Jones, Kerry

Methley, Abigail

Vseteckova, Jitka

English

Open Research Online (The Open University)

Open Research OnlineThe Open University’s repository of research publicationsand other research outputsA systematic review on use of green spaces insupporting recovery from trauma in older people livingin community in the UKOtherHow to cite:Vseteckova, Jitka; Methley, Abigail and Jones, Kerry (2020). A systematic review on use of green spaces insupporting recovery from trauma in older people living in community in the UK. Prospero - International prospectiveregister of systematic reviews, CRD42020183058.For guidance on citations see FAQs.c© [not recorded]Version: Version of RecordLink(s) to article on publisher’s website:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020183058Copyright and Moral Rights for the articles on this site are retained by the individual authors and/or other copyrightowners. For more information on Open Research Online’s data policy on reuse of materials please consult the policiespage.oro.open.ac.ukPROSPEROInternational prospective register of systematic reviewsA systematic review on use of green spaces in supporting recovery from trauma in olderpeople living in community in the UKJitka Vseteckova, Abigail Methley, Kerry Jones CitationJitka Vseteckova, Abigail Methley, Kerry Jones. A systematic review on use of green spaces insupporting recovery from trauma in older people living in community in the UK. PROSPERO 2020CRD42020183058 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020183058 Review questionWhat are the ways outer spaces are being used towards recovery from trauma in older people living incommunity? SearchesThe search will include both quantitative and qualitative studies. No restrictions for dates of publication wereimplemented. Language will be limited to English only. The search strategy will be created by an expert insystematic review searching, in collaboration with the authors. Once the strategy is finalised, it will beadapted to the syntax and subject headings of the other databases.Preliminary searches performed through: PsycINFO, MEDLINE, CINAHL, Embase, Emcare, BNI, PubMed,AMED (see attached).Other sources: NICE Evidence, Google Advanced search, Social Care Online (SCIE). Preliminary search termsgreen spaces, adults >65, trauma, UK Ecotherapy, wilderness, therapy, animal therapy, pet therapy, greencare, care farming, AND trauma/PTSD AND older/aged/elderly/adultFinal searches to include all databases listed above and the following key terms:green spaces, outdoors,blue spaces, nature, wilderness, ecotherapy, green care, outdoors, outer spaces, older, aged, elderly, adultsover 65, trauma, PTSD, UK. Types of study to be includedWe plan to include studies of any design (quantitative, qualitative, mixed-methods or professional practicearticles) and grey literature Condition or domain being studiedCooley 2020 define as (b) a focus on talking therapy used to support mental health difficulties, neurologicalimpairment, forensic rehabilitation, or to provide psychological support in physical health settings; and (c)professionals qualified to provide talking therapy and who are regulated by a professional governing body.For simplicity, these various professionals will be referred to collectively as ‘practitioners’ in reference to thetalking therapy aspect of their profession.Uptake on activities outdoors, any change in specific trauma symptoms and comorbid mental healthsymptoms such as anxiety/depression, generic measure of distress, generic measure of overallwellbeing/quality of life, health, health promotion, stress reduction, relaxation, social contact, socialconnection, social interaction, self-esteem, self-efficacy, self-image, self-confidence, self-empowerment andpossibly interpersonal relationships with others and confidence in using green spaces improvement in qualityof life, outcomes related to the recovery model including hope, optimism, identity, purpose.                                Page: 1 / 5PROSPEROInternational prospective register of systematic reviewsParticipants/populationOlder people, living in the community (anyone who is not in an inpatient unit; this therefore includes people intheir own homes, nursing or residential homes) in the UK, aged 65 +, having experienced trauma. Traumamay be identified using clinical interview and/or standardised measures of symptoms and impact onfunctioning. Intervention(s), exposure(s)Based on the above the phenomenon of interest will be green space(s), blue space(s), ecotherapy, greencare, nature, green settings, parks, forests, woodlands, wildlife, urban green settings, urban landscapes,gardens, outdoors and outer space interventions for the participant group delineated above, interventionsfocused on physical activity components (walking, cycling, yoga, taichi, mindfulness walks) and interventionswhere