The effects of gardening on quality of lif

10 11 12 OBJECTIVE: To explore how plant, gender, and the time after stroke onset influenced improvements in the quality of life of patients in a gardening program.. Quality of life impr

Trang 1

Uncorrected Author Proof

DOI:10.3233/WOR-162338

IOS Press

The effects of gardening on quality of life

in people with stroke

1

2

Fen-Ling Kuoa, Sui-Hua Hoa,b,∗and Chiuhsiang Joe Linb

3

aDivision of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

4

5

bDepartment of Industrial Management, National Taiwan University of Science and Technology, Taipei, Taiwan

6

Received 20 November 2014

7

Accepted 15 June 2015

8

Abstract.

9

BACKGROUND: Compared with traditional rehabilitation, gardening has been viewed as a more occupation-based

inter-vention to help patients improve functional performance However, there is still a need for evidence-based research into what factors interact to create the beneficial effects of gardening for people who have sustained a cerebral vascular accident (CVA)

10

11

12

OBJECTIVE: To explore how plant, gender, and the time after stroke onset influenced improvements in the quality of life

of patients in a gardening program

13

14

METHODS: One treatment of tending short-term plants, and another treatment of tending long-term plants were compared.

Quality of life improvement was evaluated according to three factors: plant, gender, and the time after stroke onset The data were analyzed with 2kreplicated factorial designs

15

16

17

RESULTS: The 2kfactorial design with replication indicated significant effects on both the social role and the family role For the social role, the interaction of plant and gender difference was significant For the family role, the significant effects were found on interaction of plant with both gender and the time after stroke onset

18

19

20

CONCLUSIONS: Tending plants with different life cycles has varied effects on the quality of life of people who have

sustained a CVA Factors related to gender and the time after stroke onset influenced role competency in this sample

21

22

Keywords: Occupational therapy, cerebrovascular accident, horticultural activity, 2kfactorial design, occupation

23

1 Introduction

24

1.1 Background

25

A cerebral vascular accident (CVA) usually results

26

in a decline in physical, mental, and/or cognitive

27

abilities, those influence functional performance

out-28

∗Address for correspondence: Sui-Hua Ho, Division of

Occu-pational Therapy, Department of Physical Medicine and

Rehabilitation, Shuang Ho Hospital, Taipei Medical University,

No 291, Zhongzheng Rd., Zhonghe, Taipei 23561, Taiwan Tel.:

+886 2 22490088 ext 1624; Fax: +886 2 22490088 ext 1634.

E-mail: D10101001@mail.ntust.edu.tw, shh283@nyu.edu.

comes The physical changes after the disease [1] and 29 the psychosocial changes within the working envi- 30 ronment [2] in turn brought the occupational stress 31 and influenced the work engagement of people [3] 32 Wang, Kapellusch [4] mentioned that the CVA recov- 33 ery, especially in perceptive, speech, and cognitive 34 domains, was a critical factor of returning to work 35 Alcˆantara, Sampaio [5] also found that health con- 36 dition would influence work ability profoundly The 37 consequences after CVA can impact the quality of 38 life (QoL) of not only patients [6] but also caregivers 39 [7] Traditional rehabilitation has provided patients 40 with many opportunities to improve their sensorimo- 41

Trang 2

tor, cognitive, and mental health However, the use

42

of repetitive and long-term rehabilitative programs

43

may discourage patients from consistently and

con-44

tinuously returning for follow-up care

45

The therapeutic garden has been viewed as a

nat-46

ural and pleasant intervention setting for improving

47

quality of life (QoL) in the elderly [8] Gardening

48

has been utilized for healing since ancient times

Evi-49

dence dated to 2000 BCE in Mesopotamia shows that

50

gardening activities have long been used for sensory

51

modulation [9] The beneficial effects of gardening on

52

veterans from World War I have also been noted [10]

53

Although previous researchers have tried to explore

54

the effects of the gardening setting on CVA survivors

55

[9, 11, 12], these studies have mostly focused on

56

a single or just a few cases, providing exploratory

57

results of variable effects There is still a need for

58

evidence-based research into the effects of

therapeu-59

tic gardening quantitatively [8] Furthermore, several

60

preliminary studies of the gardening setting have

61

reported positive therapeutic effects, including pain

62

relief [13], improvement in attention [14–16], stress

63

management [17], agitation reduction [18], and fall

64

prevention [19] The above positive effects are vital in

65

the further improvement of QoL [8] However,

insuf-66

ficient evidence remains about the beneficial effects

67

of gardening activities for people who have sustained

68

a CVA

69

Several studies have demonstrated gender

dispar-70

ities in stroke recovery [20–24] In an investigation

71

of retrospective cohort data, Boehme and Siegler [20]

