Horticultural therapy for schizophrenia

  • Review
  • Intervention




Horticultural therapy is defined as the process of utilising fruits, vegetables, flowers and plants facilitated by a trained therapist or healthcare provider, to achieve specific treatment goals or to simply improve a person's well-being. It can be used for therapy or rehabilitation programs for cognitive, physical, social, emotional, and recreational benefits, thus improving the person's body, mind and spirit. Between 5% to 15% of people with schizophrenia continue to experience symptoms in spite of medication, and may also develop undesirable adverse effects, horticultural therapy may be of value for these people.


To evaluate the effects of horticultural therapy for people with schizophrenia or schizophrenia-like illnesses compared with standard care or other additional psychosocial interventions.

Search methods

We searched the Cochrane Schizophrenia Group Trials Register (Janurary 2013) and supplemented this by contacting relevant study authors, and manually searching reference lists.

Selection criteria

We included one randomised controlled trial (RCT) comparing horticultural therapy plus standard care with standard care alone for people with schizophrenia.

Data collection and analysis

We reliably selected, quality assessed and extracted data. For continuous outcomes, we calculated a mean difference (MD) and for binary outcomes we calculated risk ratio (RR), both with 95% confidence intervals (CI). We assessed risk of bias and created a 'Summary of findings' table using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach.

Main results

We included one single blind study (total n = 24). The overall risk of bias in the study was considered to be unclear although the randomisation was adequate. It compared a package of horticultural therapy which consisted of one hour per day of horticultural activity plus standard care with standard care alone over two weeks (10 consecutive days) with no long-term follow-up. Only two people were lost to follow-up in the study, both in the horticultural therapy group (1 RCT n = 24,RR 5.00 95% CI 0.27 to 94.34, very low quality evidence). There was no clear evidence of a difference in Personal Wellbeing Index (PWI-C) change scores between groups, however confidence intervals were wide (1 RCT n = 22, MD -0.90 95% CI -10.35 to 8.55, very low quality evidence). At the end of treatment, the Depression Anxiety Stress Scale (DASS21) change scores in horticultural therapy group were greater than that in the control group (1 RCT n = 22, MD -23.70 CI -35.37 to - 12.03, very low quality evidence). The only included study did not report on adverse effects of interventions.

Authors' conclusions

Based on the current very low quality data, there is insufficient evidence to draw any conclusions on benefits or harms of horticultural therapy for people with schizophrenia. This therapy remains unproven and more and larger randomised trials are needed to increase high quality evidence in this area.








Cochrane Schizophrenia Group Trials Register(2013年1月)を検索し、これを補うために関連性のある試験の著者らに問い合わせた。参考文献一覧をハンドサーチした。




レビューアらは確実に選択し、質を評価し、データを抽出した。連続アウトカムには平均差(MD)を、2値アウトカムにはリスク比(RR)を、95%信頼区間(CI)とともに算出した。バイアスのリスクを評価し、GRADE(Grades of Recommendation, Assessment, Development and Evaluation)法を用いて表「要約の知見」を作成した。


1件の単盲検試験(合計n = 24)を選択した。試験の全体のバイアスのリスクは、ランダム化は適切であるにもかかわらず、不明とみなされた。1日1時間の園芸活動からなる園芸療法パッケージと標準ケアの併用を、標準ケア単独と2週間(連続10日)にわたって比較したが、長期追跡調査はなかった。この試験では2例のみ追跡不能となり、2例とも園芸療法群であった(RCT1件、 n = 24、RR 5.00 95% CI 0.27 ~ 94.34、エビデンスの質は非常に低い)。 信頼区間がどんなに幅広くてもPersonal Wellbeing Index (PWI-C)スコア変化の差の明らかなエビデンスはなかった(RCT1件、n = 22、MD -0.90 、95% CI -10.35~ 8.55、エビデンスの質は非常に低い)。 治療終了時、園芸療法群のDepression Anxiety Stress Scale (DASS21)のスコア変化は対照群のものよりも大きかった(RCT1件、MD -23.70 、CI -35.37 ~ - 12.03、エビデンスの質は非常に低い)。この唯一の選択した試験では、有害作用は報告されていなかった。




《注意》この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、eJIM事務局までご連絡ください。なお、2013年6月からコクラン・ライブラリーのNew review, Updated reviewとも日単位で更新されています。eJIMでは最新版の日本語訳を掲載するよう努めておりますが、タイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。

Plain language summary

Gardening activity as a therapy for schizophrenia

Horticultural therapy is based on the therapeutic value of participating in garden activities such as growing fruit or vegetables and/or flowers. Gardening is thought to improve people's well-being through being a recreational and sociable activity which may lead to improvements in people's thinking, new friendships and more positive emotions. The benefits of gardening can also apply to people with serious mental illness such as schizophrenia. Gardening reduces stress, which is important because stress can often lead to mental illness. Gardening is also hard work and a physical activity, and so motivates people with mental illness who often feel tired and apathetic. Weight gain is common for people with mental illness and gardening is good physical exercise.

