Mental health impacts of physiotherapists during the COVID-19 pandemic: a systematic review






Introduction: Health professionals have undergone a profound change in their work to combat the COVID-19 pandemic, which has led to a potential psychological and emotional impact on this population. None of the systematic reviews that evaluated the mental health of these professionals specifically addressed physical therapists. Objective: To identify mental health risks in physical therapists, and personal and systemic factors that increase their vulnerability. Methods: Systematic review performed according to Cochrane guidelines. A systematic search was performed between October 2021 and January 2022, in the following databases: CENTRAL,, WHO ICTRP, SCIENCE DIRECT, Google Scholar, SCIELO, LILACS, PUBMED/MEDLINE and bioRxiv/medRvix, for works published between 2020 and 2021. Full-text studies were considered, published or not, in any language, in any location, evaluating the impacts of mental health exclusively on physical therapists, during the pandemic. The methodological quality of the articles was evaluated using the Risk of Bias (RoB) tool using the RevMan 5.4.1 software. Results and Discussion: After searching and analyzing the eligibility criteria, 8 articles were included for qualitative analysis. All of them were cross-sectional studies, exclusively with physical therapists. The sample size was 1007 physical therapists. Conclusion: The COVID-19 pandemic increased the incidence of anxiety, depression, stress, changes in sleep and quality of life, changes in emotion and feelings, psychological distress, post-traumatic disorder and Burnout in physical therapists. However, more robust studies, and directed to the population of physical therapists, are necessary to increase the level of evidence of the study in question.


Aiyer, et al. Mental Health Impact of COVID-19 on Healthcare Worker in the USA: A Cross-Sectional Web- Based Survey. Journal of Depression and Anxiety. 2020; 9:373.

Badahdah, et al. The mental health of health care workers in Oman during the COVID-19 pandemic, International Journal of Social Psychiatry 67(1), 90–95. 2020.

Bae Y. H., & Min K. S. Associations between work-related musculoskeletal disorders, quality of life, and workplace stress in physical therapists. Ind. Health. 2016;54:347–353. 10.2486/indhealth.2015-0127.

Baik, S. H., Fox, R. S., Mills, S. D., Roesch, S. C., Sadler, G. R., Klonoff, E. A., & Malcarne,V. L. Reliability and validity of the Perceived Stress Scale-10 in Hispanic Americans with English or Spanish language preference. Journal of health psychology2019;24(5): 628-639.

Barello, S., Palamenghi, L., & Graffigna, G. (2020). Burnout and somatic symptoms among frontline healthcare professionals at the peak of the Italian COVID‐19 pandemic. Psychiatry Research, 290, 113129. 10.1016/j.psychres.2020.113129.

Bertolazi, A. N. Tradução, Adaptação Cultural e Validação de Dois Instrumentos de Avaliação do Sono: Escala de Sonolência de Sonolência de Epworth e Índice de Qualidade de Sono de Pittsburgh [tese]. Porto Alegre (RS): Universidade Federal do Rio Grande do Sul; 2008.

Brooks, et al. Social and occupational factors associated with psychological wellbeing among occupational groups affected by disaster: a systematic review. J. Ment. Health, 26 (4) (2017), pp. 373-384.

Cao, et al. SARS-CoV-2 infecção em crianças: dinâmica de transmissão e características clínicas. J.Formos. Med Assoc. Taiwan Yi Zhi; 119 :670-673. 2020.

Corrado, et al. Burnout syndrome among Italian physiotherapists: A cross‐sectional study. European Journal of Physiotherapy, 21(4), 240–245. 10.1080/21679169.2018.1536765. 2019.

De Araújo Silva, T. L., & Alchieri, J. C. Socioeconomic and demographic aspects related to stress and the burnout syndrome among Brazilian physiotherapists. Salud Mental, 37(3), 233–238. 2014.

De Sire et al. Psychological Distress and Work Environment Perception by Physical Therapists from Southern Italy during COVID-19 Pandemic: The C.A.L.A.B.R.I.A Study. Int J Environ Res Public Health. 2021;18(18):9676. Published 2021 Sep 14. doi:10.3390/ijerph18189676

De Sio et al. The impact of COVID-19 on doctors’ well-being: Results of a web survey during the lockdown in Italy. Eur. Rev. Med. Pharmacol. Sci. 2020;24:7869–7879.

Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71–75. 10.1207/s15327752jpa4901_13

Di Tella, et al. Mental health of healthcare workers during the COVID-19 pandemic in Italy, Journal of Evaluation in Clinical Practice 26(6), 1583–1587. 2020.

