The Wild Man Programme - a Nature-based Rehabilitation Enhancing Quality of Life for Men on Long-term Sick Leave

Study Overview
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Brief Summary
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The aim of the present study is to examine whether the nature based 'Wild man Programme' can help to increase quality of life among men on sick leave compared to treatment as usual. Additionally, the study examines which natural environments best work as supportive environments in the rehabilitation.

Detailed Description
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Many men in Denmark have poor mental health and need help to recover. However, designing a rehabilitation intervention appealing to men is challenging. The 'Wild man Programme' is a rehabilitation programme for men on long-term sick leave and with clinical or self-reported stress due to prolonged health problems such as stress, anxiety, depression, cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease or diabetes. The programme is a nature-based rehabilitation (NBR) initiative combining nature experiences, attention training, body awareness training and supporting community spirit. The aim of the present study is to examine whether the 'Wild man Programme' can help to increase quality of life among men on sick leave compared to treatment as usual. Additionally, the study examines which natural environments best work as supportive environments in the rehabilitation. A matched control study comparing an intervention group (N=38) which receives a nine-week nature-based intervention to a control group (N=38) receiving case management as treatment as usual in the municipalities. Outcomes are measured at baseline (T1), post treatment (T2), and at follow-up 6 months post intervention (T3). The primary outcome is an improvement in quality of life and the secondary outcome is a decrease in stress level. With the 'Wild man Programme' we investigate whether it is a model that can be implemented in the health system in Denmark to help men with different kinds of health problems improve their quality of life and stress levels. The programme can also deliver valuable information for future nature-based rehabilitation for women (Wild woman) and mixed gender groups. The project will also contribute with information on whether the method and the concept can be a valuable tool for health professionals in the health sector.

Official Title
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The Wild Man Programme. A Nature-based Rehabilitation Enhancing Quality of Life for Men on Long-term Sick Leave - a Matched Controlled Study

Conditions
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Stress, Anxiety, Depression, Cardiac Disease, Cancer, Diabetes, Copd

Intervention / Treatment
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* Other: Nature-Body-Mind-Community
* Other: Treatment as usual


Participation Criteria
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Eligibility Criteria
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The inclusion and exclusion criteria are similar for the two groups. The inclusion criteria are: male gender 18 to 68 years of age clinical or self-reported symptoms of stress, anxiety, depression clinical diagnosis of cancer, cardiovascular disease, chronic obstructive pulmonary disease (COPD), diabetes or other kinds of chronic diseases ability to walk approximately three kilometers in nature ability to understand and speak Danish The exclusion criteria are: - psychosis or psychotic disorders, brain injuries or physical disabilities that prevent the participant from participating in the physical exercise programme or move about in nature

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 68 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Interventional Model Description: The study is a matched control study where the intervention group receives a nine-week nature-based intervention and is compared to a matched control group receiving case management as treatment as usual in the municipalities (see figure 1). All primary and secondary outcomes are measured at baseline (T1), post treatment (T2), and at follow-up 6 months post intervention (T3).
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Nature-Body-Mind-Community (NBMC) + treatment as usual<br>9 weeks of nature-based therapy (Nature-Body-Mind-Community (NBMC)) treatment as usual | Other: Nature-Body-Mind-Community<br>* The Nature-Body-Mind-Community (NBMC) approach has been developed in a pilot project over 2014-2018. The 'Wild man Programme' consists of the following main elements: 1. Nature environments and nature experiences, 2. Mind relaxation and meditation, 3. Body awareness and 4. Fire talks, storytelling and community spirit.<br>Other: Treatment as usual<br>* Treatment as usual consist of the rehabilitation offered by the hospital or municipality for the specific condition e.i. cancer, diabetes, COPD, anxiety, depression and stress<br>|
| Other: Treatment as usual<br>Treatment as usual | Other: Treatment as usual<br>* Treatment as usual consist of the rehabilitation offered by the hospital or municipality for the specific condition e.i. cancer, diabetes, COPD, anxiety, depression and stress<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Level of quality of life - total score | The primary outcome is self-experienced quality of life. The World Health Organization's brief quality of life questionnaire (WHOQOL-BREF) will be used. The questionnaire examines four domains on a five-point Likert scale: Physical health, mental health, social relationships and health-related environments e.g. instant access to medical care. The global quality of life is based on the participants' scores on the four domains and they range from 0-100, with a high score indicating high quality of life. | 9 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Level of quality of life - physical health | The WHOQOL-BREF will be used. The domain of physical health is measured on a five-point Likert scale with five questions. | 9 weeks | 
| Level of quality of life - mental health | The WHOQOL-BREF will be used. The domain of mental health is measured on a five-point Likert scale with five questions. | 9 weeks | 
| Level of quality of life - social relationships | The WHOQOL-BREF will be used. The domain of social relationships is measured on a five-point Likert scale with five questions. | 9 weeks | 
| Level of quality of life - health related environments | The WHOQOL-BREF will be used. The domain of health related environments is measured on a five-point Likert scale with five questions. | 9 weeks | 
| Level of self-experienced restitution | Self-experienced restitution. The Perceived Restorativeness Scale-11 (PRS-11) will be used. | 9 weeks | 
| Level of self perceived stress | Self perceived stress. The Cohen's Perceived Stress Scale (PSS) will be used. The scale consists of 14 items measured on a five-point Likert scale. | 9 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Supportive Environment Theory (SET), Aesthetic Affective Theory (AAT), Attention Restoration Theory (ART), Nature-Body-Mind-Community (NBMC)