Horticultural therapy for schizophrenia

Horticultural therapy for general health in the older adults: A systematic review and meta-analysis

Background

With a pronounced and historically unprecedented tendency of population ageing, research on ageing and related disorders has been increasingly brought into focus. Horticultural therapy (HT), as an important role of social prescribing, has been an integrative for decades. This systematic review and meta-analysis aimed to evaluate HT for general health in older adults.

Methods

Electronic databases including PubMed, Web of Science, ScienceDirect, the Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), China National Knowledge Infrastructure (CNKI), and the Wanfang database, grey literature databases and clinical trials registers were searched from inception to March 2021. Randomized controlled trials (RCTs), quasi-RCTs (QRCTs) and the cohort studies about HT for adults aged over 60 were included in this study. Outcome measures were physical function, quality of life, BMI, mood tested by self-reported questionnaire and the expression of the immune cells. The study was registered under PROSPERO (CRD42019146184).

Results

Totally, fifteen studies (thirteen RCTs and two cohort studies) involving 1046 older participants were included. Meta-analysis showed that HT resulted in better quality of life (MD 2.09, 95% CI [1.33, 2.85], P<0. 01) and physical function (SMD 0.82, 95% [0.36, 1.29], P<0.01) compared with no-gardener; the similar findings showed in BMI (SMD -0.30, 95% [-0.57, -0.04], P = 0.02) and mood tested by self-reported questionnaire (SMD 2.80, 95% CI [1.82, 3.79], P<0. 01). And HT might be conducive on blood pressure and immunity, while all the evidence were moderate-quality judged by GRADE.

Conclusions

HT may improve physical function and quality of life in older adults, reduce BMI and enhance positive mood. A suitable duration of HT may be between 60 to 120 minutes per week lasting 1.5 to 12 months. However, it remains unclear as to what constitutes an optimal recommendation.

Effectiveness of horticultural therapy on physical functioning and psychological health outcomes for older adults: A systematic review and meta-analysis

AIMS AND OBJECTIVES

To systematically determine the effectiveness of horticultural therapy (HT) on the physical functioning and psychological health of older people.

BACKGROUND

With advancing age and increased chronic diseases, older adults are vulnerable to physical deterioration and psychological problems. There is evidence that horticultural therapy (HT) has positive effect among older adults. However, less attention has been devoted to systematically evaluating the physical functioning and psychological health effects of HT in older adults.

DESIGN

Systematic review and meta-analysis were conducted based on the checklist for PRISMA.

METHODS

The searches were conducted in PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, China Network Knowledge Infrastructure, Wan Fang, and China Science and Technology Journal Database, from their inception until June 2021. Randomised controlled trials published in either English or Chinese were reviewed. The Review Manager 5.4 software was used for meta-analyses. The quality of included studies was evaluated using the Cochrane risk of bias tool by two independent researchers.

RESULTS

Ten studies involving 884 participants were included. Compared with the control group, HT can significantly improve upper body flexibility and aerobic endurance in older adults with cancer. Besides, HT was found to be more effective for promoting emotional functioning and well-being, subjective social functioning, and quality of life among the elderly. The attendance rate for HT was 66%-100%, and no negative events were found.

CONCLUSION

Horticultural therapy has potentially positive effects on the physical functioning and psychological health of older adults. However, more rigorous randomised controlled trials with larger populations are required to confirm the findings.

RELEVANCE TO CLINICAL PRACTICE

As a safe and promising nonpharmacological intervention, healthcare professionals may consider the HT intervention when caring for older adults with cancer, dementia and frailty.

Effectiveness of Horticultural Therapy in People with Schizophrenia: A Systematic Review and Meta-Analysis

Horticultural therapy is increasingly being used in the non-pharmacological treatment of patients with schizophrenia, with previous studies demonstrating its therapeutic effects. The healing outcomes are positively correlated with the settings of the intervention. This review aimed to evaluate the effectiveness of horticultural therapy on the symptoms, rehabilitation outcomes, quality of life, and social functioning in people with schizophrenia, and the different effectiveness in hospital and non-hospital environments. This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. We researched studies through PubMed, Embase, the Cochrane Library, Science Direct, and the China National Knowledge Infrastructure. We included randomized controlled trials (RCTs) and quasi-experimental studies about horticultural therapy for people with schizophrenia, from January 2000 to December 2020, with a total of 23 studies involving 2024 people with schizophrenia included in this systematic review. This study provided evidence supporting the positive effect of horticultural therapy. This review demonstrated that non-hospital environments have a better therapeutic effect on all indicators than hospital environments. The results also demonstrated the effectiveness of horticultural therapy on symptoms, rehabilitation outcomes, quality of life, and social functioning in patients in hospital and non-hospital environments, providing further evidence-based support for landscape design.

