The effects of gardening on quality of lif

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Work xx (20xx) x–xx
DOI:10.3233/WOR-162338
IOS Press

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The effects of gardening on quality of life
in people with stroke

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Fen-Ling Kuoa , Sui-Hua Hoa,b,∗ and Chiuhsiang Joe Linb

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a Division

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of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital,
Taipei Medical University, New Taipei City, Taiwan
b Department of Industrial Management, National Taiwan University of Science and Technology, Taipei, Taiwan

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Received 20 November 2014
Accepted 15 June 2015

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Keywords: Occupational therapy, cerebrovascular accident, horticultural activity, 2k factorial design, occupation

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1. Introduction

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1.1. Background

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Abstract.
BACKGROUND: Compared with traditional rehabilitation, gardening has been viewed as a more occupation-based intervention to help patients improve functional performance. However, there is still a need for evidence-based research into what
factors interact to create the beneficial effects of gardening for people who have sustained a cerebral vascular accident (CVA).
OBJECTIVE: To explore how plant, gender, and the time after stroke onset influenced improvements in the quality of life
of patients in a gardening program.
METHODS: One treatment of tending short-term plants, and another treatment of tending long-term plants were compared.
Quality of life improvement was evaluated according to three factors: plant, gender, and the time after stroke onset. The data

were analyzed with 2k replicated factorial designs.
RESULTS: The 2k factorial design with replication indicated significant effects on both the social role and the family role.
For the social role, the interaction of plant and gender difference was significant. For the family role, the significant effects
were found on interaction of plant with both gender and the time after stroke onset.
CONCLUSIONS: Tending plants with different life cycles has varied effects on the quality of life of people who have
sustained a CVA. Factors related to gender and the time after stroke onset influenced role competency in this sample.

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A cerebral vascular accident (CVA) usually results
in a decline in physical, mental, and/or cognitive
abilities, those influence functional performance out∗ Address

for correspondence: Sui-Hua Ho, Division of Occupational Therapy, Department of Physical Medicine and
Rehabilitation, Shuang Ho Hospital, Taipei Medical University,
No. 291, Zhongzheng Rd., Zhonghe, Taipei 23561, Taiwan. Tel.:
+886 2 22490088 ext. 1624; Fax: +886 2 22490088 ext. 1634.
E-mail: ,

comes. The physical changes after the disease [1] and
the psychosocial changes within the working environment [2] in turn brought the occupational stress
and influenced the work engagement of people [3].
Wang, Kapellusch [4] mentioned that the CVA recovery, especially in perceptive, speech, and cognitive
domains, was a critical factor of returning to work.
Alcˆantara, Sampaio [5] also found that health condition would influence work ability profoundly. The
consequences after CVA can impact the quality of
life (QoL) of not only patients [6] but also caregivers
[7]. Traditional rehabilitation has provided patients
with many opportunities to improve their sensorimo-

1051-9815/16/$35.00 © 2016 – IOS Press and the authors. All rights reserved

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ate gardening activities for each gender. Although
some evidence strongly supports the gender disparity in stroke functional progress and QoL, no studies
to date have described the gender differences in QoL
improvement related to gardening with this disability
group.
Besides gender differences, issues such as severity and time after stroke onset, may also affect the
functional recovery of people with stroke. In a recent
study using a modified Rankin Scale as a measure of
functional performance, Liou and Lin [28] found that
rather than stroke severity, onset time was the more
significant indicator of functional status for people
who have sustained a CVA. Regarding the association
between time after stroke onset and the future recovery, Skilbeck, Wade [29] found that although most
recovery took place within 6 months in areas of basic
activities of daily living, arm function, and language,
there were still some non-significant improvement
in speech and language after 18 months rehabilitation in their stroke unit. Hochstenbach, den Otter
[30] also mentioned the long-term improvement in
cognitive function still occurred up to 2 years after

stroke onset by some of their participants, and the
most obvious recovery was in the attention-related
domains. In addition, G. Broeks, Lankhorst [31]
found that although most improvement happened
within 16 weeks, some arm motor functional recovery still took place after 4 years after stroke onset.
No studies were found in the current review of the
literature exploring the influence of onset time on the
quality of life of patients after therapeutic gardening
activities.
Other authors have discussed the benefits of
gardening in rehabilitation in general for patients
[32–34]. Through the therapeutic use of gardening
as a form of occupation [32, 33], therapists consider
the benefits in the process of nurturing the plants,
to select the horticultural activities, which meet the
special needs of the participants [34]. The horticultural activities may include sowing seeds, tending
seedlings, adding water, pulling weed, and harvesting
plants finally. Participants are benefited through the
active involvement of nurturing the living plants [34].
It should also be noted that different kinds of plants,
such as plants with different life cycles and characteristics, may have different effects on patients. The
plant life cycle usually starts from a seed, and the
seed will sprout to become an immature seedling.
The seedling will grow continuously to be a mature
plant. Then, the mature plant will grow flowers. After
pollination, the fertilization allows flowers to develop

