Journal of Rehabilitation Medicine 51-5 | Page 15

J Rehabil Med 2019; 51: 331–342 REVIEW ARTICLE ROLE OF REHABILITATION IN CHRONIC STRESS-INDUCED EXHAUSTION DISORDER: A NARRATIVE REVIEW Johanna WALLENSTEN, MD 1 , Marie ÅSBERG, MD, PhD 1 , Maria WIKLANDER, RPsych, PhD 2 and Anna NAGER, MD, PhD 2 From the 1 Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital and 2 Department of Neurobiology, Care Sciences and Society, Section for Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden Objective: An increase in numbers of cases of sick leave due to stress have been reported from several European countries during recent decades. Chronic stress-induced exhaustion disorder is associated with physiological and neurobiological perturbations that may contribute to cognitive problems and long- term exhaustion. Rehabilitation of patients with chronic stress-induced exhaustion disorder is there- fore challenging. This narrative review summarizes the evidence regarding the effectiveness of different interventions for the rehabilitation of patients with chronic stress-induced exhaustion disorder. Methods: Both structured and unstructured searches of research studies and reports were performed in order to find knowledge sources. The structured search had 2 predefined inclusion criteria: (i) chronic stress-induced exhaustion/clinical burnout/severe burnout/stress-induced exhaustion; and (ii) rehabil­ itation with improvement of symptoms and/or return to work as outcomes. Results: Cognitive behavioural interventions and multimodal interventions seem to reduce symptoms. Workplace interventions, either work-focused cog- nitive behavioural or workplace dialogue, seem to improve return to work. Sleep is important for both symptom improvement and return to work, and in- terventions for improving sleep might therefore be important. For improvement of cognitive function, which is a main complaint among patients with chro- nic stress-induced exhaustion disorder, aerobic and cognitive training may have some effect. Conclusion: In summary, the few studies of high- quality that examine interventions for rehabilitation of chronic stress-induced exhaustion disorder show only marginal effects. Thus, it is important to pre- vent the onset of chronic stress-induced exhaustion disorder. Key words: stress; exhaustion; burnout; fatigue; interven- tion; return to work. Accepted Feb 26, 2019; Epub ahead of print Mar 18, 2019 J Rehabil Med 2019; 51: 331–342 Correspondence address: Johanna Wallensten, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, 18371 Stockholm, Sweden. E-mail: [email protected] I ncreasing numbers of cases of sick leave due to stress have been reported from several European countries during recent decades (1). In Sweden, adjustment dis- LAY ABSTRACT There has been an increase in cases of sick leave due to stress in several European countries in recent decades. Chronic stress-induced exhaustion disorder is linked with physiological and neurobiological changes, which may add to cognitive problems and long-term exhaustion. This narrative review summarizes the published eviden- ce about the effectiveness of different interventions for the rehabilitation of patients with chronic stress-induced exhaustion disorder. Cognitive behavioural interventions and multimodal interventions reduce symptoms. Work- place interventions often improve return to work. Bet- ter sleep is associated with improvement of symptoms and return to work. Interventions for improving sleep might therefore be important. For improving cognitive function, which is a main complaint among patients with chronic stress-induced exhaustion disorder, aerobic and cognitive training may have some effect. Most interven- tions for the rehabilitation of chronic stress-induced ex- haustion disorder have only marginal effects. Therefore, it is important to prevent the onset of this disorder. order and reaction to severe stress have been the most common reasons for more than 14 days of sick leave since 2014, and chronic stress-induced exhaustion di- sorder is associated with long periods of sick leave (2). Definition of chronic stress-induced exhaustion Medical and psychological nomenclature for exhaus- tion after a long period of severe stress differs between countries and disciplines. The term “burnout” is commonly used. Burnout is a psychological concept defined by emotional exhaustion, depersonalization, and lack of personal achievement as a response to chronic occupational stress (3, 4). In the International Classification of Diseases, tenth version (ICD-10), burnout is not regarded as an illness, but as a “factor which influences health status”, which is reflected in the Z-code used for the condition. The ICD code for burnout is Z73.0. Z73 includes “problems related to life management difficulty”. Long-term chronic stress can, however, lead to a state of exhaustion that has the character of an illness, which is associated with changes in brain structure and function as well as biochemical aberrations (5–9). If such physical and mental exhaustion is induced by a long-lasting period of high levels of stress without This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2545