72

found poorer functional outcomes for female patients

73

with stroke than for their male counterparts

Addi-74

tionally, using the Barthel Index [25] and Rankin

75

Scale [26], Di Carlo and Lamassa [23] collected data

76

across 7 countries, including England, France,

Ger-77

many, Hungary, Italy, Portugal, and Spain, and found

78

a significant gender effect on activities of daily living

79

(ADL) and handicap predictors of people with stroke

80

In that study, male gender was still shown as a

bet-81

ter predictor of functional recovery A similar effect

82

was indicated in a two-year follow-up study

employ-83

ing Health-Related Quality of Life (HRQoL) Sturm

84

and Donnan [24] indicated that female gender was a

85

determiner for lower quality of life than male gender

86

Das [27] found the gender differences on ergonomic

87

risk factors among farmers Therefore, there might

88

be some gender differences on musculoskeletal

influ-89

ences for people performing gardening activities

90

Understanding gender differences in recovery from

91

CVA with various gardening programs may provide

92

practitioners with guidelines for designing

appropri-ate gardening activities for each gender Although 94 some evidence strongly supports the gender dispar- 95 ity in stroke functional progress and QoL, no studies 96

to date have described the gender differences in QoL 97 improvement related to gardening with this disability 98

Besides gender differences, issues such as sever- 100 ity and time after stroke onset, may also affect the 101 functional recovery of people with stroke In a recent 102 study using a modified Rankin Scale as a measure of 103 functional performance, Liou and Lin [28] found that 104 rather than stroke severity, onset time was the more 105 significant indicator of functional status for people 106 who have sustained a CVA Regarding the association 107 between time after stroke onset and the future recov- 108 ery, Skilbeck, Wade [29] found that although most 109 recovery took place within 6 months in areas of basic 110 activities of daily living, arm function, and language, 111 there were still some non-significant improvement 112

in speech and language after 18 months rehabilita- 113 tion in their stroke unit Hochstenbach, den Otter 114 [30] also mentioned the long-term improvement in 115 cognitive function still occurred up to 2 years after 116 stroke onset by some of their participants, and the 117 most obvious recovery was in the attention-related 118 domains In addition, G Broeks, Lankhorst [31] 119 found that although most improvement happened 120 within 16 weeks, some arm motor functional recov- 121 ery still took place after 4 years after stroke onset 122

No studies were found in the current review of the 123 literature exploring the influence of onset time on the 124 quality of life of patients after therapeutic gardening 125

Other authors have discussed the benefits of 127 gardening in rehabilitation in general for patients 128 [32–34] Through the therapeutic use of gardening 129

as a form of occupation [32, 33], therapists consider 130 the benefits in the process of nurturing the plants, 131

to select the horticultural activities, which meet the 132 special needs of the participants [34] The horticul- 133 tural activities may include sowing seeds, tending 134 seedlings, adding water, pulling weed, and harvesting 135 plants finally Participants are benefited through the 136 active involvement of nurturing the living plants [34] 137

It should also be noted that different kinds of plants, 138 such as plants with different life cycles and charac- 139 teristics, may have different effects on patients The 140 plant life cycle usually starts from a seed, and the 141 seed will sprout to become an immature seedling 142 The seedling will grow continuously to be a mature 143 plant Then, the mature plant will grow flowers After 144 pollination, the fertilization allows flowers to develop

Trang 3

seeds to restart a new life cycle of the plant The

dura-146

tion of the entire life cycle may vary from several

147

weeks to years depending on different types of plants

148

Therefore, tending for plants with different duration

149

of life cycles might bring about different physical and

150

also psychological influences to people For

exam-151

ple, participants tending plants with shorter life cycle

152

will harvest and get the feedbacks of collecting fruit

153

earlier than tending plants with longer life cycle It

154

is still unclear whether tending plants with different

155

duration of life cycle would have the same effects on

156

participants

157

1.2 Objective and Hypotheses

158

This study explored the effects of gardening on the

159

quality of life of patients with cerebral vascular

acci-160

dents The effects of plants with different duration of

161

life cycles on patients’ QoL were analyzed In this

162

research, long-term plants were plants with life cycle

163

longer than 3 months (tomato and string bean were

164

adopted in this design) Short-term plants were life

165

cycle shorter than 3 months (water spinach and lettuce

166

were adopted in this design) In addition, the amount

167

of variance in the beneficial gardening effects on

gen-168

der and the time after stroke onset was also examined

169

Based on the previous findings, although the

major-170

ity of recovery took place within 4 to 6 months after

171

stroke onset for acute patients, there was still some

172

speech recovery after 18 months [29], and arm motor

173

improvement after 4 years for chronic patients [31]

