS)
| |
| Identification | Sponsorship source: NR Country: Chile Setting: Mixed healthcare settings including: a tertiary hospital, a teaching hospital and an outpatient complex. Comments: NR Authors name: Antonia Errazuriz Institution: Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile Email: [email protected] Address: School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, Santiago, 8330077, Chile Time period: NR | |
| Notes | We kindly received the mean and SD of the primary outcome from author A. Errazuriz. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Participants were randomized into three groups (1:1:1 ratio) using computer‐generated random numbers, stratified by work position." |
| Allocation concealment (selection bias) | Unclear risk | Quote: "Allocation was executed by ordering subjects according to the random number within strata and assigning the subjects within each stratum to groups 1, 2, and 3, consecutively, until exhausting the number of subjects within each stratum." Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | 52 of the 105 (50%) randomised participants were included in the analysis. Reasons not provided. Not reported whether lost to follow‐up at random. |
| Selective reporting (reporting bias) | High risk | Trial registration: ISRCTN12039804. Did not report on Maslach Burnout Inventory and number of sick leaves in the previous three months |
| Other bias | Unclear risk | Compliance rate and response rate not reported. |
| Study characteristics | ||
| Methods | RCT, UK | |
| Participants | 20 forensic mental health nurses | |
| Interventions | 1) Experimental: psychosocial Intervention Training: 20 days of training with the aim to improve nurses' knowledge about serious mental illness and attitude towards patients and thus decrease subjective burnout. Training duration 6 months. The training helps clinicians to conceptualise their patients' problems within a more empathic framework and trains them in the skills to intervene effectively. Thus, self‐efficacy may increase and jobs may be perceived as more rewarding. | |
| Outcomes | MBI directly after training | |
| Identification | ||
| Notes | MBI‐EE included in analysis 3.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "The 20 staff who volunteered for the PSI training were randomly allocated to either the experimental PSI training group (n = 10) or a waiting list control group (n=10). The sample was stratified by ward, sex and day/night duty, thus subjects in each group represented all grades of staff and all wards." (p. 473) |
| Allocation concealment (selection bias) | Unclear risk | Not reported. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Presumably all participants completed all measurements as no data reported on dropouts. |
| Selective reporting (reporting bias) | Low risk | All outcomes reported. |
| Other bias | Unclear risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mindfulness based program (MBP)
Control (no intervention)
Overall
Included criteria: Physicians younger than 45, with an ongoing position as a resident physician at base‐line, and minimum employment of 40% Excluded criteria: NR Pretreatment: at baseline, there were no statistically significant differences between groups with regard to demo‐graphics, meditation experience, distress and quality of care outcomes except for a difference in how attentive the resident physicians were, as judged by their colleagues Compliance rate: 198 eligible 147 participated in at least 50% of the intervention > 74% Response rate: 150 of the 181 eligible physicians participated (83%) Type of healthcare worker: resident physician | |
| Interventions | Intervention characteristics Mindfulness‐based program (MBP)
Control (no intervention)
| |
| Outcomes | Copenhagen Burnout Inventory (CBI)‐ burnout
Perceived Stress Scale (PSS)
General Health Questionnaire‐12 (GHQ‐12) Mental distress
Patient Health Questionnaire (PHQ4) ‐ depression
Patient Health Questionnaire (PHQ4) ‐ anxiety
| |
| Identification | Sponsorship source: NR Country: Germany Setting: University of Freiburg Comments: NR Authors name: Johannes Fendel Institution: Department of Occupational and Consumer Psychology, Institute of Psychology, University of Freiburg, Freiburg, Germany Email: NR Address: Department of Occupational and Consumer Psychology, Institute of Psychology, University of Freiburg, Freiburg, Germany Time period: 2018‐2020 | |
| Notes | PSS included in analysis 1.1 and 1.2 PHQ included in analysis 1.4 and 1.5 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "email from the study team. We used minimisation to allocate participants into one of two groups using the software Qminim [64]. Through this approach, we minimised the imbalance between the groups with regard to gender (male, female) and baseline levels of personal burnout (CBI cut‐off values 0– 37.4 = low, 37.5–62.4 = medium, 62.5–100 = high burnout) [65]. We applied a weighted random". |
| Allocation concealment (selection bias) | Low risk | Quote: "A researcher with no contact with participants carried out minimisation and group assignment after the completion of baseline assessments." |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "Due to the nature of the interventions, participants and trainers were aware of the allocated arm. To minimise bias, self‐report measures were administered online." |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | A low drop‐out rate of 18% at follow‐up for the primary outcome. 98% included in the intention to treat analysis. |
| Selective reporting (reporting bias) | Low risk | Trial registration DRKS00014015. No indication of selective reporting on stress/burnout assessment. |
| Other bias | Low risk | No indication of other sources of bias |
| Study characteristics | ||
| Methods | RCT, the Netherlands | |
| Participants | 99 nursing assistants | |
| Interventions | 1) Experimental: Integrated emotion‐oriented care: Basic training course of two days with an intermediary period of two weeks for homework (for all staff members on intervention wards) addressing staff members' own experience, phases of ego‐experience of the demented residents and the application of (non‐)verbal empathic skills. Advanced course of seven days spread out over seven to eight months for five people from each intervention ward and an Adviser course of 10 days over nine months for one person from each intervention ward. | |
| Outcomes | The Organization and Stress Scale | |
| Identification | ||
| Notes | OSS included in analysis 3.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "A pretest‐posttest control group design with matched groups (randomized clinical trial) was used" (p. 331) |
| Allocation concealment (selection bias) | Unclear risk | Not reported. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | "During the experimental period 25 nursing assistants dropped out due to: illness (11), pregnancy (2), and transfer (9). In three cases questionnaires were missing. Data analysis was carried out on 99 'complete' cases. Drop‐out did not differ between the groups..." (p. 333) |
| Selective reporting (reporting bias) | High risk | For nursing assistants results consist of covariance analyses that were not prespecified. |
| Other bias | Low risk | We did not identify any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mindfulness‐based mHealth intervention (PsyCovidApp Group)
Control (App) group
Overall
Included criteria: healthcare workers from any medical speciality (pneumology, internal medicine, emergency, primary care, etc) and role (physicians, nurses, nurse assistants, etc) with access to a smartphone. We included health care workers who had provided direct, face‐to‐face health care to patients with a diagnosis of infection with COVID‐19. Excluded criteria: healthcare workers who were not able to download and activate the app used to deliver the intervention during the next 10 days following the baseline assessment. Pretreatment: reported socio demographic baseline characteristics of participants randomised to the intervention group were similar to socio demographic baseline characteristics of participants randomised to the control group Compliance rate: 684 healthcare workers of which 482 participated in at least 50% of the intervention 482 > 74% Response rate: 482 of the 525 (92%) eligible participants participated Type of healthcare worker: various HCWs | |
| Interventions | Intervention characteristics Mindfulness‐based mHealth intervention (PsyCovidApp Group)
Control (App) group
| |
| Outcomes | DASS ‐ overall
Maslach Burnout Inventory ‐ Emotional exhaustion
Maslach Burnout Inventory ‐ Personal accomplishment
Maslach Burnout Inventory ‐ Depersonalisation
| |
| Identification | Sponsorship source: NR Country: Spain Setting: Hospital Comments: NR Authors name: Maria Antònia Fiol‐DeRoque Institution: Health Research Institute of the Balearic Islands, Palma de Mallorca, Spain Email: [email protected] Address: Maria Jesús Serrano‐Ripoll, PhD Health Research Institute of the Balearic Islands Edificio S, Hospital Universitario Son Espases Carretera de Valldemossa Palma de Mallorca, 07120 Spain Time period: 2020 | |
| Notes | MBI‐EE included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Participants were randomly assigned (1:1) to receive the PsyCovidApp intervention or the control app over two weeks by a designated researcher" Using a computer‐generated sequence of random numbers create by Internet relay chat. |
| Allocation concealment (selection bias) | Low risk | Randomization done by a designated researcher who was not involved in data collection or analysis. |
| Blinding of participants and personnel (performance bias) | Low risk | Health care workers were blinded to group allocation (as both groups received an app) |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "Participants, the outcome data collectors and trial statisticians were unaware of the treatment allocation." |
| Incomplete outcome data (attrition bias) | Low risk | Loss to follow‐up less than 20%. 436 of the 482 randomized participants had complete two‐week outcome data. |
| Selective reporting (reporting bias) | Low risk | https://clinicaltrials.gov/ct2/show/NCT04393818 No differences between study and registration of the protocol |
| Other bias | Low risk | No indication of other source of bias |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Emotional intelligence training
Control (no intervention)
Overall
Included criteria: NR Excluded criteria: people who have not already received any training on the topic of research. If a person has already been trained, the results of the study will be affected whether the score obtained from the study is present or not? Do not use anti‐anxiety and tranquilizers during the study period. Drug use could interfere with the outcome (due to sleepiness and lack of consciousness) (either at the training stage or the completion stage of the response). No night shift before the night before the tests. Fatigue caused by night shift could interfere with completing the questionnaire or understanding the training sessions. [4] To commit to attend all or more than half of the meetings. Pregnant nurses were excluded or nurses with underlying diseases (blood pressure, diabetes, etc.) were excluded. Pretreatment: NR Compliance rate: NR Response rate: NR Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention characteristics Workplace Health Promotion Program
Control (no intervention)
| |
| Outcomes | General Health Questionnaire (GHQ)
| |
| Identification | Sponsorship source: NR Country: Iran Setting: Hospital Comments: NR Authors name: Dr. Razieh Khosrorad Institution: Department of Health Education, School of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran. Educational Neuroscience Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran. Email: rkhosrorad@yahoo. com Address: NR Time period: NR | |
| Notes | GHQ included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Target population of this study consist of nurses in units of Mohammad Vasei, Shahid Beheshti, and Shahidan Mobini Hospitals in Sabzevar, randomly divided into two groups and a sample of 135 people were randomly selected based on the list of sample group names and random number table |
| Allocation concealment (selection bias) | Unclear risk | Not reported. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Not reported |
| Selective reporting (reporting bias) | Unclear risk | Inaccessible plan number 94098 with the ethics code of IR.MEDSAB.REC.1394.51. No indication of selective reporting. |
| Other bias | Unclear risk | Response rate and compliance rate not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Engagement in proactive behaviours
Control (care as usual)
Overall
Included criteria: eligible participants were newly graduated nurses who worked at any clinical department of Uppsala University Hospital and participated in the transition‐to‐practice program Excluded criteria: NR Pretreatment: no group differences reported Type of healthcare worker: exclusively nurses Response rate: 86% Compliance rate: 95% | |
| Interventions | Intervention characteristics Engagement in proactive behaviours
Control (care as usual)
| |
| Outcomes | Items from the Stress and Energy Questionnaire
| |
| Identification | Sponsorship source: Funding: This study was supported by AFA insurance [Grant no 140007] Country: Sweden Setting: University hospital Comments: NR Authors name: Elin Frögéli Institution: Department of Clinical Neuroscience, Karolinska Institute Email: [email protected] Address: NR Time period: 2016‐2017 | |
| Notes | Included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "The participants were randomized to one of two groups of equal size at a 1:1 ratio, stratified by clinical ward. Specifically, person 1 that was registered for the program was allocated to group 1, person 2 was allocated to group 2, person 3 to group 3, and so on. However, if person 1 and person 3 came from the same clinical ward, person 3 was placed in group 2. Person 4 was then placed in group 1 and person 5 in group 2, and so on. The purpose of this design was to avoid having too many nurses from the same clinical ward being placed in the same study group, as this would cause problems of staffing on the clinical wards." Sequence generation process not mentioned. |
| Allocation concealment (selection bias) | High risk | Participants and/or investigators enroling participants could possibly foresee assignments and thus introduce selection bias. |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "Finally, no measures were taken to assure that there was no diffusion of information between the groups, which may have affected the results." Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Quote: "Attrition Analysis: We investigated differences in the study variables at baseline between participants who responded at follow‐up and those who did not. These analyses revealed no differences." Randomized 239 ‐> lost to follow‐up ‐> 55 = 23% but no differences between responders and not responders. However, these analyses have not been reported. |
| Selective reporting (reporting bias) | Unclear risk | No mention of a protocol, nor did we find one |
| Other bias | Unclear risk | Quote: "The reliability of some of the measures in the present trial was questionable, which may have limited the ability to properly assess the outcomes." ‘Loosely’ validated outcome measure |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mindfulness‐based training
Control (no intervention)
Overall
Included criteria: nurses who work in wards who had mild to moderate levels of stress and depression (according to DASS‐21) in an earlier cross‐sectional survey. Excluded criteria: nurses who work in the outpatient clinic, or nursing managers, due to the different types of patient care, roles and responsibilities. Nurses who have a history of mental illness (n = 3) were excluded in the first study. The nurses who had severe and extremely severe levels of SAD (according to DASS‐21). They were advised to seek professional help at the psychiatric/psychology clinic in the hospital. Pretreatment: reported socio‐demographic baseline characteristics of participants randomised to the intervention group were similar to socio‐demographic baseline characteristics of participants randomized to the control group Compliance rate: the drop‐out rate was high, especially for the website intervention (48.3%). Response rate: it seems that all eligible participants actually participated Type of healthcare worker: nurses | |
| Interventions | Intervention characteristics Mindfulness‐based training
Control (no intervention)
| |
| Outcomes | DASS ‐ Depression
DASS ‐ Anxiety
DASS ‐ stress
| |
| Identification | Sponsorship source: NR Country: Malaysia Setting: Hospital Comments: NR Authors name: Sajed Faisal Ghawadra Institution: Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysi Email: [email protected] Address: Khatijah Lim Abdullah, Department of Nursing Science, Faculty of Medicine, University of Malaya, 506030 Kuala Lumpur, Malaysia and Fakultas Keperawatan Universitas Airlangga, Surabaya, Indonesia Time period: NR | |
| Notes | Not able to include in analysis due to missing data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "The participants were randomly assigned to the intervention and control groups using stratified blocked randomization." Sequence generation process insufficiently described. |
| Allocation concealment (selection bias) | Unclear risk | Unable to judge whether participants and/or investigators could possibly foresee assignment |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported |
| Incomplete outcome data (attrition bias) | Low risk | 25 of the 249 (11%) participants were not analysed. Reasons provided. Not mentioned whether lost to follow‐up was at random however loss to follow‐up is below our pre‐defined cut‐off point. |
| Selective reporting (reporting bias) | Unclear risk | Trial registration, nor did we find one online |
| Other bias | Low risk | Low compliance but the per protocol analysis did not differ from the intention to treat analysis. Per‐protocol (PP) analysis was performed for (n = 136) participants who completed all the intervention (workshop and website), and for those who completed the three‐point questionnaires; the intervention and control group in PP analysis were n = 37 and 99, respectively. The results of the PP using GEE were similar to ITT, which strengthens the validity of the results |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline Characteristics Mental contrasting with implementation intentions‐ MCII
Mental contrasting with implementation intentions + further intervention groups ‐ IIMCII
Control
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: There were no significant differences between the two groups for age, years of experience, or years working Compliance rate: NR Response rate: of 251 eligible participants 129 participated > 51% Type of healthcare worker: various healthcare workers | |
| Interventions | Intervention characteristics Mental contrasting with implementation intentions ‐ MCII
Mental contrasting with implementation intentions + further intervention groups ‐ IIMCII
Control (no intervention)
| |
| Outcomes | Perceived Stress Questionnaire‐ 20‐ PSQ‐20
| |
| Identification | Sponsorship source: NR Country: Germany Setting: Various health institutions Comments: NR Authors name: Peter M Gollwitzer Institution: Department of Psychology, New York University, New York, NY, United States Email: [email protected] Address: NR Time period: NR | |
| Notes | PSQ included in analysis 1.1. Intervention groups combined to create a single pair‐wise comparison | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The message also contained the email address of the experimenter whom the nurses should contact if they wanted to register for the study. Those who registered (N = 251 nurses) were contacted in return by the experimenter (again via email) and given access to the study website that had been created by using the soscisurvey.de data collection service. Participants who entered the website (N = 129) were randomly assigned to the three conditions of the study (MCII = 41, and IIMCII = 41, Control = 47)" |
| Allocation concealment (selection bias) | Unclear risk | Not mentioned. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 105 of the 129 (81%) randomized participants answered the final questionnaire. Reasons not provided nor whether missing was at random. |
| Selective reporting (reporting bias) | Unclear risk | No registration, nor did we find one. |
| Other bias | Unclear risk | Data on participants' adherence to the MCII instructions and the frequency and context of participants using MCII is not described. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Community Resiliency Model
Control (Nutrition)
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: no significant differences were noted between the two randomised groups by age, years in nursing, or on any of the base‐line measures. Compliance rate: 59 of the 99 (60%) participants allocated to the intervention group did not receive the intervention Response rate: of the 1600 invited nurses, 196 completed baseline and were randomised (12%) Type of healthcare worker: nurses | |
| Interventions | Intervention characteristics Community Resiliency Model
Control (Nutrition)
| |
| Outcomes | Secondary traumatic stress (STSS)
Copenhagen Burnout Inventory (CBI)
| |
| Identification | Sponsorship source: NR Country: USA Setting: Hospital Comments: NR Authors name: Linda Grabbe Institution: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA Email: [email protected] Address: Corresponding author: Linda Grabbe, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA30322 Time period: 2017‐2018 | |
| Notes | CBI included in analysis 1.1 and 1.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "These participants were then randomly placed in either the intervention or control group. The" |
| Allocation concealment (selection bias) | Unclear risk | Difficult to judge whether participants and/or investigators could possible foresee assignment. However, it is assumed that randomization was performed in one go and that participants and/or investigators could not foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | Not reported whether lost to follow‐up was at random. 40% lost. |
| Selective reporting (reporting bias) | Unclear risk | No protocol registration, nor did we find one. |
| Other bias | Unclear risk | Low response and compliance rate. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline Characteristics Debriefing intervention
Control (no intervention)
Overall
Included criteria: the sample of interns invited to participate were those who were based at the teaching hospital during term 3 of 2011 Excluded criteria: interns who were seconded to other hospitals were excluded Pretreatment: reported socio‐demographic baseline characteristics of participants randomised to the intervention group were similar to socio‐demographic baseline characteristics of participants randomised to the control group. Compliance rate: attendance at the debriefing sessions was not always 100%, leading to the potential argument that those who were regularly in attendance were experiencing more or less stress. Response rate: 31 of 52 invited interns entered this study (60%). Type of healthcare worker: physicians | |
| Interventions | Intervention characteristics Debriefing intervention
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Cynicism
Maslach Burnout Inventory ‐ Professional efficacy
| |
| Identification | Sponsorship source: NR Country: Australia Setting: Hospital Comments: NR Authors name: Nishmi Gunasingam Institution: Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia Email: [email protected] Address: Dr Nishmi Gunasingam, Medical Training andAdministration Unit, RoyalPrince Alfred Hospital, Missenden Road, Camperdown, NSW 2050 Time period: 2011 | |
| Notes | MBI‐EE included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Participants were allocated a unique identifying number to maintain anonymity. A computer generated randomisation code" |
| Allocation concealment (selection bias) | Unclear risk | Quote: "allocated participants to the debriefing intervention or control group." Difficult to judge whether participants and/or investigators could possible foresee assignment. However, it is assumed that randomization was performed in one go and that participants and/or investigators could not foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one online |
| Other bias | Unclear risk | Difficult to assess compliance rate ‐> Attendance at the debriefing sessions was not always 100%, leading to the potential argument that those who were regularly in attendance were experiencing more or less stress. |
| Study characteristics | ||
| Methods | Cluster‐RCT, the Netherlands | |
| Participants | Nurses on wards of an academic hospital were screened for work and health problems: Experimental: 29 wards, 591 participants of which 151 screened positive. Control: 28 wards, 561 participants of which 161 screened positive. Experimental: 17%, Control 22% men, > 45 years age ‐ Experimental 51% Control 46%, > 10 years of experience ‐ Experimental 51% Control 41% | |
| Interventions | 1) Experimental 1: all who screened positive were referred to Occupational Health Physician (OHP). Participants who were screened as positive were invited for a face‐to‐face preventive consultation with their occupational physician. The consultation was voluntary, and workers could reschedule or cancel it if they wished. Supervisors were not informed about the screening results or about the invitation for and content of the preventive consultation of any employee. The 7‐step protocol for OHPs closely followed occupational physicians’ care as usual for consultations initiated by the employee in contrast to the compulsory consultation in the context of absenteeism. Occupational physicians received 3 hours of training from the researchers on the use of the protocol. (CBT) 2) Experimental 2: participants received personalised feedback on their screening results immediately after filling out the baseline questionnaire, both onscreen and in an e‐mail. The personalised feedback was followed by an invitation for a tailored offer of self‐help EMH interventions, on the basis of an algorithm based on the specific symptoms and the work‐relatedness of the symptoms. participants were mostly offered a choice of 2 to 3 EMH interventions to leave room for personal preferences. Participants who screened negative on all mental health complaints were invited to follow an EMH intervention aimed at enhancing and retaining their mental fitness. The EMH interventions are self‐help interventions on the Internet aimed at reducing specific mental health complaints or enhancing well‐being. The interventions are mainly based on the principles of cognitive behavioural therapy and combine a variety of aspects, e.g. providing information and advice, weekly assignments, the option of keeping a diary and a forum to get in contact with others who have similar complaints. The EMH interventions were developed as stand‐alone interventions by the Trimbos Institute (CBT). 2) Control: waiting list: In the control arm. Participants filled out the baseline questionnaire; however, results of the screening‐questionnaires were not to be reported back to participants, and no further interventions were advised at baseline. As compensation, participants in the control arm received their personal screening results together with a tailored choice for a self‐help EMH intervention six months after baseline. | |
| Outcomes | Gartner 2013: the study's primary outcome was help‐seeking behaviour; we used secondary outcomes: distress from the Dutch 4DKL, anxiety and depression from Brief Symptom Inventory Ketelaar 2013: the study used work‐functioning as the primary outcome: we used the distress part of the Dutch 4DKL as stress outcome; anxiety and depression were also measured but not reported Bolier 2014: Brief Symptom Inventory (BSI) ‐ Anxiety and Brief Symptom Inventory (BSI) ‐ depression Noben 2014: cost‐effectiveness | |
| Identification | ||
| Notes | We got the following data for the distress scale of the 4DKL at 6 months follow‐up for the group who screened positive from author K Nieuwenhuijsen: Experimental: N = 86 6.24 ± 6.52 Control: N = 116 6.82 ± 6.57 We got the following data from author S. Ketelaar: Distress measure with 4DKL at 6 months follow‐up for the group who screened positive: Experimental: N = 52 6.06 ± 6.54; Control: N = 116 6.82 ± 6.5.7 4DKL included in analysis 1.2 Intervention groups combined to create a single pair‐wise comparison. BSI‐depression included in analysis 1.4 Experimental 2 vs control 4DKL included in analysis 5.2 Experimental 1 vs Experimental 2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | " Randomization was performed at the ward level (n = 86). Randomization sequences with a block size of three were generated with Nquery Advisor (Statistical Solutions, Ltd, Cork, Ireland) by one researcher (K.N.) who was not involved in the recruitment" |
| Allocation concealment (selection bias) | Unclear risk | Not blinded |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | At 3 months lost to follow‐up: Experimental 37% / Control 30%; at 6 months Experimental 46% / Control 34% |
| Selective reporting (reporting bias) | Low risk | Gartner 2013: All outcomes reported that were announced in protocol Ketelaar 2013: Anxiety and Depression were not reported in Ketelaar 2013 but in Bolier 2014 |
| Other bias | Unclear risk | Compliance very low: 34% of those invited visited their OHP |
| Study characteristics | ||
| Methods | RCT, Turkey | |
| Participants | Quote: "All of the nurses (n = 227) were invited to complete the Maslach Burnout Inventory (MBI) developed by Maslach & Jackson (1981). Those who completed the questionnaire and received a score on emotional exhaustion higher than the median score for all nurses were invited to participate in the burnout reduction intervention." (p. 487) 108 nurses were randomised to one of three conditions. | |
| Interventions | 1) Coping training (N = 36) Quote: "The group that received coping training consisted of two groups, each group consisting of 18 people. In the first week, the concept of stress was explained to the nurses, and coping methods used by the nurses in stressful conditions were discussed. In the second session, basic communication skills on the stress level were discussed. In the third session, cognitive coping methods were presented theoretically. In the fourth session, cognitive distortions found among nurses and methods for coping with these distortions were discussed. In the fifth session, the problem‐solving method was theoretically explained to the nurses. In the sixth session, stressful situations that the nurses encountered were discussed and resolved by means of the problem‐solving method. In the seventh session, problems that the nurses had difficulty coping with were discussed by utilizing the skills learnt during the course of the programme." (p. 488) 2) Support group (N = 36) "...the support group consisted of three groups, each group consisting of 12 people. The nurses talked about the most frequently encountered stressors in the workplace and expressed their feelings towards their jobs. At the beginning of each session, the nurses expressed their feelings related to difficult situations at the workplace. Then, a problem chosen by the nurses was attempted to be solved by using reflective cycle steps. Researchers provided information when needed. Possible solution methods were discussed in the groups, and the nurses were advised to use these methods in their daily lives. The nurses shared their difficult and favourable times and also exchanged recommendations with each other." (p. 488) 3) Control: No intervention (N = 36) | |
| Outcomes | MBI | |
| Identification | ||
| Notes | MBI‐EE included in analysis 1.1 and 1.2. Intervention groups combined to create a single pair‐wise comparison. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "Random allocation was concealed by using a system of sequentially numbered, opaque, sealed envelopes containing the computer‐generated random allocation, which had been drawn up by a statistician. During the randomization, the researchers and the participants did not know the groups to which they would be allocated." (p. 487) |
| Allocation concealment (selection bias) | Low risk | See above |
| Blinding of participants and personnel (performance bias) | High risk | "No blinding was applied to the participants and the researchers." (p. 487) |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | "Intention‐to‐treat analysis was used because of sample loss." (p. 487) |
| Selective reporting (reporting bias) | Low risk | The authors only measured and adequately reported results of the MBI. |
| Other bias | Unclear risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline Characteristics Web‐based BREATHE