activities that are focussing on occupational therapy, horticultural therapy therapeutic interventionincluding wilderness therapy, social and therapeutic horticulture or garden therapy or community gardens,facilitated environmental conservation & informative walks, contact with nature, ecotherapy, ecopsychology,adventure therapy, nature-based arts and crafts including landscaping, people getting dogs and taking themoutdoors, but not if they go specifically somewhere to have canine therapy. Most existing reviews are alreadyincorporating animal therapy and literature around this topic is already available. For this reason, we will notinclude papers focussing on animal therapy specifically next to papers focussing on types of interventionsoutdoors for older people (over 65+) living in the community, having experienced trauma. Comparator(s)/controlNone Main outcome(s)Uptake on activities outdoors, any change in specific trauma symptoms and co-morbid mental healthsymptoms such as anxiety/depression, generic measure of distress, generic measure of overallwellbeing/quality of life, health, health promotion, stress reduction, relaxation, social contact, socialconnection, social interaction, self-esteem, self-efficacy, self-image, self-confidence, self-empowerment andpossibly interpersonal relationships with others and confidence in using green spaces improvement in qualityof life, outcomes related to the recovery model including hope, optimism, identity, purpose.* Measures of effectNot applicable. Additional outcome(s)Outcomes of interest relate to the levels and types of green spaces being used towards recovery fromtrauma in older people living in community within the UK. It is expected that outcomes will be diverse andcontext-specific, therefore it is not possible to produce an exhaustive list at the outset. However, examples ofoutcomes may include:• Measure of time (e.g. minutes / hours) spent outdoors per time period (e.g. day / week)• Types of outdoor activity that older people recovering from trauma report undertakingPhysical activity has been shown to provide clear health benefits including reduced risk of cardiovasculardisease, certain types of cancers, stress and depression, and improved mental / cognitive health, wellbeingand sleep (Reiner et al., 2013; Warburton et al., 2006). Therefore, knowing the physical activity levels ofcarers allows researchers to develop targeted interventions to improve the mental and physical wellbeing ofthis specific population. Furthermore, physical activity per se is now recognised as a health outcome bymajor funding councils and government organisations.* Measures of effectNot applicable. Data extraction (selection and coding)Study selection (both at title/abstract screening and full text screening) will be performed by two reviewers,                               Page: 2 / 5PROSPEROInternational prospective register of systematic reviewsindependently. Any disagreements will be solved by consensus or by the decision of a third reviewer wherenecessary. After eliminating the duplicates (studies that are identified more than once by the searchengines), an initial screening of titles, abstracts, and summaries (if applicable) will be undertaken to excluderecords that clearly do not meet the inclusion criteria. Each record will be classified as ‘include’ or‘exclude’ or ‘maybe’ with comments to identify relevant and exclude irrelevant literature. The researcherswill be inclusive at this stage and, if uncertain about the relevance of a publication or report, it will be left in.The full text will be obtained for all the records that potentially meet the inclusion criteria (based on the titleand abstract/summary only). In a second step, all the full text papers will be screened against the inclusioncriteria, using a standardized tool. Studies that do not meet the inclusion criteria will be listed with thereasons for exclusion. An adapted PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) flow-chart of study selection will be included in the review..We plan to extract data on the participants, interventions, comparators, and outcomes. In addition to that theextraction sheet will include authors, year of study/report, aim/purpose, type of paper (e.g. journal article,annual evaluation report, etc), geographical area, study population (e.g. age of carers and condition ofindividuals being cared for), sample size, study design, and key findings that relate to the systematic reviewquestion. Two reviewers will independently extract data using a structured data extraction form.Disagreements between review authors will be resolved by discussion or a third author. Risk of bias (quality) assessmentTwo reviewers will independently assess the risk of bias for randomized controlled trials using the Cochranerisk of bias tool, which includes the following domains: random