174

In this research, the chronic patients who had

sus-175

tained a CVA over 6 months were recruited to have a

176

stable condition to perform the gardening activities

177

Therefore, 18 months after stroke onset was chosen

178

as the cut point to classify the participants into two

179

groups: stage 1 (6 to 18 months after stroke onset)

180

and stage 2 (>18 months after stroke onset)

181

The study was developed to test three major

182

hypotheses

183

1) After gardening activities, males who have

sus-184

tained a CVA will demonstrate greater

improve-185

ment in their quality of life than females

186

2) After gardening activities, people in the CVA

187

stage 1 of recovery will demonstrate greater

188

improvement in their quality of life than people

189

in the CVA stage 2 of recovery

190

3) Tending plants with short-term life cycles will

191

have greater impact on quality of life than

tend-192

ing plants with long-term life cycles

193

Several pilot studies [9, 17] have supported the 194 effects of gardening for patients with stroke and 195 related diseases However, those preliminary stud- 196 ies lacked well-designed experiments and sufficiently 197 representative sampling Due to the limited scientific 198 evidence of the effects of gardening on people with 199 stroke, we explored these effects on 8 combinations 200 (2 levels of gender X 2 levels of stroke stage X 2 201 levels of plants) with 3 replications and analyzed 202 the results following the principles of experimental 203 design [35] No exploratory pilot test was run in this 204

This research explored how three factors (plant, 208 gender, and stroke stage) would influence improve- 209 ment in the quality of life of patients who have 210 sustained a CVA following their participation in a 211 gardening program The 2k factorial design, where 212

k equals 3, was applied to test the hypotheses in 213 this research Two kinds of plants, those with short- 214 term life cycles (short-term plants) and long-term 215 life cycles (long-term plants), were used Males and 216 females in stage1 and stage 2 of recovery from CVA 217

Before this research started, the leader of 220 this research project contacted with the clinical 221 occupational therapists in the Taipei Medical 222 University-Shuang Ho Hospital, Ministry of Health 223 and Welfare The major purpose of this project 224 was told to the occupational therapists, and they 225 were asked to consider appropriate participants who 226 met the inclusion criteria from their clients at that 227 time The inclusion criteria were (1) diagnosis of 228 CVA by a medical specialist, including ischemia 229 and hemorrhage, and onset time over 6 months; (2) 230 ability to communicate normally and clearly express 231 feelings; (3) no other injuries, musculoskeletal dis- 232 orders, or mental illness which could interfere with 233 participating in gardening activities; (4) agreement 234

to sign a participant consent form Then, the leader 235

of this research project invited the participants from 236 the list given by the occupational therapists, to join 237 the research After knowing all the risks/benefits 238 after joining this project and the right of dropping out

Trang 4

this experiment at any time, all invited people agreed

240

to join and signed the participant consent form

241

Thirteen participants meeting the inclusion

cri-242

teria were invited to join this research Initially, it

243

was aimed as within subject design, that was each

244

participant must complete both treatment (tending

245

long-term plant and short-term plant) Finally, there

246

were 6 participants completed both treatment Five

247

participants joined only in the short-term plant

treat-248

ment, and two joined only long-term plant treatment

249

During the study, the participants dropped out due

250

to either decreased physical condition (expressed

251

too tired to perform outdoor activities) or stopped

252

insurance benefits Thus, for the short-term plant

253

treatment, there were 11 data points For the

long-254

term plant treatment, there were 8 data points

255

Eventually, the data collected were analyzed using

256

imbalanced factorial design

257

2.3 Dependent variable

258

The response variable in this study was

improve-259

ment in quality of life Quality of life was measured

260

with the Chinese version of the Stroke Specific

Qual-261

ity of Life scale (SSQOL), which had been previously

262

translated following standard translation procedures

263

[36] and validated by Hsueh and Jeng [37] in

Tai-264

wan The SSQOL is an evaluation tool developed

265

for patients with cerebral vascular accident (CVA) It

266

consists of 49 items that focus on 12 areas of

health-267

related quality of life The items are scored on a

268

5-point Likert-type scale; the higher the score the

bet-269

ter the quality of life The reliability and validity of the

270

SSQOL for various kinds of people with stroke have

271

been reported previously [38] The reliability and

272

validity of the Danish version of the SSQOL has been

273

examined in patients with intracerebral hemorrhage

274

[39] Ewert and Stucki [40] also validated the German

275

version of the SSQOL for patients with hemorrhagic

276

and ischemic stroke, and Boosman and Passier [41]

