DementiaTGIFNCT07059390
Concurrent Trials on Nature-Based Therapy for Inpatients in Dementia and Rehabilitation Medicine Wards
A study testing Nature Immersion Therapy in people with Dementia and Acquired Brain Injury Including Stroke, run by Changi General Hospital at 1 site in Singapore.
Trial summary
Nature-based Therapy, such as forest bathing and horticultural therapy, has been shown to have physical, psychological and emotional health benefits. We posit that personalised and guided Nature-based Therapy, which leverages the benefits of therapeutic gardens in an urban hospital setting, improves the overall… Read more about this study
- Who is it for?
- Ages 21 to 100 years
- Conditions the study is for
- Dementia, Acquired Brain Injury Including Stroke
- What is being tested?
- Nature Immersion Therapy
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 1,600 participants
- Where
- 1 siteSingapore
- Study dates
- May 2027to Aug 2028
- Phase
- Interventional
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 21 to 100 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients with dementia:
- Age 65-100 years old
- Have a diagnosis of delirium/ dementia or both.
- Have diagnosis of dementia with and without behavioural symptoms of dementia (BPSD)
- Ability to communicate with the Nature-based Therapist (in languages such as English, Mandarin Chinese, Chinese dialects or Malay)
- Manageable behavioural symptoms and able to focus attention for minimum of 30 minutes
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- Rehabilitation Medicine patients:
- Age 21-100 years old
- Acquired brain injury with residual impairments, which can be either in the i) motor, and/or ii) cognitive domains, and/or iii) suspected or diagnosed mood disorders (including adjustment disorder, depression and anxiety disorders) -patients would then be stratified according to the category(s) of impairments both for consideration of interventions and for outcome measures/analysis
- Additional Physical/Cognitive Criteria required will depend on range of specific therapeutic activities that could be prescribed/administered (eg.at least 1 upper limb with Manual Muscle Testing (MMT) of at least 3/5, with ability for active grasp/release, ability to sustain attention for the duration of the session, cognitive Functional Independence Measure (FIM) score of at least 25 points etc)
Who cannot join
- In isolation due to contact, droplet or airborne precautions
- Unable to provide consent and lack of surrogate decision maker to provide consent
- Poorly managed psychiatric or behaviour symptoms with threats to others surrounding them.
- Age < 21 years
- Patients who are haemodynamically unstable.
- Patients on strict bed rest
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Singapore1 site
Changi General Hospital
Singapore
Si Ching Lim, (65) 6426 7818, lim.si.ching@singhealth.com.sg
Si Ching Lim
About this study
Official title: Changi General Hospital Complementary Health Therapy
Nature-based Therapy, such as forest bathing and horticultural therapy, has been shown to have physical, psychological and emotional health benefits. We posit that personalised and guided Nature-based Therapy, which leverages the benefits of therapeutic gardens in an urban hospital setting, improves the overall wellbeing of elderly inpatients with dementia (aged >65 years old) and their caregivers, as well as patients undergoing inpatient rehabilitation. To determine the effectiveness of Nature-based Therapy for these two inpatient populations, we designed a pilot study, TGIF, to be conducted at the dementia and rehabilitation medicine wards at Changi General Hospital in Singapore.
Read the detailed description
TGIF consists of two concurrent trials targeting two patient populations: elderly inpatients with dementia admitted to the dementia ward, and inpatients undergoing inpatient rehabilitation at the rehabilitation wards in a tertiary teaching hospital in Singapore. At the dementia wards, we aim to determine if Nature-based Therapy improved the neuropsychiatric symptoms such as agitation, restlessness and aggression among elderly inpatients living with cognitive impairment, defined as either delirium or dementia or both. Concurrent with the improved neuropsychiatric symptoms, the study team will also study the improved quality of life among the family, caregivers and hence reduced caregiver burden. At the rehabilitation medicine wards, we aim to determine if Nature-based Therapy improves mood, physical function, and quality of life.
- Conditions
- Dementia, Acquired Brain Injury Including Stroke
- Being tested
- Nature Immersion Therapy
- Keywords
- Dementia, Stroke, Traumatic Brain Injury, Delirium, Nature-Based Therapy
- Medical subject headings
- Dementia, Stroke, Brain Injuries, Traumatic, Delirium
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Nature Immersion TherapyBehavioural
During the length of inpatient stay at Changi General Hospital (CGH), which ranges from 5 to 10 days, the patients and caregivers will be enrolled for a set of 3 nature-based sessions. Each session will be conducted in groups of 4 to 6 patients incorporating a relational multi-sensory experience as well as mind-body connectedness while spending time in nature. Each of the 3 sessions will be 45 minutes each. The nature-based therapy/green social prescription plan will be conducted in groups guided by a trained CGH staff (Allied Health Professionals/Nurse). This Green social prescribing plan (Playbook) will be integrated into inpatient's care plan. Caregivers of the enrolled patients will also be part of the therapy group following the necessary consent.
