Two-part Exploration of Therapeutic Horticulture Interest and Acute Effects Among Patients with Chronic Low Back Pain: A Mixed Methods Study

Research

Objectives: Determine patient interest, perceived health and wellbeing benefits of TH.
Provide understanding of acute effects of therapeutic horticulture on LBP severity, physical function, spine motion and enjoyment of the activity.

Design: Two-part study with mixed methods design: Cross-sectional survey and pilot experiment
Setting: Part 1 Survey: UF Health Comprehensive Spine Center
Part 2 Pilot Experiment: University of Florida's Wilmot Gardens
Participants: Part 1:170 patients receiving medical care for LBP
Part 2: 9 patients receiving medical care for LBP
Interventions: Part 1: Patients were approached during clinic visits and asked if they wanted to participate in the horticulture interest survey.
Part 2:1-hour therapeutic horticulture session that involved propagating and harvesting herbs planted at various heights in an outdoor setting.
Main Outcome Measures: A therapeutic horticulture interest survey and PROMIS Pain Interference and Physical Function scores, functional tests (timed-up-and-go, spine range of motion), Roland Morris Disability Questionnaire, 11-point Numerical Pain Rating Scale, 10-item PROMIS Global Health, Tampa Scale of Kinesiophobia-11, and a study-specific patient enjoyment survey.

Results: Cross sectional Survey: 82% of patients had not previously heard of therapeutic horticulture (TH) and 68% were interested in learning more about it. Patients who reported interest in TH reported a higher level of agreement that TH could improve mood, improve muscle strength, lower stress level, increase movement and perform self-care activities with less pain (all p<.001).

Pilot Experiment: 44% reported using pain medication to manage their LBP and 66% believed gardening can provide pain relief. 55% reduction in anxiety with TH; 30% improvement in spine flexibility with TH; 100% of patients who participated in TH agreed they would be interested in this for overall pain management
All participants believed that gardening improves overall health and spine motion while reducing LBP. All reported having gardening experience at home and none had TH experience.

Conclusions: TH may offer an enjoyable alternative approach to help patients with chronic LBP self-manage pain and improve spine function.
Future larger studies could use dose response approaches, explore different TH activity types, and involve participants from different geographic locations while controlling for LBP history and psychological status.