277

validated the scale for patients with aneurysmal

sub-278

arachnoid hemorrhage Measures of reliability and

279

validity were found to be acceptable

280

2.4 Independent variables

281

The three controlled variables were gender, life

282

cycle of plants, and time after stroke onset The

differ-283

ent effects on male and female patients were tested

284

The life cycles of plants consisted of two categories:

285

long-term (>3 months) and short-term (<3 months)

286

The time after stroke onset were classified into stage

1 (6–18 months after stroke onset) and stage 2 (>18 288

The factors that were held constant were the ther- 291 apist and the gardening environment The entire 292 gardening program was conducted by one registered 293 occupational therapist In addition, evaluation and 294 intervention were conducted in the same clinical set- 295

Each participant had their own speed of recovery, 298 and differences in this speed could possibly influence 299 the improvement in their quality of life Caregiver 300 attitudes and patient motivation could also affect 301 the rate of recovery The strategy we used was to 302 select cases with similar features We recruited cases 303 only from New Taipei City in an attempt to reduce 304 the impact of nuisance factors However, since peo- 305 ple from the same place might still show different 306 amounts of improvement, once the variables of gen- 307 der and CVA level were confirmed, participants were 308 randomly assigned to either tending long-term plants 309

or tending short-term plants After three months, the 310 treatment exchanged People who tended long-term 311 plants changed to tend short-term plants, and vice 312

Before the data collection, the experimental proto- 315 col and participant consent procedure were approved 316

by the Taipei Medical University-Joint Institutional 317 Review Board (case No 201204015) The written 318 informed consent, in accordance with institutional 319 guidelines, was completed by each participant before 320

All participants attended the gardening program 323 once a week, for one hour in each session Par- 324 ticipants were guided to tend different plants by a 325 registered occupational therapist in a garden located 326 within Taipei Medical University-Shuang Ho Hospi- 327 tal, Ministry of Health and Welfare For the long-term 328 plant condition, participants tended tomato and string 329 beans, which were not harvested by the end of the gar- 330 dening program Participants in the short-term plant

Trang 5

condition tended water spinach and lettuce At the end

332

of the gardening program, all short-term plants were

333

harvested by the patients themselves For each plant

334

condition, the duration of the gardening program was

335

3 months

336

Quality of life was evaluated before and after the

337

gardening program by two registered occupational

338

therapists These two therapists were familiar with

339

the instruments and used the same scoring

guide-340

lines In addition, they were blind to the research

341

hypotheses Twelve areas were evaluated including:

342

energy level, family roles, language, mobility, mood,

343

personality, self-care, social roles, thinking, vision,

344

upper-extremity function and work productivity The

345

score for each area was obtained by summing the

346

scores on all items in each of these areas The total

347

quality of life score for each participant was obtained

348

by summing the results from the 12 areas to obtain a

349

health-related quality of life score

350

2.9 Data analysis

351

The response was defined as the change in score on

352

quality of life between the before and after measures,

353

the higher the response the greater the improvement

354

Thus, a total of 13 responses, including score changes

355

in 12 areas and one total score, were collected for each

356

participant Additionally, 3 factors, each at 2 levels,

357

were analyzed using the 23factorial design Minitab

358

(16thedition) was used as the statistical software For

359

gender, male was marked as 1 and female marked as

360

-1 For time after stroke onset, stage 1 was marked as

361

1 and stage 2 was marked as –1 For plant life cycle,

362

long-term life cycle was marked as –1 and short-term

363

life cycle was marked as 1 Due to the fact that some

364

participants could not complete all experimental

con-365

ditions, the data were analyzed using imbalanced 23

366

factorial design with replication (number of available

367

participants)

368

3 Results

369

The significant results of social role and family role

370

as determined by 23replicated factorial analyses are

371

presented as follows

372

3.1 Social role

373

According to the analysis for the 23 factorial

374

design, the Pareto chart (Fig 1), Normal plot (Fig 2),

375

and Half normal plot (Fig 3) showed significant

Fig 1 Pareto chart for social role Plant: factor A, Gender: factor

B, Time after stroke onset: factor C.

