Altern Ther Health Med. 2024 Apr;30(4):10-17.
Chronic low back pain (LBP) is common and associated with disability worldwide. Therapists trained in Therapeutic Horticulture (TH) use gardening activities and proximity to nature for therapy and rehabilitation. Patients seeking care for LBP would benefit physically and psychologically from participating in TH.
The first aim of this study was to determine if and which patients who were receiving care for chronic LBP were interested in TH to help manage their pain. The second aim of the project was to quantify changes in LBP, functional tasks and anxiety upon completion of a TH session in patients with LBP.
METHODS/DESIGN: This was a 2-part study with a mixed methods design: the cross-sectional survey Group and the pilot experimental Group. The Cross-sectional Survey component comprised a total of 170 patients; age 55.9±17.3 years; 58% women. The Pilot Experimental component comprised a total of 9 patients; age 48±14.7 years; 78% women.
PARTICIPANTS CROSS-SECTIONAL COMPONENT: Patients receiving medical care for LBP with or without additional joint pain sites (n=170; age 55.9 ± 17.3 years; 58% women.
A total of 9 patients (7 women); mean age 48 ± 14.7 years and mean duration of back pain 12.6 ± 8.1 years.
Patients were receiving medical care at the University of Florida Health Comprehensive Spine Center in the United States, in the tertiary care health system.
1-hour TH session that involved trained therapists using propagating and harvesting herbs planted at various heights in an outdoor setting for therapy and rehabilitation.
A therapeutic horticulture interest survey, PROMIS Pain Interference and Physical Function scores, functional tests (timed-get-up-and-go [TUG], spine range of motion), Roland Morris Disability Questionnaire (RMDQ), 11-point Numerical Pain Rating Scale (NRSpain), 10-item PROMIS Global Health Questionnaire, Tampa Scale of Kinesiophobia-11 and patient enjoyment.
Cross-sectional survey component: A total of 2% of patients had not previously heard of TH and 68% were interested in learning more about it. Patients who expressed interest in TH reported a higher level of agreement that TH could improve mood, improve muscle strength, lower stress level, increase movement and enable patients to perform self-care activities with less pain (all P < .001). PROMIS Pain Interference and Physical Function scores did not differ by interest in TH (P > .05). Pilot Experimental component: In the pilot session, 44% reported using pain medication to manage their low back pain and 66% believed gardening could provide pain relief. Improvements were observed in anxiety (55.3%; P =.017), spine flexion (31.4%; P =.003) and spine rotation to the left (26.7%; P =.005). All participants believed that gardening improved overall health and spine motion while reducing low back pain. All patients reported having gardening experience at home and none had TH experience.
Patients presenting to an outpatient spine clinic may be receptive to trying TH in conjunction with or in place of conventional medicine to promote health and well-being. The pilot experimental group data suggested that acute TH is enjoyable and may confer the benefits of reducing anxiety and improving spine motion. Future larger studies could use different dose response approaches, explore different TH activity types and involve participants from different geographic locations while controlling for LBP history and psychological status.
慢性下腰痛（LBP）很常见，并且与全球范围内的残疾有关。接受过园艺疗法（Therapeutic Horticulture，TH）培训的治疗师使用园艺活动和接近自然来进行治疗和康复。寻求 LBP 治疗的患者将在身体和心理上受益于参与 TH。
该研究的第一个目的是确定正在接受慢性 LBP 治疗的患者中，有多少人对 TH 感兴趣，以帮助他们缓解疼痛。该项目的第二个目的是量化接受 LBP 治疗的患者在完成 TH 疗程后 LBP、功能任务和焦虑的变化。
方法/设计：这是一项具有混合方法设计的 2 部分研究：横断面调查组和试点实验组。横断面调查部分共包括 170 名患者；年龄 55.9±17.3 岁；58%为女性。试点实验组共包括 9 名患者；年龄 48±14.7 岁；78%为女性。
接受 LBP 医疗护理的患者，无论是否有其他关节疼痛部位（n=170；年龄 55.9 ± 17.3 岁；58%为女性。
共 9 名患者（7 名女性）；平均年龄 48 ± 14.7 岁，背痛平均持续时间 12.6 ± 8.1 年。
患者在美国佛罗里达大学健康综合脊柱中心接受医疗护理，该中心位于三级保健系统中。
1 小时的 TH 疗程，包括训练有素的治疗师使用在不同高度种植的草药进行治疗和康复。
TH 兴趣调查、PROMIS 疼痛干扰和身体功能评分、功能测试（定时起身和走动 [TUG]、脊柱活动范围）、Roland Morris 残疾问卷（RMDQ）、11 点数字疼痛评分量表（NRSpain）、10 项 PROMIS 全球健康问卷、坦帕运动恐惧量表-11 和患者享受度。
横断面调查部分：共有 2%的患者以前从未听说过 TH，68%的患者有兴趣了解更多信息。对 TH 感兴趣的患者报告说，他们更同意 TH 可以改善情绪、增强肌肉力量、降低压力水平、增加活动量并使患者能够在疼痛减轻的情况下进行自我护理活动（均 P <.001）。对 TH 感兴趣与 PROMIS 疼痛干扰和身体功能评分无差异（P >.05）。试点实验组：在试点课程中，44%的患者报告使用止痛药来管理他们的下腰痛，66%的患者认为园艺可以提供疼痛缓解。焦虑症改善了 55.3%（P =.017），脊柱弯曲度改善了 31.4%（P =.003），脊柱向左旋转改善了 26.7%（P =.005）。所有参与者都认为园艺改善了整体健康和脊柱运动，同时减轻了下腰痛。所有患者都报告在家中有园艺经验，没有人有 TH 经验。
在门诊脊柱诊所就诊的患者可能愿意尝试将 TH 与传统医学结合或替代传统医学，以促进健康和幸福感。试点实验组的数据表明，急性 TH 是令人愉快的，并且可以减少焦虑和改善脊柱运动。未来的大型研究可以使用不同的剂量反应方法，探索不同的 TH 活动类型，并在控制 LBP 病史和心理状态的情况下，让来自不同地理位置的参与者参与。
