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Review article - Peer-reviewed, 2021

Does More Time in a Therapeutic Garden Lead to a Faster Return to Work? A Prospective Cohort Study of Nature-Based Therapy, Exploring the Relationship between Dose and Response in the Rehabilitation of Long-Term Patients Suffering from Stress

Grahn, Patrik; Pálsdóttir, Anna María


Background: Stress-related mental illness is increasing worldwide and leading to long-term illness. Most of those affected are aged 30-50, so the need for rehabilitation and return to work for these patients is great. Research indicates that staying in nature can lead to stress recovery. The question is whether nature-based therapy can rehabilitate people who suffer from long-term stress-related mental illness, and how long a period of rehabilitation is necessary.

Methods and findings: The research was carried out at Alnarp Rehabilitation Garden, which is a specially designed health garden on the Swedish University of Agricultural Sciences’ campus area, where the participants in the study were treated by a licensed rehabilitation team. The intention was to examine three cohorts of participants prospectively. These were offered different lengths of a nature-based rehabilitation program through a natural experiment. Participants were referred to Alnarp Rehabilitation Garden from three local social insurance agencies that granted different lengths of rehabilitation programs: 8 weeks, 12 weeks and 24 weeks. The length of the program was determined by which local social insurance agencies they belonged to, not the participants' level of illness. Primary outcome was return to work. Other outcomes were occupational function, personal control and sense of coherence. The results showed that all three rehabilitation interventions gave significantly good results, but that longer nature-based rehabilitation led to significantly better results for all outcomes. The 12-week program provided 75% greater return to paid work and the 24-week program 120% greater return to paid work than the 8-week program.

Conclusion: There is a significant positive relationship between treatment time in the rehabilitation garden and return to work. The study also indicates that the effects may level off after twelve weeks. More studies are needed to further investigate the relationships.


supportive environments; perceived sensory dimensions; Alnarp rehabilitation garden; green care; horticultural therapy

Published in

International Journal of Physical Medicine & Rehabilitation
2021, volume: 9, number: 6, article number: 614

Authors' information

Swedish University of Agricultural Sciences, Department of People and Society
Pálsdóttir, Anna María (Palsdottir, Anna Maria)
Swedish University of Agricultural Sciences, Department of People and Society

Associated SLU-program

Built environment
SLU Future One Health
SLU Urban Futures

Sustainable Development Goals

SDG11 Sustainable cities and communities
SDG3 Good health and well-being

UKÄ Subject classification

Applied Psychology
Occupational Therapy

URI (permanent link to this page)