An enriched environmental programme during inpatient neuro-rehabilitation: A randomized controlled trial

Objective: To assess the effectiveness of an enriched environmental activities programme in an inpatient tertiary neurorehabilitation unit. Methods: A total of 103 participants were randomized to an intervention group (n = 52) undertaking an enriched environmental activities programme or a control group (n = 51) receiving usual ward activity. Primary outcome measure: Depression, Anxiety Stress Scale (DASS). Other measures included: Neurological Impairment Scale; Multidimensional Health Locus of Control, Rosenberg Self-Esteem Scale, Montreal Cognitive Assessment (MoCA); Functional Independence Measure (FIM), and Euro-Quality of Life-5D. Questionnaire assessments were performed at admission, discharge and 3-months post-discharge. Results: Mean age of subjects was 62.5 years (standard deviation 18.5), 63% were male; 53 had stroke and the remainder had other neurological conditions. Compared with controls, the intervention group showed significant improvement at discharge in: DASS: "total", "depression", and "stress" subscales (p < 0.05 for all, with small effect sizes (η²) = 0.04-0.05); MoCA (p = 0.048, η² = 0.04) and FIM motor (total and "selfcare", "mobility" subscales (p < 0.05 for all, with moderate effect sizes, η² = 0.0-0.08). At 3-month follow-up, significant differences were maintained in most secondary outcomes in the intervention group. Cognitive function and activities improved most in participants with stroke. Conclusion: An enriched environmental programme can produce significant improvements in functional and cognitive ability in inpatient neurological cohorts compared with routine ward activity programmes.