| Study group | Role | What they receive |
|---|---|---|
| Dementia Patients - Intervention | Experimental | Patients with dementia who undergo Nature Immersion Therapy Receives: Behavioral: Nature Immersion Therapy |
| Dementia Patients - Control | No intervention | Patients with dementia who do not undergo Nature Immersion Therapy |
| Rehabilitation Patients - Intervention | Experimental | Rehabilitation patients who undergo Nature Immersion Therapy Receives: Behavioral: Nature Immersion Therapy |
| Rehabilitation Patients - Control | No intervention | Rehabilitation patients who do not undergo Nature Immersion Therapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pittsburg Agitation Scale
The Pittsburgh Agitation Scale (PAS) is a quick, observational tool used to assess the severity of agitation in dementia patients, focusing on four behavioral dimensions: aberrant vocalizations, motor agitation, aggressiveness, and resistance to care
Measured: Baseline and at the end of intervention, an average 7 days
DASS-21
The DASS-21 (Depression, Anxiety, and Stress Scale - 21 Items) is a self-report questionnaire designed to measure the severity of symptoms related to depression, anxiety, and stress in adults. It consists of 21 questions, with seven questions for each of the three scales: depression, anxiety, and stress.
Measured: Baseline and at the end of intervention, an average of 7 days
Secondary outcomes (2)
EQ-5D-5L
The EQ-5D-5L is a generic, self-completed questionnaire that assesses health-related quality of life (HRQoL) across five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with five levels of severity for each dimension, and includes a visual analogue scale (EQ VAS).
Measured: Baseline and at the end of intervention, an average of 7 days
Zarit Burden Interview
The Zarit Burden Interview (ZBI) is a widely used tool to assess the level of caregiver burden experienced by individuals who care for people with chronic illnesses. It is a self-report questionnaire that evaluates the physical, emotional, and social impact of caregiving on the caregiver's well-being.
Measured: Baseline and at the end of intervention, an average of 7 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Jul 2025
- Study startMay 2027 (estimated)
- Primary completionJun 2028 (estimated)
- Study completionAug 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (8)Papers the sponsor has linked to this study.
- Other trials for DementiaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Care provider, Investigator, Outcomes assessor
- Enrolment
- 1,600 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Changi General Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Si Ching Lim, MD, Principal investigator, Changi General Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07059390
- Sponsor's protocol ID
- 2025-032
- Acronym
- TGIF
- Status last verified
- Mar 2025
- First submitted
- 26 Jun 2025
- Last updated
- 23 Mar 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: The dataset is restricted due to ethical limitations.
Publications
Hansen MM, Jones R, Tocchini K. Shinrin-Yoku (Forest Bathing) and Nature Therapy: A State-of-the-Art Review. Int J Environ Res Public Health. 2017 Jul 28;14(8):851. doi: 10.3390/ijerph14080851.
PubMed 28788101Vibholm AP, Christensen JR, Pallesen H. Nature-based rehabilitation for adults with acquired brain injury: a scoping review. Int J Environ Health Res. 2020 Dec;30(6):661-676. doi: 10.1080/09603123.2019.1620183. Epub 2019 May 27.
PubMed 31131619Ng KST, Sia A, Ng MKW, Tan CTY, Chan HY, Tan CH, Rawtaer I, Feng L, Mahendran R, Larbi A, Kua EH, Ho RCM. Effects of Horticultural Therapy on Asian Older Adults: A Randomized Controlled Trial. Int J Environ Res Public Health. 2018 Aug 9;15(8):1705. doi: 10.3390/ijerph15081705.
PubMed 30096932Howarth M, Brettle A, Hardman M, Maden M. What is the evidence for the impact of gardens and gardening on health and well-being: a scoping review and evidence-based logic model to guide healthcare strategy decision making on the use of gardening approaches as a social prescription. BMJ Open. 2020 Jul 19;10(7):e036923. doi: 10.1136/bmjopen-2020-036923.
PubMed 32690529Antonelli M, Barbieri G, Donelli D. Effects of forest bathing (shinrin-yoku) on levels of cortisol as a stress biomarker: a systematic review and meta-analysis. Int J Biometeorol. 2019 Aug;63(8):1117-1134. doi: 10.1007/s00484-019-01717-x. Epub 2019 Apr 18.
PubMed 31001682Li Q. Effect of forest bathing trips on human immune function. Environ Health Prev Med. 2010 Jan;15(1):9-17. doi: 10.1007/s12199-008-0068-3.
PubMed 19568839Siah CJR, Goh YS, Lee J, Poon SN, Ow Yong JQY, Tam WW. The effects of forest bathing on psychological well-being: A systematic review and meta-analysis. Int J Ment Health Nurs. 2023 Aug;32(4):1038-1054. doi: 10.1111/inm.13131. Epub 2023 Mar 2.
PubMed 36864583Kavanaugh J, Hardison ME, Rogers HH, White C, Gross J. Assessing the Impact of a Shinrin-Yoku (Forest Bathing) Intervention on Physician/Healthcare Professional Burnout: A Randomized, Controlled Trial. Int J Environ Res Public Health. 2022 Nov 4;19(21):14505. doi: 10.3390/ijerph192114505.
PubMed 36361384