Carver, C. S., 1997, ‘You want to measure coping but your protocol’s too long: Consider the Brief Cope’, International Journal of Behavioral Medicine 4(1), 92–100.

Ferry, A. V., Wereski, R., Strachan, F. E., & Mills, N. L. (2020). Predictors of healthcare worker burnout during the COVID‐19 pandemic. medRxiv. 10.1101/2020.08.26.20182378

Fleck, M. P. A., Louzada, S., Xavier, M, Chachamovich, E., Vieira, G., Santos, L., et al. Aplicaçăo da versăo em português do instrumento de avaliação de qualidade de vida da organização mundial da saúde (WHOQOL-100) 1999. Rev Saúde Pública 1999;33:198-205.

Giusti, E. M., Pedroli, E., D'Aniello, G. E., Stramba Badiale, C., Pietrabissa, G., Manna, C., Stramba Badiale, M., Riva, G., Castelnuovo, G., & Molinari, E. (2020). The psychological impact of the COVID‐19 outbreak on health professionals: A cross‐sectional study. Frontiers in Psychology, 11, 1684. 10.3389/fpsyg.2020.01684

Hassem, et al. COVID-19: Contrasting experiences of South African physiotherapists based on patient exposure. South African Journal of Physiotherapy. 2022; 78(1), a1576.

Hays, R. D., Schalet, B. D., Spritzer, K. L., & Cella, D., 2017, ‘ Two-item PROMIS® Global Physical and Mental Health scales’, Journal of Patient-Reported Outcomes 1(1), 1–5.

Higgins, et al. RoB 2 Guidance: Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). 2019. n. July, p. 1–24. <


Jácome, et al. Burnout in Portuguese physiotherapists during COVID-19 pandemic. Physiother Res Int. 2021;26(3):e1915.10.1002/pri.1915.

Jalili, M., Niroomand, M., Hadavand, F., Zeinali, K., & Fotouhi, A. (2020). Burnout among healthcare professionals during COVID‐19 pandemic: A cross‐sectional study. medRxiv. 10.1101/2020.06.12.20129650.

Koontalay, A., et al. “Healthcare Workers' Burdens During the COVID-19 Pandemic: A Qualitative Systematic Review.” Journal of multidisciplinary healthcare vol. 14 3015-3025. 27 Oct. 2021,10.2147/JMDH.S330041

Kristensen, T. S., Borritz, M., Villadsen, E., & Christensen, K. B. (2005). The Copenhagen Burnout Inventory: A new tool for the assessment of burnout. Work & Stress, 19(3), 192–207.Maunder et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerg. Infect. Dis., 12 (12) (2006), pp. 1924-1932.

Kroenke K., & Spitzer R. L., Williams J.B. The PHQ-9: Validity of a brief depression severity measure. J. Gen. Intern. Med. 2001;16:606–613. 10.1046/j.1525-1497.2001.016009606.x.

Lázaro-Pérez, et al. Anxiety about the risk of death of their patients in health professionals in Spain: Analysis at the peak of the COVID-19 pandemic. Int. J. Environ. Res. Public Health. 2020.

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343. 10.1016/0005-7967(94)00075-u.

Lu, W., et al. Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study, Psychiatry Research 288, 112936. 2020.

Luceño‐Moreno, et al. Symptoms of posttraumatic stress, anxiety, depression, levels of resilience and burnout in Spanish health personnel during the COVID‐19 pandemic. International Journal of Environmental Research and Public Health, 17(15), 5514. 2020.

Malach-Pines, A., 2005, ‘The burnout measure, short version’, International Journal of Stress Management 12(1), 78–88.

Maroufizadeh S., Omani-Samani R., Almasi-Hashiani A., Amini P., & Sepidarkish M. The reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with infertility. Reprod Health. 2019;16:137. 10.1186/s12978-019-0802-x.

Moazzami, et al. COVID-19 and telemedicine: Immediate action required for maintaining healthcare providers well-being. J Clin Virol. 2020; 126:104345

Moher, D., et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

Nautiyal, et al. Prevalence of Stress Level in Physiotherapy Working Profession During Covid-19 Pandemic. Indian Journal of Public Health Research & Development. 2021; 12(4).

Oliveira, M. F., & Machado, T. S. (2011). Tradução e validação da Escala de Resiliência para Estudantes do Ensino Superior. Análise Psicológica, 29, 579–591.‐82312011000400007&nrm=iso.

Organização Mundial da Saúde. 'Nomeando a doença do coronavírus (COVID-19) e o vírus que a causa', [online], a-doença-coronavírus-(covid-2019)-e-o-vírus-que-causa-a. 2020.