Control (no intervention)
Overall
Included criteria: Nurses had to be 21 years of age or older and work at one of the participating hospitals Excluded criteria: NR Pretreatment: reported socio‐demographic baseline characteristics of participants randomised to the intervention group were similar to socio‐demographic baseline characteristics of participants randomised to the control group. Compliance rate: the majority of program group participants logged into the program 1 to 3 times. Ten participants in the experimental group never logged into the program. The average number of logins for those who logged in at least once was 2.5. The average amount of time spent in the BREATHE program was 43 minutes. Response rate: of 117 eligible participants 105 participated > 88% Type of healthcare worker: nurses | |
| Interventions | Intervention characteristics Web‐based BREATHE
Control (no intervention)
| |
| Outcomes | Nursing Stress Scale
Symptoms of distress
| |
| Identification | Sponsorship source: NR Country: USA Setting: Hospital Comments: NR Authors name: Rebekah K. Hersch Institution: ISA Associates, Inc. Email: [email protected] Address: SA Associates, Inc., 201 North Union Street, Suite 330, Alexandria, Virginia Time period: NR | |
| Notes | Symptoms of distress included in analysis 4.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Randomization was conducted using a block randomized design with blocks of 4 and 6. The 0 and 1 within each block were random and the order of the group of 4 and the group of 6 was random. Randomization occurred after each participant completed the pretest question‐ naire. The online questionnaire site was checked every day to determine who completed the pretest each day and individuals were assigned to the next condition on the randomization table as they completed the questionnaire." |
| Allocation concealment (selection bias) | Unclear risk | Quote: "Once randomization was complete, participants were notified of the condition to which they were assigned (no blinding procedures were employed) and were informed of next steps; experimental group participants were sent a link to the BREATHE program along with a randomly generated username and password and instructions for using the program." Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 14 of the 104 randomised participants were lost to follow‐up (1 control group vs 13 intervention group). Missing data were imputated. Missing not at random. We found that the following participants were less likely to respond to the posttest measure: those who reported greater number of days in which they had five or more drinks on the same occasion at pretest, those who reported more drinks per day at pretest, and those who had lower scores on the understanding of depression and anxiety measure at pretest |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one online |
| Other bias | Low risk | No indication of other sources of bias |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: Parallel group | |
| Participants | Baseline characteristics Mindfulness‐based Yoga
Control (no intervention)
Overall
Included criteria: employees who provided direct patient care (including but not limited to nurses, nursing assistants, therapists, physicians, and social workers), older than 18 years. Excluded criteria: the presence of joint or muscle problems that limited mobility (e.g. advanced arthritis, herniated disk, or past injuries that prevent painless or safe movement), having routinely practised yoga or any other MB intervention in the past 6 months, or currently on medication that might interact with the results of salivary cortisol measures, including prednisone, cortisone, or steroid‐based medicine. Pretreatment: reported socio‐demographic baseline characteristics of participants randomised to the intervention group were similar to socio‐demographic baseline characteristics of participants randomised to the control group. Compliance rate: there was 98.7% attendance across all sessions for those in the MB yoga intervention group. Response rate: NR Type of healthcare worker: Nurses & other healthcare professionals | |
| Interventions | Intervention characteristics Mindfulness‐based Yoga
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
The Perceived Stress Scale (PSS)
| |
| Identification | Sponsorship source: NR Country: USA Setting: Hospital Comments: NR Authors name: Kelly Hilcove Institution: Honor Health Scottsdale Shea Medical Center Email: [email protected] Address: BSN, RN, HNB‐BC, Board Certified Holistic Nurse, Honor Health Scottsdale Shea Medical Center, 9003 East Shea Boulevard, Scottsdale, AZ 85261, Time period: NR | |
| Notes | PSS included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Once identified as eligible, participants signed consent, completed subjective assessments, and were randomly assigned to the intervention or control group using a computerized randomization tool." |
| Allocation concealment (selection bias) | Unclear risk | Difficult to judge whether participants and/or investigators could possibly foresee assignment. However, it is assumed that randomization was performed in one go and that participants and/or investigators could not foresee the assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "Two members of the control group were not able to participate in collection of post‐intervention data, due to personal time constraints, yielding an attrition rate of 2.5%." |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we fine one online |
| Other bias | Unclear risk | Response rate not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mindful‐Compassion Art‐based Therapy (MCAT)
Waitlist‐control
Overall
Included criteria: inclusion criteria included healthcare workers (i.e. physicians, nurse, medical social workers, and allied health professionals) whose primary job was caring for terminally ill patients, 21 years old and above, and fluent in both written and spoken English Excluded criteria: exclusion criteria included the inability to provide informed consent or major depression (or other mental health conditions) or both. Pretreatment: reported socio‐demographic baseline characteristics of participants randomised to the intervention group were similar to socio‐demographic baseline characteristics of participants randomised to the control group. Compliance rate: NR Response rate: NR Type of healthcare worker: physicians, nurse, medical social workers, and allied health professionals | |
| Interventions | Intervention characteristics Mindful‐Compassion Art‐based Therapy (MCAT)
Waitlist‐control
| |
| Outcomes | Maslach Burnout inventory general survey‐ burn‐out
Maslach Burnout inventory general survey‐ exhaustion
Maslach Burnout Inventory ‐ cynicism
Maslach Burnout Inventory ‐ professional efficacy
| |
| Identification | Sponsorship source: NR Country: Singapore Setting: Hospice Comments: NR Authors name: Andy Hau Yan Ho Institution: Action Research for Community Health Laboratory, Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore Email: [email protected] Address: NR Time period: NR | |
| Notes | MBI‐EE included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Simple randomization for each recruitment round was conducted by using an allocation sequence based on a computer‐generated list of random numbers. Specifically, a random number sequence ranging from 1 to 18 or 20 (depending on the number of participants recruited in each recruitment round) was generated via Research Randomizer (Urbaniak and Plous, 2019). Thereafter, each participant was randomly assigned a unique number from the sequence. |
| Allocation concealment (selection bias) | Unclear risk | See above. Difficult to judge whether participants and/or investigators could possibly foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No attrition throughout the entire research period. |
| Selective reporting (reporting bias) | Low risk | Trial registration NCT03440606. No indication of selective outcome reporting. |
| Other bias | Unclear risk | Response rate and compliance rate not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Balint group intervention
Control (no intervention)
Overall
Included criteria: The inclusion criteria encompassed (1) working in an ICU a licensed nurse for at least one year and working in hospitals with at least 1000 beds and 100 ICU nurses. Excluded criteria: the exclusion criteria were: (1) Participants who have neuropsychiatric disorders; (2) Participants in pregnancy or lactation; (3) Participants who incomplete or invalid questionnaire. Pretreatment: reported socio‐demographic baseline characteristics of participants randomised to the intervention group were similar to socio‐demographic baseline characteristics of participants randomised to the control group. Compliance rate: 100% Response rate: 100% Type of healthcare worker: nurses | |
| Interventions | Intervention characteristics Balint group intervention
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment
| |
| Identification | Sponsorship source: NR Country: China Setting: Hospital Comments: NR Authors name: Huigen Huang Institution: Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China Email: [email protected] Address: No. 102 Zhongshan Er Road, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China. Time period: 2016 | |
| Notes | MBI‐EE included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "under the leadership of Guangdong General Hospital from May 2016 to November 2016. The participants were selected through random sampling first, then they were divided into two groups (i.e. the intervention group and the control group) with a random number generator." |
| Allocation concealment (selection bias) | Unclear risk | Then they were divided into two groups (i.e. the intervention group and the control group) with a random number generator Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 6 of the 152 randomised participants withdrew (4%). Reasons provided. Missing not at random however loss to follow‐up is below our pre‐defined cut‐off point. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one online. |
| Other bias | Low risk | No indication of other sources of bias |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Balint intervention
Wait‐list control group
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: there were no significant differences between the two groups for age and gender Compliance rate: 100% Response rate: all residents invited voluntarily participated (100% response rate). Type of healthcare worker: residents | |
| Interventions | Intervention characteristics Balint intervention
Wait‐list control group
| |
| Outcomes | Maslach Burnout Inventory human services survey ‐ Emotional Exhaustion
Maslach Burnout Inventory human services survey ‐ Depersonalisation
Maslach Burnout Inventory human services survey ‐ Personal accomplishment
| |
| Identification | Sponsorship source: NR Country: China Setting: Hospital Comments: NR Authors name: Lei Huang Institution: Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China, Medical Education Division, Tongji Hospital, Tongji University School of Medicine, Shanghai, China Email: [email protected] Address: NR Time period: 2016 | |
| Notes | MBI‐EE Included in analysis 1.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Following consent and the completion of the first round of assessment completion, the 36 residents were randomly assigned to the intervention (n = 18) or the control group (n = 18)." Sequence generation process insufficiently described |
| Allocation concealment (selection bias) | Unclear risk | Difficult to judge whether participants and/or investigators could possible foresee assignment. However, it is assumed that randomization was performed in one go and that participants and/or investigators could not foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up. |
| Selective reporting (reporting bias) | Low risk | No trial registration or no study protocol reported. No indication of selective reporting. |
| Other bias | Low risk | No indication of other sources of bias reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Intervention (resilience)
Control (no intervention)
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: there were no significant differences between intervention and control group regarding age, gender, marital status, weekly working hours, and stressor load before the intervention. Compliance rate: NR Response rate: NR Type of healthcare worker: nurses | |
| Interventions | Intervention characteristics Intervention (resilience)
Control (no intervention)
| |
| Outcomes | General Health Questionnaire‐28‐ (GHQ‐28)
Mainz Inventory of Microstressors (MIMI)
Perceived Stress Scale (PSS)
| |
| Identification | Sponsorship source: NR Country: Germany Setting: Hospital Comments: NR Authors name: Gesche Janzarik Institution: Leibniz Institute for Resilience Research Email: [email protected] Address: Leibniz Institute for Resilience Research (LIR) Mainz, 55122 Mainz, Germany Time period: NR | |
| Notes | PSS included in analysis 4.1 and 4.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "This randomised controlled trial included three assessment points: pre‐test, post‐test, and three follow‐up measurements at three, six, and nine months." Not reported how randomisation took place (e.g. software) |
| Allocation concealment (selection bias) | Unclear risk | Difficult to judge whether participants and/or investigators could possible foresee assignment. However, it is assumed that randomization was performed in one go and that participants and/or investigators could not foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | 58 of the 72 (80%) randomised participants responded to the latest follow‐up time included in this review. Reasons provided. Not mentioned whether missing was at random. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one online. |
| Other bias | Unclear risk | Compliance rate and response rate not reported. |
| Study characteristics | ||
| Methods | Cluster‐RCT, Denmark | |
| Participants | 210 eldercare workers | |
| Interventions | 1) Experimental 1: Stress Management Intervention: The SMI was developed to address the work stress in health care with particular attention to prevention of burnout and development of strategies for stress management. Training occurred over 20 weeks, with group sessions every 2 weeks, and each session lasting 2 hours. Between sessions, the participants were given assignments concerning implementation of the programme in daily practice. | |
| Outcomes | MBI (results not reported in article but obtained directly from author)
| |
| Identification | MBI‐EE included in analysis 1.2 | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "Randomization was performed at group level because the intervention programs were meant to involve the employee as a group during education and implementation. The assignment to the different intervention programs was balanced to secure representation of all 3 programs in each of the wards." (p.1762) |
| Allocation concealment (selection bias) | Unclear risk | Not reported. |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | Quote: "Altogether, 163 members of the source population (79%) participated in both baseline and follow‐up investigation, and completed at least 2 sets of diaries during the study period. The proportion of dropouts from baseline to follow‐up did not differ significantly across intervention groups. We observed no differences in age and number of years occupied in health care and mean intensity of LBP during the past year between participants who remained in the study and participants who dropped out." (p.1762). |
| Selective reporting (reporting bias) | High risk | Results data for the MBI, Setterlind's Stress Scores and rating of social support were not reported because they were not statistically significantly different between groups. "...[N]o significant changes were found in either of the intervention arms in ... the Maslach Burnout Inventory, the Setterlind stress scores, or the rating of social support (data not shown)" (p. 1765) |
| Other bias | Low risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Yoga
Control (no intervention)
Overall
Included criteria: not participating in yoga and similar regular exercise program during the research, not having any health problems that will prevent yoga, to agree to participate in the study. Excluded criteria: NR Pretreatment: reported sociodemographic baseline characteristics of participants randomised to the intervention group were similar to sociodemographic baseline characteristics of participants randomised to the control group. Compliance rate: two of the 35 participants in the experimental group excluded from the study because they did not regularly participate in yoga practice. Response rate: Of 80 participants 67 participated > 84% Type of healthcare worker: nurses | |
| Interventions | Intervention characteristics Yoga
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment
| |
| Identification | Sponsorship source: NR Country: Turkey Setting: Nursing faculty Comments: NR Authors name: Mehtap Kavurmaci Institution: Department of Internal Medicine Nursing, Atatürk University, Erzurum, Turkey Email: [email protected] Address: Mehtap Kavurmaci, PhD, Department of InternalMedicine Nursing, Atatürk University, Erzurum25080, Turkey Time period: 2019 | |
| Notes | MBI‐EE included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The individuals were selected for the sample by the probability sampling method of simple random sampling. These individuals were listed for the simple random sampling method, and it was select 70 individuals from the table of random numbers including 35 in the experiment group and 35 in the control group." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Two of the participants in the experimental group were excluded from the study because they did not regularly participate in yoga practice. One of the participants in the control group was excluded from the study because he did not complete his final test. Unknown whether non‐completers differed from completers however loss to follow‐up is below our pre‐defined cut‐off point. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one online. |
| Other bias | Low risk | No indication of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: cluster‐randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Novel training (intervention group)
Usual training (control group)
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: there were no significant differences between the UT and intervention arms with respect to age, gender, or additional professional degrees. At baseline, pretest data reveal that UT and intervention groups did not differ significantly in their scores on the PHOSAH, MBI, PPOS, or Empowerment at Work Scale (Table 2). Mean scores on the PHOSAH, the primary outcome measure, were 7.4 (SD 4.2) for fellows in the UT group and 8.2 (SD 3.3) for the intervention group (P = 0.35). However, baseline performance on the PHOSAH was somewhat lower than previously published, with mean score of 9 (SD 3.4) .15 Fellows in both groups had similar levels of satisfaction with their fellowship training in several domains of humanism and professionalism (Table 3). Compliance rate: NR Response rate: NR Type of healthcare worker: paediatric haematology‐oncology fellows | |
| Interventions | Intervention characteristics Novel training (intervention group)
Usual training (control group)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
| |
| Identification | Sponsorship source: NR Country: USA Setting: Hospital Comments: NR Authors name: Jennifer Kesselheim Institution: Department of Pediatric Oncology, Dana‐Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusettes Email: [email protected] Address: Jennifer Kesselheim, Dana‐Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusettes 450 Brookline Avenue, D1107, Boston, MA02215 Time period: 2016‐2017 | |
| Notes | MBI‐EE included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: Program directors committed to study participation sought local approval from their Institutional Review Board after which their program was randomized to either the intervention or UT arm of the study. Sequence generation process insufficiently described. |
| Allocation concealment (selection bias) | Unclear risk | Unable to judge whether participants and/or investigators could possible foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 89 of the 100 randomised participants included in the analysis (89%). Reasons not described nor whether missing was at random. However loss to follow‐up is below our pre‐defined cut‐off point. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we fine one online |
| Other bias | Unclear risk | Unit of analysis error (i.e. when a study ignored the clustering of the data in their analysis). Compliance not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Emotion regulation training
Control (no intervention)
Overall
Included criteria: employment in intensive or critical care units, no previous participation in an ERT program and not currently taking psychotropic medication or other unprescribed substances. Excluded criteria: NR Pretreatment: at baseline, an independent sample t‐test showed no significant difference between the two groups in terms of age and working hours per month. The two groups also did not differ in sex, nor marital status. There were no between‐group differences in CERQ, DASS‐21, and ProQoL‐5 subscale scores at baseline. The statistical analysis controlled for baseline scores for CERQ, DASS‐21 and ProQoL‐5 scores as confounders. Compliance rate: four of the 30 (13%) participants randomised to the intervention group missed more than 2 sessions Response rate: nine of the 71 (13%) eligible participants did not want to participate Type of healthcare worker: nurses | |
| Interventions | Intervention characteristics Emotion regulation training
Control (no intervention)
| |
| Outcomes | Professional Quality of Life (ProQol) ‐ Burn out
DASS ‐ depression
DASS ‐ Anxiety
DASS‐ Stress
| |
| Identification | Sponsorship source: NR Country: Iran Setting: Hospital Comments: NR Authors name: Hamid Kharatzadeh BSc, MSc, PhD Candidate Institution: Department of Clinical Psychology, Faculty ofHuman Sciences, Shahed University, Tehran, Iran Email: [email protected] Address: Mousa Alavi, Nursing and Midwifery CareResearch Center, Faculty of Nursing andMidwifery, Isfahan University of MedicalSciences, Isfahan, Iran Time period: 2018‐2019 | |
| Notes | DASS‐stress included in analysis 1.1 DASS ‐ depression included in analysis 1.4 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "randomly allocated to either the treatment group" Using a computer‐based randomization allocation |
| Allocation concealment (selection bias) | Unclear risk | Quote: "using a computer‐based randomiza‐ tion allocation (refer to the study CONSORT diagram, Figure 1)." Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Follow‐up lost less then 20% (53 of the 60 randomised participants included in the analysis). |
| Selective reporting (reporting bias) | Low risk | IRCT20171005036572N3. No indication of selective outcome reporting |
| Other bias | Low risk | No indication of other sources of bias |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline Characteristics Repetitive transcranial magnetic stimulation (rTMS)
Control (placebo)
Overall
Included criteria: NR Excluded criteria: individuals with 1) past or current diagnosis of any axis I psychiatric disorder based on the Structured Clinical Interview for DSM‐IV‐TR Axis I Disorders, Patient Edition (SCID‐I/P),19 2) severe medical illness, 3) organic mental disorder, seizure disorder, or mental retardation, 4) pregnancy, 5) current psychotropic medication use, 6) surgical treatment of intracranial lesions, or 7) a magnetic substance in their brain or orbital area. Pretreatment: at baseline, there were no significant differences between the intervention group and the control group with regard to age, duration of employment, working hours per week, marital status, occupation, socio‐economic status, all Compliance rate: among the 28 enroled participants, data from four participants were dropped because they did not complete the TMS sessions or QEEG assessment: one participant from the active‐TMS group and one participant from the sham‐TMS group discontinued the TMS sessions due to headache and one participant from the active‐TMS group and one participant from the sham‐TMS group missed their QEEG appointments without giving notification. Ultimately, 24 participants completed all TMS sessions and QEEG assessments Response rate: NR Type of healthcare worker: various HCWs | |
| Interventions | Intervention characteristics Repetitive transcranial magnetic stimulation (rTMS)
Control (sham TMS)
| |
| Outcomes | Psychological strain
Beck’s depression inventory
Beck’s anxiety inventory
| |
| Identification | Sponsorship source: NR Country: South‐Korea Setting: Hospital Comments: NR Authors name: Young In Kim Institution: Department of Psychiatry, Chung‐Ang University Hospital, Seoul, Republic of Korea Email: [email protected] Address: Sun Mi Kim, MD, PhD Department of Psychiatry, Chung‐Ang University Hospital, 102 Heukseok‐ro, Dongjak‐gu, Seoul 06973, Republic of Korea Tel: +82‐2‐6299‐1519, Fax: +82‐2‐6298‐1508 Time period: NR | |
| Notes | PSY included in analysis 2.1 Beck’s depression inventory included in analysis 2.3 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Participants were randomly divided into two groups: the active‐TMS group and the sham‐TMS group. " Sequence generation process insufficiently described |
| Allocation concealment (selection bias) | Unclear risk | Difficult to judge whether participants and/or investigators could possibly foresee assignment |
| Blinding of participants and personnel (performance bias) | Low risk | Participants were randomly divided into two groups: the active‐TMS group and the sham‐TMS group. |
| Blinding of outcome assessment (detection bias) | Low risk | Participants were blinded and outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No intention to treat analysis. Among the 28 enroled participants, data from four participants were dropped because they did not complete the TMS sessions or QEEG assessment (14%): one participant from the active‐TMS group and one participant from the sham‐TMS group discontinued the TMS sessions due to headache and one participant from the active‐TMS group and one participant from the sham‐TMS group missed their QEEG appointments without giving notification. Ultimately, 24 participants completed all TMS sessions and QEEG assessments. Missing not at random however below our pre‐defined cut‐off value. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one online. No indication of selective reporting. |
| Other bias | Unclear risk | Not able to assess response rate. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Dog
Coloring
Control (no intervention)
Overall
Included criteria: emergency care providers, including nurses, residents, and physicians on duty in the ED of Eskenazi hospital Excluded criteria: provider statement of dislike, allergy, fear or other reason to not interact with a therapy dog, and prior enrolment Pretreatment: no significant differences in age and gender between the two experimental groups and the control group. Authors did not report any other results. Compliance rate: 127 eligible and 122 participated in at least 50% of the intervention thus > 96% Response rate: NR Type of healthcare worker: nurse, physician resident | |
| Interventions | Intervention characteristics Dog
Colouring
Control (no intervention)
| |
| Outcomes | Perceived Stress Scale (PSS)
Stress (VAS)
| |
| Identification | Sponsorship source: NR Country: USA Setting: Hospital Comments: NR Authors name: Jeffrey A Kline Institution: Indiana University School of Medicine, Indianapolis Email: [email protected] Address: Indiana University School of Medicine, Indianapolis Time period: 2018 | |
| Notes | Author J Kline kindly provided the mean and SD of the primary outcome for the intervention groups. Modified PSS included in analysis 2.1. Intervention groups combined to create a single pair‐wise comparison | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "were randomized by preprinted random sequence to receive either exposure to a therapy dog or to coloring a mandala." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up |
| Selective reporting (reporting bias) | Low risk | Trial registration NCT03628820. No selective outcome reporting. |
| Other bias | Unclear risk | Response rate not reported. |
| Study characteristics | ||
| Methods | RCT, Brazil | |
| Participants | 75 nurses at the Teaching Hospital of the University of São Paulo. Quote: "In order to define the sample of participants, the authors used the Stress Inventory or Stress Symptoms List – SSL. This instrument was applied to all subjects who agreed to participate in the study (N = 109); however, only subjects who achieved mean (29 to 60 points), high (61 to 120 points) or very high (>120 points) scores were included in the sample; 75 of them completed the study. As for the distribution of the participants, 22 subjects were placed in the Control Group, 27 in the Needles Group and 26 in the Seeds Group." (p. 88) Quote: "The inclusion criteria were: belonging to the nursing team; voluntary participation in the study with availability to attend the sessions; obtaining a minimum SSL score at mean, high and very high stress level; not being pregnant. The authors excluded from the sample all the subjects who went on vacation or medical leave after the beginning of the study; did not show up to the session or gave up due to adverse effects, and those who had low SSL score." (p. 88) | |
| Interventions | 1) Experimental 1: Auriculotherapy (form of acupuncture performed on the ears) with needles (n = 27) 2) Experimental 2: Auriculotherapy with seeds (n = 26) 3) Control: No intervention(n = 22) "The intervention groups received eight sessions (one session a week), with duration of 5 to 10 minutes each session, on the Shenmen, Kidney and Brainstem points. The first two points have calmative properties and the kidney point has energetic function. After the location of the reactive points with a point locator, the ear auricle was hygienized with cotton and ethyl alcohol 70% and, then, semi‐permanent needles were applied or seeds were fixed with adhesive plaster, according to the intervention group. In the group of auriculo therapy with seeds, mustard seeds were used, and the participants were instructed to stimulate them three times a day, for 15 times, with moderate pressure. The volunteers were instructed to remove the needles or seeds 24 hours before the session and, in case there was any discomfort, itching or signs of allergy, they should remove them before that." (p. 88) | |
| Outcomes | Stress Symptoms List | |
| Identification | ||
| Notes | SSl included in analysis 2.1. Intervention groups combined to create a single pair‐wise comparison. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "This randomized controlled clinical experiment was performed with three groups..." (p. 88) |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | "...there was a loss of 34 subjects during the study. Seven professionals went on vacation after the beginning of the study and two on medical leave; 12 missed the session because they had forgotten it, due to traffic problems or the difficulty to reschedule it and seven did not show up for the first session. One participant gave up due to adverse effects, in this case, nightmares, and five exclusions were due to low score (1), not belonging to the nursing team (3), and not filling out properly the questionnaires (1)." (p. 89) The authors do not report how the dropouts were distributed among the study groups. |
| Selective reporting (reporting bias) | High risk | The authors present data separately for participants who had high SSL scores to begin with in table 2 but not at all for participants with a moderate SSL score. |
| Other bias | Low risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Auriculotherapy (protocol group)
Auriculotherapy (no protocol group)
Control (no intervention)
Overall
Included criteria: voluntary participation in the study with the availability of time to attend the sessions, and obtaining a score in the SSL indicating a medium or high level of stress. Excluded criteria: nephrolithiasis with surgical indication (the Kidney point can stimulate the expulsion of stones), performing another energy therapy, taking anxiolytic or anti‐depressant medication, or being pregnant. Pretreatment: NR Compliance rate: NR Response rate: 175 of the 213 (82%) eligible nurses participated Type of healthcare worker: nurses | |
| Interventions | Intervention characteristics Auriculotherapy (protocol group)
Auriculotherapy (no protocol group)
Control (no intervention)
| |
