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

NCT ID: NCT07059390

Last Updated: 2025-07-10

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 1600 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-08-31
• Study Completion Date: 2027-08-31

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.

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.

Conditions

Dementia; Acquired Brain Injury Including Stroke

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: TRIPLE

Study Groups

Dementia Patients - Intervention

Patients with dementia who undergo Nature Immersion Therapy

Group Type: EXPERIMENTAL

Nature Immersion Therapy

Intervention Type: 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 - Control

Patients with dementia who do not undergo Nature Immersion Therapy

Group Type: NO_INTERVENTION

No interventions assigned to this group

Rehabilitation Patients - Intervention

Rehabilitation patients who undergo Nature Immersion Therapy

Group Type: EXPERIMENTAL

Nature Immersion Therapy

Intervention Type: 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.

Rehabilitation Patients - Control

Rehabilitation patients who do not undergo Nature Immersion Therapy

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

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 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.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

Patients with dementia:

1. Age 65-100 years old

2. Have a diagnosis of delirium/ dementia or both.

3. Have diagnosis of dementia with and without behavioural symptoms of dementia (BPSD)

4. Ability to communicate with the Nature-based Therapist (in languages such as English, Mandarin Chinese, Chinese dialects or Malay)

5. Manageable behavioural symptoms and able to focus attention for minimum of 30 minutes

Rehabilitation Medicine patients:

1. Age 21-100 years old

2. 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

3. 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

1. In isolation due to contact, droplet or airborne precautions

2. Unable to provide consent and lack of surrogate decision maker to provide consent

3. Poorly managed psychiatric or behaviour symptoms with threats to others surrounding them.

4. Age < 21 years

5. Patients who are haemodynamically unstable.

6. Patients on strict bed rest

• Minimum Eligible Age: 21 Years
• Maximum Eligible Age: 100 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Changi General Hospital

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Si Ching Lim, MD

Role: PRINCIPAL_INVESTIGATOR

Changi General Hospital

Locations

Changi General Hospital

Singapore, , Singapore

Countries

Singapore

Central Contacts

Si Ching Lim

Role: CONTACT

lim.si.ching@singhealth.com.sg

(65) 6426 7818

Facility Contacts

Si Ching Lim

Role: primary

lim.si.ching@singhealth.com.sg

(65) 6426 7818

References

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.

Reference Type: BACKGROUND

PMID: 28788101 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 31131619 (View on PubMed)

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.

Reference Type: BACKGROUND

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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.

Reference Type: BACKGROUND

PMID: 32690529 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 31001682 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 19568839 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 36864583 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 36361384 (View on PubMed)

Other Identifiers

2025-032

Identifier Type: -

Identifier Source: org_study_id