Authors' objectives: Background: In December 2018 mental illness diagnoses comprised 53% and 40% of all cases of sick leave among women and men respectively, and stress-related diagnoses accounted for approximately 20% of all cases in Sweden. The diagnosis “Exhaustion disorder” (ED) is used in Sweden to define patients with exhaustion as a consequence of identifiable stressor(s) present for at least six months. Diagnostic criteria include: exhaustion, cognitive dysfunction, sleep disturbance, reduced tolerance to further stress, and somatic symptoms. Patients with stress-related disorders usually receive psychological support, physical activity, guidance and medication as needed for symptoms of depression and anxiety. Nature-based rehabilitation (NBR) is not standardised but is always led by a multi-disciplinary rehabilitation team, usually including a physiotherapist, an occupational therapist, a psychotherapist/psychologist and personnel with competences related to garden/gardening and nature. In 2016, a Health Technology Assessment (HTA) report on NBR for patients with longstanding stress-related disorders was published (Bernhardsson et al., 2016), indicating uncertainty of effect of NBR compared with other rehabilitation programmes, but perceived positive effects reported in qualitative studies. The present HTA report is an update of the 2016 report and includes both the previous studies and those identified in a new systematic search. Questions at issue: 1) Is multidisciplinary, group-based, NBR more effective than either multidisciplinary, group-based, rehabilitation that is not nature-based, or any other rehabilitation that is not nature-based, for patients with longstanding (>6 months) stress-related disorders, in terms of health-related quality of life (HRQoL), sick leave, work ability, healthcare consumption, perceived stress, depression, anxiety, fatigue/exhaustion, cognitive disability, pain or insomnia/sleep disturbances? 2) What are the experiences and perceived effects of participating in NBR in patients with longstanding stress-related disorders?

Authors' results and conclusions: The effectiveness of NBR compared with other forms of rehabilitation in patients with longstanding stress-related disorders remains poorly studied. Regarding critical outcomes, there may be little or no difference in sick-leave, healthcare consumption, or HRQoL after NBR compared with non-NBR or other rehabilitation for patients with longstanding stress-related disorders (GRADE ⊕⊕). Effects on all other studied outcomes are uncertain. Qualitative studies suggest patients experience positive health effects from being in natural environments and working in a garden. There is thus qualitative evidence of a perceived positive effect of NBR on long-standing stress related disorders, but no quantitative evidence that NBR is more effective than other forms of rehabilitation for longstanding stress-related disorders.

Project Status: Completed

Year Published: 2020

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-1728378332-384/native/2020_112%20HTA-rapport%20Gr%c3%b6n%20Rehab.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se