Mindfulness-Based Stress Reduction (MBSR) protocol applied to systemic sclerosis (SSc) patients: a pilot interventional study focused on nursing assessment and perceived stress

Background: MBSR is a protocol, developed by John Kabat-Zinn, which
fosters awareness by focusing on the present experience. Basing on scientific evidences, the numerous benefits of MBSR on diseases symptoms
have been widely demonstrated.1–2 No studies have used MBSR on SSc.
SSc is characterised by skin and systemic involvement: patients may
complain for pain, psychological distress, concerns about disfigurement
and reduced self-esteem.3 Thus, nurse’s role is pivotal not only in
improving SSc patients global health and quality of life (QoL) but also in
ameliorating their self-management strategies.
Objectives: to assess the effect of MBSR protocol on sleep quality, QoL
and perceived stress in SSc.
Methods: 28 SSc patients were enrolled and randomly assigned to experimental group or to control group, and were assessed at baseline and
after 8 weeks of MBSR program for the experimental group compared to
the control group. The following clinimetric outcomes were measured:
QoL with SF-36, sleep quality with a NRS (0–10 range) and Likert scale
on night awakenings, perceived stress scale (PSS) and Likert Scale on
the way they cope with the stress. Data are presented as differences of
Mean and Percentage (%), between and within the groups.
Results: QoL presented an improvement for Mental Index Subscale for
the experimental group (44.3 to 49.06) while the control group did not
show any modification (40.73–40.75). For the impact of sleep quality,
MBSR obtained an improvement from 53.3% at baseline to 26.7% at the
end of the study: these patients still felt a bad sleep quality but were
from far better in respect to controls that did not show any change. In
MBSR group night awakenings were reduced from 73% to 60%, while in
the control group were increased from 54% to 67%. Satisfaction of sleep
quality was slightly improved in MBSR group (6.8 to 7.6) while controls
did not experience any change (5.25 to 5.45). MBSR patients at baseline
classified stress as a “high” health problem (53%) while after MBSR
training only 20% kept the same answer.
Conclusions: MBSR program, applied for the first time to SSc patients,
showed a very good tolerability and a positive impact on aspects of life
like sleep quality, stress perception and self-management strategies. The
present study has limitations, nevertheless this is the first time that an
alternative approach, such as MBSR, is used. Obviously, MBSR is a
supportive approach which can provide to patients a self-management
strategy against stress and disease perceptions and in the future it can
be integrated to pharmacological therapy and clinical rehabilitation.