| Outcomes | Vasconcelos’ Stress Symptoms List (SSL)
| |
| Identification | Sponsorship source: NR Country: Brasil Setting: Hospital Comments: NR Authors name: Leonice Fumiko Sato Kurebayashi Institution: Doctoral student, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil. Email: [email protected] Address: Maria Júlia Paes da Silva Universidade de São Paulo. Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 409Bairro: Cerqueira César CEP: 05409‐000, São Paulo, SP, Brasil Time period: 2011 | |
| Notes | SSL included in analysis 2.1. Intervention groups combined to create a single pair‐wise comparison | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "using numbers randomly generated by the site www.randomizer.org" |
| Allocation concealment (selection bias) | Unclear risk | Difficult to judge whether participants and/or investigators could possibly foresee assignment. However, it is assumed that randomisation was performed in one go and that participants and/or investigators could not foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up. |
| Selective reporting (reporting bias) | Low risk | Protocol registration checked, no selective reporting. |
| Other bias | Unclear risk | 'Loosely' validated outcome measure. Compliance rate not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mono‐sensory
Bisensory
Multisensory
Control (no intervention)
Overall
Included criteria: female health professionals aged between 18 and 60 years old who worked in healthcare or healthcare‐related areas Excluded criteria: relevant dermatological findings, women who worked at night or alternating shifts (due to the known chronobiological changes that could affect the outcomes in this study), as well as women who were pregnant or lactating. Pretreatment: reported socio‐demographic baseline characteristics of participants randomised to the intervention group were similar to socio‐demographic baseline characteristics of participants randomised to the control group. Compliance rate: we were surprised by the lack of time and availability of participants to take part in the study. Although many participants were interested in participating during the recruitment stage, they showed poor compliance and did not attend subsequent evaluations, especially those scheduled for 15 days and 30 days following the study (follow‐up). Response rate: of the 374 eligible participants 123 were randomised (33%) Type of healthcare worker: nurses | |
| Interventions | Intervention characteristics Mono‐sensory
Bisensory
Multisensory
Control (no intervention)
| |
| Outcomes | The ISS Inventory of Symptoms of Stress
| |
| Identification | Sponsorship source: Hospital Isrealita Albert Einstein Country: Brasil Setting: Private hospital Comments: NR Authors name: Eliseth Ribeiro Leão Institution: Research Institute, Hospital Israelita Albert Einstein. São Paulo, Brazil Email: [email protected] Address: NR Time period: 2014 | |
| Notes | Dichotomous outcome measure that we could not enter into the meta‐analysis | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "signed an informed consent form. Then, we randomized participants and conducted a pilot test with seven volunteers to evaluate any necessary adjustments to the study (1 control participant, and two participants for each of the intervention groups). Participants were randomized using opaque, sealed and numbered envelopes and then ran‐ domly selected using a computer program with numbers generated by the Research Randomizer1 in order to distribute participants among the four arms of the study: |
| Allocation concealment (selection bias) | Unclear risk | Participants were randomized using opaque, sealed and numbered envelopes and then randomly selected using a computer program with numbers generated by the Research Randomizer in order to distribute participants among the four arms of the study. The enrolment occurred continuously from July to October, 2014. The follow‐up of each participant was always performed 30 days after the end of the intervention. The study was conducted at a single center. Data collection was completed in December 2014. Difficult to judge whether participants and/or investigators could possibly foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes were self‐report. |
| Incomplete outcome data (attrition bias) | High risk | 30 of the randomised participants were not included in the analysis (30/123 24%). Reasons provided. Not reported whether missing at random. |
| Selective reporting (reporting bias) | Low risk | Trial registration NCT02406755. No indication of selective reporting. |
| Other bias | Unclear risk | 251/374 (67%) did not want to participate. Low compliance ‐> We were surprised by the lack of time and availability of participants to take part in the study. Although a large number of participants were interested in participating during the recruitment stage, they showed poor compliance and did not attend subsequent evaluations, especially those scheduled for 15 days and 30 days following the study (follow‐up). |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline Characteristics Enhanced stress resilience training‐1 (ESRT‐1)
Control‐1 (no intervention)
Enhanced stress resilience training‐2 (ESRT‐2)
Control‐2 (no intervention)
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: reported socio‐demographic baseline characteristics of participants randomised to the intervention group were similar to socio‐demographic baseline characteristics of participants randomised to the control group Compliance rate: 89 assigned to intervention 50% actually participated Response rate: NR Type of healthcare worker: post‐graduate residents and surgeons | |
| Interventions | Intervention characteristics Enhanced stress resilience training‐1 (ESRT‐1)
Control‐1 (no intervention)
Enhanced stress resilience training‐2 (ESRT‐2)
Control‐2 (no intervention)
| |
| Outcomes | Cohen's Perceived Stress Scale (PSS‐10)
Maslach Burnout Inventory ‐ emotional exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
| |
| Identification | Sponsorship source: NR Country: USA Setting: Hospital Comments: NR Authors name: Carter C. Lebares Institution: Department of Surgery, University of California, San Francisco Email: [email protected] Address: NR Time period: 2016‐2017 | |
| Notes | PSS included in analysis 2.1 and 2.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "In 2016 and 2017, we conducted a partially‐blinded, pilot, parallel group randomized trial (NCT#03141190) with 1:1 allocation of PGY‐1 residents to ESRT‐1 (n ¼ 23) versus active Control‐1 (n ¼ 21). ESRT‐1 participants (100% surgical) were" Computer‐generated randomization |
| Allocation concealment (selection bias) | Unclear risk | One male control mistakenly attended the first week of ESRT‐2 and was allowed to continue in the intervention arm |
| Blinding of participants and personnel (performance bias) | Unclear risk | Although participants were blinded to assignment and asked not to discuss class content between arms, communication was certainly possible and should be considered in evaluating our results. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Although participants were blinded to the assignment and asked not to discuss class content between arms, communication was certainly possible and should be considered in evaluating our results. Outcomes are self‐report. |
| Incomplete outcome data (attrition bias) | Low risk | Total absences were minimal (10%) across all trials, populations, and conditions; 80% were attributable to scheduled vacations or emergent patient situations. The remainder were attributable to over‐sleeping. Attrition was limited to two female participants (both nonsurgical), who dropped from ESRT‐2 (intervention arm) due to disinterest in performing home practice and feeling ‘‘overloaded’’ by additional obligations.Participants who did not complete the study felt more overloaded however loss to follow‐up is below our pre‐defined cut‐off point. |
| Selective reporting (reporting bias) | Low risk | Trial registration NCT03141190NCT03518359. No indication of selective reporting. |
| Other bias | Low risk | No indication of other sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial, Taiwan | |
| Participants | 60 hospital nurses suffering from either: insomnia, headache or gastrointestinal discomfort. | |
| Interventions | 1) Experimental: assertiveness training: six 2‐hour sessions on Monday, Wednesday and Friday at 2pm to 4pm on two consecutive weeks. The contents of sessions included the concept of beliefs and negative self‐statements, building a positive belief system, applying assertion to clinical settings and developing group and self‐reinforcement support systems. | |
| Outcomes | Perceived Stress Scale, Rathus Assertiveness Schedule | |
| Identification | ||
| Notes | PSS included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "Subjects were randomly assigned to one of two treatments: assertiveness training (AT) or alternate treatment control (ATC), which served as a control and contained updated knowledge of new computer technology for in patient settings." (p. 419) |
| Allocation concealment (selection bias) | Unclear risk | "Subjects admitted to the study agreed to random treatment assignment and a 2‐month commitment to the study. However, the subjects did not know whether they would receive treatment or control procedures during that time." (p. 425) Difficult to judge whether participants and/or investigators could possibly foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | "Of the respondents who initially chose to participate, three did not complete the study and were not included in the data analysis due to their failure to attend all sessions, failure to complete the questionnaire, or decision to leave hospital employment." (p. 425) Loss to follow‐up is below our review pre‐defined cut‐off point (three of the 60 (0.05%)) |
| Selective reporting (reporting bias) | Low risk | All outcomes reported. |
| Other bias | Low risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Psychotherapy
Control (no intervention)
Overall
Included criteria: the participant must be a practising physician of the primary healthcare system in Almaty (Kazakhstan), he/she should have at least one year of work experience; he/she must provide signed informed consent. Excluded criteria: incomplete filling out of questionnaires, refusal to participate in the study, lack of informed consent, dismissal from work. Pretreatment: according to the results, there was no statistically significant difference between age, gender, marital status and speciality of doctors in the two groups. Type of healthcare worker: exclusively doctors involved in primary healthcare Response rate: 93% Compliance rate: 23% | |
| Interventions | Intervention characteristics Psychotherapy
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
| |
| Identification | Sponsorship source: NR Country: Republic of Kazakhstan Setting: Two out‐patient‐clinics Comments: NR Authors name: Sergey Lee Institution: S.D. Asfendiyarov Kazakh National Medical University Email: [email protected] Address: Tole Bi Street 94, Almaty, 050000, Kazakhstan Time period: 2019 | |
| Notes | MBI‐EE included in analysis 1.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Participants were assigned with an individual number, after which they were randomized using online random tools (experimental and control groups into two groups): |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | 112 of the 243 randomised participants included in the analyses. Not reported whether lost to follow‐up was at random. |
| Selective reporting (reporting bias) | Unclear risk | No trial protocol reported, nor did we find one online. |
| Other bias | Low risk | No indication of other bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Auricular acupressure (experimental)
Control (placebo acupressure)
Overall
Included criteria: Outpatient nurses who were over 20 years of age and working in a medical institution with no experience of receiving auricular acupressure. Excluded criteria: Those who were receiving complementary or alternative therapies; those taking antidepressants, anticonvulsants, or sleeping pills; and those with skin integrity problems were excluded from the study. Pretreatment: No statistically significant differences emerged between the two groups on stress, anxiety, depression, and physiological index Type of healthcare worker: Exclusively outpatient nurses Response rate: 100% Compliance rate: 90% | |
| Interventions | Intervention characteristics Auricular acupressure (experimental)
Control (placebo acupressure)
| |
| Outcomes | Perceived Stress Scale (PSS)
Beck Depression Inventory‐II (BDI‐II)
State‐Trait Anxiety Inventory (STAI)
| |
| Identification | Sponsorship source: NR Country: South Korea Setting: A medical institution Comments: NR Authors name: Hyojung Park Institution: College of Nursing, Ewha Womans University Email: [email protected] Address: 52, Ewhayeodae‐gil, Seodaemun‐gu, Seoul 03760, South Korea Time period: June 2018 to August 2018 | |
| Notes | PSS included in analysis 2.1 Beck Depression Inventory‐II (BDI‐II) included in analysis 2.3 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Participants for the experimental group and the control group were selected through randomization. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | Low risk | Participants were blinded. |
| Blinding of outcome assessment (detection bias) | Low risk | Participants were blinded and outcomes are self‐reported |
| Incomplete outcome data (attrition bias) | Low risk | 54 of the 60 randomised participants included in the analyses. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Low risk | No indication of other risk of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Yoga
Control (no intervention)
Overall
Included criteria: the inclusion criteria consisted of mental health professionals who were not involved in a formal exercise program and who were willing to participate in this study. Excluded criteria: exclusion criteria included pain due to injuries to shoulders, waist, or lower back, and musculoskeletal diseases such as muscle strains, that made participants unsuitable to participate in this study. Pretreatment: the demographic characteristics of the two groups, including gender, marital status, religious reference, educational status, job title, and age, showed no significant differences. The total scores of pretest stress adaptation between yoga and control groups did not reach statistical significance. The total scores of pretest work‐related stress between the two groups reached statistical significance. Thus, we took the total scores of pretest work‐related stress as a covariate to control for possible confounding. Type of healthcare worker: mental health professionals in a teaching hospital, but 38% non‐medical nor nursing staff Response rate: 80% Compliance rate: 100% | |
| Interventions | Intervention characteristics Yoga
Control (no intervention)
| |
| Outcomes | Work‐related stress scale
Stress adaptation scale
| |
| Identification | Sponsorship source: Funding for this study was provided by a grant RA12042 from Changhua Show Chwan Memorial Hospital and a grant MOST‐103‐2314‐B‐166‐003 from the Minister of Science in Taiwan Country: Taiwan Setting: A teaching hospital Comments: NR Authors name: Shu‐Hui Yeh Institution: Central Taiwan University of Science and Technology–Nursing Email: [email protected] ; [email protected] Address: No.666 Buzih Road, Beitun District, Taichung City 40601, Taiwan Time period: NR | |
| Notes | Stress adaptation scale (higher is better) included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | This study was a single‐blind, parallel‐arm randomized controlled trial in which the analyzer was unaware of which group was the experimental or control group. The intervention consisted of a series of weekly, 60‐minute yoga classes over a 12‐week period (Figure 1). Those who were assigned to the control group participated in a free tea time during which they watched television and did not exercise. The participants each signed an informed consent prior to enroling in the study. Then, the participants signed the informed consent form and were randomly assigned to yoga or control groups by drawing lots. There were 30 participants each in the yoga and control groups. It was expected that the two groups were homogeneous through drawing lots of random allocation. |
| Allocation concealment (selection bias) | High risk | Then, the participants signed the informed consent form and were randomly assigned to yoga or control groups by drawing lots. There were 30 participants each in the yoga and control groups. It was expected that the two groups were homogeneous through drawing lots of random allocation. |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Unclear risk | Statistically significant baseline differences on stress. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mindfulness‐based group intervention
Control (wait list)
Overall
Included criteria: being employed as a full‐time nurse Excluded criteria: (a) being a student nurse, (b) suffering from serious somatic disease, (c) taking mood‐regulating drugs, (d) having suffered a major traumatic event in the past 6 months, and (e) having participated in mindfulness training previously. Pretreatment: no significant differences were observed between the two groups for any of the demographic characteristics. Type of healthcare worker: exclusively nurses Response rate: NR Compliance rate: 82% | |
| Interventions | Intervention characteristics Mindfulness‐based group intervention
Control (wait list)
| |
| Outcomes | Perceived Stress Scale (PSS)
| |
| Identification | Sponsorship source: This study was supported by a grant from the General Program of Science and Technology Plan for Health Care in Dongguan City of Guangdong Province. The funder played no role in the study design, data collection, data analysis, manuscript preparation, or decision to publish the report. Country: China Setting: Two general hospitals Comments: NR Authors name: Guoping He Institution: Xiangya Nursing School of Central South University Email: [email protected] Address: No. 172, Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China Time period: 2017 | |
| Notes | PSS included in analysis 1.1 and 1.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "utilized a randomized controlled design.Eligible participants were randomized 1:1 using a computer‐generated random number table to the intervention group or the wait‐list control group." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Unclear risk | Response rate not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Authentic Connections Groups
Control (no intervention)
Overall
Included criteria: inclusion required at least one child 18 years of age or younger. Excluded criteria: NR Pretreatment: other than the difference in proportion of NP/PAs and physicians, the intervention and control groups did not differ in demographics, baseline adjustment or cortisol levels. Type of healthcare worker: female (physicians, PhD’s in clinical practice, NPs, and PAs) Response rate: NR Compliance rate: 100% | |
| Interventions | Intervention characteristics Authentic Connections Groups
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment
Beck Depression Inventory
| |
| Identification | Sponsorship source: This study was supported by a Seed fund from Arizona State University to Luthar. Mayo Clinic funded and supported medical‐care professionals’ time to participate in study activities Country: United States Setting: Mayo Clinic Comments: NR Authors name: Suniya S. Luthar Institution: Department of Psychology, Arizona State University, Tempe, Arizona Email: [email protected] Address: 950 S. McAllister Drive, Tempe, AZ85281 Time period: February to November 2015 | |
| Notes | MBI‐EE included in analysis 4.1 Beck Depression scale included in analysis 4.4 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Participants were assigned randomly to the ACG intervention group (n ¼ 21) or to the control group (n ¼ 19)" |
| Allocation concealment (selection bias) | Unclear risk | Not mentioned. |
| Blinding of participants and personnel (performance bias) | Low risk | Quote: "With blinded random assignment," |
| Blinding of outcome assessment (detection bias) | Low risk | Participants were blinded and outcomes self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "On psychological measures, one participant was missing data on parenting stress at follow‐up. On biological measures, pregnancies and maternity leaves precluded draws from one woman throughout, and from two at the follow‐up. An additional two could not schedule times to provide samples at follow‐up, and two were statistical outliers and removed from the analysis (> 2 SD from the mean)." |
| Selective reporting (reporting bias) | Unclear risk | No trial registration nor did we find one online. |
| Other bias | Unclear risk | Response rate not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Psychosocial Resiliency Training
Control (no intervention)
Overall
Included criteria: inclusion criteria were (1) employment as a hospital doctor, (2) working at least full time, (3) work‐ing experience of less than a year, (4) being able and willing to participate, and (5) agreement to complete a survey at least two times. Excluded criteria: NR Pretreatment: baseline data on gender, age, and perceived health indicate only small, insignificant differences between the control and the intervention group. Type of healthcare worker: exclusively junior physicians Response rate: NR Compliance rate: 89% | |
| Interventions | Intervention characteristics Psychosocial Resiliency Training
Control (no intervention)
| |
| Outcomes | Perceived Stress Questionnaire (PSQ)
| |
| Identification | Sponsorship source: NR Country: Germany Setting: Hospital: several clinic departments specialising in different medical specialities (e.g., internal medicine, paediatrics, neurology, and gynaecology). Comments: NR Authors name: Stefanie Mache Institution: Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg‐Eppendorf Email: [email protected] Address: Seewartenstrasse 10, 20459 Hamburg, Germany Time period: February to August 2014 | |
| Notes | PSQ included in analysis 1.1, 1.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Quote: "physicians were randomized into an intervention and control group. Of" |
| Allocation concealment (selection bias) | Unclear risk | Not mentioned. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Unclear risk | Response rate not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Self‐care health intervention programme
Control (no intervention)
Overall
Included criteria: study participation requires positive inclusion criteria: (1) employment as a psychiatrist in a psychiatric department, (2) working full time, (3) being able and willing to take part in the study, (4) agreement to complete a survey at least three times. Excluded criteria: NR Pretreatment: only small, insignificant differences between intervention and control group have been found in baseline data on gender, age and working experience. Statistically significant positive advance was found for perceived stress, resilience and self‐efficacy in the intervention group. Type of healthcare worker: exclusively physicians Response rate: 51% Compliance rate: 95% | |
| Interventions | Intervention characteristics Self‐care health intervention programme
Control (no intervention)
| |
| Outcomes | Perceived Stress Questionnaire (PSQ)
| |
| Identification | Sponsorship source: NR Country: Germany Setting: Twelve hospital departments in the North of Germany specialising in Psychiatry Medicine Comments: NR Authors name: Stefanie Mache Institution: Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg‐Eppendorf Email: [email protected] Address: Seewartenstrasse 10, 20459 Hamburg, Germany Time period: NR | |
| Notes | PSQ included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "study. These physicians were randomised into two groups through a computer‐generated algorithm." |
| Allocation concealment (selection bias) | Unclear risk | Quote: "The surveys were conducted by using a secure web‐based survey sys tem, via links within e‐mail messages." |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "76 participants; four needed to be excluded due to health reasons (sickness absence)." Loss to follow‐up below our review's pre‐defined cut‐off value. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Low risk | No indication of other bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Psychosocial competency training program
Control (wait list)
Overall
Included criteria: (1) regular access to the Internet, (2) working full time in the hospital, and (3) working experience of max. Two years (4) being able and willing to participate for the next 36 weeks, (5) agreement to complete the questionnaires, (6) no prior knowledge of or experience with a mental health promotion training. Excluded criteria: NR Pretreatment: baseline data on socio‐demographic differences indicated only small, insignificant differences between IG and CG (P > 0.05). Type of healthcare worker: junior physicians working in clinic departments of oncology and haematology medicine Response rate: 66% Compliance rate: 100% | |
| Interventions | Intervention characteristics Psychosocial competency training program
Control (wait list)
| |
| Outcomes | Perceived Stress Questionnaire (PSQ)
Maslach Burnout Inventory ‐ Emotional Exhaustion
| |
| Identification | Sponsorship source: NR Country: Germany Setting: Oncology and hematology hospital departments Comments: NR Authors name: Stefanie Mache Institution: Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg‐Eppendorf Email: [email protected] Address: NR Time period: NR | |
| Notes | MBI‐EE included in analysis 1.1, 1.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "participants were randomized with the ratio 50%:50% to the 2 study groups (IG or CG). The randomization was performed with a computer‐generated list of numbers." |
| Allocation concealment (selection bias) | Low risk | Quote: "This list was created by an independent assistant; the other assistant was blinded to the list, securing covered distribution to research conditions." |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "There was a total dropout rate (from randomization to analyses) of 10%. Eleven participants decided not to finish the study (reasons included illness and participants did not show up) and did not answer the questionnaires. Overall, 4% (3 of 80) of participants at T1, 6% (5 of 80) of partici‐ pants at T2, and 5% (4 of 80) of participants at T3 did not provide all follow‐up data for the outcomes. Participants who did not provide all follow‐up data did not differ in a meaningful way from those who provided data, neither on the primary outcome or any other baseline outcomes (P > .05)" |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Low risk | No indication of other bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mental health promotion program
Control (wait list)
Overall
Included criteria: inclusion criteria were as follows: (a) employment in emergency medicine, (b) working full‐time in the hospital, (c) working experience of less than 3 years, (d) being able and willing to participate, (e) agreement to complete the questionnaires, and (f) e‐mail access, availability of a computer, tablet, or a smartphone, and access to the Internet. Excluded criteria: exclusion criteria were as follows: (a) having any psychiatric illness, (b) taking any psychiatric drugs, (c) engaging any counselling service, and (d) parallel use of psychosocial counselling. Pretreatment: baseline data on socio‐demographic differences indicated only small, insignificant differences between the intervention and the comparison group. Type of healthcare worker: exclusively junior physicians Response rate: NR Compliance rate: 100% | |
| Interventions | Intervention characteristics Mental health promotion program
Control (wait list)
| |
| Outcomes | Perceived Stress Questionnaire (PSQ)
Maslach Burnout Inventory ‐ Emotional Exhaustion
| |
| Identification | Sponsorship source: NR Country: Germany Setting: Six hospitals: clinic departments of emergency medicine Comments: NR Authors name: Stefanie Mache Institution: Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg‐Eppendorf Email: [email protected] Address: Seewartenstrasse 10, 20459 Hamburg, Germany Time period: NR | |
| Notes | MBi‐EE included in analysis 1.1, 1.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "participants were randomized at a ratio of 1: 1 to the two study arms (intervention or control group). The randomization was performed with a computer‐generated list of numbers." |
| Allocation concealment (selection bias) | Low risk | Quote: "This list was generated by an independent research assistant; the other researcher was blinded to the list, ensuring concealed allocation to research conditions." |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 63 of the 70 randomised participants included in the analysis. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find on online |
| Other bias | Unclear risk | Response rate not reported. |
| Study characteristics | ||
| Methods | Randomised controlled trial, Canada | |
| Participants | 30 nurses and nurse aides working in a large urban geriatric teaching hospital | |
| Interventions | 1) Experimental: mindfulness‐based stress reduction programme: four 30‐minute group sessions including didactic section and experiential exercises. Participants also received a CD or audiocassette of guided exercises and a manual with the help of which they were instructed to practise for at least 10 minutes per day five days per week. | |
| Outcomes | MBI, Smith Relaxation Dispositions Inventory | |
| Identification | ||
| Notes | MBI‐EE included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | "Nurses and nurse aides were recruited from long‐term and complex continuing care units in a large urban geriatric teaching hospital and randomly assigned to intervention or wait‐list control groups. Because the study was conducted during the summer, however, several exceptions were made to accommodate participants' vacation schedules and additional control participants were recruited." (p. 106) |
| Allocation concealment (selection bias) | Unclear risk | Not reported. |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | It is unclear if any participants dropped out. |
| Selective reporting (reporting bias) | Low risk | All outcomes reported |
| Other bias | Low risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Structured Yoga Program
Control (wait list)
Overall
Included criteria: Working at the hospital for at least 1 year. Excluded criteria: We excluded those who were already under pharmacological treatment for any psychiatric disorder at the time of enrolment; having service left for less than a year (from the date of enrolment); any clinical condition that would affect the ability to practice yoga. Pretreatment: the baseline characteristics were comparable in both the groups except sex, where a higher proportion of males were present in the wait‐list group. The main outcome parameters were similar in both groups. As per the per‐protocol analysis the baseline parameters also showed the similar findings. Type of healthcare worker: exclusively in‐service nursing staff working at the hospital Response rate: 97% Compliance rate: 42% | |
| Interventions | Intervention characteristics Structured Yoga Program
Control (wait list)
| |
| Outcomes | Perceived Stress Scale (PSS)
| |
| Identification | Sponsorship source: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: All the lab investigations were done free of cost for the participants. The necessary requirements were provided from the institution where I work. Country: India Setting: A tertiary care hospital Comments: NR Authors name: Puneet Misra Institution: Centre for Community Medicine, Room No. 30, Centre for Community Medicine, Old OT Block, All India Institute of Medical Sciences Email: [email protected] Address: Ansarinagar East, 110029, Delhi, India Time period: 2018 | |
| Notes | Included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The investigation team collected unpredictable allocation sequence [using computer software and permuted block randomization] generated by a third party not involved in the study. The block size was multiple of 2 and variable in size." |
| Allocation concealment (selection bias) | Unclear risk | Quote: "After the baseline assessment was over, the sealed opaque envelop at her/his respective enrolment number was opened in front of the participants to maintain the allocation concealment. The participants were allocated in either of the 2 groups; intervention i.e. yoga group or the wait‐listed group." Difficult to judge whether participants and/or investigators could possibly foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "Masking of the allocated group was not feasible in the study."
