Horticultural Therapy for Patients With Chronic Musculoskeletal Pain: Results of a Pilot Study

Context Therapists can use horticultural therapy as an adjuvant therapy in a nonthreatening context, with the intent of bringing about positive effects in physical health, mental health, and social interaction. Very few experimental studies exist that test its clinical effectiveness. Objective To determine whether the addition of horticultural therapy to a pain-management program improved physical function, mental health, and ability to cope with pain. Design The research team designed a prospective, nonrandomized, controlled cohort study, enrolling all patients consecutively referred to the Zurzach Interdisciplinary Pain Program (ZISP) who met the study's criteria. The team divided them into two cohorts based on when medical professionals referred them: before (control group) or after (intervention group) introduction of a horticultural therapy program. Setting The setting was the rehabilitation clinic (RehaClinic) in Bad Zurzach, Switzerland. Participants Seventy-nine patients with chronic musculoskeletal pain (fibromyalgia or chronic, nonspecific back pain) participated in the study. Interventions The research team compared a 4-week, inpatient, interdisciplinary pain-management program with horticultural therapy (intervention, n=37) with a pain-management program without horticultural therapy (control, n=42). The horticultural therapy program consisted of seven sessions of group therapy, each of 1-hour duration. Outcome Measures The research team assessed the outcome using the Medical Outcome Study Short Form-36 (SF-36), the West Haven-Yale Multidimensional Pain Inventory (MPI), the Hospital Anxiety and Depression Scale (HADS), the Coping Strategies Questionnaire (CSQ), and two functional performance tests. The team tested participants on entry to and discharge from the 4-week pain-management program. Results Between-group differences in sociodemographic and outcome variables were not significant on participants' entry to the pain-management program. On discharge, the research team measured small to moderate outcome effects (effect size [ES] up to 0.71) within both groups. The study found significantly larger improvements for the horticultural therapy group vs the control group in SF-36 role physical (ES=0.71 vs 0.22; P=.018); SF-36 mental health (ES=0.46 vs 0.16; P=.027); HADS anxiety (ES=0.26 vs 0.03; P=.043); and CSQ pain behavior (ES=0.30 vs -0.05; P=.032). Conclusion The addition of horticultural therapy to a pain-management program improved participants' physical and mental health and their coping ability with respect to chronic musculoskeletal pain.