What is the evidence for the impact of gardens and gardening on health and well-being: a scoping review and evidence-based logic model to guide healthcare strategy decision making on the use of gardening approaches as a social prescription

OBJECTIVE

To systematically identify and describe studies that have evaluated the impact of gardens and gardening on health and well-being. A secondary objective was to use this evidence to build evidence-based logic models to guide health strategy decision making about gardens and gardening as a non-medical, social prescription.

DESIGN

Scoping review of the impact of gardens and gardening on health and well-being. Gardens include private spaces and those open to the public or part of hospitals, care homes, hospices or third sector organisations.

DATA SOURCES

A range of biomedical and health management journals was searched including Medline, CINAHL, Psychinfo, Web of Knowledge, ASSIA, Cochrane, Joanna Briggs, Greenfile, Environment Complete and a number of indicative websites were searched to locate context-specific data and grey literature. We searched from 1990 to November 2019.

ELIGIBILITY CRITERIA

We included research studies (including systematic reviews) that assessed the effect, value or impact of any garden that met the gardening definition.

DATA EXTRACTION AND SYNTHESIS

Three reviewers jointly screened 50 records by titles and abstracts to ensure calibration. Each record title was screened independently by 2 out of 3 members of the project team and each abstract was screened by 1 member of a team of 3. Random checks on abstract and full-text screening were conducted by a fourth member of the team and any discrepancies were resolved through double-checking and discussion.

RESULTS

From the 8896 papers located, a total of 77* studies was included. Over 35 validated health, well-being and functional biometric outcome measures were reported. Interventions ranged from viewing gardens, taking part in gardening or undertaking therapeutic activities. The findings demonstrated links between gardens and improved mental well-being, increased physical activity and a reduction in social isolation enabling the development of 2 logic models.

CONCLUSIONS

Gardens and gardening can improve the health and well-being for people with a range of health and social needs. The benefits of gardens and gardening could be used as a 'social prescription' globally, for people with long-term conditions (LTCs). Our logic models provide an evidence-based illustration that can guide health strategy decision making about the referral of people with LTCs to socially prescribed, non-medical interventions involving gardens and gardening.

Nature-based Group Therapy Reflections: A Grounded Theory Study

Nature-based therapies have a long history in mental health care. Beneficial effects have been documented for nature-based therapies in a variety of other health care settings. The aims of this grounded theory study were to understand the processes of maintaining nature-based therapeutic groups and the value of the activities to patients in a psychiatric inpatient setting. Over a nine-month period, semi-structured surveys of patient responses to nature-based activities were administered to patients in a pilot therapy group assessing the feasibility of a nature-based group program. Findings indicated that the group promoted use of the senses, social interaction, and care of self/others. Perceptions of benefits led to a nuanced understanding of the effects of being in contact with nature. Based on our findings we offer a preliminary theoretical model for patient engagement with nature-based programming in inpatient mental health care.

Nature-based interventions in institutional and organisational settings: a scoping review

The objective of this review was to scope the literature on nature-based interventions that could be conducted in institutional settings where people reside full-time for care or rehabilitation purposes. Systematic searches were conducted across CINAHL, Medline, Criminal Justice Abstracts, PsycINFO, Scopus, Social Care Online and Cochrane CENTRAL. A total of 85 studies (reported in 86 articles) were included. Four intervention modalities were identified: Gardening/therapeutic horticulture; animal-assisted therapies; care farming and virtual reality-based simulations of natural environments. The interventions were conducted across a range of settings, including inpatient wards, care homes, prisons and women's shelters. Generally, favourable impacts were seen across intervention types, although the reported effects varied widely. There is a growing body of literature on nature-based interventions that could be applied to a variety of institutional settings. Within most intervention types, there is sufficient research data available to perform full systematic reviews. Recommendations for future systematic reviews are offered.

Traditional Chinese medicine for schizophrenia: A survey of randomized trials

OBJECTIVE

To survey the reports of randomized trials of traditional Chinese medicine (TCM) interventions for schizophrenia and produce a broad overview of this type of research activity in this area.