|
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | Quote: "Of the 52 participants joining the class, 25 participants discontinued in the first month, 5 participants in the second month and 3 participants in the third month. Therefore, the remaining 19 participants completed the minimum required 20 yoga sessions. At the end of the 12 weeks of follow up, 19 participants of intervention group and 32 participants of wait‐list control group was included in the analysis." Judgement Comment: > 20% loss to follow‐up |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Low risk | No indication of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Emotional intelligence training
Control (daily training)
Overall
Included criteria: the inclusion criterion was the possession of Chinese nurses' practice qualification certificates. Excluded criteria: the exclusion criteria were as follows: (a) suffering from serious physical or mental illness; (b) taking psychotropic drugs; (c) nursing staff who took maternity leave, sick leave, retirement, or further study in the study period; (d) had participated in systematic EI training before; and (e) had worked in a psychiatric ward. If participants in the intervention group were absent twice, they were excluded from the study. Pretreatment: there were no statistically significant differences in demographic characteristics between the two groups at baseline. Type of healthcare worker: exclusively nurses Response rate: 76% Compliance rate: 81% | |
| Interventions | Intervention characteristics Emotional intelligence training
Control (received daily briefings in meetings between head nurses, which were held regularly to discuss specific problems. There was no emotional intelligence training conducted with the control group.)
| |
| Outcomes | Perceived Stress Scale (PSS)
| |
| Identification | Sponsorship source: This study was supported by the Nursing Research Project of The Second Xiangya Hospital, Central South University (2017‐YHL‐15). Country: China Setting: NR Comments: NR Authors name: LingZhi Huang, QiongNi Chen Institution: The Second Xiangya Hospital, Central South University Email: [email protected], [email protected] Address: 139 Renmin Middle Road, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China. Time period: January 2019 ‐ January 2020 | |
| Notes | PSS included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Ten wards were randomly assigned to the intervention group and ten to the control group." |
| Allocation concealment (selection bias) | Unclear risk | Difficult to judge whether participants and/or investigators could possibly foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "Overall, the intervention and control groups lost 10 and 5 participants, respectively." 15 of the 103 randomised participants lost to follow‐up, which is below our pre‐defined cut‐off value. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Low risk | No indication of other bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial, Argentina | |
| Participants | 74 hospital paediatric resident physicians. " A total of 81% were female; the mean age was 27.3 ± 1.4 years; 57% were working in inpatient areas, 35% in the outpatient clinic, and 8% in the intensive care unit." " A comparison of the characteristics of both groups (experimental and control) revealed no significant differences." (p. 494) | |
| Interventions | 1) Experimental: self‐care workshop intervention (n = 37). quote: "The experimental group received a brief intervention consisting of two 2.5‐hour workshops directed by mental health professionals, which covered repercussions of burnout syndrome on professional activity, recognition of risk indicators for burnout syndrome, and tools to cope (identification of strengths, coping behaviors, preventive and self‐care behaviors)." (p. 494) 2) Control: (n = 37) No intervention | |
| Outcomes | MBI | |
| Identification | ||
| Notes | It is unclear why 43 (37%) out of the available 117 resident physicians did not participate in the study. Not able to include in analysis due to missing data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "After administration of the questionnaire, subjects were randomly assigned to one of the two study groups." (p. 494) |
| Allocation concealment (selection bias) | Unclear risk | Not reported. |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Apparently no participants were lost to follow‐up |
| Selective reporting (reporting bias) | Unclear risk | The authors do not report standard deviations with the mean MBI subscale scores. |
| Other bias | Unclear risk | It is unclear if these 74 were all the participants or only those that could be followed up. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Acceptance and mindfulness workshop
Control (wait list)
Overall
Included criteria: inclusion criteria were that participants were over 18 years, able to provide informed consent, and had at least six months experience of working within ID services. Excluded criteria: NR Pretreatment: no significant differences were found between the intervention and control groups in relation to age, experience of working in ID services, hours worked per week, gender, professional qualifications or education. Type of healthcare worker: Support staff involved in the direct care of individuals with ID. Response rate: 100% Compliance rate: 85% | |
| Interventions | Intervention characteristics Acceptance and mindfulness workshop
Control (wait list)
| |
| Outcomes | Staff Stressor Questionnaire (SSQ)
General Health Questionnaire (GHQ‐12)
| |
| Identification | Sponsorship source: NR Country: NR Setting: Independent care organisations working with individuals with ID Comments: NR Authors name: Douglas AlexanderJames McConachie Institution: University of Edinburgh, Department of Clinical Psychology, School of Health in Social Science Email: [email protected] Address: University of Edinburgh, Teviot Place, Edinburgh, Scotland EH8 9AG, UK Time period: NR | |
| Notes | GHQ included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Permuted block randomisation was used to generate quasi‐random numbers (www.jerrydallal.com/random/ random_block_size.htm) to allocate the 120 participants to the intervention or control conditions (see Fig. 1)." |
| Allocation concealment (selection bias) | High risk | Quote: "there was no allocation concealment, and the allocation of staff to the two conditions was not fully adhered to by line managers." |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "The latter factor is a particular source of potential bias, as the reason the participants changed conditions is unknown. They may have either been particularly motivated to attend the workshop, or the line manager may have been keen for them to attend or not attend." |
| Blinding of outcome assessment (detection bias) | High risk | Participants not blinded whereas outcomes are self‐reported |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "There were similar levels of attrition from both the intervention and control group (see Fig. 1). The data was found to be missing completely at random (MCAR) (Schlomer, Bauman, & Card, 2010) considering all cases and outcome measures MCAR (P > 0.05) (X 2 = 30.686, df = 27, p = .284). The" 27.5 % lost to follow‐up ‐> MCAR |
| Selective reporting (reporting bias) | Low risk | No trial registration, no indication of selective reporting. |
| Other bias | Low risk | No indication of other bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Positive psychology‐based coaching intervention
Control (wait list)
Overall
Included criteria: inclusion criteria were currently working at least part‐time as a PCP (0.5 FTE clinical practice), having 25 years or less of experience as a PCP, and not planning to retire within two years. Excluded criteria: potential participants were screened for psychological distress using the SCL‐10 (Nguyen et al.,1983). We used the cut‐off score determined by Müller et al. (2010) of 4.0 to indicate those with high levels of psychological distress and a licenced mental health professional was retained to speak with those who reported a level of distress ≥ 4.0. All participants attained scores < 4.0 Pretreatment: no demographic variables were significantly different between the primary and wait‐listed groups. Type of healthcare worker: exclusively Primary Care Physician Response rate: 100% Compliance rate: 97% | |
| Interventions | Intervention characteristics Positive psychology‐based coaching intervention
Control (wait list)
| |
| Outcomes | Stress in General Scale
Maslach Burnout Index
| |
| Identification | Sponsorship source: This project was supported by the Institute of Coaching at McLean Hospital, Harvard Medical School affiliate. Country: United States Setting: Four medical practices in a large city (both community and hospital‐based settings). Comments: NR Authors name: Alyssa McGonagle Institution: University of North Carolina at Charlotte Email: [email protected] Address: 9201 University City Boulevard, Charlotte, NC 28223‐0001 Time period: NR | |
| Notes | MBI ‐ one combined scale included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "and received a participant code. Eligible participants then completed an initial survey assessing all outcome measures, and were randomized using a coin flip into either an immediate start coaching group (primary) or wait‐listed control group with a six‐month delay. |
| Allocation concealment (selection bias) | Unclear risk | Not mentioned. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up. |
| Selective reporting (reporting bias) | Low risk | No trial registration, no indication of selective reporting. |
| Other bias | Unclear risk | Judgement Comment: The authors combined the MBI into one scale, which is not according to the MBI handbook. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Multimodal resilience training program
Control (no intervention)
Overall
Included criteria: nurses were eligible to participate if they (1) were currently working 20 hours per week at the ICU bedside, (2) had no underlying medical condition that would be a contraindication to exercise, and (3) scored 82 or less on the Connor‐Davidson Resilience Scale (CD‐RISC). Excluded criteria: nurses were excluded from participating if they (1) were unable to participate in a two‐day educational workshop or (2) had a medical condition that would limit exercise. Pretreatment: measures of PTSD, burnout syndrome, resiliency, and symptoms of anxiety or depression did not differ significantly between the 2 groups. Type of healthcare worker: exclusively ICU nurses Response rate: NR Compliance rate: 93% | |
| Interventions | Intervention characteristics Multimodal resilience training program
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional exhaustion
Maslach Burnout Inventory ‐ Depersonalization
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
The Hospital Anxiety and Depression Scale (HADS)
| |
| Identification | Sponsorship source: This study was funded by a grant from the National Institutes of Health (grant number K24 HL‐089223‐07). Country: United States Setting: An academic institution Comments: NR Authors name: Meredith Mealer Institution: Pulmonary Sciences and Critical Care Medicine, University of Colorado Email: [email protected] Address: Anschutz Medical Center, 12700 E 19th Ave, C‐272, Aurora, CO 80045 Time period: 2012‐2013 | |
| Notes | MBI‐EE included in analysis 4.1 HADS included in analysis 4.4 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "An honest broker was used to ensure that participants’ responses remained anonymous. The honest broker was not part of the study team, assigned unique identification numbers to participants, and then linked individual participants’ information with those identification numbers. |
| Allocation concealment (selection bias) | Unclear risk | See above Difficult to judge whether participants could possibly foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "All data were entered into the REDCap data management system 30 by using unique study identfication numbers so that study personnel remained blinded to the identity of the participants. Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "randomized to the control arm. Two participants withdrew from the study before the start of the 12‐week training period: 1 from the intervention arm and 1 from the control arm. Therefore, 27 participants participated" |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Unclear risk | Response rate not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline Characteristics Interventions about the psychology of burnout, stress, coping with patient death, and managing distress
Control (no intervention)
Overall
Included criteria: doctors who currently practice medicine, have regular contact with patients Excluded criteria: NR Pretreatment: there were no significant differences between the two trial groups at baseline Type of healthcare worker: exclusively doctors Response rate: 89% Compliance rate: 78% | |
| Interventions | Intervention characteristics Interventions about the psychology of burnout, stress, coping with patient death, and managing distress
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment
General Anxiety Disorder
| |
| Identification | Sponsorship source: The RCT was not funded or determined by Focus Games or any organization involved with the app/board game. Country: United Kingdom Setting: Among nine randomly selected NHS trusts, 9 royal colleges of medicine, and the British Medical Association (BMA) Comments: NR Authors name: Asta Medisauskaite Institution: Research Department of Medical Education Email: [email protected] Address: UCL Medical School Room GF/644, Royal Free Hospital, NW3 2PF. Time period: From July to November 2016 | |
| Notes | MBI‐EE included in analysis 1.1. GAD included in analysis 1.4. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Qualtrics software randomly assigned doctors to one of 5 trial groups:" |
| Allocation concealment (selection bias) | Low risk | Quote: "Blindly to the researchers, Qualtrics software randomly assigned doctors to one of 5 trial groups:" |
| Blinding of participants and personnel (performance bias) | Low risk | Quote: "doctors were randomly and blindly assigned to one of 5 trial groups." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "The trial group was manipulated between‐subjects such that doctors were randomly and blindly assigned to one of 5 trial groups." Outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | Quote: "2.2.4. Sample" Loss to follow‐up: 25% intervention; 27% control |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Low risk | No indication of other bias. |
| Study characteristics | ||
| Methods | RCT, the Netherlands | |
| Participants | 161 psychiatric nurses in long‐stay settings | |
| Interventions | 1) Experimental: support and advice given by nurse managers or quality care co‐ordinators: Participants were assigned to patients as primary nurses and given advice by nurse managers or quality care co‐ordinators and they followed a training programme about communication skills over a year. | |
| Outcomes | MBI | |
| Identification | ||
| Notes | MBI‐EE included in analysis 3.3. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Random sampling was used to select 492 nurses to complete the questionnaires." (p. 696) |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | Quote: "Two main problems were encountered in this study, namely a high drop‐out rate largely due to job turnover among nurses, and the imitation of the intervention by the control group." (p. 697) A total of 51.6% of the participants dropped out during the study |
| Selective reporting (reporting bias) | Low risk | All outcomes reported. |
| Other bias | Low risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Self‐Care Traumatic Episode Protocol
Control (wait list)
Overall
Included criteria: participants were considered suitable for study inclusion if they met the following criteria: they were willing to participate voluntarily in treatment; they provided written consent; and were licenced mental health clinicians who had taken basic EMDR training. Excluded criteria: participants were excluded if they disclosed severe levels of clinical distress, if they were concurrently receiving psychological treatment during the study period, or if they endorsed suicidal intent. Pretreatment: NR Compliance rate: 94% Response rate: NR Type of healthcare worker: 34 participants included master’s level clinical social workers (n = 8), Canadian Certified Counsellors (n = 4), master’s or PhD‐level registered psychologists (n = 21), and psychiatrists (n = 1). | |
| Interventions | Intervention characteristics Self‐Care Traumatic Episode Protocol
Control (wait list)
| |
| Outcomes | Depression Anxiety Stress Scale (DASS‐21)
| |
| Identification | Sponsorship source: the authors received no specific grant or financial support for the research, authorship, and/or publication of this article. Country: Canada Setting: NR Comments: NR Authors name: Judy Moench Institution: Judy Moench Psychological Services Ltd. Email: [email protected] Address: #260, 10230 142 Street, NW Edmonton, AB, T5N 3Y6, Canada. Time period: June 2020 | |
| Notes | Included in analysis 4.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Using a randomisation sequence based on a random number table. |
| Allocation concealment (selection bias) | Unclear risk | Participants were randomized by a research assistant. Insufficient information to understand whether intervention allocations could have been foreseen by participants in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 5% lost to follow‐up. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Unclear risk | Response rate was not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Acceptance and Commitment Therapy (ACT)
Control (wait list)
Overall
Included criteria: the inclusion criteria were to be over 18 years old and have at least 6 months of experience in the ce Excluded criteria: NR Pretreatment: no significant group differences were found at baseline for demographics, neither for outcome measures. Compliance rate: 86% Response rate: 43% Type of healthcare worker: various | |
| Interventions | Intervention characteristics Acceptance and Commitment Therapy (ACT)
Control (wait list)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment
State‐Trait Anxiety Inventory (STAI) ‐ Anxiety‐Trait
| |
| Identification | Sponsorship source: Country: NR Setting: CSSV Ricard Fortuny Hospital: a center made up of 6 long‐term hospitalization units, two nursing home units, a day center and a palliative unit. Comments: NR Authors name: Xavier Montaner Institution: Consorci Sociosanitari Ricard Fortuny Email: [email protected] Address: Avinguda Garraf 3, 08720, Vilafranca del Penedés (Barcelona), Spain Time period: The study was carried out between May 2017 and September 2018 | |
| Notes | MBI‐EE included in analysis 4.1 and 4.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "randomly assigned" |
| Allocation concealment (selection bias) | Unclear risk | Not described |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "The drop‐out rate at the end of the intervention in the sample as a whole was 15.5%, 17.3% at 3 months of follow‐up, and 20% at 12 months of follow‐up. Although the attrition effect was higher in the IG, there were no statistically significant differences between groups drop‐out rates (Table 2)." |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Low risk | No indication of other bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Massage with aromatherapy
Control (no intervention)
Overall
Included criteria: under employment bond and working in the surgical centre for at least one year; acceptance to participate in the study, including the stages of the study protocol; score of at least 12 points on the List of Stress Symptoms (LSS); and olfactory acceptance of the Lavandula angustifolia and Pelargonium graveolens aromas. Excluded criteria: all workers on vacation or on leave during the data collection period, as well as pregnant women. Pretreatment: except for the variable of time in the institution, there were no differences with statistical significance, confirming homogeneity among the study groups. Type of healthcare worker: nursing staff workers (nurses and nursing technicians) Response rate: 81% Compliance rate: 100% | |
| Interventions | Intervention characteristics Massage with aromatherapy
Control (no intervention)
| |
| Outcomes | The List of Stress Symptoms (LSS)
Work stress scale (WSS)
| |
| Identification | Sponsorship source: NR Country: Brazil Setting: A surgical center of a teaching hospital Comments: NR Authors name: Juliana Montibeler Institution: Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Enfermagem Email: [email protected] Address: Rua Dr. José Barbosa de Barros, 1540 – Bloco 2 – Apto 106CEP 18610‐307 – Botucatu, SP, Brazil Time period: 2016 | |
| Notes | LSS included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Quote: "A draw was made to randomize participants into two groups:" |
| Allocation concealment (selection bias) | High risk | Quote: "Esc Enferm USP · 2018;52:03348 A draw was made to randomize participants into two groups. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find on online. |
| Other bias | Low risk | No indication of other bias. |
| Study characteristics | ||
| Methods | RCT with individual participants, USA | |
| Participants | Paediatric oncology staff (50% nurses, 20% physicians); Experimental 23 Control 24; Men: Experimental 30% Control 8%; Age: not reported; stated to be equal; Experience > 10 years: Experimental 48% Control 46% | |
| Interventions | 1) Experimental: 8 weeks of didactic and experiential mindfulness education via a structured, skills‐training course delivered in a group setting at their hospital. The course included 1 initial 6‐hour session; 6 weekly 1‐hour follow‐up sessions; and a final 3‐hour wrap‐up session (15 hours total class time) 2) Control: No intervention | |
| Outcomes | MBI; Perceived Stress Scale | |
| Identification | ||
| Notes | Authors provided additional data: SDs of MBI at follow‐up: Experimental: EE: 7.67; DP: 3.54; PA 3.69 Control: EE: 6.39; DP: 4.59; PA: 5.27 MBI‐EE included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Using a computer‐generated random numbers schema in blocks of ten |
| Allocation concealment (selection bias) | Unclear risk | Participants were stratified according to their respective professions and randomised to a mindfulness‐based course (intervention) or no intervention (control) |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | All participants reported outcomes |
| Selective reporting (reporting bias) | Low risk | All outcomes stated in the 'Methods' section reported. |
| Other bias | Low risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | RCT, USA | |
| Participants | 12 respiratory therapists | |
| Interventions | 1) Experimental: stress management programme: 8 weekly group sessions on average 60 minutes and a manual containing homework assignments to be completed between sessions. Topics covered were deep muscle relaxation, cognitive‐behavioural exercises to identify and examine stressful situations, replacing negative thoughts and emotions with adaptive rational cognitions, effective communication skills, social support networks and problem‐solving skills, physical fitness, nutrition and weight management and maintenance of behaviour change. | |
| Outcomes | MBI, C‐H Inventory of Phys Symptoms, The Hassles Scale, The Uplifts Scale | |
| Identification | ||
| Notes | MBI included in analysis 4.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "The 12 participating employees were randomly assigned to one of two conditions: 6 to an 8‐week stress management programme and 6 to a wait‐list control group." (p. 120) |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | There were no dropouts because of small sample size. |
| Selective reporting (reporting bias) | Low risk | All outcomes reported. |
| Other bias | Low risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Reiki treatment
Placebo condition
Control (no intervention)
Overall
Included criteria: inclusion criteria included identification of a moderate to high risk of STS as determined by the Professional Quality of Life scale: Compassion Satisfaction, Burnout, and Compassion Fatigue/Secondary Trauma subscales (ProQOL R‐V; Stamm, 2009) Excluded criteria: respondents who were not at moderate to high risk for STS were not included in the study sample. Additional exclusion criteria included having received a Reiki treatment or other energy modality in the past month and pregnancy. Pretreatment: the dependent variables did not differ at baseline among the three groups (Reiki, placebo, and control). Compliance rate: NR Response rate: 85% Type of healthcare worker: 51% social work professionals,42% social work student interns, 5% licenced professional counsellors (LPCs). | |
| Interventions | Intervention characteristics Reiki treatment
Placebo condition
Control (no intervention)
| |
| Outcomes | Professional Quality of Life ‐ Compassion Fatigue/Secondary Trauma
Symptom Questionnaire (SQ)
| |
| Identification | Sponsorship source: NR Country: United States Setting: One state in the Deep South Comments: NR Authors name: Martha P. Novoa Institution: energy practitioner at the White Horse Email: NR Address: Baton Rouge, LA Time period: Recruitment for the study started in January 2010 and ended in May 2011. | |
