44 ALTERNATIVE THERAPIES, mar/apr 2012, VOL. 18, NO. 2 This article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#10786791. To subscribe, visit alternative-therapies.com. Horticultural Therapy for Chronic Pain Patients Horticultural Therapy for Patients With Chronic Musculoskeletal Pain: Results of a Pilot Study Martin L. Verra, MPtSc; Felix Angst, MD, MPH; Trudi Beck, MSc; Susanne Lehmann, RN; Roberto Brioschi, MSc; Renata Schneiter, MSc; André Aeschlimann, MD original research AbSTRACT Context • Therapists can use horticultural therapy as an adju- vant therapy in a nonthreatening context, with the intent of bringing about positive effects in physical health, mental health, and social interaction. Very few experimental studies exist that test its clinical effectiveness. Objective • To determine whether the addition of horticultural therapy to a pain-management program improved physical func- tion, mental health, and ability to cope with pain. Design • The research team designed a prospective, nonrandom- ized, controlled cohort study, enrolling all patients consecutively referred to the Zurzach Interdisciplinary Pain Program (ZISP) who met the study’s criteria. The team divided them into two cohorts based on when medical professionals referred them: before (control group) or after (intervention group) introduction of a horticultural therapy program. Setting • The setting was the rehabilitation clinic (RehaClinic) in Bad Zurzach, Switzerland. Participants • Seventy-nine patients with chronic musculoskel- etal pain ( ibromyalgia or chronic, nonspeciic back pain) partici- pated in the study. Interventions • The research team compared a 4-week, inpa- tient, interdisciplinary pain-management program with horticul- tural therapy (intervention, n = 37) with a pain-management program without horticultural therapy (control, n = 42). The horticultural therapy program consisted of seven sessions of group therapy, each of 1-hour duration. Outcome Measures • The research team assessed the outcome using the Medical Outcome Study Short Form-36 (SF-36), the West Haven-Yale Multidimensional Pain Inventory (MPI), the Hospital Anxiety and Depression Scale (HADS), the Coping Strategies Questionnaire (CSQ ), and two functional performance tests. The team tested participants on entry to and discharge from the 4-week pain-management program. Results • Between-group differences in sociodemographic and outcome variables were not signiicant on participants’ entry to the pain-management program. On discharge, the research team measured small to moderate outcome effects (effect size [ES] up to 0.71) within both groups. The study found signiicantly larger improvements for the horticultural therapy group vs the control group in SF-36 role physical (ES = 0.71 vs 0.22; P = .018); SF-36 mental health (ES = 0.46 vs 0.16; P = .027); HADS anxiety (ES = 0.26 vs 0.03; P = .043); and CSQ pain behavior (ES = 0.30 vs –0.05; P = .032). Conclusion • The addition of horticultural therapy to a pain- management program improved participants’ physical and men- tal health and their coping ability with respect to chronic muscu- loskeletal pain. (Altern Ther Health Med. 2012;18(2):44-50.) Martin L. Verra, MPtSc, is director at the Physiotherapy Institute, Inselspital, bern University Hospital, Switzerland, and research assistant at the rehabilitation clinic (RehaClinic), bad Zurzach, Switzerland. Felix Angst, MD, MPH, is head of research at RehaClinic, bad Zurzach. Professor Trudi Beck, MSc, is lecturer in the Department of Social Sciences, Zurich University of Applied Sciences, Duebendorf, Switzerland. Susanne Lehmann, RN, is research nurse and Roberto Brioschi, MSc, is clinical psychologist at RehaClinic, bad Zurzach. Renata Schneiter, MSc, is a professor in the School of Life Sciences and Facility Management, Zurich University of Applied Sciences, Wädenswil, Switzerland. André Aeschlimann, MD, is medical director at RehaClinic, bad Zurzach. Corresponding author: Martin L. Verra E-mail: martin.verra@insel.ch Author Disclosure Statement: The Zurzach Rehabilitation Foundation SPA, Bad Zurzach, Switzerland, supported this study. The Swiss Confederation’s innovation promotion agency (CTI proj- ect no. 8047.2 ESPP 2006-2009) provided additional inancial sup- port. No author has any conlict of interest to declare. H orticultural therapy is the engagement of a person in gardening-related activities that a trained therapist facilitates to achieve speciic treatment goals. 1 It is a process through which these therapists use plants, gardening activities, and proximity to nature as vehicles in therapy and rehabilitation programs. 2 Horticultural therapy used in physical rehabilitation retrains muscles and improves coordination, balance, and strength. Therapists often use horticul- tural therapy as an adjuvant therapy in a nonthreatening context in addition to occupational and physical therapies. 3-5 Horticultural