Pais‐Ribeiro, J. L., Honrado, A., & Leal, I. (2004). Contribuição para o Estudo da Adaptação Portuguesa das Escalas de Ansiedade, Depressão e Stress (EADS) de 21 itens de Lovibond e Lovibond. Psicologia Saúde & Doenças, 5, 229–239.‐00862004000200007&nrm=iso.

Palacios-Ceña, et al. Emotional Experience and Feelings during First COVID-19 Outbreak Perceived by Physical Therapists: A Qualitative Study in Madrid, Spain. Int J Environ Res Public Health. 2020;18(1):127. Published 2020 Dec 27.10.3390/ijerph18010127

Pasikowski T. Polish adaptation of the questionnaire Maslach Burnout Inventory. W: Sęk H., red. Burnout. Causes, mechanisms, prevention. PWN, Warszawa. 2000; 135-48.

Pavlakis, et al. Burnout syndrome in Cypriot physiotherapists: A national survey. BMC Health Services Research, 10(1), 63. 10.1186/1472-6963-10-63. 2010.

Pniak, et al. Occupational Burnout Among Active Physiotherapists Working in Clinical Hospitals During the COVID-19 Pandemic in South-eastern Poland. WORK: A Journal of Prevention, Assessment & Rehabilitation. 2021; 68 (2): 285 – 295.

Review Manager (RevMan) [Programa de computador]. Versão 5.4.1, The Cochrane Collaboration, 2020.

Rodrigues, et al. Occupational stress in Portuguese physiotherapists. Occupational safety and hygiene IV (pp. 299–302). CRC Press. 2016.

Salazar de Pablo, G., et al. Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis. Journal of affective disorders vol. 275 (2020): 48-57.10.1016/j.jad.2020.06.022.

Seixas, et al. Burnout in Portuguese physiotherapists, prevalence and influencing factors. International Journal of Occupational and Environmental Safety, 4(1), 37–47. 2020.

Śliwiński, et al. Burnout among physiotherapists and length of service. International Journal of Occupational Medicine & Environmental Health, 27(2), 224–235. 2014.

Shiozawa, P., & Uchida, R. R. An updated systematic review on the coronavirus pandemic: lessons for psychiatry. Braz J Psychiatry. 2020;42(3):330-331.10.1590/1516-4446-2020-0975.

Silva, et al. Avaliação da qualidade do sono e sua relação com a qualidade de vida de trabalhadores noturnos da enfermagem do hospital de são Lourenço-MG. Revista Saúde em Foco,10, 581-590. 2018.

Snaith, R. P., 2003, ‘The Hospital Anxiety and Depression Scale’, Health and Quality of Life Outcomes 1(1), 29.

Souza, M. A., & Stancato, K. (2010). Avaliação da qualidade de vida de profissionais de saúde em Campinas. Revista de Atenção à Saúde,12(49), 155-161.

Vaishnavi, S., Connor, K., & Davidson, J. R., 2007, ‘An abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC), the CD-RISC2: Psychometric properties and applications in psychopharmacological trials’, Psychiatry Research 152(2–3), 293–297.

Wagnild, G. M., & Young, H. M. (1993). Development and psychometric evaluation of the resilience scale. Journal of Nursing Measurement, 1(2), 165–178.

Yang et al. The Mental Health Burden of the COVID-19 Pandemic on Physical Therapists. Int J Environ Res Public Health. 2020;17(10):3723. Published 2020 May 25. doi:10.3390/ijerph17103723

Xiong Y., & Peng L. Focusing on health-care providers’ experiences in the COVID-19 crisis. Lancet Glob. Health. 2020;8:e740–e741. 10.1016/S2214-109X(20)30214-X.

Xiao, et al. Psychological impact of healthcare workers in China during COVID-19 pneumonia epidemic: A multi-center cross-sectional survey investigation. J. Affect. Disord. 2020;274:405–410.

Zancan, et al. The impact on the quality of life of physiotherapists in the Covid-19 pandemic front line. Research, Society and Development. 2022; 11 (1).



How to Cite

MASTROIANNI, V. W.; AMORIM, I. F. I. de M.; SILVA, J. H.; CAMPOS, S. L. .; ARAÚJO, M. das G. R. de .; ANDRADE, A. de F. D. de; BRANDÃO, D. C. Mental health impacts of physiotherapists during the COVID-19 pandemic: a systematic review. Research, Society and Development, [S. l.], v. 11, n. 10, p. e591111033093, 2022. DOI: 10.33448/rsd-v11i10.33093. Disponível em: Acesso em: 11 dec. 2023.



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