Fig 2 Normal plot for social role Plant: factor A, Gender: factor

effects of variable A (plant) (F = 8.22, p = 0.015) and 377

AB interaction (plant and gender) (F = 8.8, p = 0.013) 378

on improvement of the social role area Based on 379 further analysis of the main effect (Fig 4), partici- 380 pants tending short-term plants demonstrated greater 381 improvement in the social role area than those who 382 tended long-term plants The interaction plot (Fig 5) 383 showed that females demonstrated more improve- 384 ment than males when tending short-term plants 385 Based on the cube plot (Fig 6), the optimal level 386 combination of the social role response was found 387

in female participants in the stage 2 tending short- 388 term plants Based on the correlation coefficients in 389 Table 1, the regression function is as follows: 390

Trang 6

Fig 3 Half normal plot for social role Plant: factor A, Gender:

factor B, Time after stroke onset: factor C.

Fig 4 Main effects plot for social role Plant: factor A (1,

short-term; –1, long-term), gender: factor B (1, male; –1, female), time

after stroke onset: factor C (1, stage 1; –1, stage 2).

Fig 5 Interaction plot for social role Plant: factor A (1,

Fig 6 The design for the social role area shown geometrically in the cube plot Optimal level combination appeared on plant (1), gender (–1), and onset time (–1).

Table 1 The estimated effects and coefficients for the social role area

ˆy = 0.0167 + 0.7167x 1+ 0.3083x 2+ 0.2833x 3 391

+ (–0.7417)x 1 x 2 + (–0.1167)x 1 x 3 + (–0.0250) 392

x 2 x 3+ 0.225 x 1 x 2 x 3 r 2 = 0.5781 393

where ˆy is the predicted quality of life improve- 394

ment, x 1is the variable representing factor A (plant), 395

x 2is the variable representing factor B (gender), and 396

x 3 is the variable representing factor C (time after 397

stroke onset) The x 1 x 2 , x 1 x 3 , and x 2 x 3 represent 398 the two-way interactions The three-way interaction 399

is represented by x 1 x 2 x 3 In this fitted regression 400

model, x 1 , x 2 , and x 3 were all defined on a coded 401

According to the analysis with the 23 factorial 404 design, the significant effects of variable AB inter- 405

action (plant and gender) (F = 13.57, p = 0.004) and 406

AC interaction (plant and time after stroke onset) 407

(F = 6.08, p = 0.031) on improvement in the fam- 408 ily role area were revealed in the Pareto chart 409 (Fig 7), Normal plot (Fig 8), and Half normal plot

Trang 7

Fig 7 Pareto chart for family role Plant: factor A, Gender: factor

Fig 8 Normal plot for family role Plant: factor A, Gender: factor

(Fig 9) The main effects of three factors are shown

411

in Fig 10 The interaction plot (Fig 11) showed

412

that males demonstrated greater improvement than

413

females while tending long-term plants

Addition-414

ally, patients in the stage 1 tending long-term plants

415

demonstrated greater improvement than those in the

416

stage 2 The cube plot for the design of family roles

417

in Fig 12 revealed that the optimal level

combina-418

tion of family role area appeared in two situations:

419

female patients in the stage 2 tending short-term pants

420

and male patients in the stage 1 tending long-term

421

plants Based on the correlation coefficients shown

422

in Table 2, the regression function was as follows:

423

ˆy = (–0.1208) + (–0.0708)x 1 + (–0.0542)x 2

424

+ (–0.0375)x 3 + (–0.5042)x 1 x 2 + (–0.3375)x 1 x 3

425

+ (–0.2208) x 2 x 3 + (–0.0208) x 1 x 2 x 3 r 2 = 0.6966

426

Fig 9 Half normal plot for family role Plant: factor A, Gender: factor B, Time after stroke onset: factor C.

Fig 10 Main effects plot for family role Plant: factor A (1, short-term; –1, long-term), gender: factor B (1, male; –1, female), time after stroke onset: factor C (1, stage 1; –1, stage 2).

where ˆy is the predicted quality of life improvement, 427

x 1 is the variable representing factor A (plant), x 2 428

is the variable representing factor B (gender), and 429

x 3 is the variable representing factor C (time after 430

stroke) In this fitted regression model, x 1 x 2 rep- 431

resents the interactions between x 1 and x 2 , x 1 x 3 432

represents the interaction between x 1 and x 3 , and 433

x 2 x 3 represents the two-way interaction between 434

x 2 and x 3 The three-way interaction is repre- 435

sented by x 1 x 2 x 3 The variables of x 1 , x 2, and 436

x 3 were all defined on a coded scale from –1 437

Trang 8

Fig 11 Interaction plot for family role Plant: factor A (1,

Fig 12 The design for family role shown geometrically in the

cube plot Optimal level combination appeared in two situations:

plant (1), gender (–1), onset time (–1), plant (–1), gender (1), onset

time (1)

