Nature-based interventions and nature interaction for people with acquired brain injury: A systematic scoping review

Substantial evidence demonstrates natural environments benefit human health, but lesser known is specific knowledge on benefits for people with acquired brain injury (ABI), including impacts across the continuum of recovery or the breadth of nature interaction. This systematic scoping review aimed to report on research exploring nature-based interventions and nature interaction for people with ABI, and to identify gaps in the research. Six databases were searched. Eligibility criteria were 1) majority of participants (more than 50 %) are adults (18 years and above) with ABI, or therapists/health professionals' perspectives on nature or nature-based interventions for people with ABI, 2) nature-based intervention or nature interaction, 3) all contexts including hospital, rehabilitation, community and home environments, 4) primary research studies and metanalysis reporting on nature-based intervention or nature exposure/immersion and, 5) in English or translated to English. Out of the 16,490 articles screened 38 relevant articles were identified. Most studies were completed during inpatient (n = 13) and outpatient rehabilitation (n = 10), with less research occurring post rehabilitation (n = 12) and during acute care (n = 2); one was longitudinal across these phases, and one was unable to be determined. The interaction, or exposure, to nature was incidental in fourteen of the studies, and intentional for the remaining (n = 24). Most of the studies explored nature in outdoor environments, with gardens and green space being most common (n = 28) and nature in indoor environments explored in only seven studies. Quantitative research most often evaluated depression and anxiety outcomes (n = 12), followed by well-being and quality of life (n = 5); and independence, activity performance and participation (n = 5). Quantitative results indicated that nature positively impacts depression, anxiety and mood, along with well-being and quality of life. But there were mixed results for sleep and fatigue, stress, self-efficacy, and independence/activity participation. Common qualitative study outcomes were well-being and quality of life (n = 7), restoration (n = 7), self-efficacy and motivation (n = 6), depression, anxiety and mood (n = 5), and benefits to the rehabilitation process (n = 5). Overall, nature interactions offer significant benefits for people with ABI, and wherever possible healthcare professionals are encouraged to incorporate nature into the rehabilitation process. Research is needed to provide robust further evidence and understand the best methods of intentionally using nature in rehabilitation, with stage of recovery an important consideration. Two areas for future research with very little exploration to date were nature exposure in the acute care stage of recovery and incidental nature exposure. The need and value of involving people with ABI in the development of intentional nature interactions, healthcare building design, and research design, was highlighted as critical to ensure nature is incorporated to its full potential. • Nature is important in all stages of recovery and rehabilitation. • Incidental hospital interaction reduced psychological distress, increased wellbeing. • Intentional interaction in hospital was usually through gardening/gardens. • Community interaction can be more intense/challenging. • Inaccessible nature is frustrating, virtual approaches may provide a solution.