Introduction
     In Western Society, the 21st century has brought significant technological advances, yet it has also seen the pervasive rise of burnout, a phenomenon well-documented since the mid-20th century (Samra, 2018). During the 1960s and1970s, air traffic controllers were among the first to report a form of exhaustion that resulted in a decline in the quality of their work, largely due to poor training environments, shifting work patterns, and extended shifts without adequate breaks (Samra, 2018). It was not until 1974 that psychologist Herbert Freudenberger formally coined the term "burnout," describing it as a complex response to the environmental stressors of work, characterizedby symptoms such as depersonalization, lack of personal accomplishment, and profound exhaustion (Samra, 2018).

     This early recognition of work-related stressors led Christina Maslach to perform a series of interviews revealing that emotional exhaustion, depersonalization and reduced self-efficacy that can manifest in some workers (Nadon et al., 2022). These interviews laid the groundwork for Christina Maslach to develop the Maslach Burnout Inventory Questionnaire (MBI), marking a pivotal turning point in the conceptualization and measurement of burnout (Nadon et al., 2022). The development of the MBI significantly advanced the study of burnout by offering a standardized method of measurement and encouraging quantitative research into a relatively new psychological concept. This led to a significant expansion inthe research output on burnout, with the number of publications growing dramatically from just 8 in the 1970s to over 16,000 by 2022, highlighting a growing academic and practical interest in understanding and addressing burnout across diverse fields.

     Consequently, healthcare delivery, a field where emotional demands are particularly high began to see an increased recognition in burnout in healthcare professionals (Nadonet al., 2022). Today, students and practicing healthcare professionals are frequently subjected to prolonged working hours and the need to manage complex conditions while staying current with changing guidelines (González-Sánchez etal., 2017; Santos et al., 2010). These intense work demands contribute to high levels of stress (González-Sánchez et al., 2017), often culminating in burnout syndrome—marked by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. Maslachs conceptualization of burnout defines it as a psychological condition characterized by three sequentialstages: exhaustion, depersonalization, and reduced professional efficacy (Nadonet al., 2022). Initially, work-related stressors deplete an employee's resources, leading to exhaustion (Nadonet al., 2022). This exhaustion then causes employees to emotionally disengage from their work and clients as a defensive mechanism against further depletion, leading to depersonalization. Ultimately, this emotional withdrawal causes employees to perceive a decline in their self-efficacy as their coping strategies negatively impact their work performance. However, despite affecting 67% of healthcare professionals, burnout syndrome is still not universally recognized as a mental health disorder, partly due to unclear diagnostic criteria (Nadon et al., 2022). 

     A meta-analysis by Aronssonet al. (2017) proposed that symptoms of burnout in physiotherapists include feelings of exhaustion, increased disassociation from their job, as well as colleagues, and reduced self-perceived professional efficacy when managing patient’s conditions. This characterization underscores the pervasive impact of burnout on health care professionals, affecting both their well-being and clinical performance. Indeed, one of the central tenets of patient centred care is establishing a therapeutic relationship with a patient built upon genuine empathy (Rodríguez-Nogueira et al., 2022). However, the two components of burnout, depersonalization, and emotional exhaustion, has been shown to negatively impact empathy, and by association patient care (Rodríguez-Nogueira et al., 2022). Therefore, its imperative to critically assess and expand upon current preventative mechanisms and coping strategies for managing burnout syndrome to preserve clinician effectiveness and well-being.  

Strategies Combating Burnout
     González-Sánchezet al. (2017) examined the impactof organizational factors inrelation to burnout among physiotherapists, revealing several key domains that influence the prevalence and severity of burnout. Notably, the volume of patient care, reflectedboth in the number of patients treated per day (>20 patients) and the hours dedicated to direct patientinteractions (>40 hours), emerges as a critical stressor, with physiotherapists handling higher patient loads experiencing significantly greater levels of emotional exhaustion and depersonalization. This suggests that the demands of patient care, particularly in high-volume settings, are central to the development of burnout. Moreover, the distinction between private and public sector employment highlights how the structure and expectations of the workplace can further exacerbate stress, with those in private practice reporting higher levels of burnout, likely due to the competitive nature of private practice that involves longer work hours and increased patient care responsibilities.  

     However,the methodology employed González-Sánchez et al. (2017) raises significant questions to the generalisability of these results. The inclusion criteria consisted of physiotherapists with 1-year experience but excluded those on sick leave which may have omitted those at higher risk of burnout, thereby potentially under representing the prevalence and severity of the condition. Furthermore, the study reported a low response rate using a traditional postal service, with 131 (22.43%) out of apotential 584 responding, suggesting other means of submission may have been useful. Additionally, it could be argued that those most disfranchised from an organisation are less likely to respond to a questionnaire, especially when experiencing feelings of emotional exhaustion, depersonalization, and low personal achievement. Nevertheless, the study's findings point to the requirement of organizations to thoroughly consider policies that limit maximum working hours (<40 hours) and maximum patients seen per day (<20 patients) to foster a more sustainable and supportive environment.

     At a professional level, Fereydounnia (2011) surveyed physiotherapists working in Iran, out of the 245 physiotherapists, 145 (62.3%) responders reported a deficiency in training opportunities within their workplace. This absence of opportunities for professional growth and development was found to correlate significantly with elevated levels of burnout, particularly manifesting through increased scores in emotional exhaustion. In contrast, Fischer et al. (2013) found no association between clinical supervision and burnout in a relatively smaller sample of South Tyrol physiotherapists (N= 132), despite approximatelyonly 50% of participants receiving clinical supervision. The discrepancy between the two studies may be explained by the differences implementing clinical support and supervision. In support of this premise, the results from Fischer et al. (2013) are not in keeping with the wider literature, with several studies noting a positive benefit of clinical supervision on burnout in other health professionals (Edwards et al., 2006; Wallbank &Hatton, 2011; Iosim et al., 2021). Collectively, the literature underscores the critical role that access to professional development plays in mitigating burnout, suggesting that enhancing training and growth opportunities could serve as a pivotal strategy in reducing burnout symptoms among physiotherapists. 

     In terms of personality, clinicians who set unrealistic expectations due to lack of experience or set by demanding patients are likely to experience significantly higher levels of work-related stress (Rogan et al., 2019). The tendency to setting overly optimistic goals often stems from a deep-seated compulsion to help, and if successful, can lead to what is known as compassion satisfaction (Rogan et al., 2019). Conversely, if treatment outcomes fail to meet the expectations of either the clinician or the patient, this can significantly diminish the clinician's sense of self-efficacy, a condition referred to as compassion fatigue. This risk is particularly heightened for inexperienced clinicians who may face greater emotional turmoil, especially when managing chronic patients who may have less than favourable outcomes (Rogan et al., 2019). As a result, clinicians who are frequently exposed to extreme elation or disappointment from patient outcomes are more susceptible to work-related stress (Rogan et al., 2019).

     Therefore, educating clinicians on expectation management is crucial for reducing work-related stress and preventing burnout. By advocating for a more moderate treatment philosophy, or by providing training on how to set realistic goals based on normative data, clinicians can more effectively manage and align patient expectations with reasonable outcomes and treatments duration. This approach not only helps manage patients’ beliefs and expectations but also supports clinicians in maintaining their own mental well-being by mitigating potential frustrations and disappointment. However, clinicians must be willing admit the limitations rehabilitation as well as acknowledge the inevitability that a small proportion of patients will fail regardless of clinician’s efforts.