Pilot Pragmatic Randomized Controlled Trial: Horticultural Therapy for Inpatient Older Adults in an Acute Care Hospital

Not Applicable

Completed

• Conditions: Hospitalism; Frailty
• Interventions: Other: Horticultural Therapy

• Registration Number: NCT04654949
• Lead Sponsor: Khoo Teck Puat Hospital

Brief Summary

This study aims to investigate the feasibility and effectiveness of Horticultural Therapy (HT) on engagement, mood, and quality of life (QoL) of older adults in geriatric acute care in Singapore. Investigators will also assess the effectiveness of HT on mobility and hospitalisation experience. This pilot study could inform how HT can be implemented in geriatric acute care and its effect on hospitalisation experience and recovery of function.

Detailed Description

Horticultural therapy (HT) is a non-pharmacological treatment utilizing plant-related activities as a form of alternative medicine to achieve specific goals that lead to person's well-being. Geriatric patients in acute care wards are at risk of functional decline related to acute illness and prolonged bed rest during hospitalization. HT can complement medical treatment to ameliorate the adverse effects of hospitalisation in older adults. There is evidence that HT can improve the physical and psychological well-being of the older adults in different settings. The beneficial effects of HT have mostly been documented in nursing homes, community rehabilitation facilities and senior activity centres, but not in geriatric acute care settings. There is also a need to harness available knowledge and implement it where appropriate. This study aims to investigate the feasibility and effectiveness of HT on engagement, mood, and quality of life (QoL) of older adults in geriatric acute care in Singapore. Investigators will also assess the effectiveness of HT on mobility and hospitalisation experience. This pilot study could inform how HT can be implemented in geriatric acute care and its effect on hospitalisation experience and recovery of function.

Study Timeline

• Study Start: 2019-08-06
• Study First Submitted: 2020-10-27
• Study First Submitted QC: 2020-12-02
• Study First Posted: 2020-12-04
• Primary Completion: 2022-09-05
• Study Completion: 2022-09-05
• Status Verified: 2023-08
• Last Update Submitted: 2023-08-24
• Last Update Posted: 2023-08-28

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 80

Inclusion Criteria

• 70 years old and above
• an inpatient in Khoo Teck Puat Hospital
• able to understand simple instructions (with abbreviated mental test's score of 6 and above)
• have stable vital signs - blood pressure, heart rate and peripheral capillary oxygen saturation - to take part in horticultural therapy activities

Exclusion Criteria

• on contact or droplet precaution
• diagnosed with severe auditory-visual impairments
• have major depressive disorder
• have endocrine disorders
• on steroid-based medications such as asthma and allergies that might affect the salivary cortisol level
• on the Dangerously Ill List

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Horticultural Therapy	Horticultural Therapy	The Horticultural Therapy group receives 30 minutes of horticultural therapy activities using mobile horticulture kits conducted by therapists or therapy assistants to engage participants at their bedside.

Primary Outcome Measures

Name	Time	Method
Average Score of Engagement Assessed by Menorah Park Engagement Scale (MPES)	Five days	MPES consists of four different types of engagement: "constructive", "passive", "self" and "none" (Judge, Camp \& Orsulic-Jeras, 2000).; Each type of engagement is recorded on five-minutes intervals during the 30-minutes sessions for both intervention and control group. The score of 0, 1 and 2 represent engagement "not observed", "observed for less than two and a half minutes" and "observed for more than two and a half minutes" respectively.; The average score of each type of engagement for all sessions during assessment period is compared between the two groups. The assessment period is five days, or from recruitment date to participants' discharge date from the acute care hospital.
Change in Mobility Performance Assessed by Modified Perme ICU scale	Five days	Change in mobility performance from baseline (before randomization) to last session during the assessment period is measured by the modified Perme ICU scale (Perme, Nawa, Winkelman \& Masud, 2014).; The mobility domains of "bed mobility", "transfers" and "gait" are recorded with the score of 0 to 7, indicates for "total assistance", "maximum assistance", "moderate assistance", "minimal assistance", "contact guard", "standby assistance", "supervision" and "independent" respectively.; The assessment period is five days, or from recruitment date to participants' discharge date from the acute care hospital.
Average Score of Mood Assessed by Apparent Affect Rating Scale (AARS)	Five days	AARS consists of five different domains of mood: pleasure, general alertness, anxiety/ fear, anger and sadness (Lawton, Haitsma \& Klapper, 1996).; Each domain of mood is recorded on five-minutes intervals during the 30-minutes sessions for both intervention and control group. The score of 0, 1 and 2 represent engagement "not observed", "observed for less than two and a half minutes" and "observed for more than two and a half minutes" respectively.; The average score of each domain of mood for all sessions during assessment period is compared between the two groups. The assessment period is five days, or from recruitment date to participants' discharge date from the acute care hospital.
Change in Quality of Life Assessed by the EQ-5D	Five days	Change in quality of life is measured by the change in the score of the EuroQol EQ-5D from baseline (before randomization) to last session during the assessment period (Brooks \& Charro, 1996). The EQ-5D covers five dimensions on health status - mobility, self-care, usual activities and anxiety/depression using 5 response levels - no problem, slight problem, moderate problem, severe problem and extreme problem.; The assessment period is five days, or from recruitment date to participants' discharge date from the acute care hospital.

Secondary Outcome Measures

Name	Time	Method
Change in Emotion Assessed by Emoticon Scale	5 days	The Emoticon Scale consists of seven simple emotion icons with smiling faces (A/1-C/3), a neutral face (D/4), and frowning faces (E/5-G/7) on a Likert scale (Tan et al., 2018). Participants are asked to rate their mood at point of assessment at baseline (before randomisation) and at the last session of the assessment period.; The assessment period is five days, or from recruitment date to participants' discharge date from the acute care hospital.
Hospitalisation Experience Questionnaire	Five days	It is a 10-self administered questionnaire modified from the Person-centered care assessment tool (PCAT) (Edvardsson et al., 2010) which aims to evaluate the quality of health care settings as perceived by patients.; The score is Likert scale from 0 to 5, with 0 indicating "No, I disagree completely" and 5 indicating "Yes, I agree completely". Hospitalisation Experience Questionnaire is administered at the last session of the assessment period.; The assessment period is five days, or from recruitment date to participants' discharge date from the acute care hospital.
Number of Transitions in the Mobility Status	Five days	Participants' mobility state at the start of the session, the highest mobility state during session and the number of transitions in the mobility are captured using the mobilisation scale. The average score of highest mobility status and number of transitions in the mobility are compared between intervention and control group. The higher the score indicates better outcome.; The assessment period is five days, or from recruitment date to participants' discharge date from the acute care hospital.

Trial Locations

Locations (1)

Khoo Teck Puat Hospital; 🇸🇬 Singapore, Singapore