METHOD

We searched the Cochrane Schizophrenia Group's comprehensive Trials Register (January 2016), selected all relevant randomized trials, and extracted the data within each study. Finally, we sought relevant reviews on the Cochrane Library.

RESULTS

We initially screened 423 articles from which we identified 378 relevant studies randomizing 35 341 participants (average study size 94, SD 60). There were 7 herbs used as single medicine, 4 compositions or extractions, more than 144 herbal mixes, and 7 TCM principles reported for schizophrenia. Nonpharmacological interventions of TCM included acupuncture and exercise. The most commonly evaluated treatments are Ginkgo biloba, acupuncture, Wendan decoction, and Shugan Jieyu Capsule. There are 3 directly relevant Cochrane reviews.

CONCLUSIONS

Most treatment approaches-and some in common use-have only one or two relevant small trials. Some coordination of effort would help ensure that further well-designed appropriately sized randomized trials are conducted. Systematic reviews should be performed in this field but with titles that take into account the complexity of TCM.

Treatment Effect of Antipsychotics in Combination with Horticultural Therapy on Patients with Schizophrenia: A Randomized, Double-blind, Placebo-controlled Study

BACKGROUND

As a newly developed treatment method for schizophrenia, horticultural therapy is gaining more attention. However, there is as of now little research investigating this topic as well as a general lack of studies adopting into standard treatment plans.

AIMS

Investigate treatment effect of horticultural therapy on patients with schizophrenia and its possibility of standardized application in psychiatric hospitals.

METHODS

110 patients with schizophrenia who met the inclusion criteria and provided informed consent were selected from the rehabilitation ward of the Minhang District Mental Health Center from September 2015 to December 2015. We used random-number methods to classify patients into either the intervention group or the control group. While the two groups both received normal medications, the intervention group also attended horticultural therapy. Patients in the intervention group were led by a rehabilitation therapist who had obtained the level II psychological counselor qualification (the standard qualification for counselors in China). The treatment period lasted for 12 weeks. Treatment was held 3 times every week and each session lasted for 90 minutes. The specific contents included ridging, planting, watering, fertilizing and pruning of flowers; plowing, sowing, watering, fertilizing, weeding and catching pests for gardens; appreciating, collecting vegetables, cooking and tasting for flowers and grasses. During the final 10 minutes of every session, patients mutually expressed their thoughts and experiences and the rehabilitation therapist concluded the session. The two groups were measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, the end of the 4th week and the end of the 12th week.

RESULTS

There was no statistically significant difference in gender, age, course of disease, marital status, mean dosage of antipsychotic medications and PANSS score before the intervention among two groups. The PANSS score in the intervention group was statistically significant lower than in the control group both at the end of the 4th week (t=-4.03, p<0.001) and at the end of the 12th week (t=-5.57, p<0.001). There were statistically significant differences before and after intervention in the intervention group (F=253.03, p<0.001); there was statistically significant differences before and after intervention in the control group (F=67.66, p<0.001). There was statistically significant difference in the positive scale score among the two groups both at the end of the 4th week (t=-3.69, p<0.001) and the end of the 12th week (t=-3.55, p<0.001); there was a statistically significant difference in the general psychopathology scale score among the two groups both at the end of the 4th week (t=-3.67, p<0.001) and the end of the 12th week (t=-3.34, p<0.001). Likewise, there were statistically significant differences in the positive scale scores at baseline, end of the 4th week and the end of the 12th week both among the intervention group (F=13.76, p<0.001) and the control group (F=5.12, p=0.02); there were statistically significant differences in the general psychopathology scale scores at the baseline, the end of the 4th weekand the end of the 12th week both among the intervention group (F=156.40, p<0.001) and the control group (F=56.72, p<0.001). There was statistically significant differences in the negative scale score at the end of the 12th week among the two groups (t=-2.76, p<0.001). There were statistically significant differences in the positive scale scores at the baseline, the end of the 4th week and the end of the 12th week both among the intervention group (F=103.94, p<0.001) and the control group (F=34.03, p<0.001).

CONCLUSIONS

Although antipsychotic medications can alleviate the psychiatric symptoms of patients with schizophrenia, the treatment effect for both positive and negative symptoms would be even more effective if it is combined with horticultural therapy.