A Multimodal Stress-Prevention Program Supplemented by Telephone-Coaching Sessions to Reduce Perceived Stress among German Farmers: Results from a Randomized Controlled Trial

Abstract

This study compared the effectiveness of a 12-day stress-prevention program (SGS) supplemented by individualized, structured, four-session telephone-coaching to that of an SGS without telephone-coaching in entrepreneurs from the green professions presenting with increased stress levels. All participants went through the SGS before being randomized either to the telephone-coaching group (TC) or to the control group without telephone-coaching (noTC). SGS included four key therapeutic elements: stress-management intervention, relaxation, physical exercise, and balneotherapy. The primary outcome was the current degree of subjectively experienced stress assessed with the Perceived Stress Questionnaire (PSQ) at a 9-month follow-up. Secondary outcomes included burnout symptoms, well-being, health status, sleep disorders, expectation of self-efficacy, depression, anxiety, ability to work, pain, and days of sick leave. Assessments were conducted at baseline, 12 days (end of program), and 1 (start telephone-coaching), 3, 6 (end of telephone-coaching), and 9 months. Data from 103 adults (TC = 51; noTC = 52), mostly fulltime farmers, were available for analysis (mean age: 55.3; 49.1% female). Participants experienced significant immediate improvement in all outcome measurements, which declined somewhat during the first three months after the end of SGS and then remained stable for at least another six months. While within-group changes from baseline to 9 months showed significant improvements at medium to large effect sizes for all target variables (PSQ-total, TC: −13.38 (±14.98); 95%-CI: (−17.68; −9.07); noTC: −11.09 (±14.15); 95%-CI: (−15.11; −7.07)), no statistically significant differences were found between the groups at any time and for any target variable (between-group ANCOVA for PSQ-total at 9 months, parameter estimator for the group: −1.58; 95%-CI: (−7.29; 4.13)). The stress-prevention program SGS is a feasible, effective, and practical way to reduce perceived stress and improve participants’ resources. Four subsequent telephone-coaching sessions do not seem to contribute to a further improvement in the results.

Sleep and spa therapies: What is the role of balneotherapy associated with exercise? A systematic review

“…Except for the study by Sekine and colleagues (2006), all the studies set up a balneotherapy intervention protocol, with more than half of the studies (sixteen) showing both an intervention and control (or with other therapies excluding balneotherapy) group ( Buskila et al, 2001 ; Neumann et al, 2001 ; Altan et al, 2004 , 2006 ; Dönmez et al, 2005 ; Yurtkuran et al, 2006 ; Kamioka et al, 2009 ; Yang et al, 2018 ; Naumann et al, 2020 ; Rapolienė et al, 2020 ; Stier-Jarmer et al, 2020 ; Özkuk and Ateş, 2020 ; Koç et al, 2021 ; Maindet et al, 2021 ; Bestaş et al, 2022 ), whereas the remaining studies did not randomize the study sample ( Evcik et al, 2007 ; Blasche et al, 2010 ; Koike et al, 2013 ; Latorre-Román et al, 2015 ; Koçak et al, 2020 ).…”

“…However, Sekine and colleagues (2006) study evaluated the individual spa visit frequency for 3 years, but it did not report the mean visit frequency or other values comparable with the other articles ( Sekine et al, 2006 ). The minimum number of balneotherapy treatment sessions was four ( Stier-Jarmer et al, 2020 ), while the maximum was thirty-six ( Altan et al, 2004 ). Also in this case, it was not possible to establish the exact number of treatment sessions in the studies by Sekine and colleagues (2006) and Yang and colleagues (2006) ( Sekine et al, 2006 ; Yang et al, 2018 ).…”