4 Discussion

439

4.1 Social role

440

Significant effects of plant type and gender/plant

441

interaction were found for improvement in quality

442

of life under social role For all participants, the

443

care of short-term plants was linked to improved

444

social role This difference between short and long

445

term plant care could be due to the shorter harvest

446

period of short-term plants However, when gender

447

was considered simultaneously, females showed

bet-448

ter responses than males to short-term plants In our

449

observation, the short-term plants (water spinach and

Table 2 The estimated effects and coefficients for the family role area

plantXgenderXstroke –0.0417 –0.0208 0.1369 –0.15 0.882

lettuce) were harvested by the participants at the end 451

of the gardening program This harvest could provide 452 participants with a chance to share the vegetables with 453 friends and thereby enhance their social interactions 454 However, it still needs further investigation to explore 455 the reason of gender differences on the improvement 456

The significant interaction of plant and gender 459 using the 2kreplicated factorial design showed that 460 while tending long-term plants, males tended to show 461 greater improvement in the family role than females 462 This might be explained by the features of tomatoes 463 and string beans, the long-term plants adopted in this 464 research Although at the end of the gardening pro- 465 gram, these two plants had not been harvested, fruit 466 had begun growing on the stems It is possible that 467 the tomatoes and string beans were more likely to 468 give people obvious visual feedback stimuli than the 469 short-term plants (water spinach and lettuce) Rosen- 470 blitt and Soler [42] observed more sensation seeking 471 behavior, especially for visual sensation, in men than 472

in women Therefore, we speculated that the obvious 473 appearance of fruit could give male participants more 474 confidence that they could be productive gardeners 475 and be less of a burden on their families 476 The significant interaction of plant and time after 477 stroke onset showed that when tending long-term 478 plants, participants in the CVA stage 1 tended to show 479 greater improvement in their quality of life scores 480 than those in the stage 2 As reported in several previ- 481 ous studies, acute stage CVA patients are more likely 482

to suffer feelings of depression than chronic stage 483 patients [43–45] due to the sudden impact of stroke 484

on their lives The feelings of depression may cause 485 acute patients to see themselves as a burden on their 486 families In this study, after tending long-term plants, 487 participants with stroke less than 18 months showed 488 that their perception of family burden decreased more

Trang 9

significantly than people sustained a CVA over 18

490

months Based on our findings, the visually obvious

491

fruit, tomatoes and string beans, may increase the

492

confidence of participants and improve their quality

493

of life in the family role area

494

4.3 Limitations

495

In interpreting the findings, it is important to

con-496

sider the following limitations:

497

1) Baseline condition:

498

Each participant had a different baseline

condi-499

tion, which may have resulted in different speeds

500

of improvement However, it is hard to control the

501

baseline condition Therefore, we measured the

dif-502

ference between the pre-test and the post-test to

503

reflect improvement from the onset to the end of

504

gardening program for each participant

505

2) Natural disease progression:

506

The variables we measured may have been affected

507

by the variation of natural disease progression,

partic-508

ularly in the areas of physical, mental, and functional

509

performance, which could cause variation in

qual-510

ity of life improvement Using a large number of

511

participants may reduce the effect of natural disease

512

progression, because it is unlikely that all participants

513

develop this progression during measurement period

514

Due to the availability of participants qualifying the

515

selection criteria of the study, the study results were

516

obtained based on a relatively small number of

par-517

ticipants It is recommended to increase the number

518

of participants in the future

519

3) Limits to randomization:

520

Once a case was selected, the variables of gender

521

and disease severity were defined The only variable

522

we could select for this case was the plant life cycle

523

Randomly arranging the participants into different

524

groups tending long-term and short-term plants could

525

further reduce the errors However, the ideal

condi-526

tion should be the full randomization of all factors

527

5 Conclusion

528

This research provides further evidence for the use

529

of gardening programs with people who are

recover-530

ing from CVA Higher levels of quality of life were

531

shown by female participants sustained a CVA over

532

18 months tended short-term plants (see cube plot

in Fig 12) Additionally, the optimal level of social 534 role improvement was seen in female participants 535 sustained a CVA over 18 months tending short-term 536 plants It should be noticed that the effects of plant 537 features and gender-related differences enhanced the 538 social role of participants in this sample In addition, 539 based on our analysis, in the future to improve the 540 quality of life for people with CVA, especially in the 541 family role, practitioners are recommended to con- 542 sider plant features, gender differences, and the time 543 after CVA onset when arranging gardening programs 544 Although sample size in this research was small, 545 significant results were obtained This study shows 546 that tending different types of plants resulted in 547 significant differences in the beneficial effects of 548 gardening on quality of life for people with CVA 549 Gender-related differences and the time after CVA 550 onset need to be taken into consideration in future 551 studies Based on this finding, we think that further 552 experiments examining factors related to partici- 553 pants’ preferences would be useful in identifying 554 the key factors in motivation enhancement It is also 555 suggested that future studies employ longer periods 556

of gardening to further examine whether the visual 557 effect of the appearance of fruit is significant There 558 are factors in the gardening process that can influ- 559 ence the quality of life of people who have sustained a 560 CVA The current findings provide future researchers 561 with directions for further investigation in this area 562

The funding was supported by Shuang Ho Hos- 564 pital, Taipei Medical University The number of this 565 research project is 101SHH-HCP-04 566

[1] Andersen G, Christensen D, Kirkevold M, Johnsen S Post- 570

stroke fatigue and return to work: A 2-year follow-up Acta 571

[2] Hackett ML, Glozier N, Jan S, Lindley R Returning to paid 573

employment after stroke: The Psychosocial Outcomes In 574

StrokE (POISE) cohort study PloS one 2012;7(7):e41795 575

[3] Padula RS, Chiavegato LD, Cabral CMN, Almeid T, Ortiz T, 576

Carregaro RL Is occupational stress associated with work

Trang 10

engagement? WORK: A Journal of Prevention, Assessment

578

and Rehabilitation 2012;41(Supplement 1):2963-5.

579

[4] Wang Y-C, Kapellusch J, Garg A Important factors

influ-580

encing the return to work after stroke WORK: A Journal

581

of Prevention, Assessment and Rehabilitation 2014;47(4):

582

553-9.

583

[5] Alcˆantara MA, Sampaio RF, Assuncao AA, Silva F Work

584

Ability: Using structural equation modeling to assess the

585

effects of aging, health and work on the population of

Brazil-586

ian municipal employees WORK: A Journal of Prevention,

587

Assessment and Rehabilitation 2014;49(3):465-72.

588

[6] King RB Quality of life after stroke Stroke 1996;27(9):

589

1467-72.

590

[7] Morimoto T, Schreiner AS, Asano H Caregiver burden and

591

health-related quality of life among Japanese stroke

care-592

givers Age Ageing 2003;32(2):218-23.

593

[8] Detweiler MB, Sharma T, Detweiler JG, Murphy PF, Lane

594

S, Carman J, et al What is the evidence to support the use

595

of therapeutic gardens for the elderly? Psychiatry Investig

596

2012;9(2):100-10.

597

[9] Detweiler MB, Warf C Dementia wander garden aids post

598

cerebrovascular stroke restorative therapy: A case study.

599

Altern Ther Health Med 2005;11(4):54-8.

600

[10] Lewis C The evolution of horticultural therapy in the US.

601

Fourth Annual Meeting of the National Council for

Ther-602

apy and Rehabilitation Through Horticulture; September 6;

603

Philadelphia, Pennsylvania 1976.

604

[11] Fleming K, Alford D Case studies part 2; physical

dis-605

ability Vanessa: Diagnosis demyelinating encephalitis with

606

hemiplegia J Hortic 1998;9:35-6.

607

[12] Karph A Case studies part 2; physical disability Caroline:

608

Diagnosis depressive disorder NOS J Hortic 1998;9:42.

609

[13] Ulrich RS View through a window may influence recovery

610

from surgery Science 1984;224(4647):420-1.

611

[14] Hartig T, Mang M, Evans GW Restorative effects of natural

612

environment experiences Environ Behav 1991;23(1):3-26.

613

[15] Stark MA Restoring attention in pregnancy the natural

envi-614

ronment Clin Nurs Res 2003;12(3):246-65.

615

[16] Cimprich B, Ronis DL An environmental intervention to

616

restore attention in women with newly diagnosed breast

617

cancer Cancer Nurs 2003;26(4):284-92.

618

[17] Van Den Berg AE, Custers MH Gardening promotes

neu-619

roendocrine and affective restoration from stress J Health

620

Psychol 2011;16(1):3-11.