| Notes | Not able to include in analysis due to missing data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The researchers randomly assigned treatment conditions using three differ‐ently colored pebbles: orange corresponded to Reiki treatment, white corre‐sponded to the placebo condition, and blue corresponded to the control group. Thirty‐three pebbles of each color were put in a paper bag and mixed." |
| Allocation concealment (selection bias) | High risk | Quote: "The researcher pulled a random pebble from the bag and the participant was assigned to treatment according to the colour of the pebble. Once the pebble had been selected it was discarded." At the end of the randomisation the researcher could possibly foresee assignment as not many pebbles were left. |
| Blinding of participants and personnel (performance bias) | Low risk | Participants were blinded to treatment condition. |
| Blinding of outcome assessment (detection bias) | Low risk | Participants were blinded to treatment condition and outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Not recorded. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, no indication of selective reporting. |
| Other bias | Unclear risk | Compliance rate was not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Acceptance and Commitment Therapy
Control (wait list)
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: there were also no significant between‐group differences on any demographic measure at baseline or follow‐up (all P‐values > 0.20) Compliance rate: 87% Response rate: NR Type of healthcare worker: Nurses and nurse aides | |
| Interventions | Intervention characteristics Acceptance and Commitment Therapy
Control (wait list)
| |
| Outcomes | General Health Questionnaire (GHQ‐12)
| |
| Identification | Sponsorship source: This project was supported by a research grant provided by the Ohio Bureau Workers Compensation Ohio Occupational Safety and Health Research Program. Country: United States Setting: Nursing homes and assisted living facilities Comments: NR Authors name: William H. O’Brien Institution: Department of Psychology, Bowling Green State University Email: [email protected] Address: Bowling Green, OH 43403 Time period: NR | |
| Notes | GHQ included in analysis 4.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Interested participants were randomly assigned to the treatment or control group and then contacted by the project coordinators. An assessment session was then scheduled. Randomisation sequence generation process not described |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "participants were informed that they were either in the treatment group or wait‐list control group." |
| Blinding of outcome assessment (detection bias) | High risk | Quote: "This was described to them as the immediate treatment group or the delayed treatment group." Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "There were no significant differences in dropout rates between the ACT and control groups (Fisher’s exact test p = 0.36)." |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Unclear risk | Response rate was not reported. |
| Study characteristics | ||
| Methods | RCT, USA | |
| Participants | 58 staff members (64% nurses, 12% physicians and 24% other) of a large hospital | |
| Interventions | 1) Experimental: Eight‐Point Program Spiritual Skills Training: 8 weekly 2‐hour training sessions about meditation skills (passage meditation, mantram repetition, slowing down, focused attention, training the senses, putting others first, spiritual association and inspirational reading). | |
| Outcomes | Perceived Stress Scale, MBI, Medical Outcomes Study | |
| Identification | ||
| Notes | Included in analysis 2.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Details of randomisation were provided in a separate supplement to the article: "While participants were completing pretests, individuals were randomly assigned to treatment (n = 30) or wait‐list control (n = 31). Computer pre‐generated 1:1 random assignment tables had been prepared by the lead investigator for each potential number of registering participants, up to 60, for each session (precise number of registrants could not be anticipated). At each session, as participants completed pretests, their consent forms were rapidly assembled in an arbitrary order and given sequential numbers by the lead investigator or the main instructor. The total number of received consent forms dictated the appropriate random assignment table, which dictated how to separate the numbered consent forms into two groups." (p. S4) |
| Allocation concealment (selection bias) | Unclear risk | "Immediately following pretest, participants were informed of their group assignment. One or two weeks later, those in the treatment condition began the eight‐week training, meeting together in one large group." (p. S4) |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | "Selected characteristics of the 58 final participants included in the intention‐to‐treat analysis are displayed in Table 1" (p. 715) |
| Selective reporting (reporting bias) | Low risk | All outcomes reported. |
| Other bias | Unclear risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Psychological empowerment program
Control (no intervention)
Overall
Included criteria: scored less than 17 on the Beck Depression Inventory and did not have any diagnosed physical or mental disease. Excluded criteria: NR Pretreatment: NR Type of healthcare worker: exclusively nurses Response rate: 86% Compliance rate: 83% | |
| Interventions | Intervention characteristics Psychological empowerment program
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional exhaustion
Maslach Burnout Inventory ‐ Desensitization
Maslach Burnout Inventory ‐ Personal achievement
| |
| Identification | Sponsorship source: NR Country: Turkey Setting: Adult inpatient oncology clinics Comments: NR Authors name: Azize AtliO ̈zbas Institution: Hacettepe University Nursing Faculty, Psychiatric Nursing Department, Hacettepe Universitesi Hems ̧irelik Faku ̈ ltesi Email: [email protected] Address: 06100 Sıhhiye, Ankara, Turkey. Time period: NR | |
| Notes | MBI‐EE included in analysis 4.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Using a computerized black‐box randomization assignment program," |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "Some 8 nurses dropped out of the intervention group and 1 dropped of the control group," Nine of 82 randomised (11%) nurses were lost to follow‐up. This is below our pre‐defined cut‐off value. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Low risk | No indication of other bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Progressive muscle relaxation combined with music
Control (no intervention)
Overall
Included criteria: the eligible nurses included those who (a) were 18 years old, (b) had an experience of at least three months in ICUs, and (c) had no documented history of chronic obstructive pulmonary disease, heart failure and asthma. Excluded criteria: the exclusion criteria were as follows: (a) history of severe psychiatric disorder, (b) ICU experience of less than three months, and (c) not currently using any complementary therapy modalities such as acupuncture, massage therapy, relaxation techniques, and yoga that can be influential on perceived stress and fatigue or coping styles. Pretreatment: the study groups were homogeneous in terms of age, gender, marital status, educational level, income status, living with either their family or friends, comorbid conditions, experience in ICU, working hours per week and satisfaction levels with ICUs (P > 0.05). Compliance rate: 90% Response rate: 89% Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention characteristics Progressive muscle relaxation combined with music
Control (no intervention)
| |
| Outcomes | Perceived Stress Scale (PSS)
| |
| Identification | Sponsorship source: The author(s) received no financial support for the research, authorship, and/or publication of this article Country: Turkey Setting: University of Health Sciences, Ankara Gulhane Training and Research Hospital Comments: NR Authors name: Zehra Gok Metin Institution: Hacettepe University Email: [email protected] Address: Hacettepe University, Faculty of Nursing, 06000 Sihhiye, Ankara, Turkey. Time period: were recruited from 1 July 2018 to 15 January 2019. | |
| Notes | We kindly received the mean and SD from the author. PSS included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "were assigned randomly into two groups (Group A: 31; Group B: 32) through lottery method (A: Control; B: Intervention)" |
| Allocation concealment (selection bias) | Low risk | Quote: "by the second author of the present report who was not involved in the intervention procedures, and the PI informed the nurses about the randomisation results." |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "All the sessions comprising PMR combined with music were also conducted by the PI who was not blinded to the study groups due to the nature of PMR. ," |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up |
| Selective reporting (reporting bias) | Unclear risk | No trial registration, nor did we find one online. |
| Other bias | Low risk | No indication of other bias. |
| Study characteristics | ||
| Methods | RCT, USA | |
| Participants | 14 registered or licenced practical female nurses aged 49 years and older who were currently employed at an academic medical centre full‐time or part‐time in a staff nurse position that involved lifting patients. | |
| Interventions | 1) Experimental: Tai Chi: onsite Tai Chi classes once a week and to practise on their own for 10 minutes each day at least four days per week for 15 weeks. Each Tai Chi class lasted 45 minutes, with 10 minutes of breathing exercises, followed by 30 minutes of Tai Chi practice, and ended with 5 minutes of visualisation and cool‐down exercises. | |
| Outcomes | Nursing Stress Scale, Perceived Stress Scale | |
| Identification | Not able to include in analysis due to missing data. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported. |
| Allocation concealment (selection bias) | Unclear risk | Not reported. |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | 3/14 participants dropped out. No imputation of data. |
| Selective reporting (reporting bias) | Unclear risk | Only change values were reported. |
| Other bias | Low risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Compassion fatigue resiliency I
Compassion fatigue resiliency II
Control (no intervention)
Overall
Included criteria: nurses working in inpatient oncology–haematology, outpatient chemotherapy, or BMT unit Excluded criteria: providing care for paediatric oncology patients, being a nurse manager, not providing direct patient care Pretreatment: there was a statistically significant difference between the groups regarding age, total work hours per week, total years of professional experience, total years of oncology experience, level of received social support, and marital status (P < 0.05). The comparison of the mean scores for nurses’ compassion satisfaction P = 0.036 Compliance rate: 100% Response rate: NR Type of healthcare worker: nurses | |
| Interventions | Intervention characteristics Compassion fatigue resiliency I
Compassion fatigue resiliency II
Control (no intervention)
| |
| Outcomes | Professional quality of life scale‐IV ‐ Compassion fatigue
Professional quality of life scale‐IV ‐ Burnout
Professional quality of life scale‐IV ‐ Compassion satisfaction
Perceived Stress Scale (PSS)
| |
| Identification | Sponsorship source: This research received no specific grant from any funding agency in the public, commercial, or not‐for‐profit sectors Country: Turkey Setting: Oncology–haematology inpatient services, outpatient chemotherapy units, and bone marrow transplant (BMT) units of three private hospitals in Istanbul Comments: NR Authors name: Tuğba Pehlivan Institution: Koç University Hospital Email: [email protected] Address: Istanbul, Turkey. Time period: January 2017 January 2019 | |
| Notes | We kindly got the mean and SD for the primary outcome from author T. Pehlivan. PSS included in analysis 1.1, 1.2 and 1.3. Intervention groups combined to create a single pair‐wise comparison | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Nurses were randomly assigned to the Experimental I, Experimental II, or control group" Sequence generation process insufficiently described. |
| Allocation concealment (selection bias) | Unclear risk | Difficult to judge whether participants and/or investigators could possible foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | Low number of participants that filled in the one‐year follow‐up questionnaire. Lost to follow‐up 57/125 (45%). Reasons provided. Not sure whether loss to follow‐up was at random. |
| Selective reporting (reporting bias) | Low risk | Outcomes reported according to trial registration. |
| Other bias | Unclear risk | Not able to assess response rate. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Progressive muscle relaxation exercise (PMRE)
Control (no intervention)
Overall
Included criteria: sample inclusion criteria were as follows: Not having a disease that prevents students from doing PMR, such as metabolic diseases, cancer, heart disease, and diabetes, and not receiving antidepressant treatment, not doing any other mind–body exercises and using a smartphone Excluded criteria: NR Pretreatment: there were no statistically significant differences between the groups’ age and gender (P > 0.05) Compliance rate: 16 of the 100 less than 4 days (16%) Response rate: 100% Type of healthcare worker: exclusively student nurse interns | |
| Interventions | Intervention characteristics Progressive muscle relaxation exercise (PMRE)
Control (no intervention)
| |
| Outcomes | Burnout Measure Short Version
| |
| Identification | Sponsorship source: This study did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors Country: Turkey Setting: Gynecology and obstetrics clinics Comments: NR Authors name: Sıdıka Pelit‐Aksu Institution: Department of Nursing, Faculty of HealthSciences, Gazi University, Ankara, Turkey Email: [email protected] Address: Sıdıka Pelit‐Aksu, MSN, RN, Department ofNursing, Faculty of Health Sciences, GaziUniversity, Emek mah. Bişkek Cad. 6. Cad.(eski 81. sokak) No:2 06490 Çankaya, Ankara, Turkey Time period: 2018–2019 | |
| Notes | Burnout Measure Short Version included in analysis 2.1. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "All of the students who met the inclusion criterias were grouped randomly using simple randomization method. Students names were selected from course attendance sheet of the internship and they were assigned simultaneously and sequentially to experimental group (EG = 100) and control group (CG = 100)." Sequence generation process insufficiently described |
| Allocation concealment (selection bias) | Low risk | Quote: "Students names were selected from course attendance sheet of the internship and they were assigned simultaneously and sequentially to experimental group (EG = 100) and control group (CG = 100)." |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported.
|
| Incomplete outcome data (attrition bias) | High risk | 55 of the 200 randomised participants were lost to follow‐up (28%). Not mentioned whether loss to follow‐up was at random. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one online. |
| Other bias | Unclear risk | Quote: "and the information leakage from experimental groups to the control groups may have affected the results of the study." |
| Study characteristics | ||
| Methods | RCT, Sweden | |
| Participants | 131 healthcare workers who scored above the 75th percentile on the exhaustion dimension of the Oldenburg Burnout Inventory | |
| Interventions | 1) Experimental: reflecting peer‐support group: Ten 2‐hour weekly sessions where participants discussed and reflected with colleagues about work‐related stress and burnout, provided mutual support for each other, compared experiences and set individual goals to find out alternative ways to handle perceived stressful situations. The sessions started with a short 10‐minute guided relaxation. | |
| Outcomes | The General Nordic Questionnaire for Psychological and Social Factors at Work (QPS Nordic), Oldenburg Burnout Inventory, The Hospital Anxiety and Depression Scale, The Short Form Health Survey (SF‐36) | |
| Identification | ||
| Notes | OBI included in analysis 3.2 and the HADS in analysis 3.4 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The randomization procedure was performed by a statistician using the Statistical Analysis Software, version 8.2." (p. 508) |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | Altogether 27% of participants dropped out during follow‐up and the reasons for the control group participants leaving were not known |
| Selective reporting (reporting bias) | Low risk | All outcomes reported. |
| Other bias | Low risk | We did not find any indications of other sources of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Auriculotherapy
Placebo
Control (wait list)
Overall
Included criteria: The sample consisted of 168 nurses who presented a stress score between 40 and 110 points on the List of Stress Symptoms (LSS). Since few people presented very high stress level, the level was limited to medium and high in order to obtain homogeneous samples. Other inclusion criteria were voluntary participation and availability for the auriculotherapy sessions Excluded criteria: NR Pretreatment: No socio‐demographic NR for primary outcomes. Compliance rate: NR Response rate: NR appears to be 100% Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention characteristics Auriculotherapy
Placebo
Control (wait list)
| |
| Outcomes | The List of Stress Symptoms (LSS)
| |
| Identification | Sponsorship source: NR Country: Brazil Setting: Hospital Comments: NR Authors name: Juliana Miyuki do Prado Institution: Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil Email: [email protected] Address: Leonice Fumiko Sato Kurebayashi Rua Vieira Fazenda, 80, Vila MarianaCEP 04117‐030 – São Paulo, SP, Brazil Time period: 2014 | |
| Notes | LSS included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "From the inclusion criteria, the participants were randomized to the three groups by the Random Allocation Software, each group receiving 56 participants. Thirty‐five people left the study. " |
| Allocation concealment (selection bias) | Unclear risk | Quote: "From the inclusion criteria, the participants were randomized to the three groups by the Random Allocation Software, each group receiving 56 participants. Thirty‐five people left the study. " Difficult to judge whether participants and/or investigators could possibly foresee assignment |
| Blinding of participants and personnel (performance bias) | Low risk | Quote: "This is a randomized, single‐blind, controlled trial with three groups: experimental auriculotherapy (with points indicated for stress), sham auriculotherapy (with sham points), and control group (without any treatment). The study was conducted with nurses of the Hospital Beneficência Portuguesa in São Paulo, São Joaquim Unit, in 2014. The control group without intervention was a waiting list, and the participants of this group later received the auriculotherapy intervention for the same time and number of sessions." Participants were blinded. |
| Blinding of outcome assessment (detection bias) | Low risk | Participants were blinded and outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk |
Judgement Comment: 35 of the 168 randomised participants were lost to follow‐up (21%). Not reported whether lost to follow‐up was at random. Reasons for lost to follow‐up provided. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or study protocol reported, nor did we find one online. |
| Other bias | Unclear risk | Compliance rate and response rate difficult to assess. |
| Study characteristics | ||
| Methods | RCT, UK | |
| Participants | 42 nurses working in a low‐secure mental health unit (LSU). Inclusion criteria: working on the LSU for a minimum of 35 hours and having direct contact with service users. Exclusion criteria: having been previously trained in Psychosocial Intervention. Quote: "A total of 79 nursing staff worked on the LSU. Forty‐two (58%) volunteered to participate in the study and provided informed consent. Of the remaining 37 staff, none actively refused, but eight were on sick leave, 23 were unable to be released by their managers to attend the training and six were excluded as they had previously been trained in PSI." (p. 61) Quote"There were no significant differences at baseline between the experimental and control groups in terms of age, gender, clinical area or qualification." (p. 62) | |
| Interventions | 1) Experimental: psychosocial intervention training (12 qualified and 10 unqualified nurses). Quote: "Nurses allocated to the experimental group attended a PSI [Psychosocial Intervention] training programme which was delivered in a meeting room within the LSU. As the learning outcomes for qualified and unqualified staff were different, they were trained on separate courses. The training programme for qualified staff consisted of 16 half‐day sessions delivered over 8 months. The content covered a broad range of PSI including cognitive behavioural approaches for managing symptoms..." " The training for unqualified staff was delivered in 8 half‐day sessions and focused on understanding symptom related behaviours, relationship formation and helping services users to cope with symptoms..." "Teaching sessions were supplemented by small group supervision..." (p. 61) 2) Control: no intervention control (9 qualified and 11 unqualified nurses) | |
| Outcomes | The MBI | |
| Identification | ||
| Notes | From reference list: Doyle 2007 ‐ check for inclusion MBI‐EE included in analysis 3.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "A randomized controlled design was adopted with nurses who volunteered to participate being allocated to either the experimental PSI training group or a waiting list control group." (p. 60) Random sequence generation process insufficiently described. |
| Allocation concealment (selection bias) | Unclear risk | Not reported if group allocation was concealed |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Apparently no participants were lost to follow‐up |
| Selective reporting (reporting bias) | Low risk | The authors report all results for outcome measures listed in the Methods section |
| Other bias | Unclear risk | We did not find any indications of other sources of bias |
| Study characteristics | ||
| Methods | RCT, UK | |
| Participants | 62 health service workers | |
| Interventions | 1) Experimental: Stress Management Training (SMT): 6 weekly 2‐hour sessions of didactic learning, practice of techniques, group exercises and discussion. Topics covered were: nature, signs, causes and symptoms of stress, progressive muscular relaxation, relationship difficulties at home and work, assertiveness techniques, cognitive appraisal and reappraisal, time‐management and goal‐setting skills and emotions and seeking social support. | |
| Outcomes | General Health Questionnaire (GHQ‐12) used to obtain a score labelled psychological distress | |
| Identification | ||
| Notes | GHQ included in analysis 4.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "The main features of the overall study design include random allocation of groups to receive SMT either immediately or after a waiting period." (p. 329) |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | Only the data for those participants (62/92) who had completed the full set of assessment questionnaires were used in the analyses |
| Selective reporting (reporting bias) | Low risk | All outcomes reported |
| Other bias | Low risk | We did not find any indications of other sources of bias |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline Characteristics Cognitive Behavioral Stress Management (CBSM)
Yoga‐Based Stress Management (YBSM)
Overall
Included criteria: to determine eligibility, potential participants completed the Physical Activity Readiness Questionnaire (PAR‐Q; Canadian Society for Exercise Physiology, 2002), a 7‐item questionnaire assessing individuals’ ability to engage in exercise without risk. Only potential participants who answered No to all of the PAR‐Q items were eligible to participate in this study. Employees who attested to meeting all eligibility requirements underwent an informed consent process. Excluded criteria: NR Pretreatment: The two intervention groups were statistically similar to each other on most demographic baseline variables. However, the sample of mental health care providers was, on average, significantly less stressed than national norms (Table 2; Crawford & Henry, 2003). Compliance rate: YBSM participants attended an average of 6.43 sessions (SD = 1.78), and CBSM participants attended an average of 6.13 sessions (SD = 1.86), a difference that was not statistically significantly different. Response rate: not able to assess Type of healthcare worker: exclusively frontline mental health care providers. | |
| Interventions | Intervention characteristics Cognitive Behavioural Stress Management (CBSM)
Yoga‐Based Stress Management (YBSM)
| |
| Outcomes | DASS‐stress
DASS anxiety
DASS depression
ProQOL ‐ Compassion satisfaction
ProQOL ‐ Burnout
ProQOL ‐ Secondary Trauma
PHQ‐9‐ Patient Health Questionnaire.
