Nature-based interventions to promote health for people with stress-related illness: An integrative review.

The review included 25 studies with different designs, so the findings are themes and patterns rather than one consistent result. Many quantitative studies did not show statistically significant effects, possibly because they had low participant numbers. All included studies were from Sweden and Denmark, so the programmes may not fit other health-care systems or diagnoses. Most participants were on long-term sick leave, and health insurance and treatment regulations may affect who can take part. The search was limited to English and academic journals, and no time limit was used, although the oldest article was published in 2008. More than half of the included studies were published in the same two journals, which may narrow the range of views. The interventions bundled many components, such as therapy, mindfulness, garden or forest activities, physical therapy and social interaction, so the contribution of any single component cannot be separated. Post-traumatic stress disorder was excluded, so the findings do not apply to that diagnosis. Only one of the 25 included articles had a nursing author, so nursing-specific evidence was limited.

The authors declared no conflict of interest.

Do not conclude that nature-based therapy is better than other treatments. Stress and sick leave decreased in some studies, but control groups also improved, and several differences were not significant. The programmes also combined many components, so any single element cannot be isolated.