Effects of Outdoor Therapy on Delirium in Patients With Prolonged Intensive Care Unit Stays: A Single-Centre Retrospective Study.
Daichi Tsukakoshi, Hitoshi Mutai, Shuhei Yamamoto and 6 others
PMID 41257506WHAT IT FOUND
Supervised outdoor sessions in ICU patients with stays of at least 7 days were associated with lower discharge delirium scores after comparing similar patients, and more sessions were linked to lower scores.
Same-day scores also dropped after the first outing.
Key findings
01After comparing similar patients, ICDSC scores at ICU discharge were median 3.0 in the outdoor-therapy group and median 4.0 in the matched control group (p = 0.013).
02On the day of the first outdoor session, ICDSC scores decreased from median 4.0 to median 2.0 (p < 0.001).
03A greater number of outdoor sessions was independently associated with lower ICDSC scores at ICU discharge (p = 0.025).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was observational and not randomised, so unmeasured factors such as agitation trajectory, family presence or staffing intensity may have influenced both outdoor therapy selection and delirium scores. The outdoor-therapy group was older, had longer ICU stays, more delirium during the stay and more psychotropic medication at baseline. The unadjusted primary comparison at ICU discharge was null; the positive result depended on matching and adjustment. Outdoor session duration was not recorded, and dose was measured only by number of sessions, so therapy intensity is unclear. ICDSC is a screening tool rather than a detailed severity measure, so misclassification is possible. Post-exposure medication changes were not fully captured, and time-dependent variables such as ventilator days and ICU length of stay were not adjusted in the usual way. Outdoor sessions were delivered after the highest ICDSC score had been recorded, so selection and timing effects may remain. The study was single-centre and did not assess long-term cognitive or functional outcomes. The reported inclusion period extends to 31 December 2023, but the participant flow reports screening from 1 January 2019 through 31 December 2022.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not conclude outdoor therapy causes less delirium. This was an observational study, the unadjusted discharge scores did not differ, and outdoor therapy was given alongside ICU treatments, psychotropic medications and other non-pharmacological measures.