| |
| Identification | Sponsorship source: NR Country: USA Setting: Department of Psychiatry at a large regional hospital in New England. Comments: NR Authors name: Kristen E. Riley Institution: Department of Psychology, University of Connecticut Email: [email protected] Address: 486 Babbidge Rd., Unit 1020, Storrs, CT 06269, USA Time period: NR | |
| Notes | DASS‐stress included in analysis 5.1 and 5.2. PHQ included in analysis 5.4 and 5.5. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Participants were directed to an online, secure website (Qualtrics) to complete the online survey assessments at each of the four study time points. Baseline survey assessments were completed within 3 days after completing informed consent. After completing baseline measures, participants were e‐mailed their randomized group assignment (CBSM or YBSM) and information on the meeting time and place of the assigned group." Random sequence generation process insufficiently described. |
| Allocation concealment (selection bias) | Unclear risk | Difficult to judge whether participants and/or investigators could possibly foresee assignment, however it is assumed that it affects outcomes is small. |
| Blinding of participants and personnel (performance bias) | High risk | Quote: "After completing baseline measures, participants were e‐mailed their randomized group assignment (CBSM or YBSM) and information on the meeting time and place of the assigned group. Two 8‐week" Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "Thirty‐eight participants completed baseline questionnaires (YBSM = 19, CBSM = 19), 28 participants completed postintervention Time 2 questionnaires, 25 participants completed Time 3 2‐month follow‐up questionnaires, and 19 completed 6‐month post‐follow‐up questionnaires. Based on t tests and chi‐squared tests, drop‐out participants did not differ significantly on any baseline variable from those who remained in the study." |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or study protocol reported, nor did we find one online |
| Other bias | Unclear risk | Response rate not reported. |
| Study characteristics | ||
| Methods | RCT with individual participants, Portugal | |
| Participants | Physiotherapists scoring more than 26 on Emotional Exhaustion subscale of MBI out of 106 screened with MBI, and not familiar with Qigong; Experimental n = 8 Control n = 8 | |
| Interventions | 1) Experimental: Qigong exercise: posture, breathing and mind focus; classes 20 min/day 1 week; self‐treatment 2X / day 2 weeks, total 3 weeks 2) Control: waiting list for 3 weeks; after that they got the treatment as well | |
| Outcomes | MBI | |
| Identification | ||
| Notes | MBI‐EE included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "the design was a prospective randomized controlled study" |
| Allocation concealment (selection bias) | Unclear risk | Quote: "the design was a prospective randomized controlled study" |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Outcomes for all participants reported |
| Selective reporting (reporting bias) | Unclear risk | Baseline data not reported for the RCT group only |
| Other bias | Low risk | We did not find any indications of other sources of bias |
| Study characteristics | ||
| Methods | Study design:‐cluster randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics MINDBODYSTRONG
Control (no intervention)
Overall
Included criteria: inclusion criteria included all NLRNs hired during the study period who signed consent for the study. Excluded criteria: exclusion criteria included any NLRN who did not consent to participate in the study. Pretreatment: A MANOVA was used to determine group differences at baseline. No significant differences were noted in mean variable scores between the control group and the intervention group for any of the study variables Compliance rate: 96% Response rate: 85% (89 out of 105) Type of healthcare worker: exclusively newly licenced nurses | |
| Interventions | Intervention characteristics MINDBODYSTRONG
Control (no intervention)
| |
| Outcomes | Perceived Stress Scale (PSS)
Generalized Anxiety Disorder Scale (GAD‐7)
Personal Health Questionnaire
| |
| Identification | Sponsorship source: NR Country: USA Setting: a large, Midwestern academic medical center with an accredited nurse residency program. Comments: NR Authors name: Dr Sampson Institution: The Ohio State University Wexner Medical Center Email: [email protected] Address: 600 Ackerman Rd, Suite 2017E, Columbus, OH 43202 Time period: 2018‐2019 | |
| Notes | We kindly received the mean and SD of the PSS for both groups from author M. Sampson PSS included in analysis 1.1 and 1.2. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Participants were NLRNs hired between July 1, 2018, and September 30, 2018, and placed in 1 of 4 cohorts based on hire date. Two cohorts were randomly assigned to the control group, and 2 cohorts were randomly assigned to the MINDBODYSTRONG intervention group." Sequence generation process insufficiently described |
| Allocation concealment (selection bias) | Unclear risk | Difficult to judge whether participants and/or investigators could possibly foresee assignment. However, it is assumed that randomization was performed in one go and that participants and/or investigators could not foresee assignment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 89 of the 93 (96%) randomised participants included in the analyses. Not reported whether loss to follow‐up was at random. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one online |
| Other bias | Low risk | No indication of other sources of bias |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Resilience, insight, self‐compassion, and empowerment (RISE)
Control (no intervention)
Overall
Included criteria: inclusion criteria for participants were age 18 years or older; licenced as a registered nurse; employed by the health care system in a hospital‐based setting; able to speak, read, and understand English fluently; able to provide informed consent; and willing and able to comply with all study procedures and requirements for the duration of the study. Excluded criteria: exclusion criteria were employed by the health care system as an advanced registered nurse practitioner, employed in a role that completes another registered nurse’s annual evaluations, or at imminent risk of harm to themselves or others. Pretreatment: NR Compliance rate: many nurses in both the intervention group and the control group withdrew from the study before starting the intervention because they had scheduling conflicts, employment changes, or personal obligations that affected their ability to attend. Response rate: NR Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention characteristics Resilience, insight, self‐compassion, and empowerment (RISE)
Control (no intervention)
| |
| Outcomes | Perceived Stress Scale (PSS)
Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
| |
| Identification | Sponsorship source: The authors received no financial support for the research, authorship, and/or publication of this article. Country: USA Setting: Hospital‐based setting Comments: NR Authors name: Amanda T. Sawyer, Institution: Research Institute, Advent Health Email: [email protected] Address: Orlando, 301 East Princeton Street, Orlando, FL 32804, USA. Time period: NR | |
| Notes | We kindly received the mean and SD for the primary outcome from author A. Swayer PSS included in analysis 1.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "This study was a parallel randomized controlled trial with an allocation ratio of 1:1. Participants were randomized into the intervention or wait‐list control group by a computer‐generated randomized number concealed from the recruitment team member in an opaque envelope until it was time to assign a participant to a group." |
| Allocation concealment (selection bias) | Low risk | Quote: "This study was a parallel randomized controlled trial with an allocation ratio of 1:1. Participants were randomized into the intervention or wait‐list control group by a computer‐ generated randomized number concealed from the recruitment team member in an opaque envelope until it was time to assign a participant to a group. " |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | Quote: "Many nurses in both the intervention group and the control group withdrew from the study before starting the intervention because they had scheduling conflicts, employment changes, or personal obligations that affected their ability to attend. At the 1‐month, 3‐month, and 6‐month follow‐up timepoints, there were 75, 63, and 49 participants in the study, respectively." 26 of the 75 randomised participants were lost to follow‐up (35%). Not reported whether loss to follow‐up was at random. |
| Selective reporting (reporting bias) | Low risk | Quote: "The study was approved by the institutional review board and registered on ClinicalTrials.gov." The authors did not provide a registration number. Using Google we found registration information for a pilot study ‐> https://clinicaltrials.gov/ct2/show/NCT03645707. No indication of selective reporting |
| Other bias | Unclear risk | Quote: "Many nurses in both the intervention group and the control group withdrew from the study before starting the intervention because they had scheduling conflicts, employment changes, or personal obligations that affected their ability to attend. At the 1‐month, 3‐month, and 6‐month follow‐up timepoints, there were 75, 63, and 49 participants in the study, respectively." Compliance rate could not be assessed. Baseline differences not reported. |
| Study characteristics | ||
| Methods | Cluster‐randomised trial, the Netherlands | |
| Participants | 300 professional caregivers in homes for elderly persons | |
| Interventions | 1) Experimental: emotion‐oriented care training, clinical lessons and supervision meetings: 1‐hour clinical lesson, 6‐day training programme with 4 days at a 2‐week interval and last 2 days at a 4‐week interval. The participants were taught about the dementia syndrome and various care models for communicating with elderly people with dementia (e.g. reality orientation, validation and reminiscence), inequality of the resident‐caregiver relation, understanding the residents' perception of the environment and the attitude and (non‐)verbal communication of staff towards the resident. Intervention homes also received 3 half‐day supervision meetings to support the implementation of emotion‐oriented care. | |
| Outcomes | MBI, Job satisfaction | |
| Identification | Not able to include in analysis due to missing data. | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Randomization was performed on the level of homes. ...within each pair, one home was randomly assigned to the intervention or control group, and the home was assigned to the alternate state." (p. S51) |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "Missing values on items that were part of a scale or subscale were replaced according to the "mean value of valid subtests" principle (i.e. replacement by the mean value calculated from the valid item scores of the [sub‐] scale obtained for the same subject at the same time point). This replacement strategy was only used if less than 25% of the items of a scale or subscale had missing values." (p. S52) |
| Selective reporting (reporting bias) | Low risk | All outcomes reported |
| Other bias | Low risk | We did not find any indications of other sources of bias |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mindful Medicine Curriculum (MMC)
Control (waitlist)
Overall
Included criteria: inclusion criteria were (a) employed as a primary care physician by Providence Medical Group (PMG), (b) working at least 30% time in direct patient care, (c) aged between 25 and 75 years, (d) willing to be randomised to the intervention or wait list control group, and (e) no prior participation in the same MBI offered at PMG. Excluded criteria: NR Pretreatment: there were no significant differences between the intervention (n = 17) and wait list control (n = 16) group on any demographic variables (all P > 0.05). Compliance rate: 1/15 (6.7%) did not receive the intervention Response rate: NR Type of healthcare worker: exclusively primary care physicians | |
| Interventions | Intervention characteristics Mindful Medicine Curriculum (MMC)
Control (waitlist)
| |
| Outcomes | Perceived Stress Scale
Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
| |
| Identification | Sponsorship source: The author(s) received no financial support for the research, authorship, and/or publication of this article. Country: USA Setting: family medicine and internal medicine departments Comments: NA Authors name: David A. Schroeder Institution: Providence Heart Clinic, Portland, OR (DAS); Endocrinology–Medical Education, Providence Medical Center, Portland, OR (ES); Department of Internal Medicine, Oregon Health and Sciences University, Email: [email protected]. Address: Michael S. Christopher, PhD, School of Professional Psychology, Pacific University, 190 SE 8th Avenue, Suite 260, Hillsboro, OR 97123; e‐mail: [email protected] Time period: December 2014 and May 2015 | |
| Notes | PSS included in analysis 1.1. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "After completing the baseline measures, participants were randomized 1:1 into the intervention or a waitlist control." Sequence generation process insufficiently described. |
| Allocation concealment (selection bias) | Unclear risk | Quote: "After completing the baseline measures, participants were randomized 1:1 into the intervention or a waitlist control." Difficult to judge whether participants and/or investigators could possibly foresee assignment |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 4 of the 33 (12%) randomised participants included in the analyses. Not reported whether loss to follow‐up was at random. However loss to follow‐up is below our pre‐defined cut‐off point. |
| Selective reporting (reporting bias) | Low risk | Quote: "Trial Registration Not applicable, because this article does not contain any clinical trials." No trial registration or no study protocol reported. No indication of selective reporting. |
| Other bias | Unclear risk | Quote: "Potential participants were recruited via email for 3 weeks prior to the first MBI group (January 2015). Participants responded to the recruitment email by directing their browser to the study website, which was housed on Qualtrics, a secure web‐based survey system." Not able to assess response rate. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Mindfulness Curriculum
Control (wait list)
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: NR Compliance rate: NR Response rate: NR Type of healthcare worker: quote: "Physicians, nurses, physician assistants, nurse practitioners, clinical nurse specialists, social workers, physical therapists, occupational therapists, pharmacists, psychologists, and chaplains" | |
| Interventions | Intervention characteristics Mindfulness Curriculum
Control (wait list)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
| |
| Identification | Sponsorship source: "Portions of the project were funded by a Research AccelerationProgram grant from Carilion Clinic." Country: USA Setting: Academic medical centre Comments: The publication discusses two studies: 1 a quasi‐experimental study and another an RCT. The RCT details are abstracted here. Authors name: Laurie Walker Seidel Institution: Virginia Tech Email: [email protected] Address: Roanoke City Public Schools Central Office, 40 Douglass Ave, Roanoke, VA 24012, USA Time period: 2016‐2017 | |
| Notes | MBI‐EE included in analysis 2.1 and 2.2 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Participants were randomly assigned to either the intervention group or a waitlist control group. Sequence generation process insufficiently described. |
| Allocation concealment (selection bias) | Unclear risk | Unable to judge whether participants and/or investigators could possible foresee assignment |
| Blinding of participants and personnel (performance bias) | High risk | Blinding not possible |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Of the 103 healthcare professionals who enroled, 83 completed the study (81%). Reasons not provide, nor whether missing was at random. Lost to follow‐up just below our pre‐defined cut‐off value. |
| Selective reporting (reporting bias) | Low risk | No trial registration or no study protocol reported. No indication of selective reporting. |
| Other bias | Unclear risk | No information on baseline differences. Contamination between groups ‐> There was a low attrition rate, supporting the effectiveness of offering each class multiple times within the week to expand choice and flexibility with the typical scheduling of a healthcare environment. The pattern of results may indicate that participants' knowing they were eventually to receive mindfulness training motivated members of the control group to improve their outlook. Although one cannot be certain about any post hoc explanation, it seems more likely that intervention participants shared what they learnt with those in the control group during the training period. It was observed during study 2 enrolment, for example, that several groupings of friends were assigned randomly to different conditions. Sharing information may explain why control participants increased mindful awareness during the intervention but did not continue that increase to the 6‐month posttest |
| Study characteristics | ||
| Methods | RCT, USA | |
| Participants | 38 healthcare professionals including physicians, nurses, social workers, physical therapists and psychologists | |
| Interventions | 1) Experimental: Mindfulness‐Based Stress Reduction programme: 8 weekly 2‐hour training sessions about employing the techniques involved in sitting meditation, body scan, Hatha yoga, 3‐minute breathing space (a "minimeditation") and a "loving kindness" meditation. | |
| Outcomes | MBI, Perceived Stress Scale, Brief Symptom Inventory | |
| Identification | ||
| Notes | PSS included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Participants were randomly assigned to an 8‐week MBSR group or a wait‐list control group." (p. 167) |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | Quote: "Owing to the pilot nature of this study and the small sample size, we did not perform intention‐to‐treat analyses but compared only those participants who did not drop out" (p. 169) |
| Selective reporting (reporting bias) | Low risk | All outcomes reported |
| Other bias | Low risk | We did not find any indications of other sources of bias |
| Study characteristics | ||
| Methods | Study design: cluster‐randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline Characteristics Emotional intelligence training
Control (no intervention)
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: the two study arms were not significantly different in terms of age, working experience, and working hours (Table 1); the distribution of employment status, shift working, and number of night shifts per week, were also not different between the two groups (Table 2). No significant difference was observed between the two groups in terms of emotional intelligence and mental health mean scores before the intervention (Tables 3 and 4). Compliance rate: 25 of the 28 randomised participants did not receive the intervention for being busy. Response rate: 84 of the 140 eligible participants did not participate (60%) Type of healthcare worker: various healthcare professionals including nurses 44 (75%), head nurses 10 (17%) and supervisors 5 (9%) | |
| Interventions | Intervention characteristics Cognitive‐behavioral therapy + relaxation
Control (no intervention)
| |
| Outcomes | 28‐item Goldberg's general health questionnaires (GHQ‐20)
| |
| Identification | Sponsorship source: The authors would like to thank the Vice‐Chancellor for Research, Shiraz University of Medical Sciences, for financially supporting this study. Country: Iran Setting: Hospital Comments: NR Authors name: Farkhondeh Sharif, PhD Institution: Faculty of Nursing, Department of Mental Health Nursing, Shiraz University of Medical Science. Email: [email protected] Address: NR Time period: NR | |
| Notes | GHQ included in analysis 1.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Of 200 ICU nurses, 28 were working in Shahid Faghihi hospital and selected as the control group; 28 nurses who were working in Namazi hospital were allocated to the intervention group. Selection of the hospitals for the control and the intervention group was random. |
| Allocation concealment (selection bias) | Unclear risk | Not reported. |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 52 of the 56 randomised participants included in the analysis. Not reported whether missing was at random. |
| Selective reporting (reporting bias) | Unclear risk | Inaccessible trial registration. No indication of selective reporting. |
| Other bias | Unclear risk | Low participation rate (40%). Did not incorporate unit of analysis error. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Patchouli
Control (placebo)
Overall
Included criteria: participants were included if they (1) understood the purpose of this study and agreed to participate voluntarily, (2) had been a nurse in the emergency room for at least 6 months, (3) did not have any disease and were not being treated for illness, (4) were not pregnant, (5) did not have an abnormality in olfactory function, (6) did not have asthma or an allergic reaction to patchouli oil, (7) were not receiving stress management such as an exercise or massage program, (8) had never received aromatherapy, and (9) were not regularly taking any medication that was likely to affect mental health status. Excluded criteria: NR Pretreatment: There were no significant differences between the groups in age, gender, body mass index, marital status, education, religion, duration of nursing career, duration of serving as emergency nurses, and experience of traumatic events. Compliance rate: 83% Response rate: 100% Type of healthcare worker: exclusively emergency nurses | |
| Interventions | Intervention characteristics Patchouli
Control (placebo)
| |
| Outcomes | ProQOL ‐ Compassion satisfaction
Professional quality of life scale‐IV ‐ Compassion fatigue
ProQOL ‐ Burnout
Stress (VAS)
| |
| Identification | Sponsorship source: This work was supported by a grant from the Basic Science Research Program through the National ResearchFoundation of Korea (NRF‐2018R1D1A1B07050048) and the Institute of Nursing Research, Korea University Grant. Country: Korea Setting: University hospital Comments: NR Authors name: You Kyoung Shin Institution: Department of Basic Nursing Science, College of Nursing, Korea University, Seoul, Republic of Korea Email: NR Address: NR Time period: May to August 2018 | |
| Notes | VAS Stress Included in analysis 2.1 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Therefore, 60 subjects were recruited and randomly assigned to the two groups by an investigator using a random number table." |
| Allocation concealment (selection bias) | Low risk | Quote: "To conceal the allocation sequence, generation of the random allocation sequence and recruitment of participants were conducted by independent investigators." |
| Blinding of participants and personnel (performance bias) | Low risk | Quote: "Participants were blinded to the type of essential oil they inhaled to avoid any placebo effect and were not informed of the study group to which they were allocated." |
| Blinding of outcome assessment (detection bias) | Low risk | Participants were blinded and outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | High risk | Quote: "Of the 60 subjects recruited to this study, 10 discontinued interventions and were therefore excluded. Thus, 50 subjects were included, 25 in 5% patchouli oil (patchouli) group and 25 in sweet almond oil (control) group (Fig. 1)." No intention‐to‐treat analysis. |
| Selective reporting (reporting bias) | Low risk | Trial registration KCT0004615. No indication of selective reporting |
| Other bias | Low risk | No indication of other source of bias |
| Study characteristics | ||
| Methods | RCT, USA | |
| Participants | 40 physicians working at Mayo Clinic Rochester Quote: "Inclusion criteria were: (1) being a faculty member of the DOM and (2) being able and willing to participate. Exclusion criteria were: (1) recent (within the past 6 months) psychotic episode or (2) clinically significant acute unstable neurological, psychiatric, hepatic, renal, cardiovascular, or respiratory disease that prevented participation in the study." (p. 859) Quote: "Mean age of the participants in the active arm (46.8 ± 8.3 years) was comparable to the control arm (50.2 ± 5.7 years). Gender distribution was comparable across the two arms (55% vs 50% males in the active and control arm, respectively)." (p. 859) | |
| Interventions | 1) Experimental: Stress Management and Resiliency Training (SMART) programme (n = 20). Quote: "The study intervention was a single 90‐min session training in the SMART program. The SMART program has been adapted from Attention and Interpretation Therapy (AIT). AIT is a structured therapy developed at the Mayo Clinic to decrease stress and enhance resilience. AIT addresses two aspects of human experience, attention and interpretation." "AIT guides learners to delay judgement and pay greater attention to the novelty of the world. Complementing attention training is instruction to help participants direct their interpretations away from fixed prejudices towards a more flexible disposition while cultivating skills such as gratitude, compassion, acceptance, forgiveness, and higher meaning." " Participants were also offered an optional 30–60‐min follow‐up session depending on individual needs. (p. 859) 2) Control: No intervention control (n = 20) | |
| Outcomes | Perceived Stress Scale, Smith Anxiety Scale | |
| Identification | PSS included in analysis 4.1 and the Smith Anxiety Scale in 4.4 | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "After obtaining the informed consent, physicians were randomly assigned to one of two groups ‐ an active arm or a wait‐list control arm." (p. 859) |
| Allocation concealment (selection bias) | Unclear risk | The authors do not report if they concealed allocation |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Apparently there were no dropouts |
| Selective reporting (reporting bias) | Unclear risk | The authors report all results for outcome measures listed in the 'Methods' section. |
| Other bias | Unclear risk | Quote:"Eight participants (all in the control arm) declined to participate after randomization and prior to filling out any assessments because of scheduling issues" (p. 860) |
| Study characteristics | ||
| Methods | RCT, Australia | |
| Participants | 40 trained hospital nurses who complained being overstressed | |
| Interventions | 1) Experimental: Ego‐enhancement training: One 50‐minute session and three 20‐minute sessions 1 week as part of training in the techniques of: physical relaxation, mental calmness, disposing of "rubbish", removal of a barrier and enjoyment of a special place. | |
| Outcomes | Stress Profile | |
| Identification | ||
| Notes | Stress profile included in analysis 2.2. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote:"In the first stage of the experiment the nurses were matched on their Profile scores, one member of each pair being allocated at random to either a non‐treatment control group or an experimental group experiencing four treatment sessions" (p. 318) |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | It is unclear if any participants dropped out |
| Selective reporting (reporting bias) | Low risk | Only 1 outcome measure used and reported |
| Other bias | Low risk | We did not find any indications of other sources of bias |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Experimental group: expressive writing
Control group: neutral writing instruction
Overall
Included criteria: professionals that work in the Palliative Care field, speak and write Italian Excluded criteria: NR Pretreatment: NR Compliance rate: NR Response rate: NR Type of healthcare worker: palliative healthcare workers | |
| Interventions | Intervention characteristics Experimental group: expressive writing
Control group: neutral writing instruction
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
| |
| Identification | Sponsorship source: NR Country: Italy Setting: Palliative care and hospice Comments: NR Authors name: Annalisa Tonarelli Institution: Department of Medicine and Surgery, University of Parma, Italy; Email: [email protected] Address: Annalisa TonarelliDepartment of Medicine and Surgery, University of Parma, ItalyVia Gramsci 14 ‐ 43126, Parma, Italy Time period: NR | |
| Notes | Not able to include in analysis due to missing data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Participants who expressed the desire to partici‐ pate in the study, after signing the informed consent, were assigned by randomization" No details on how randomisation sequence was generated. |
| Allocation concealment (selection bias) | Unclear risk |
Not described well enough |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Not described |
| Selective reporting (reporting bias) | Unclear risk | No registration protocol nor did we find one online |
| Other bias | Unclear risk | Did not report reponse rate, compliance rate, differences between the groups at baseline |
| Study characteristics | ||
| Methods | RCT, Taiwan | |
| Participants | 137 nurses | |
| Interventions | 1) Experimental: Training about stress at work, relaxation, breathing, imagery and meditation: One 90‐minute session in each of 2 weeks and 1 follow‐up session in the 5th week. Training covered: sources of stress at work, relaxation as a coping method and meditation including breathing exercise and imagery that emphasised the underlying cognitive process of meditation. | |
| Outcomes | Nurse Stress Checklist, Chinese General Health Questionnaire | |
| Identification | ||
| Notes | GHQ included in analysis 2.1. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "For each unit, a coin was thrown to select which nurse from this unit would be assigned to either the experimental or control group." (p. 56) |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | It is unclear if any participants dropped out |
| Selective reporting (reporting bias) | Low risk | All outcomes reported |
| Other bias | Low risk | We did not find any indications of other sources of bias |
| Study characteristics | ||
| Methods | Study design: cluster‐randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Experimental group 1: MRBS 4 weeks
Experimental group 1: MRBS 8 weeks
Control: no intervention
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: At baseline, statistically significant differences were found between the three groups in age, professional type, and work experience. Compliance rate: NR Response rate: NR Type of healthcare worker: various types of healthcare workers | |
| Interventions | Intervention characteristics Experimental group 1: MRBS 4 weeks
Experimental group 1: MRBS 8 weeks
Control: no intervention
| |
| Outcomes | PSQ
| |
| Identification | Sponsorship source: NR Country: Spain Setting: Spanish National Health System teaching units Comments: NR Authors name: Juan Carlos Verdes‐Montenegro‐Atalaya Institution: Family and Community Medicine Teaching Department of Burgos, 0 Email: [email protected] Address: Family and Community Medicine Teaching Department of Burgos, 09006 Burgos, Spain Time period: NR | |
| Notes | PHQ included in analysis 1.1. Intervention groups combined to create a single pair‐wise comparison | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Each TU was considered as a different and independent cluster, randomly assigned to the CG (2 TUs) or one of the two EGs (4 TUs)." Insufficiently described. |
| Allocation concealment (selection bias) | Unclear risk | Quote: "EG1 participants were included in a standard training program of mindfulness and self‐compassion; while EG2, in an abbreviated one. Furthermore, the participants from each TU were stratified according to the type of professional (66 tutors versus 66 resident intern specialists)." Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 53 of the 165 (32%) randomised participants lost to follow‐up. Reasons provided. The baseline characteristics of participants who dropped out of the study were similar to those who completed it, so systematic selectionbias is unlikely. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported nor did we find one online |
| Other bias | Unclear risk | Statistically significant differences were observed between the three groups in age, type of professional, and time working in the Spanish National Health System |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Experimental group: active intervention and regular management.
Control (no intervention)
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: there were no significant differences between the control group and intervention group nurses in the job burnout scales before the intervention Compliance rate: NR Response rate: NR Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention characteristics Experimental group: active intervention and regular management.