621

[18] Walch JM, Rabin BS, Day R, Williams JN, Choi K, Kang

622

JD The effect of sunlight on postoperative analgesic

medi-623

cation use: A prospective study of patients undergoing spinal

624

surgery Psychosom Med 2005;67(1):156-63.

625

[19] Detweiler MB, Murphy PF, Kim KY, Myers LC, Ashai A.

626

Scheduled medications and falls in dementia patients

utiliz-627

ing a wander garden Am J Alzheimers Dis Other Demen

628

2009;24(4):322-32.

629

[20] Boehme AK, Siegler JE, Mullen MT, Albright KC, Lyerly

630

MJ, Monlezun DJ, et al Racial and gender differences

631

in stroke severity, outcomes, and treatment in patients

632

with acute ischemic stroke J Stroke Cerebrovasc Dis

633

2014;23(4):e255-61.

634

[21] Kapral MK, Fang J, Hill MD, Silver F, Richards J, Jaigobin

635

C, et al Sex differences in stroke care and outcomes results

636

from the registry of the canadian stroke network Stroke

637

2005;36(4):809-14.

638

[22] Dougu N, Takashima S, Sasahara E, Taguchi Y, Toyoda

639

S, Hirai T, et al Predictors of poor outcome in patients

640

with acute cerebral infarction J Clin Neurol 2011;7(4):

641

197-202.

642

[23] Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile 643

AM, Wolfe CD, et al Sex differences in the clinical presen- 644

tation, resource use, and 3-month outcome of acute stroke in 645

Europe data from a multicenter multinational hospital-based 646

[24] Sturm JW, Donnan GA, Dewey HM, Macdonell RA, Gilli- 648

gan AK, Srikanth V, et al Quality of life after stroke the 649

North East Melbourne Stroke Incidence Study (NEMESIS) 650

[25] Mahoney FI Functional evaluation: The Barthel index 652

[26] Rankin J Cerebral vascular accidents in patients over 654

the age of 60 II Prognosis Scottish Medical Journal 655

[27] Das B Gender differences in prevalence of musculoskele- 657

tal disorders among the rice farmers of West Bengal, India 658

WORK: A Journal of Prevention, Assessment and Rehabil- 659

[28] Liou L-M, Lin H-F, Tsai C-L, Lin R-T, Lai C-L Timing of 661

stroke onset determines discharge-functional status but not 662

stroke severity: A hospital-based study Kaohsiung J Med 663

[29] Skilbeck CE, Wade DT, Hewer RL, Wood VA Recovery 665

after stroke Journal of Neurology, Neurosurgery & Psychi- 666

[30] Hochstenbach JB, den Otter R, Mulder TW Cognitive 668

recovery after stroke: A 2-year follow-up Archives of Phys- 669

ical Medicine and Rehabilitation 2003;84(10):1499-504 670

The long-term outcome of arm function after stroke: 672

Results of a follow-up study Disability and Rehabilitation 673

[32] Wagenfeld A, Atchison B “Putting the occupation back 675

in occupational therapy:” A survey of occupational therapy 676

practitioners’ use of gardening as an intervention The Open 677

critical review British Journal of Occupational Therapy 680

[34] Relf D, Dorn S Horticulture: Meeting the needs of special 682

[35] Montgomery DC Design and analysis of experiments 8 ed 684

[36] Lin J-H, Wang W-C, Sheu C-F, Lo SK, Hsueh I-P, Hsieh 686

C-L A Rasch analysis of a self-perceived change in quality 687

of life scale in patients with mild stroke Qual Life Res 688

[37] Hsueh I, Jeng J-S, Lee Y, Sheu C-F, Hsieh C-L Construct 690

validity of the stroke-specific quality of life question- 691

naire in ischemic stroke patients Arch Phys Med Rehabil 692

[38] Williams LS, Weinberger M, Harris LE, Clark DO, Biller J 694

Development of a stroke-specific quality of life scale Stroke 695

[39] Muus I, Williams LS, Ringsberg KC Validation of the 697

Stroke Specific Quality of Life Scale (SS-QOL): Test of 698

reliability and validity of the Danish version (SS-QOL-DK) 699

[40] Ewert T, Stucki G Validity of the SS-QOL in Germany and 701

in survivors of hemorrhagic or ischemic stroke Neuroreha- 702

[41] Boosman H, Passier PE, Visser-Meily JM, Rinkel GJ, Post 704

MW Validation of the Stroke Specific Quality of Life scale 705

in patients with aneurysmal subarachnoid haemorrhage J 706

Định dạng
Số trang	11
Dung lượng	650,59 KB