sequence generation, allocation concealment,blinding of outcome assessors, completeness of outcome data, and selective outcome reporting. We alsoplan to assess the following additional sources of bias: baseline imbalance and inappropriate administrationof an intervention as recommended by the Cochrane Handbook for Systematic Reviews of Interventions.Studies will be judged at high risk of bias if there was a high risk of bias for 1 or more key domains and atunclear risk of bias if they had an unclear risk of bias for at least 2 domains. Authors of papers will becontacted if information is missing. Strategy for data synthesisFindings from included studies will be synthesized narratively. The ‘Guidance on the Conduct of NarrativeSynthesis in Systematic Reviews’ will be used to advise the narrative synthesis. First, a preliminarysynthesis will be conducted to develop an initial description of the findings of included records and toorganize them so that patterns across records can be identified. In a second step, thematic analysis will beused to analyse the findings. The following five steps of thematic analysis will be followed adopting arecursive process:a) Familiarization with the extracted datab) Generation of initial codesc) Searching for themesd) Reviewing themese) Defining and naming themesDepending on the findings available, the reviewers will aim to provide a flow chart mapping the physicalactivity of carers. This review will highlight the current and desired levels of physical activity of carers, as wellas the need for more high-quality research in this field. The information presented in this review may beconsidered, in the future, by primary care providers and funding bodies when planning future support for thisgrowing population of carers.Meta-analysis will be conducted if data is found to be sufficiently homogeneous, although this is notexpected. We will decide if it is appropriate to pool our measures of effect by assessing if the includedstudies are similar enough (in terms of their population, intervention characteristics, and reported outcomes)to draw meaningful conclusions. If a meta?analysis of the included studies is indicated, we will assess                               Page: 3 / 5PROSPEROInternational prospective register of systematic reviewsstatistical heterogeneity by visual inspection of the scatter of effect estimates in the forest plot and bycalculating the I² statistic, after using the inverse variance method. In the case of a high degree ofheterogeneity (I² greater than 50%), we will explore possible reasons for variability by conducting subgroupanalysis. Analysis of subgroups or subsetsNot applicable Contact details for further informationJitka Vseteckovajitka.vseteckova@open.ac.uk Organisational affiliation of the reviewThe Open University Review team members and their organisational affiliationsDr Jitka Vseteckova. The Open UniversityDr Abigail Methley. Northamptonshire Healthcare NHS Foundation TrustDr Kerry Jones. The Open University Type and method of reviewNarrative synthesis, Systematic review Anticipated or actual start date01 February 2020 Anticipated completion date01 March 2021 Funding sources/sponsorsNot applicable Conflicts of interestNone known LanguageEnglish CountryEngland Stage of reviewReview Ongoing Subject index terms statusSubject indexing assigned by CRD Subject index termsColor; Humans; United Kingdom Date of registration in PROSPERO12 June 2020 Date of first submission29 April 2020 Stage of review at time of this submission                               Page: 4 / 5PROSPEROInternational prospective register of systematic reviews Stage Started CompletedPreliminary searches Yes NoPiloting of the study selection process No NoFormal screening of search results against eligibility criteria No NoData extraction No NoRisk of bias (quality) assessment No NoData analysis No NoThe record owner confirms that the information they have supplied for this submission is accurate andcomplete and they understand that deliberate provision of inaccurate information or omission of data may beconstrued as scientific misconduct.The record owner confirms that they will update the status of the review when it is completed and will addpublication details in due course. Versions12 June 2020 PROSPEROThis information has been provided by the named contact for this review. CRD has accepted this information in goodfaith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submissionis accurate and complete. CRD bears no responsibility or liability for the content of this registration record, anyassociated files or external websites. Powered by TCPDF (www.tcpdf.org)                               Page: 5 / 5

A systematic review on use of green spaces in supporting recovery from trauma in older people living in community in the UK

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