Outdoor or nature-based rehabilitation of patients after stroke

Stroke is a common cause of death among the elderly. For those who survive a stroke, rehabilitation is important to restore function, prevent complications and increase the quality of life. New methods of promoting rehabilitation are constantly being developed. Rehabilitation in the outdoor environment and nature-based rehabilitation are methods offered around the country for various disease conditions.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: Report no: ut202104 Registration no: SBU 2019/671


What scientific studies are there on outdoor or nature-based rehabilitation of patients after stroke?

Identified literature

One relevant systematic review [1] and three primary studies were identified [2-4]. The primary studies were not assessed for risk of bias

Table 1. Systematic reviews with low/medium risk of bias.

Included studies Population/Intervention Outcome
Kamioka et al 2014
4 RCT All populations where at least one treatment group received horticultural therapy (HT). All cure and rehabilitation effects
Authors' conclusion:
“Although there was insufficient evidence in the studies of HT due to poor methodological and reporting quality and heterogeneity, HT may be an effective treatment for mental and behavioral disorders such as dementia, schizophrenia, depression, and terminal-care for cancer.”


  1. Kamioka H, Tsutani K, Yamada M, Park H, Okuizumi H, Honda T, et al. Effectiveness of horticultural therapy: a systematic review of randomized controlled trials. Complement Ther Med. 2014;22(5):930-43. https://www.sciencedirect.com/science/article/pii/S096522991400137X?via%3Dihub
  2. Pálsdóttir AM, Stigmar K, Norrving B, Petersson IF, Åström M, Pessah-Rasmussen H. The nature stroke study; NASTRU: A randomized controlled trial of nature-based post-stroke fatigue rehabilitation. J Rehabil Med. 2020;52(2):jrm00020. https://www.medicaljournals.se/jrm/content/abstract/10.2340/16501977-2652 
  3. Wen Y., Lian L., Jiayin M., Zhijun W., Shuyi C., Wenzhu H. An observation on the curative effects of rehabilitation intervention of adjuvant horticultural therapy for the treatment of stroke-induced unilateral spatial neglect. Acta Medica Mediterranea. 2019;35(1):29-32. https://www.actamedicamediterranea.com/archive/2019/medica-1/an-observation-on-the-curative-effects-of-rehabilitation-intervention-of-adjuvant-horticultural-therapy-for-the-treatment-of-stroke-induced-unilat-eral-spatial-neglect   
  4. Langhammer B, Stanghelle JK. Exercise on a treadmill or walking outdoors? A randomized controlled trial comparing effectiveness of two walking exercise programmes late after stroke. Clin Rehabil. 2010;24(1):46-54. https://journals.sagepub.com/doi/10.1177/0269215509343328?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&
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