Since 5% to 15% of people with schizophrenia experience symptoms in spite of taking antipsychotic drugs and also because these drugs have debilitating side effects, horticultural therapy may be of value to these people.

This review focuses on the effects of horticultural therapy for people with schizophrenia. An electronic search for relevant randomised trials was run in January 2013. Only one trial was included, it randomised a total of 24 people with schizophrenia to received either their standard care plus horticultural therapy or standard care only. The trial only lasted 2 weeks (10 consecutive days) with no long-term follow-up. There are few results and the quality of evidence was rated by the review authors to be very low quality. Some of the information from this one study favoured horticultural therapy but there is insufficient evidence to draw any conclusions on benefits or harms of horticultural therapy for people with schizophrenia. More large, better conducted and reported trials are required to determine the effectiveness and benefits of horticultural therapy.

This plain language summary has been written by a consumer Ben Gray, Service User and Service User Expert, Rethink Mental Illness.





本レビューでは、統合失調患者に対する園芸療法の効果に焦点を当てる。関連性のあるランダム化試験の電子検索を2013年1月に実施した。1件のみを選択した。この試験では、統合失調症患者24例を標準ケアと園芸療法併用または標準ケア単独のいずれかに無作為に割付けた。試験期間はわずか2週間(連続10日)で、長期追跡調査はなかった。結果は少数でエビデンスの質はレビュー著者によって非常に低いと評価された。 この1件の試験から得られた情報の一部は園芸療法に有利であったが、統合失調症患者に対する園芸療法の利益と有害性に関する結論を導き出すにはエビデンスが不十分であった。園芸療法の有効性と利益を判定するために、より規模の大きい、実施や報告がより良好な試験が必要である。

この平易な要約は利用者であるBen Gray( Service User and Service User Expert、 Rethink Mental Illness)によって書かれている。


《注意》この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、eJIM事務局までご連絡ください。なお、2013年6月からコクラン・ライブラリーのNew review, Updated reviewとも日単位で更新されています。eJIMでは最新版の日本語訳を掲載するよう努めておりますが、タイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。

Laički sažetak

Vrtlarske aktivnosti kao terapija za shizofreniju

Terapija vrtlarenjem temelji se na terapeutskoj vrijednosti sudjelovanja u vrtlarskim aktivnostima poput uzgajanja voća ili povrća i/ili cvijeća. Vrtlarenje se smatra učinkovitim u općem poboljšanju kao rekreacijska i društvena aktivnost koja može dovesti do poboljšanja u ljudskom mišljenju, novim prijateljstvima i mnogim pozitivnim emocijama. Učinci vrtlarenja se također mogu primijeniti kod ljudi s težim duševnim oboljenjima poput shizofrenije. Vrtlarenje smanjuje stres što je važno jer stres često može dovesti do duševnog oboljenja. Vrtlarenje je ujedno i težak rad i fizička aktivnost, i kao takva motivira duševno oboljele osobe koje se često osjećaju umorno i bezvoljno. Porast tjelesne težine je učestao kod duševno oboljelih osoba i vrtlarenje je dobra fizička vježba.

S obzirom da između 5% do 15% bolesnika oboljelih od shizofrenije imaju simptome unatoč uzimanju antipsihotika, i da navedeni lijekovi imaju teške nuspojave, terapija vrtlarenjem može biti korisna tim osobama.

Ovaj Cochrane sustavni pregled je usmjeren na učinke terapije vrtlarenjem kod oboljelih od shizofrenije. Elektroničko pretraživanje relevantnih randomiziranih istraživanja učinjeno je tijekom siječnja 2013. godine. Uključeno je samo jedno istraživanje koje je randomiziralo (nasumično razvrstalo) 24 osobe oboljele od shizofrenije u skupine koje su primale standardnu skrb uz terapiju vrtlarenjem ili samo standardnu skrb. Istraživanje se provodilo kroz 2 tjedna (10 radnih dana) bez dugoročnog praćenja. Dobiveno je malo rezultata i kvaliteta dokaza je od strane autora pregleda procijenjena kao vrlo niska kvaliteta.Dio podataka dobivenih iz jedne studije pokazao je koristan učinak terapije vrtlarenjem, ali s nedostatnim dokazima koji bi doveli do zaključaka o prednostima ili manama terapije vrtlarenjem u oboljelih od shizofrenije. Potrebna su veća, bolje provedena i bolje opisana istraživanja kako bi se mogla utvrditi učinkovitost i prednost terapije vrtlarenjem.

Ovaj laički sažetak u engleskom originalu napisao je Benjamin Gray iz udruge Rethink Mental Illness.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Linda Rossini Gajšak
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr