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Concurrent Trials on Nature-Based Therapy for Inpatients in Dementia and Rehabilitation Medicine Wards

No phase Interventional Dementia Acquired Brain Injury Including Stroke

For patients and families

In plain language

An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.

What is being studied
The protocol lists: Nature Immersion Therapy.
Who it may be relevant to
Registry conditions: Dementia, Acquired Brain Injury Including Stroke. Basic parameters: 21 years — 100 years · All.
What needs checking
Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
Where it takes place
Singapore
Next step
Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →

Unsure about the terms? Read our patient guide →

Official title

Changi General Hospital Complementary Health Therapy

Overview

Nature-based Therapy, such as forest bathing and horticultural therapy, has been shown to have physical, psychological and emotional health benefits. We posit that personalised and guided Nature-based Therapy, which leverages the benefits of therapeutic gardens in an urban hospital setting, improves the overall wellbeing of elderly inpatients with dementia (aged \>65 years old) and their caregivers, as well as patients undergoing inpatient rehabilitation. To determine the effectiveness of Nature-based Therapy for these two inpatient populations, we designed a pilot study, TGIF, to be conducted at the dementia and rehabilitation medicine wards at Changi General Hospital in Singapore.

Detailed description

TGIF consists of two concurrent trials targeting two patient populations: elderly inpatients with dementia admitted to the dementia ward, and inpatients undergoing inpatient rehabilitation at the rehabilitation wards in a tertiary teaching hospital in Singapore. At the dementia wards, we aim to determine if Nature-based Therapy improved the neuropsychiatric symptoms such as agitation, restlessness and aggression among elderly inpatients living with cognitive impairment, defined as either delirium or dementia or both. Concurrent with the improved neuropsychiatric symptoms, the study team will also study the improved quality of life among the family, caregivers and hence reduced caregiver burden. At the rehabilitation medicine wards, we aim to determine if Nature-based Therapy improves mood, physical function, and quality of life.

Interventions

  • Behavioral Nature Immersion Therapy
    During the length of inpatient stay at Changi General Hospital (CGH), which ranges from 5 to 10 days, the patients and caregivers will be enrolled for a set of 3 nature-based sessions. Each session will be conducted in groups of 4 to 6 patients incorporating a relational multi-sensory experience as well as mind-body connectedness while spending time in nature. Each of the 3 sessions will be 45 minutes each. The nature-based therapy/green social prescription plan will be conducted in groups guide

Primary outcome measures

  • Pittsburg Agitation Scale [Time frame: Baseline and at the end of intervention, an average 7 days]
  • DASS-21 [Time frame: Baseline and at the end of intervention, an average of 7 days]
Secondary outcome measures (2)
  • EQ-5D-5L [Time frame: Baseline and at the end of intervention, an average of 7 days]
  • Zarit Burden Interview [Time frame: Baseline and at the end of intervention, an average of 7 days]

Eligibility criteria

Inclusion criteria

Patients with dementia:

  • Age 65-100 years old
  • Have a diagnosis of delirium/ dementia or both.
  • Have diagnosis of dementia with and without behavioural symptoms of dementia (BPSD)
  • Ability to communicate with the Nature-based Therapist (in languages such as English, Mandarin Chinese, Chinese dialects or Malay)
  • Manageable behavioural symptoms and able to focus attention for minimum of 30 minutes

Rehabilitation Medicine patients:

  • Age 21-100 years old
  • Acquired brain injury with residual impairments, which can be either in the i) motor, and/or ii) cognitive domains, and/or iii) suspected or diagnosed mood disorders (including adjustment disorder, depression and anxiety disorders) -patients would then be stratified according to the category(s) of impairments both for consideration of interventions and for outcome measures/analysis
  • Additional Physical/Cognitive Criteria required will depend on range of specific therapeutic activities that could be prescribed/administered (eg.at least 1 upper limb with Manual Muscle Testing (MMT) of at least 3/5, with ability for active grasp/release, ability to sustain attention for the duration of the session, cognitive Functional Independence Measure (FIM) score of at least 25 points etc)

Exclusion criteria

  • In isolation due to contact, droplet or airborne precautions
  • Unable to provide consent and lack of surrogate decision maker to provide consent
  • Poorly managed psychiatric or behaviour symptoms with threats to others surrounding them.
  • Age < 21 years
  • Patients who are haemodynamically unstable.
  • Patients on strict bed rest

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation
Randomized
Model
Parallel assignment
Masking
Triple blind
Primary purpose
Health services research

Study locations

Singapore · 1 center
  • Changi General Hospital — Singapore

Publications

  • Hansen MM, Jones R, Tocchini K. Shinrin-Yoku (Forest Bathing) and Nature Therapy: A State-of-the-Art Review. Int J Environ Res Public Health. 2017 Jul 28;14(8):851. doi: 10.3390/ijerph14080851. PMID 28788101
  • Vibholm AP, Christensen JR, Pallesen H. Nature-based rehabilitation for adults with acquired brain injury: a scoping review. Int J Environ Health Res. 2020 Dec;30(6):661-676. doi: 10.1080/09603123.2019.1620183. Epub 2019 May 27. PMID 31131619
  • Ng KST, Sia A, Ng MKW, Tan CTY, Chan HY, Tan CH, Rawtaer I, Feng L, Mahendran R, Larbi A, Kua EH, Ho RCM. Effects of Horticultural Therapy on Asian Older Adults: A Randomized Controlled Trial. Int J Environ Res Public Health. 2018 Aug 9;15(8):1705. doi: 10.3390/ijerph15081705. PMID 30096932
  • Howarth M, Brettle A, Hardman M, Maden M. 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. BMJ Open. 2020 Jul 19;10(7):e036923. doi: 10.1136/bmjopen-2020-036923. PMID 32690529
  • Antonelli M, Barbieri G, Donelli D. Effects of forest bathing (shinrin-yoku) on levels of cortisol as a stress biomarker: a systematic review and meta-analysis. Int J Biometeorol. 2019 Aug;63(8):1117-1134. doi: 10.1007/s00484-019-01717-x. Epub 2019 Apr 18. PMID 31001682
  • Li Q. Effect of forest bathing trips on human immune function. Environ Health Prev Med. 2010 Jan;15(1):9-17. doi: 10.1007/s12199-008-0068-3. PMID 19568839
  • Siah CJR, Goh YS, Lee J, Poon SN, Ow Yong JQY, Tam WW. The effects of forest bathing on psychological well-being: A systematic review and meta-analysis. Int J Ment Health Nurs. 2023 Aug;32(4):1038-1054. doi: 10.1111/inm.13131. Epub 2023 Mar 2. PMID 36864583
  • Kavanaugh J, Hardison ME, Rogers HH, White C, Gross J. Assessing the Impact of a Shinrin-Yoku (Forest Bathing) Intervention on Physician/Healthcare Professional Burnout: A Randomized, Controlled Trial. Int J Environ Res Public Health. 2022 Nov 4;19(21):14505. doi: 10.3390/ijerph192114505. PMID 36361384

Identifiers

NCT: NCT07059390 · 2025-032

Primary sources (government registries)

View this study on ClinicalTrials.gov ↗