The Nature stroke study; NASTRU - A randomised controlled trial of nature-based post-stroke fatigue rehabilitation

Abstract

Fatigue is common after stroke and contributes to disability and impaired quality of life. Currently, there is insufficient evidence on the efficacy of any intervention for post-stroke fatigue. The aim of the study was to examine whether 10 weeks Nature-based rehabilitation (NRB) as add-on to standard care may improve post-stroke fatigue, perceived value of everyday occupations, function, activity and participation compared to standard care only (Clinical Trial.gov Identifier: NCT02435043, 2012/352, 05-06-2015). The study was carried out as a single blinded two-armed randomised controlled trial. Stroke survivors identified through routine 3-month follow-up visit (sub-acute) or medical records (chronic stroke > 1 year earlier) were randomised to Standard care + NBR or Standard care only. Blinded evaluations were conducted at follow-up 8 and 14 months after randomisation. The primary outcomes were post-stroke fatigue (Mental Fatigue Scale, total score) and perceived value of everyday occupations (Oval-pd) 8 months after randomisation. About a quarter of the screened patients were eligible; half accepted to participate and 101 were randomised, mean age 67 years, 60% female. The patients with sub-acute stroke were highly compliant with the intervention. Fatigue decreased to a value below the suggested cut-off for mental fatigue (<10.5) in the intervention group but not in the control group; no statistically significant differences were found though between the groups. Conclusion: NASTRU is the first randomised study on NBR for patients with post stroke fatigue. NBR was feasible and well tolerated. The study was underpowered due to difficulties in recruiting participants. No significant differences were detected between intervention and control group. A larger RCT is warranted. Keywords: clinical trial, enriched environment, everyday occupations, horticulture therapy, quality of life.

Nature-based rehabilitation for adults with acquired brain injury: a scoping review

“…After screening titles, 10,252 were excluded and seven studies remained for full text reading (Figure 1). Only two articles and a conference abstract paper were found via database search (Thomas 2004;Walker et al 2005;Palsdottir 2017), while three experimental studies (Kim M-Y et al 2010;Ho et al 2016) and a qualitative study (Barello et al 2016) were found by hand search and obtained via Google Scholar. All of these, except the conference paper, were included, and further two possible records were found in a systematic review (Kamioka et al 2014) and Google Scholar but were excluded as they only had full text in Korean or published as conference abstracts (Palsdottir 2017).…”

Effect of horticultural therapy on mental health: A meta‐analysis of randomized controlled trials

“…Some HT studies have implemented SNOSE (e.g. Palsdottir et al, 2020). The process involves a rigorous methodology and article publication interpretation process that includes an explanation of security measures, and who prepared and opened the envelopes (Clark et al, 2016).…”

Occupational Therapy Interventions for Poststroke Fatigue: A Scoping Review

“…Several interventions drew on CBT and/or elements of CBT: Cognitive restructuring and problem-solving were used by Nguyen et al (2019), included in the cognitive treatment component of the COGRAT intervention in Zedlitz et al (2012), and in the emotional regulation component used by Stubberud et al (2019). Although MBSR was one of the three categories, elements of mindfulness were also used in other interventions, including the multicomponent interventions used by Stubberud et al (2019) and Pálsdóttir et al (2020). Other commonalities across interventions included tailoring strategies to individual participants such that they could be implemented in participants’ daily routines, and the use of homework tasks (e.g., home strategy practice) and assignments (e.g., maintaining a fatigue diary).…”

“…A third study in the multicomponent intervention group investigated a nature-based rehabilitation (NBR) program on PSF (Pálsdóttir et al, 2020). The intervention group underwent standard care in addition to NBR, which was grounded in horticultural therapy, supported by a multimodal rehabilitation team that utilized nature for multisensory stimulation for physical, emotional, and cognitive stimulation.…”