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tor, cognitive, and mental health. However, the use
of repetitive and long-term rehabilitative programs
may discourage patients from consistently and continuously returning for follow-up care.
The therapeutic garden has been viewed as a natural and pleasant intervention setting for improving
quality of life (QoL) in the elderly [8]. Gardening
has been utilized for healing since ancient times. Evidence dated to 2000 BCE in Mesopotamia shows that
gardening activities have long been used for sensory
modulation [9]. The beneficial effects of gardening on
veterans from World War I have also been noted [10].
Although previous researchers have tried to explore
the effects of the gardening setting on CVA survivors
[9, 11, 12], these studies have mostly focused on
a single or just a few cases, providing exploratory
results of variable effects. There is still a need for
evidence-based research into the effects of therapeutic gardening quantitatively [8]. Furthermore, several
preliminary studies of the gardening setting have
reported positive therapeutic effects, including pain
relief [13], improvement in attention [14–16], stress
management [17], agitation reduction [18], and fall
prevention [19]. The above positive effects are vital in
the further improvement of QoL [8]. However, insufficient evidence remains about the beneficial effects
of gardening activities for people who have sustained
a CVA.
Several studies have demonstrated gender disparities in stroke recovery [20–24]. In an investigation

of retrospective cohort data, Boehme and Siegler [20]
found poorer functional outcomes for female patients
with stroke than for their male counterparts. Additionally, using the Barthel Index [25] and Rankin
Scale [26], Di Carlo and Lamassa [23] collected data
across 7 countries, including England, France, Germany, Hungary, Italy, Portugal, and Spain, and found
a significant gender effect on activities of daily living
(ADL) and handicap predictors of people with stroke.
In that study, male gender was still shown as a better predictor of functional recovery. A similar effect
was indicated in a two-year follow-up study employing Health-Related Quality of Life (HRQoL). Sturm
and Donnan [24] indicated that female gender was a
determiner for lower quality of life than male gender.
Das [27] found the gender differences on ergonomic
risk factors among farmers. Therefore, there might
be some gender differences on musculoskeletal influences for people performing gardening activities.
Understanding gender differences in recovery from
CVA with various gardening programs may provide
practitioners with guidelines for designing appropri-

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Several pilot studies [9, 17] have supported the
effects of gardening for patients with stroke and
related diseases. However, those preliminary studies lacked well-designed experiments and sufficiently
representative sampling. Due to the limited scientific
evidence of the effects of gardening on people with
stroke, we explored these effects on 8 combinations
(2 levels of gender X 2 levels of stroke stage X 2
levels of plants) with 3 replications and analyzed
the results following the principles of experimental
design [35]. No exploratory pilot test was run in this
research.

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1.2. Objective and Hypotheses

2. Methodology

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This study explored the effects of gardening on the
quality of life of patients with cerebral vascular accidents. The effects of plants with different duration of
life cycles on patients’ QoL were analyzed. In this
research, long-term plants were plants with life cycle
longer than 3 months (tomato and string bean were
adopted in this design). Short-term plants were life
cycle shorter than 3 months (water spinach and lettuce
were adopted in this design). In addition, the amount

of variance in the beneficial gardening effects on gender and the time after stroke onset was also examined.
Based on the previous findings, although the majority of recovery took place within 4 to 6 months after
stroke onset for acute patients, there was still some
speech recovery after 18 months [29], and arm motor
improvement after 4 years for chronic patients [31].
In this research, the chronic patients who had sustained a CVA over 6 months were recruited to have a
stable condition to perform the gardening activities.
Therefore, 18 months after stroke onset was chosen
as the cut point to classify the participants into two
groups: stage 1 (6 to 18 months after stroke onset)
and stage 2 (>18 months after stroke onset).
The study was developed to test three major
hypotheses.

2.1. Experimental design

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This research explored how three factors (plant,
gender, and stroke stage) would influence improvement in the quality of life of patients who have
sustained a CVA following their participation in a
gardening program. The 2k factorial design, where
k equals 3, was applied to test the hypotheses in
this research. Two kinds of plants, those with shortterm life cycles (short-term plants) and long-term
life cycles (long-term plants), were used. Males and
females in stage1 and stage 2 of recovery from CVA
were recruited.