“…Also in this case, it was not possible to establish the exact number of treatment sessions in the studies by Sekine and colleagues (2006) and Yang and colleagues (2006) ( Sekine et al, 2006 ; Yang et al, 2018 ). Most of the articles reported balneotherapy session length of 20 min ( Buskila et al, 2001 ; Neumann et al, 2001 ; Dönmez et al, 2005 ; Yurtkuran et al, 2006 ; Evcik et al, 2007 ; Kamioka et al, 2009 ; Koike et al, 2013 ; Latorre-Román et al, 2015 ; Koçak et al, 2020 ; Naumann et al, 2020 ; Rapolienė et al, 2020 ; Stier-Jarmer et al, 2020 ; Özkuk and Ateş, 2020 ; Koç et al, 2021 ; Bestaş et al, 2022 ), but in some cases, it was longer (30 min or more) ( Altan et al, 2004 , 2006 ; Blasche et al, 2010 ; Yang et al, 2018 ; Maindet et al, 2021 ).…”

“…Sleep was assessed mainly with subjective assessment methods, through ad hoc questions about sleep problems ( Buskila et al, 2001 ), number of hours slept ( Kamioka et al, 2009 ) and sleep quality ( Yang et al, 2018 ) in three articles; through specific-sleep items of broader questionnaires in seven articles ( Nottingham Health Profile —NHP-Sleep ( Wiklund, 1990 ; Altan et al, 2006 ; Yurtkuran et al, 2006 ; Evcik et al, 2007 ; Koçak et al, 2020 ; Özkuk and Ateş, 2020 ); Recovery Stress Questionnaire ( Kallus, 1995 ; Blasche et al, 2010 ); Hamilton Depression Scale ( Williams, 1988 ; Altan et al, 2004 ); through the Visual Analogue Scale (VAS) ( Wewers and Lowe, 1990 ) method in four articles ( Neumann et al, 2001 ; Dönmez et al, 2005 ; Rapolienė et al, 2020 ; Koç et al, 2021 ); through specific sleep questionnaires in seven articles ( Pittsburgh Sleep Quality Index —PSQI ( Buysse et al, 1989 ; Sekine et al, 2006 ; Koçak et al, 2020 ; Naumann et al, 2020 ; Maindet et al, 2021 ; Bestaş et al, 2022 ); Oviedo Sleep Questionnaire —OSQ ( Bobes et al, 1998 ; Latorre-Román et al, 2015 ); Insomnia Severity Index —ISI ( Bastien, 2001 ; Stier-Jarmer et al, 2020 ). Only one study used actigraphy ( Sadeh, 2011 ; Koike et al, 2013 ), one of the most utilized objective methods to record and evaluate sleep.…”

“…Sleep changes were considered a primary outcome in eight studies ( Altan et al, 2004 ; Sekine et al, 2006 ; Blasche et al, 2010 ; Latorre-Román et al, 2015 ; Yang et al, 2018 ; Koçak et al, 2020 ; Özkuk and Ateş, 2020 ; Bestaş et al, 2022 ), a secondary outcome in the majority of the studies ( Buskila et al, 2001 ; Dönmez et al, 2005 ; Altan et al, 2006 ; Sekine et al, 2006 ; Yurtkuran et al, 2006 ; Kamioka et al, 2009 ; Naumann et al, 2020 ; Rapolienė et al, 2020 ; Stier-Jarmer et al, 2020 ; Koç et al, 2021 ; Maindet et al, 2021 ), while it was not specified in three studies ( Neumann et al, 2001 ; Evcik et al, 2007 ; Koike et al, 2013 ). Most of the studies evaluated sleep at the beginning and the end of the balneotherapy and at several follow-up times ( Buskila et al, 2001 ; Neumann et al, 2001 ; Altan et al, 2004 , 2006 ; Dönmez et al, 2005 ; Yurtkuran et al, 2006 ; Evcik et al, 2007 ; Kamioka et al, 2009 ; Blasche et al, 2010 ; Koçak et al, 2020 ; Naumann et al, 2020 ; Rapolienė et al, 2020 ; Stier-Jarmer et al, 2020 ; Özkuk and Ateş, 2020 ; Maindet et al, 2021 ; Bestaş et al, 2022 ); whereas, four studies checked for sleep changes only at the end of the balneotherapy protocol ( Koike et al, 2013 ; Latorre-Román et al, 2015 ; Yang et al, 2018 ; Koç et al, 2021 ).…”