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
| |
| Identification | Sponsorship source: NR Country: China Setting: Hospital Comments: NA Authors name: Rong Wei Institution: Department of Clinical Nursing, Qianfoshan Hospital, Jinan, Shandong, China. Email: [email protected] Address: Jianxin Li, Department of Clinical Nursing, Qianfoshan Hospital, NO. 16766, Jingshi Road, Jinan, Shandong, China; Time period: NR | |
| Notes | MBI‐EE included in analysis 1.1. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "total of 112 registered nurses were randomly selected from 3 of 8 comprehensive high‐level hospitals in Jinan, China." Only mentioned that nurses where randomly selected. |
| Allocation concealment (selection bias) | Unclear risk | Unable to judge whether participants and/or investigators could possible foresee assignment |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss to follow‐up. |
| Selective reporting (reporting bias) | Unclear risk | No trial registration or no study protocol reported, nor did we find one online |
| Other bias | Unclear risk | Compliance rate and response rate not reported. |
| Study characteristics | ||
| Methods | RCT, USA | |
| Participants | 60 acute care hospital nurses | |
| Interventions | 1) Experimental: four weeks of Stress Inoculation (SI) training divided as: i) Education‐only group (Ed) weekly 30‐minute sessions of information about anxiety, stress and coping skills and practice of self‐monitoring of stress producing events (n = 12) | |
| Outcomes | MBI (used frequency and intensity separately for each subscale); we used Emotional Exhaustion intensity scores. Job‐Related Tension Index, Life Satisfaction Index, STAI, Rathus Assertiveness Schedule, systolic and diastolic blood pressure | |
| Identification | ||
| Notes | Results are only presented for the group including CS (n = 24) versus education plus no‐intervention (n = 24). MBI‐EE included in analysis 1.1 and STAI included in analysis 1.4. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...60 registered nurses... were stratified on the basis of work shift and randomly assigned to 1 of 6 counselors and one of five treatment conditions." (p. 212) |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Quote: "No subject attrition occurred at posttesting." (p. 213) |
| Selective reporting (reporting bias) | Low risk | All outcomes reported |
| Other bias | Low risk | We did not find any indications of other sources of bias |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Protected time with facilitated small group curriculum
Control (protected time unstructured)
Overall
Included criteria: practising physicians in the Mayo Clinic Department of Medicine Excluded criteria: not specified Pretreatment: baseline characteristics were similar for both groups with no statistically significant differences observed. However, the intervention group had "slightly higher rates of high emotional exhaustion and overall burnout." P values for statistical significance are not provided in the paper. Compliance rate: NR Response rate: 13% Type of healthcare worker: physicians | |
| Interventions | Intervention characteristics Protected time with facilitated small group curriculum
Control (protected time unstructured)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Perceived Stress Scale (PSS)
| |
| Identification | Sponsorship source: Mayo Clinic Program on Professionalism and Ethics and the Department of Medicine at Mayo Clinic, Rochester, USA. Country: USA Setting: One medical centre Comments: NR Authors name: Colin P. West Institution: Division of General Internal Medicine, Department of Medicine, Mayo Clinic Email: [email protected] Address: Division of General Internal Medicine, Department of Medicine, Mayo Clinic, 200 First St, Rochester, MN 55905, USA. Time period: 2010‐2012 | |
| Notes | We kindly receivede the mean and SD for the primary outcome from author C. West. PSS included in analysis 4.1 and 4.2. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Participants were randomized in a concealed fashion into 2 groups via a computer‐generated algorithm." |
| Allocation concealment (selection bias) | Low risk | Participants were randomized in a concealed fashion into 2 groups via a computer generated algorithm |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Low response rate. 74 of the 565 eligible physicians participated (13%) |
| Selective reporting (reporting bias) | Low risk | Data we kindly received match trial registration: NCT01159977 |
| Other bias | Low risk | No indication of other source of bias. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline Characteristics Experimental group: topic focused discussion
Control (no intervention)
Overall
Included criteria: NR Excluded criteria: NR Pretreatment: NR Compliance rate: NR Response rate: 21% Type of healthcare worker: physicians | |
| Interventions | Intervention characteristics Experimental group: topic focused discussion
Control (no intervention)
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
| |
| Identification | Sponsorship source: NR Country: United States of America Setting: Hospital Comments: NR Authors name: Colin West Institution: Department of Quantitative Health Sciences Mayo Clinic, Rochester, MN; and the Division of Hematology, Email: [email protected] Address: Department of Medicine, Stanford University, Palo Alto, CA Time period: 2013‐2014 | |
| Notes | We kindly receivede the mean and SD for the primary outcome from author C. West MBI‐EE included in analysis 1.1 and 1.2. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Participants were randomized in concealed fashion into two arms via a computer‐ generated algorithm." |
| Allocation concealment (selection bias) | Low risk | Participants were randomized in concealed fashion into two arms via a computer‐ generated algorithm. |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | 107 of the 123 randomized participants (87%) complete follow‐up data. |
| Selective reporting (reporting bias) | Low risk | Registation trial checked: NCT04466423. No indication of selective outcome reporting. |
| Other bias | Unclear risk | Compliance not reported. |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Educational group
Mindfulness‐based intervention
Overall
Included criteria: a) they had obtained professional certification; (b) they were independently responsible for clinical work; (c) they were willing to participate and available to attend sessions; and (d) they were suffering from“moderate or above” occupational burnout Excluded criteria: (a) they had been in work for less than one year; (b) they were on vacation or on study leave; (c) they had taken a mindfulness program such as MBSR or MBCT and had been practising mindfulness in the last six months. Pretreatment: reported socio demographic baseline characteristics of participants randomised to the intervention group were similar to socio demographic baseline characteristics of participants randomised to the control group Compliance rate: EB (46/53 87%). MBIB (45/53 85%) Response rate: 63% Type of healthcare worker: exclusively nurses | |
| Interventions | Intervention characteristics Educational group
Mindfulness‐based intervention
| |
| Outcomes | Maslach Burnout Inventory ‐ Emotional Exhaustion
Maslach Burnout Inventory ‐ Depersonalisation
Maslach Burnout Inventory ‐ Personal accomplishment (lack of)
| |
| Identification | Sponsorship source: NR Country: China Setting: Hospital Comments: NR Authors name: Caixia Xie Institution: Nursing School, West China School of Medicine/West China Hospital, Sichuan University Email: [email protected] [email protected] Address: Chengdu 610041, Sichuan, China Time period: 2017‐2018 | |
| Notes | MBI‐EE included in analysis 5.1. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Participants were assigned to the EB or the MBIB group. This" Sequence generation process insufficiently described. |
| Allocation concealment (selection bias) | Unclear risk | Quote: "Participants in the EB group were randomly divided into three subgroups, consisting of 18, 17, and 17 individuals, respectively." Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment. |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | No loss at follow‐up |
| Selective reporting (reporting bias) | Low risk | Trial registration in Chinese. No indication of selective reporting. |
| Other bias | Low risk | No indication of other sources of bias |
| Study characteristics | ||
| Methods | RCT, Iran | |
| Participants | 76 nursing students Quote: "The study population included all male and female nursing students who were studying in Isfahan Nursing and Midwifery university in 2010‐2011, in the second and third years (third, fourth, fifth and sixth semesters). 72 [sic] students were randomly assigned to two groups using the list of students studying in the second and third year in 2010‐2011 and based on the odd and even numbers." (p. 210) "The groups were heterogeneous in terms of gender..." (p. 210) | |
| Interventions | 1) Experimental: Stress management training (n = 38). Quote: "[First group (n=38) trained stress management training program (8 two hours sessions, twice a week). And second group (n = 38) did not received [sic] training." (p. 210) The stress management program consisted of: information about stress, gradual muscle relaxation and its implementation with mental imagery, consequences and physical symptoms of stress, relaxation and imagery and training and diaphragm breathing practices, linking thoughts and emotions and familiarity with cognitive errors, discussion about relaxation exercises and replacement of logical thoughts and personal stress management program. 2) Control: no intervention (n = 38) | |
| Outcomes | DASS‐42: Depression, Anxiety and Stress Scale | |
| Identification | ||
| Notes | DASS‐stress included in analysis 2.1 and DASS‐depression in analysis 2.3. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Quote: "...students were randomly assigned to two groups using the list of students studying in the second and third year in 2010‐2011 and based on the odd and even numbers." (p. 210) |
| Allocation concealment (selection bias) | Unclear risk | Not reported if group allocation was concealed |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | It is difficult to tell if some participants were lost to follow‐up or not as the authors give three separate numbers for the amount of participants. Quote: "This study was a parallel ‐group randomized quasi‐experimental trial...on 68 BSc nursing students.", " 72 students were randomly assigned..." and "Finally seventy‐six subjects elected among them." (p. 210) |
| Selective reporting (reporting bias) | Low risk | The study had only one outcome and its results are all reported |
| Other bias | Low risk | We did not find any indications of other sources of bias |
| Study characteristics | ||
| Methods | RCT, China | |
| Participants | 65 nurse managers | |
| Interventions | 1) Experimental 1: cognitive relaxation: participants were asked to imagine the relaxation of different muscle groups. | |
| Outcomes | C‐STAI, C‐GHQ | |
| Identification | ||
| Notes | GHQ included in analysis 2.1 and C‐STAI in analysis 2.3. Intervention groups combined to create a single pair‐wise comparison. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Of the 65 participants, 35 were randomly assigned to the experimental condition and the remaining 30 were put to the control condition. Subsequently, the 35 subjects assigned to the experimental condition were randomly allocated to the stretch‐release relaxation (n = 17) and cognitive relaxation (n = 18) groups." (p. 256) |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) | High risk | Participants not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Unclear risk | Quote: "All participants including the TC [test control] group were assessed again in a follow‐up session after 1 month." (p. 258). Insufficiently recorded to judge attrition bias |
| Selective reporting (reporting bias) | Low risk | All outcomes reported. |
| Other bias | Low risk | We did not find any indications of other sources of bias |
| Study characteristics | ||
| Methods | Study design: randomised controlled trial Study grouping: parallel group | |
| Participants | Baseline characteristics Acceptance and Commitment Therapy (ACT)
Control (no intervention ‐ routine support)
Overall
Included criteria: ‐ having a bachelor’s or higher degree in nursing, ‐ at least 2 years of work experience in psychiatric wards, ‐ attending intervention sessions based on ACT for the first time, and ‐ no history of taking psychiatric drugs in the past and present. Excluded criteria: ‐ not completing the questionnaires, ‐ absenteeism in more than one intervention session, and ‐ the occurrence of stressful events during the study. Pretreatment: statistical difference not reported. Only numbers and proportions were reported which were similar on most variables but no statistical reporting. Compliance rate: 94%. two out of 35 participants in the intervention group were excluded since they missed more than one session out of eight, i.e. 33 of the participants attended 6 or more sessions. Response rate: NR. 84 psychiatric nurses from all 23 wards in the hospital were randomly selected and screened for eligibility proportional to the required sample size for the study. However, the total number of nurses in the facility is not reported. Type of healthcare worker: psychiatric nurses | |
| Interventions | Intervention characteristics Acceptance and Commitment Therapy (ACT)
Control (no intervention ‐ routine support)
| |
| Outcomes | Perceived Stress Scale (PSS)
| |
| Identification | Sponsorship source: Islamic Azad University, Tehran. Country: Iran Setting: One large psychiatric hospital Comments: NR Authors name: Ladan Fattah Moghaddam Institution: Tehran University of Medical Sciences, Islamic Azad University, Tehran, Iran Email: [email protected] Address: Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Islamic Azad University, Tehran, Iran Time period: 2018 | |
| Notes | PSS included in analysis 1.1. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Of the 84 nurses selected, fourteen were excluded due to lack of inclusion criteria, and 70 remaining nurses were each assigned a number and were randomly divided into experimental and control groups, each consisting of 35 participants. (Fig. 1). Sequence generation process insufficiently described. |
| Allocation concealment (selection bias) | Unclear risk | Allocation concealment not recorded. Difficult to judge whether participants and/or investigators could possibly foresee assignment |
| Blinding of participants and personnel (performance bias) | High risk | Participants were not blinded. |
| Blinding of outcome assessment (detection bias) | High risk | Participants were not blinded whereas outcomes are self‐reported. |
| Incomplete outcome data (attrition bias) | Low risk | Attrition rate was less than 20% and a priori outcomes were reported. |
| Selective reporting (reporting bias) | Low risk | Trial registration IRCT20180506039557N1. No indication of selective reporting |
| Other bias | Unclear risk | Response rate could not be calculated since total number of nurses was not provided. Statistical differences if any on baseline parameters not reported. |
ACT: Acceptance and Commitment Therapy; BP: blood pressure;BSI: Brief Symptom Inventory;DCWs: Direct Care Workers' ERT: Emotion regulation training; ESRT‐1: Enhanced stress resilience training‐1; GHQ: General Health Questionnaire; HCW: healthcare worker; HR: heart rate;ICU: intensive care unit; MBI: Maslach Burnout Inventory;MBSR: Mindfulness‐based stress reduction;NLGNs: newly incensed graduate nurses;PSQ: Perceived Stress Questionnaire; PSS: Perceived Stress Scale; SD: standard deviation;SMI: Stress Management Intervention; TTI: Transfer Technique Intervention; PTSD: Post‐traumatic stress disorder; STAI: State‐Trait Anxiety Inventory; WCG: waitist control group
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
| Wrong population: not only healthcare workers | |
| Wrong comparison (intervention type 2 vs intervention type 2) | |
| Wrong intervention: organisational intervention | |
| Wrong outcome (stressor) ‐ trial protocol checked. | |
| Wrong population: not only healthcare workers | |
| Not an article, wrong population: consisted of not only healthcare workers (original study considered) . | |
| Wrong intervention (organisational intervention). | |
| Wrong population: caregivers of family not officially employed | |
| Wrong comparison (intervention type 1 vs intervention type 1) | |
| Wrong population: students | |
| Wrong outcome (stressor) | |
| Wrong intervention: organisational intervention | |
| Wrong study design | |
| Thesis (not an article in a peer‐reviewed scientific journal) | |
| Not an article | |
| Wrong intervention:organisational intervention | |
| Wrong population: students | |
| Wrong study design | |
| Wrong intervention | |
| Wrong population: not only healthcare workers | |
| Wrong intervention: organisational intervention | |
| Wrong population: not only healthcare workers | |
| Wrong intervention: organisational intervention. | |
| Wrong population: also volunteers | |
| Wrong intervention | |
| Wrong comparison (intervention type 2 vs intervention type 2) | |
| Wrong population: not only healthcare workers | |
| Wrong population: not only healthcare workers | |
| Wrong intervention | |
| Wrong study design | |
| Wrong outcome assessment: use of unvalidated questionnaire | |
| Wrong study design | |
| Wrong outcomes. Trial protocol checked. | |
| Wrong outcome (stressor) | |
| Wrong intervention: organisational intervention | |
| Wrong population: not only healthcare workers | |
| Wrong outcome assessment: use of unvalidated questionnaire | |
| Wrong outcome (stressor) | |
| Wrong outcome (stressor) | |
| Wrong study design | |
| Wrong comparison (intervention type 2 vs intervention type 2) | |
| Wrong comparison (intervention type 1 vs intervention type 1) | |
| Wrong population: not only healthcare workers | |
| Wrong population: not only healthcare workers | |
| Duplicate | |
| Wrong study design | |
| Wrong intervention | |
| Use of unvalidated questionnaire. | |
| Not an article | |
| Wrong study design | |
| Wrong population: not only healtcare workers | |
| Wrong study design | |
| Not an article | |
| Wrong study design | |
| Wrong population: not only healthcare workers | |
| Wrong population: students | |
| Wrong outcome. Stressor only outcome. | |
| Wrong intervention: Organisational intervention | |
| Wrong intervention:organisational intervention | |
| Wrong study design | |
| Wrong study design | |
| Wrong population: no healthcare workers | |
| Wrong study design | |
| Wrong population: caregivers with symptoms | |
| Wrong population: student nurses | |
| Wrong outcome (stressor) | |
| Wrong study design | |
| Not an article | |
| Wrong intervention: organisational intervention | |
| Not an article | |
| Wrong population: not only healthcare workers | |
| Wrong population: not only healthcare workers | |
| Not an article | |
| Wrong intervention | |
| Abstract of a PhD‐thesis (not an article in a peer‐reviewed scientific journal) | |
| Abstract of a PhD‐thesis, not an article in a peer‐review scientific journal | |
| Wrong comparison (intervention type 2 vs intervention type 2) | |
| Not an article | |
| Wrong intervention:organisational intervention | |
| Wrong comparison (intervention type 1 vs intervention type 1) | |
| Wrong intervention: organisational intervention | |
| wrong comparison (intervention type 1 vs intervention type 1) | |
| Wrong intervention: organisational intervention | |
| Wrong population: no healthcare workers | |
| Wrong intervention ‐ organisational intervention | |
| Thesis (not an article in a peer‐reviewed scientific journal) | |
| Wrong intervention | |
| Wrong intervention: organisational intervention. | |
| Thesis (not an article in a peer‐reviewed scientific journal) | |
| Wrong comparison (intervention type 1 vs intervention type 1) | |
| Use of unvalidated questionnaire | |
| Wrong outcome (stressor). Trial registration checked. | |
| Thesis (not an article in a peer‐reviewed scientific journal) | |
| Wrong study design | |
| Wrong outcome | |
| Not an article | |
| Wrong population: students | |
| Wrong intervention: organisational intervention | |
| Wrong study design | |
| Not an article | |
| Wrong study design | |
| Wrong outcome (stressor) | |
| Wrong intervention. | |
| Duplicate | |
| Wrong outcomes | |
| Wrong outcomes | |
| Wrong outcome (stressor) | |
| Wrong outcome (stressor) | |
| Wrong outcomes | |
| Wrong outcomes | |
| Wrong outcomes | |
| Wrong population: students | |
| Not an article | |
| Wrong study design | |
| Wrong outcomes | |
| Not an article | |
| Wrong outcomes | |
| Wrong outcomes | |
| Not an article | |
| Wrong outcomes | |
| Wrong intervention:organisational intervention | |
| Wrong population: not only healthcare workers | |
| Wrong outcome (stressor) | |
| Wrong intervention | |
| Wrong outcome | |
| Wrong outcome assessment: no use of validated questionnaire | |
| Not an article | |
| Wrong population: not only healthcare workers | |
| Wrong intervention: organisational intervention | |
| Wrong study design | |
| Wromg population:not only healthcare workers | |
| Thesis (not an article in a peer‐reviewed scientific journal) | |
| Review | |
| Review | |
| Review | |
| Wrong outcomes | |
| Wrong intervention | |
| Wrong outcome | |
| Wrong outcome assessment: no use of validated questionnaire | |
| Thesis (not an article in a peer‐reviewed scientific journal) | |
| Wrong outcomes | |
| Wrong study design | |
| Wrong population: not only healthcare workers | |
| Wrong publication type | |
| Wrong study design | |
| Not an article | |
| Wrong population: students | |
| We kindly got the mean and SD for the primary outcome from author E. Smoktunowicz. However, we retrospectively excluded this study as it includes wrong comparison (intervention type 1 vs intervention type 1) | |
| Wrong population: students | |
| Wrong population: not only healthcare workers | |
| Wrong population: not only healthcare workers | |
| Wrong comparison (intervention type 2 vs intervention type 2) | |
| Thesis (not an article in a peer‐reviewed scientific journal) | |
| Wrong outcomes. Trial protocol checked. | |
| Wrong intervention: organisational intervention | |
| Wrong outcomes | |
| Wrong outcomes | |
| Wrong intervention:organisational intervention | |
| Wrong outcomes | |
| Wrong outcomes. Study protocol checked. | |
| Wrong outcomes | |
| Wroing outcome use of unvalidated questionnaire | |
| Wrong intervention: pharmacological intervention | |
| Wrong comparison (intervention type 1 vs intervention type 1) | |
| Not an article | |
| Wrong study design | |
| Wrong intervention | |
| Wrong outcomes | |
| Wrong outcomes | |
| Wrong intervention | |
| Wrong outcome (stressor) | |
| Wrong population: students | |
| Wrong study design: not randomised | |
| Wrong intervention: organisational intervention |
Characteristics of studies awaiting classification [ordered by study ID]
| Methods | ? |
| Participants | Nurses |
| Interventions | Resilience education |
| Outcomes | Quality of working life |
| Notes | in Persian awaiting translation |
| Methods | Randomised control trial |
| Participants | Nurses |
| Interventions | Workplace Health Promotion Program |
| Outcomes | ProQol |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Nurses |
| Interventions | Mindfulness |
| Outcomes | MBI |
| Notes | In Chines awaiting translation. Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | physicians |
| Interventions | Novel Online Group‐Coaching Program |
| Outcomes | MBI |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Nurses |
| Interventions | Psychological resilience training |
| Outcomes | The Perceived Stress Scale, the Positive and Negative Affect Schedule & the Pittsburgh Sleep Quality Index Scale |
| Notes | No full text available |
| Methods | Randomised controlled trial |
| Participants | Nurses |
| Interventions | Unified Protocol (UP) prevention program to provide emotional regulation skills to cope with stressful situations. |
| Outcomes | Emotional symptomatology, emotional regulation, burnout, |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Paediatric Interns |
| Interventions | Mindfulness |
| Outcomes | Maslach Burnout Inventory (MBI) |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial? |
| Participants | Nurses |
| Interventions | Lavender essential oil |
| Outcomes | Taft Anderson job stress questionnaire |
| Notes | Article in Persian awaiting translation |
| Methods | Randomised controlled trial |
| Participants | Nurses |
| Interventions | Motivational Messages Sent to Emergency Nurses During the COVID‐19 Pandemic |
| Outcomes | The Job Satisfaction Scale, Compassion Fatigue Scale, and Communication Skills Scale |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | physicians, nurse practitioners, and certified nurse midwives. |
| Interventions | three monthly self‐facilitated groups for faculty |
| Outcomes | Burnout & work stress |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Nurses |
| Interventions | Gong medication |
| Outcomes | Stress & burnout |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Nurses |
| Interventions | Internet cognitive behavioural therapy (iCBT) |
| Outcomes | depressive and anxiety symptoms, measured by using the Depression Anxiety and Stress Scales (DASS) |
| Notes |
| Methods | Randomised controlled trial |
| Participants | Various healthcare workers |
| Interventions | Transcendental Meditation (TM) is a mantra meditation practice with potential efficacy in reducing stress. |
| Outcomes | Psychological distress measured by the Global Severity Index. Secondary outcomes included changes in burnout (measured by the Maslach Burnout Inventory), insomnia (measured by the Insomnia Severity Index), and anxiety (measured by the Generalized Anxiety Disorder‐7 scale). |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Surgical Intensive Care Unit (SICU) personnel |
| Interventions | Mindfulness‐based worksite intervention |
| Outcomes | Depression, Anxiety and Stress Scale (DASS‐21) |
| Notes | No full text available. |
| Methods | Randomised controlled trial |
| Participants | Healthcare workers (not specified) |
| Interventions | Mindfulness Based Intervention (MBI), Mindfulness in Motion (MIM), |
| Outcomes | Burnout & perceived stress |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | pediatric nurses |
| Interventions | Balint group |
| Outcomes | MBI |
| Notes | Article in Chinese awaiting translation |
| Methods | Randomised controlled trial |
| Participants | Dementia healthcare workers |
| Interventions | Acceptance and Commitment Therapy (ACT) |
| Outcomes | MBI |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Healthcare Professionals |
| Interventions | Creative Arts Therapy |
| Outcomes | Burnout |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Nurses |
| Interventions | Mindfulness‐Based Intervention |
| Outcomes | ProQol |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Resident Physicians |
| Interventions | Hybrid Mindful Awareness Practices ( |
| Outcomes | MBI |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Professionals working with trauma survivors |
| Interventions | web‐based intervention, “The Helpers’ Stress” |
| Outcomes | MBI |
| Notes | In Polish awaiting translaten |
| Methods | Randomised controlled trial |
| Participants | Nurses |
| Interventions | cognitive behavioral therapy |
| Outcomes | Utrecht Work Engagement Scale–9 item (UWES‐9) |
| Notes | Trial protocol checked bmjopen‐2018‐025138. In the trial protocol DASS stress is one of the outcomes but not reported in this article. |
| Methods | Randomised controlled trial |
| Participants | Physicians |
| Interventions | The Stress Management and Resilience Training (SMART) program is an evidence‐based intervention designed to build resilience. |
| Outcomes | Stress |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Cardiac surgery nurses |
| Interventions | Educational intervention |
| Outcomes | Nursing Stress Scale (NSS) |
| Notes | Article in Persian awaiting translation |
| Methods | Randomised controlled trial |
| Participants | Healthcare workers |
| Interventions | Unguided, digital, mindfulness‐based self‐help (MBSH) |
| Outcomes | MBI |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Healthcare workers |
| Interventions | Yoga and music intervention |
| Outcomes | Stress |
| Notes | Selected with the updated search on the 26th of September 2022. |
| Methods | Randomised controlled trial |
| Participants | Nurses |
| Interventions | stress management training |
| Outcomes | The Job Stress Questionnaire |
| Notes | No full text available |
| Methods | ? |
| Participants | Psychiatric nurses |
| Interventions | drum circle activity combined with the psychological diary technique |
| Outcomes | stress |
| Notes | Article in Chinese awaiting translation |
Characteristics of ongoing studies [ordered by study ID]
| Study name | Al‐Hammouri |
| Methods | Randomised controlled trial |
| Participants | Inclusion criteria: 1) Jordanian nurses |
| Interventions | The intervention protocol is similar to the brief mindfulness‐based stress reduction program designed by Mackenzie (2006). He synthesises its main elements from Kabat‐Zinn's (1990) traditional mindfulness‐based stress reduction program. The participants will be recruited from nurses inside the hospital for the two intervention groups so that the 65 nurses will receive the mindfulness meditation session inside one of the hospital rooms equipped to deliver the intervention, and the second group of the 65 nurses who will receive the intervention in a natural setting outside the hospital (i.e. park or recreation centre, that will be decided based on the funding to be determined after getting the IRB approval). Intervention groups will practice mindfulness meditation once weekly for 4 weeks as a group (i.e. 4 sessions for each of the two interventional groups). There are no recommendations about group size in the literature, but we will use small group sizes between 10 and 20 participants in each session for convenience. Mindfulness‐based intervention trainers will guide the mindfulness meditation sessions, and each session is 30 minutes long. The intervention comprises four 30‐minute training sessions that cover the following topics: an introduction to mindfulness, typical barriers to practice, the repercussions of attachment and aversion to judging events, and methods for bringing mindfulness into one's daily life. The body scan, sitting meditation, and a brief three‐minute breathing exercise for use in times of acute stress were all experienced components of the sessions (Mackenzie et al., 2006; Poulin et al. 2008). In addition, the participants in the intervention groups will be instructed to practice mindfulness mediation individually at home for at least 10 minutes |
| Outcomes | Stress Overload Scale Depression will be measured using the Center for Epidemiologic Studies Depression Scale‐Revised (CESD‐R). |
| Starting date | 31/05/2022 |
| Contact information | Jordan University of Science & Technology P.O.Box 3030, Irbid 22110, Jordan Jordan |
| Notes |
| Study name | NR |
| Methods | Randomised controlled trial |
| Participants | Healthcare workers of care homes |
| Interventions | Mindfulness‐based stress reduction (MBSR) |
| Outcomes | The Work Stress Inventory The Karasek Job Content Questionnaire |
| Starting date | ? |
| Contact information | |
| Notes |
| Study name | STOPTHEBURN |
| Methods | Randomised controlled Trial |
| Participants | ICU clinicians & non‐physicians (nurses, pharmacists, therapists). |
| Interventions | debriefing |
| Outcomes | Maslach Burnout Inventory (MBI) Score. Patient Health Questionnaire 8 (PHQ‐8) and Generalized Anxiety Disorder 7‐item scale (GAD‐7). |
| Starting date | ? |
| Contact information | |
| Notes |
| Study name | NR |
| Methods | Randomised controlled trial |
| Participants | Healthcare professionals |
| Interventions | Compassion course A cognitive behavioural stress management course |
| Outcomes | COPSOQ / PROQOL |
| Starting date | February 2021 |
| Contact information | Anna Bratt, Linnaeus University [email protected] |
| Notes |
| Study name | Jeffers |
| Methods | Randomised controlled trial |
| Participants | Nurse currently rostered to work in the RBWH DEM Able to attend program |
| Interventions | A face‐to‐face self‐care intervention program designed and supervised by an accredited clinical psychologist with over 10 years of experience. Participants will be offered one of two weekly hospital based sessions of approximately 1 hour duration for 5 weeks (10 participants should be in each of the sessions) with a home program. |
| Outcomes | Stress will be measured using the Depression, Anxiety and Stress Scale‐21 Professional Quality of Life will be measured using the Professional Quality of Life Scale, version 5 (Pro‐QOL‐5) |
| Starting date | 23/10/2017 |
| Contact information | Ms Carol Jeffers |
