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

NCT07059390 | Not Yet Recruiting

• 1 other identifier: 2025-032
• Study Type: interventional
• Target: 1,600
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Dementia; Acquired Brain Injury Including Stroke

Keywords

Dementia; Stroke; Traumatic Brain Injury; Delirium; Nature-Based Therapy

Outcome Measures

Primary Outcomes (2)

• Pittsburg Agitation Scale

  The Pittsburgh Agitation Scale (PAS) is a quick, observational tool used to assess the severity of agitation in dementia patients, focusing on four behavioral dimensions: aberrant vocalizations, motor agitation, aggressiveness, and resistance to care

  Baseline and at the end of intervention, an average 7 days

• DASS-21

  The DASS-21 (Depression, Anxiety, and Stress Scale - 21 Items) is a self-report questionnaire designed to measure the severity of symptoms related to depression, anxiety, and stress in adults. It consists of 21 questions, with seven questions for each of the three scales: depression, anxiety, and stress.

  Baseline and at the end of intervention, an average of 7 days

Secondary Outcomes (2)

• EQ-5D-5L

  Baseline and at the end of intervention, an average of 7 days

• Zarit Burden Interview

  Baseline and at the end of intervention, an average of 7 days

Study Arms (4)

Dementia Patients - Intervention

EXPERIMENTAL

Patients with dementia who undergo Nature Immersion Therapy

Behavioral: Nature Immersion Therapy

Dementia Patients - Control

NO INTERVENTION

Patients with dementia who do not undergo Nature Immersion Therapy

Rehabilitation Patients - Intervention

EXPERIMENTAL

Rehabilitation patients who undergo Nature Immersion Therapy

Behavioral: Nature Immersion Therapy

Rehabilitation Patients - Control

NO INTERVENTION

Rehabilitation patients who do not undergo Nature Immersion Therapy

Interventions

Nature Immersion Therapy BEHAVIORAL

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 guided by a trained CGH staff (Allied Health Professionals/Nurse). This Green social prescribing plan (Playbook) will be integrated into inpatient's care plan. Caregivers of the enrolled patients will also be part of the therapy group following the necessary consent.

Dementia Patients - Intervention; Rehabilitation Patients - Intervention

Eligibility Criteria

• Age: 21 Years - 100 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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)

You may not qualify if:

• 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

Sponsors & Collaborators

• Changi General Hospital: lead

Study Sites (1)

Changi General Hospital

Singapore, Singapore

Location

Related Publications (8)

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

MeSH Terms

Conditions

Dementia; Stroke; Brain Injuries, Traumatic; Delirium

Condition Hierarchy (Ancestors)

Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Mental Disorders; Cerebrovascular Disorders; Vascular Diseases; Cardiovascular Diseases; Brain Injuries; Craniocerebral Trauma; Trauma, Nervous System; Wounds and Injuries; Confusion; Neurobehavioral Manifestations; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Si Ching Lim, MD

  Changi General Hospital

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Si Ching Lim

CONTACT

(65) 6426 7818; lim.si.ching@singhealth.com.sg

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 26, 2025
• First Posted: July 10, 2025
• Study Start (Estimated): May 1, 2027
• Primary Completion (Estimated): June 1, 2028
• Study Completion (Estimated): August 1, 2028
• Last Updated: March 23, 2026

Record last verified: 2025-03

Data Sharing

• IPD Sharing: Will not share

Locations

SG (1)