| Notes |
| Study name | NR |
| Methods | Randomised controlled trial |
| Participants | Nurses |
| Interventions | Internet‐based Cognitive Behavioral Therapy (iCBT) |
| Outcomes | Psychological distress |
| Starting date | ? |
| Contact information | kkuribayashi‐[email protected] |
| Notes |
| Study name | Brief Daily Body‐Mind‐Spirit Practice |
| Methods | Multi‐site randomised controlled trial |
| Participants | Community Mental Health Workers |
| Interventions | Brief Daily Body‐Mind‐Spirit Practice |
| Outcomes | Copenhagen Burnout Inventory |
| Starting date | ? |
| Contact information | SM Ng Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong |
| Notes |
| Study name | MINDUUDD |
| Methods | Multicentre cluster‐randomised controlled trial |
| Participants | Community medicine physicians and nurses |
| Interventions | Mindfulness and self‐compassion 4‐session programme versus an 8‐session programme |
| Outcomes | |
| Starting date | June 2019 |
| Contact information | |
| Notes |
| Study name | Mindful Self‐Care and Resiliency (MSCR) |
| Methods | Randomised controlled trial |
| Participants | Rural general practitioners |
| Interventions | Mindful Self‐Care and Resiliency (MSCR) |
| Outcomes | Compassion fatigue? |
| Starting date | ? |
| Contact information | |
| Notes |
| Study name | REST |
| Methods | Randomised controlled trial |
| Participants | Healthcare workers during the COVID‐19 pandemic |
| Interventions | Online cognitive behavioural therapy program |
| Outcomes | Perceived Stress Scale (PSS) |
| Starting date | September 2021 |
| Contact information | |
| Notes |
PSQ: Perceived Stress Questionnaire
Data and analyses
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) Show forest plot | 41 | 3645 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.37 [‐0.52, ‐0.23] |
| Analysis 1.1  Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) | ||||
| 1.1.1 No intervention | 29 | 2434 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.35 [‐0.53, ‐0.16] |
| 1.1.2 Wait list | 9 | 619 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.52 [‐0.80, ‐0.25] |
| 1.1.3 Placebo | 1 | 436 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.02 [‐0.21, 0.16] |
| 1.1.4 No stress‐reduction intervention | 2 | 156 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.33 [‐1.19, 0.53] |
| 1.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 19 | 1851 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.43 [‐0.71, ‐0.14] |
| Analysis 1.2  Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) | ||||
| 1.2.1 No intervention | 11 | 1271 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.46 [‐0.90, ‐0.02] |
| 1.2.2 Wait list | 6 | 480 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.53 [‐0.83, ‐0.24] |
| 1.2.3 No stress reduction intervention | 2 | 100 | Std. Mean Difference (IV, Random, 95% CI) | 0.16 [‐0.23, 0.56] |
| 1.3 Any symptoms of stress‐related outcome (follow‐up >12 months) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 1.3  Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 3: Any symptoms of stress‐related outcome (follow‐up >12 months) | ||||
| 1.4 Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention) Show forest plot | 8 | 742 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.27 [‐0.58, 0.03] |
| Analysis 1.4  Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 4: Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention) | ||||
| 1.4.1 No intervention | 7 | 482 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.28 [‐0.68, 0.11] |
| 1.4.2 Wait list | 1 | 260 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.28 [‐0.53, ‐0.04] |
| 1.5 Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 3 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 1.5  Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 5: Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention) | ||||
| 1.5.1 No intervention | 3 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.6 Explanatory analysis ‐ subgroup (short vs long duration of intervention): any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) Show forest plot | 41 | 3645 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.37 [‐0.52, ‐0.23] |
| Analysis 1.6  Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 6: Explanatory analysis ‐ subgroup (short vs long duration of intervention): any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) | ||||
| 1.6.1 Short (< 12weeks) | 29 | 2647 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.32 [‐0.49, ‐0.15] |
| 1.6.2 Long (≥ 12 weeks) | 12 | 998 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.50 [‐0.78, ‐0.22] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) Show forest plot | 35 | 2366 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.55 [‐0.70, ‐0.40] |
| Analysis 2.1  Comparison 2: ‘Focus one’s attention away from the experience of stress by means of relaxation, exercise or something else’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) | ||||
| 2.1.1 No intervention | 22 | 1565 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.48 [‐0.61, ‐0.35] |
| 2.1.2 Wait list | 8 | 429 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.88 [‐1.53, ‐0.24] |
| 2.1.3 Placebo | 3 | 168 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.43 [‐0.74, ‐0.12] |
| 2.1.4 No stress‐reduction intervention | 2 | 204 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.27 [‐0.55, 0.00] |
| 2.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 6 | 427 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.41 [‐0.79, ‐0.03] |
| Analysis 2.2  Comparison 2: ‘Focus one’s attention away from the experience of stress by means of relaxation, exercise or something else’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) | ||||
| 2.2.1 No intervention | 4 | 312 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.43 [‐0.98, 0.12] |
| 2.2.2 Wait list | 2 | 115 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.40 [‐0.77, ‐0.03] |
| 2.3 Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention) Show forest plot | 7 | 378 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.07 [‐1.95, ‐0.19] |
| Analysis 2.3  Comparison 2: ‘Focus one’s attention away from the experience of stress by means of relaxation, exercise or something else’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 3: Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention) | ||||
| 2.3.1 No intervention | 2 | 127 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.67 [‐1.60, 0.25] |
| 2.3.2 Wait list | 3 | 173 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.89 [‐4.24, 0.46] |
| 2.3.3 Placebo | 2 | 78 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.34 [‐0.79, 0.11] |
| 2.4 Explanatory analysis ‐ subgroup (short vs long duration of intervention): any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) Show forest plot | 35 | 2366 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.55 [‐0.70, ‐0.40] |
| Analysis 2.4  Comparison 2: ‘Focus one’s attention away from the experience of stress by means of relaxation, exercise or something else’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 4: Explanatory analysis ‐ subgroup (short vs long duration of intervention): any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) | ||||
| 2.4.1 Short (<12 weeks) | 33 | 2255 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.52 [‐0.68, ‐0.37] |
| 2.4.2 Long (≥ 12 weeks) | 2 | 111 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.96 [‐1.48, ‐0.43] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) Show forest plot | 3 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 3.1  Comparison 3: ‘Focus on work‐related risk factors on an individual level such as work demands’ vs No intervention/no stress‐reduction intervention (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) | ||||
| 3.1.1 No intervention | 2 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.1.2 No stress‐reduction intervention | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 3.2  Comparison 3: ‘Focus on work‐related risk factors on an individual level such as work demands’ vs No intervention/no stress‐reduction intervention (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) | ||||
| 3.3 Any symptoms of stress‐related outcome (follow‐up >12 months) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 3.3  Comparison 3: ‘Focus on work‐related risk factors on an individual level such as work demands’ vs No intervention/no stress‐reduction intervention (SMD), Outcome 3: Any symptoms of stress‐related outcome (follow‐up >12 months) | ||||
| 3.4 Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 3.4  Comparison 3: ‘Focus on work‐related risk factors on an individual level such as work demands’ vs No intervention/no stress‐reduction intervention (SMD), Outcome 4: Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention) | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) Show forest plot | 15 | 1003 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.67 [‐0.95, ‐0.39] |
| Analysis 4.1  Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) | ||||
| 4.1.1 No intervention | 10 | 666 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.71 [‐1.08, ‐0.34] |
| 4.1.2 Wait list | 4 | 270 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.79 [‐1.21, ‐0.38] |
| 4.1.3 No stress‐reduction intervention | 1 | 67 | Std. Mean Difference (IV, Random, 95% CI) | 0.13 [‐0.35, 0.61] |
| 4.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 6 | 574 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.48 [‐0.95, ‐0.00] |
| Analysis 4.2  Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) | ||||
| 4.2.1 No intervention | 3 | 330 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.70 [‐1.52, 0.12] |
| 4.2.2 Wait list | 2 | 177 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.36 [‐0.65, ‐0.06] |
| 4.2.3 No stress‐reduction intervention | 1 | 67 | Std. Mean Difference (IV, Random, 95% CI) | 0.00 [‐0.48, 0.48] |
| 4.3 Any symptoms of stress‐related outcome (follow‐up > 12 months) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 4.3  Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 3: Any symptoms of stress‐related outcome (follow‐up > 12 months) | ||||
| 4.4 Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention) Show forest plot | 4 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 4.4  Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 4: Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention) | ||||
| 4.4.1 No intervention | 3 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 4.4.2 Wait list | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 4.5 Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 4.5  Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 5: Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention) | ||||
| 4.6 Psychological symptoms: anxiety and depression (follow‐up > 12 months after the end of the intervention) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 4.6  Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 6: Psychological symptoms: anxiety and depression (follow‐up > 12 months after the end of the intervention) | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months) Show forest plot | 3 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 5.1  Comparison 5: Focus one’s attention on the experience of stress vs focus one’s attention away from the experience of stress, Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months) | ||||
| 5.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 5.2  Comparison 5: Focus one’s attention on the experience of stress vs focus one’s attention away from the experience of stress, Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) | ||||
| 5.3 Psychological symptoms: anxiety and depression (follow‐up up to 3 months) Show forest plot | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 5.3  Comparison 5: Focus one’s attention on the experience of stress vs focus one’s attention away from the experience of stress, Outcome 3: Psychological symptoms: anxiety and depression (follow‐up up to 3 months) | ||||
| 5.4 Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 1 | 38 | Std. Mean Difference (IV, Random, 95% CI) | 0.24 [‐0.39, 0.88] |
| Analysis 5.4  Comparison 5: Focus one’s attention on the experience of stress vs focus one’s attention away from the experience of stress, Outcome 4: Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention) | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 6.1  Comparison 6: ‘Combination of interventions’ vs focus one's attention on the experience of stress (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months) | ||||
| 6.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Analysis 6.2  Comparison 6: ‘Combination of interventions’ vs focus one's attention on the experience of stress (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) | ||||
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Funnel plot (1.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
Funnel plot (1.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention))
Funnel plot (2.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention))
Funnel plot (4.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention))
Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention)
Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 3: Any symptoms of stress‐related outcome (follow‐up >12 months)
Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 4: Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention)
Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 5: Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention)
Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 6: Explanatory analysis ‐ subgroup (short vs long duration of intervention): any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
Comparison 2: ‘Focus one’s attention away from the experience of stress by means of relaxation, exercise or something else’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
Comparison 2: ‘Focus one’s attention away from the experience of stress by means of relaxation, exercise or something else’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention)
Comparison 2: ‘Focus one’s attention away from the experience of stress by means of relaxation, exercise or something else’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 3: Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention)
Comparison 2: ‘Focus one’s attention away from the experience of stress by means of relaxation, exercise or something else’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 4: Explanatory analysis ‐ subgroup (short vs long duration of intervention): any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
Comparison 3: ‘Focus on work‐related risk factors on an individual level such as work demands’ vs No intervention/no stress‐reduction intervention (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
Comparison 3: ‘Focus on work‐related risk factors on an individual level such as work demands’ vs No intervention/no stress‐reduction intervention (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention)
Comparison 3: ‘Focus on work‐related risk factors on an individual level such as work demands’ vs No intervention/no stress‐reduction intervention (SMD), Outcome 3: Any symptoms of stress‐related outcome (follow‐up >12 months)
Comparison 3: ‘Focus on work‐related risk factors on an individual level such as work demands’ vs No intervention/no stress‐reduction intervention (SMD), Outcome 4: Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention)
Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention)
Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 3: Any symptoms of stress‐related outcome (follow‐up > 12 months)
Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 4: Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention)
Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 5: Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention)
Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 6: Psychological symptoms: anxiety and depression (follow‐up > 12 months after the end of the intervention)
Comparison 5: Focus one’s attention on the experience of stress vs focus one’s attention away from the experience of stress, Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months)
Comparison 5: Focus one’s attention on the experience of stress vs focus one’s attention away from the experience of stress, Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention)
Comparison 5: Focus one’s attention on the experience of stress vs focus one’s attention away from the experience of stress, Outcome 3: Psychological symptoms: anxiety and depression (follow‐up up to 3 months)
Comparison 5: Focus one’s attention on the experience of stress vs focus one’s attention away from the experience of stress, Outcome 4: Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention)
Comparison 6: ‘Combination of interventions’ vs focus one's attention on the experience of stress (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months)
Comparison 6: ‘Combination of interventions’ vs focus one's attention on the experience of stress (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention)
| An intervention in which one's attention is on the experience of stress compared to no intervention/wait list/placebo/no stress‐reduction intervention for stress reduction in healthcare workers | ||||
| Patient or population: healthcare workers | ||||
| Outcomes | Anticipated absolute effects* (95% CI) | № of participants | Certainty of the evidence | What happens |
|---|---|---|---|---|
| Effect with an intervention in which one's attention is on the experience of stress | ||||
| Stress symptoms (follow‐up up to and including 3 months after end of intervention) | SMD 0.37 lower | 3645 | ⊕⊕⊝⊝ | On the short term, an intervention in which one's attention is on the experience of stress may result in a reduction in stress symptoms. The standardized mean difference translates back to 4.6 fewer (6.4 fewer to 2.8 fewer) points on the MBI‐emotional exhaustion scale2. |
| Stress symptoms (follow‐up > 3 to 12 months after end of intervention) | SMD 0.43 lower | 1851 | ⊕⊕⊝⊝ | On the medium term, focus one's attention on the experience of stress may result in a reduction in stress symptoms. The standardized mean difference translates back to 5.3 fewer (8.7 fewer to 1.7 fewer) points on the MBI‐emotional exhaustion scale3. |
| Stress symptoms (follow‐up >12 months after end of intervention) | no effect estimate | 68 | ⊕⊝⊝⊝ | The evidence is very uncertain about the long‐term effect on stress symptoms of focusing one's attention on the experience of stress. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||
| GRADE Working Group grades of evidence | ||||
| 1 The certainty of the evidence was downgraded by two levels for very serious risk of bias (bias arising from the randomisation process and lack of blinding; i.e. performance bias) in combination with some inconsistency and suspicion of publication bias. 2 The certainty of the evidence was downgraded by three levels for very serious risk of bias (bias arising from the randomisation process and lack of blinding; i.e. performance bias) and very serious imprecision (small sample size, the confidence interval includes both a benefit and a harm). 3 The MBI‐Emotional exhaustion scale has a total score of 54 and we used the mean score (23.6) and standard deviation (12.2) of the control healthcare workers population in Fiol DeRoque 2021 as reference for interpreting the effect sizes. A score below 18 points is regarded as a low score on emotional exhaustion and a score above 36 as a high score on emotional exhaustion (Maslach 1996). | ||||
| An intervention in which one's attention is away from the experience of stress compared to no intervention/wait list/placebo/no stress‐reduction intervention for stress reduction in healthcare workers | ||||
| Patient or population: healthcare workers | ||||
| Outcomes | Anticipated absolute effects* (95% CI) | № of participants | Certainty of the evidence | What happens |
|---|---|---|---|---|
| Risk with an intervention in which one's attention is away from the experience of stress | ||||
| Stress symptoms (follow‐up up to and including 3 months after end of intervention) | SMD 0.55 lower | 2366 | ⊕⊕⊝⊝ | On the short term, an intervention in which one's attention is away from the experience of stress may result in a reduction in stress symptoms. The standardized mean difference translates back to 6.8 fewer (8.6 fewer to 4.9 fewer) points on the MBI‐emotional exhaustion scale2. |
| Stress symptoms (follow‐up > 3 to 12 months after end of intervention) | SMD 0.41 lower | 427 | ⊕⊕⊝⊝ | On the medium term, an intervention in which one's attention is away from the experience of stress may result in a reduction in stress symptoms. The standardized mean difference translates back to 5.0 fewer (9.7 fewer to 0.4 fewer) points on the MBI‐emotional exhaustion scale2. |
| Stress symptoms (follow‐up >12 months after end of intervention) | ‐ | (0 RCTs) | ‐ | No studies reported the long‐term effect on stress symptoms of focusing one's attention away from the experience of stress. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||
| GRADE Working Group grades of evidence | ||||
| 1 The certainty of the evidence was downgraded by two levels for very serious risk of bias (bias arising from the randomisation process and lack of blinding; i.e. performance bias) in combination with some inconsistency and suspicion of publication bias. 3 The MBI‐emotional exhaustion scale has a total score of 54 and we used the mean score (23.6) and standard deviation (12.2) of the control healthcare workers population in Fiol DeRoque 2021 as reference for interpreting the effect sizes. A score below 18 points is regarded as a low score on emotional exhaustion and a score above 36 as a high score on emotional exhaustion (Maslach 1996). | ||||
| An intervention in which the focus is on work‐related risk factors on an individual level compared to no intervention/no stress‐reduction intervention for stress reduction in healthcare workers | ||||
| Patient or population: healthcare workers | ||||
| Outcomes | Anticipated absolute effects* (95% CI) | № of participants | Certainty of the evidence | What happens |
|---|---|---|---|---|
| Effect with an intervention in which the focus is on work‐related risk factors on an individual level | ||||
| Stress symptoms (follow‐up up to and including 3 months after end of intervention) | no effect estimate | 87 | ⊕⊝⊝⊝ | The evidence is very uncertain about the short‐term effect of an intervention in which the focus is on work‐related risk factors on stress symptoms. |
| Stress symptoms (follow‐up > 3 to 12 months after end of intervention) | no effect estimate | 152 | ⊕⊝⊝⊝ | The evidence is very uncertain about the medium‐term effect of an intervention in which the focus is on work‐related risk factors on stress symptoms. |
| Stress symptoms (follow‐up >12 months after end of intervention) | no effect estimate | 161 | ⊕⊝⊝⊝ | The evidence is very uncertain about the long‐term effect of an intervention in which the focus is on work‐related risk factors on stress symptoms. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||
| GRADE Working Group grades of evidence | ||||
| 1 The certainty of the evidence was downgraded by three levels for very serious risk of bias (bias arising from the randomisation process and lack of blinding; i.e. performance bias), inconsistency and very serious imprecision (small sample size, the confidence interval includes both a benefit and a harm). 2 The certainty of the evidence was downgraded by three levels for very serious risk of bias (bias arising from the randomisation process and lack of blinding; i.e. performance bias) and very serious imprecision (small sample size, the confidence interval includes both a benefit and no effect). | ||||
| A combination of individual‐level interventions compared to no intervention/wait list/no stress‐reduction intervention for stress reduction in healthcare workers | ||||
| Patient or population: healthcare workers | ||||
| Outcomes | Anticipated absolute effects* (95% CI) | № of participants | Certainty of the evidence | What happens |
|---|---|---|---|---|
| Effect with a combination of individual‐level interventions | ||||
| Stress symptoms (follow‐up up to and including 3 months after end of intervention) | SMD 0.67 lower | 1003 | ⊕⊕⊝⊝ | On the short term, a combination of individual‐level interventions may result in a reduction in stress symptoms. The standardized mean difference translates back to 8.2 fewer (11.7 fewer to 4.8 fewer) points on the MBI‐Emotional exhaustion scale4. |
| Stress symptoms (follow‐up > 3 to 12 months after end of intervention) | SMD 0.48 lower | 574 | ⊕⊕⊝⊝ | On the medium term, a combination of individual‐level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect. The standardized mean difference translates back to 5.9 fewer points (11.7 fewer to no difference) on the MBI‐Emotional exhaustion scale4. |
| Stress symptoms (follow‐up >12 months after end of intervention) | no effect estimate | 88 | ⊕⊝⊝⊝ | The evidence is very uncertain about the long‐term effect of a combination of individual‐level interventions on stress symptoms. |
| CI: confidence interval; SMD: standardized mean difference | ||||
| GRADE Working Group grades of evidence | ||||
| 1 The certainty of the evidence was downgraded by two levels for very serious risk of bias (bias arising from the randomisation process and lack of blinding; i.e. performance bias) in combination with some inconsistency and suspicion of publication bias. 2 The certainty of the evidence was downgraded by two levels for very serious risk of bias (lack of blinding; i.e. performance bias) and inconsistency. We did not downgrade for imprecision, as the wide confidence interval is due to the inconsistency between study results. 3 The certainty of the evidence was downgraded by three levels for very serious risk of bias (bias arising from the randomisation process and lack of blinding; i.e. performance bias) and very serious imprecision (small sample size, the confidence interval includes both a benefit and a harm). 4 The MBI‐emotional exhaustion scale has a total score of 54 and we used the mean score (23.6) and standard deviation (12.2) of the control HCW population in Fiol DeRoque 2021 as reference for interpreting the effect sizes. A score below 18 points is regarded as a low score on emotional exhaustion and a score above 36 as a high score on emotional exhaustion (Maslach 1996). | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) Show forest plot | 41 | 3645 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.37 [‐0.52, ‐0.23] |
| 1.1.1 No intervention | 29 | 2434 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.35 [‐0.53, ‐0.16] |
| 1.1.2 Wait list | 9 | 619 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.52 [‐0.80, ‐0.25] |
| 1.1.3 Placebo | 1 | 436 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.02 [‐0.21, 0.16] |
| 1.1.4 No stress‐reduction intervention | 2 | 156 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.33 [‐1.19, 0.53] |
| 1.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 19 | 1851 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.43 [‐0.71, ‐0.14] |
| 1.2.1 No intervention | 11 | 1271 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.46 [‐0.90, ‐0.02] |
| 1.2.2 Wait list | 6 | 480 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.53 [‐0.83, ‐0.24] |
| 1.2.3 No stress reduction intervention | 2 | 100 | Std. Mean Difference (IV, Random, 95% CI) | 0.16 [‐0.23, 0.56] |
| 1.3 Any symptoms of stress‐related outcome (follow‐up >12 months) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.4 Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention) Show forest plot | 8 | 742 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.27 [‐0.58, 0.03] |
| 1.4.1 No intervention | 7 | 482 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.28 [‐0.68, 0.11] |
| 1.4.2 Wait list | 1 | 260 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.28 [‐0.53, ‐0.04] |
| 1.5 Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 3 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.5.1 No intervention | 3 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 1.6 Explanatory analysis ‐ subgroup (short vs long duration of intervention): any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) Show forest plot | 41 | 3645 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.37 [‐0.52, ‐0.23] |
| 1.6.1 Short (< 12weeks) | 29 | 2647 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.32 [‐0.49, ‐0.15] |
| 1.6.2 Long (≥ 12 weeks) | 12 | 998 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.50 [‐0.78, ‐0.22] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) Show forest plot | 35 | 2366 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.55 [‐0.70, ‐0.40] |
| 2.1.1 No intervention | 22 | 1565 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.48 [‐0.61, ‐0.35] |
| 2.1.2 Wait list | 8 | 429 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.88 [‐1.53, ‐0.24] |
| 2.1.3 Placebo | 3 | 168 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.43 [‐0.74, ‐0.12] |
| 2.1.4 No stress‐reduction intervention | 2 | 204 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.27 [‐0.55, 0.00] |
| 2.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 6 | 427 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.41 [‐0.79, ‐0.03] |
| 2.2.1 No intervention | 4 | 312 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.43 [‐0.98, 0.12] |
| 2.2.2 Wait list | 2 | 115 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.40 [‐0.77, ‐0.03] |
| 2.3 Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention) Show forest plot | 7 | 378 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.07 [‐1.95, ‐0.19] |
| 2.3.1 No intervention | 2 | 127 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.67 [‐1.60, 0.25] |
| 2.3.2 Wait list | 3 | 173 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.89 [‐4.24, 0.46] |
| 2.3.3 Placebo | 2 | 78 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.34 [‐0.79, 0.11] |
| 2.4 Explanatory analysis ‐ subgroup (short vs long duration of intervention): any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) Show forest plot | 35 | 2366 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.55 [‐0.70, ‐0.40] |
| 2.4.1 Short (<12 weeks) | 33 | 2255 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.52 [‐0.68, ‐0.37] |
| 2.4.2 Long (≥ 12 weeks) | 2 | 111 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.96 [‐1.48, ‐0.43] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) Show forest plot | 3 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.1.1 No intervention | 2 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.1.2 No stress‐reduction intervention | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.3 Any symptoms of stress‐related outcome (follow‐up >12 months) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.4 Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention) Show forest plot | 15 | 1003 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.67 [‐0.95, ‐0.39] |
| 4.1.1 No intervention | 10 | 666 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.71 [‐1.08, ‐0.34] |
| 4.1.2 Wait list | 4 | 270 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.79 [‐1.21, ‐0.38] |
| 4.1.3 No stress‐reduction intervention | 1 | 67 | Std. Mean Difference (IV, Random, 95% CI) | 0.13 [‐0.35, 0.61] |
| 4.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 6 | 574 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.48 [‐0.95, ‐0.00] |
| 4.2.1 No intervention | 3 | 330 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.70 [‐1.52, 0.12] |
| 4.2.2 Wait list | 2 | 177 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.36 [‐0.65, ‐0.06] |
| 4.2.3 No stress‐reduction intervention | 1 | 67 | Std. Mean Difference (IV, Random, 95% CI) | 0.00 [‐0.48, 0.48] |
| 4.3 Any symptoms of stress‐related outcome (follow‐up > 12 months) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 4.4 Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention) Show forest plot | 4 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 4.4.1 No intervention | 3 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 4.4.2 Wait list | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 4.5 Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 4.6 Psychological symptoms: anxiety and depression (follow‐up > 12 months after the end of the intervention) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months) Show forest plot | 3 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 5.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 5.3 Psychological symptoms: anxiety and depression (follow‐up up to 3 months) Show forest plot | 1 | Std. Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 5.4 Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 1 | 38 | Std. Mean Difference (IV, Random, 95% CI) | 0.24 [‐0.39, 0.88] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 6.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