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1) After gardening activities, males who have sustained a CVA will demonstrate greater improvement in their quality of life than females.
2) After gardening activities, people in the CVA
stage 1 of recovery will demonstrate greater
improvement in their quality of life than people
in the CVA stage 2 of recovery.
3) Tending plants with short-term life cycles will
have greater impact on quality of life than tending plants with long-term life cycles.

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seeds to restart a new life cycle of the plant. The duration of the entire life cycle may vary from several
weeks to years depending on different types of plants.
Therefore, tending for plants with different duration
of life cycles might bring about different physical and
also psychological influences to people. For example, participants tending plants with shorter life cycle
will harvest and get the feedbacks of collecting fruit
earlier than tending plants with longer life cycle. It
is still unclear whether tending plants with different
duration of life cycle would have the same effects on
participants.

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2.2. Participants
Before this research started, the leader of
this research project contacted with the clinical
occupational therapists in the Taipei Medical
University-Shuang Ho Hospital, Ministry of Health
and Welfare. The major purpose of this project
was told to the occupational therapists, and they
were asked to consider appropriate participants who
met the inclusion criteria from their clients at that
time. The inclusion criteria were (1) diagnosis of
CVA by a medical specialist, including ischemia
and hemorrhage, and onset time over 6 months; (2)
ability to communicate normally and clearly express
feelings; (3) no other injuries, musculoskeletal disorders, or mental illness which could interfere with
participating in gardening activities; (4) agreement
to sign a participant consent form. Then, the leader
of this research project invited the participants from
the list given by the occupational therapists, to join
the research. After knowing all the risks/benefits
after joining this project and the right of dropping out

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2.3. Dependent variable

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2.4. Independent variables

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2.5. Held constant variables
The factors that were held constant were the therapist and the gardening environment. The entire
gardening program was conducted by one registered
occupational therapist. In addition, evaluation and
intervention were conducted in the same clinical setting.
2.6. Nuisance factors

Each participant had their own speed of recovery,
and differences in this speed could possibly influence
the improvement in their quality of life. Caregiver
attitudes and patient motivation could also affect
the rate of recovery. The strategy we used was to
select cases with similar features. We recruited cases
only from New Taipei City in an attempt to reduce
the impact of nuisance factors. However, since people from the same place might still show different
amounts of improvement, once the variables of gender and CVA level were confirmed, participants were

randomly assigned to either tending long-term plants
or tending short-term plants. After three months, the
treatment exchanged. People who tended long-term
plants changed to tend short-term plants, and vice
versa.

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The response variable in this study was improvement in quality of life. Quality of life was measured
with the Chinese version of the Stroke Specific Quality of Life scale (SSQOL), which had been previously
translated following standard translation procedures
[36] and validated by Hsueh and Jeng [37] in Taiwan. The SSQOL is an evaluation tool developed
for patients with cerebral vascular accident (CVA). It
consists of 49 items that focus on 12 areas of healthrelated quality of life. The items are scored on a
5-point Likert-type scale; the higher the score the better the quality of life. The reliability and validity of the
SSQOL for various kinds of people with stroke have
been reported previously [38]. The reliability and
validity of the Danish version of the SSQOL has been
examined in patients with intracerebral hemorrhage
[39]. Ewert and Stucki [40] also validated the German
version of the SSQOL for patients with hemorrhagic
and ischemic stroke, and Boosman and Passier [41]
validated the scale for patients with aneurysmal subarachnoid hemorrhage. Measures of reliability and
validity were found to be acceptable.

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1 (6–18 months after stroke onset) and stage 2 (>18
months after stroke onset).

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this experiment at any time, all invited people agreed
to join and signed the participant consent form.
Thirteen participants meeting the inclusion criteria were invited to join this research. Initially, it
was aimed as within subject design, that was each
participant must complete both treatment (tending
long-term plant and short-term plant). Finally, there
were 6 participants completed both treatment. Five
participants joined only in the short-term plant treatment, and two joined only long-term plant treatment.
During the study, the participants dropped out due
to either decreased physical condition (expressed
too tired to perform outdoor activities) or stopped
insurance benefits. Thus, for the short-term plant
treatment, there were 11 data points. For the longterm plant treatment, there were 8 data points.
Eventually, the data collected were analyzed using
imbalanced factorial design.

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The three controlled variables were gender, life
cycle of plants, and time after stroke onset. The different effects on male and female patients were tested.
The life cycles of plants consisted of two categories:
long-term (>3 months) and short-term (<3 months).
The time after stroke onset were classified into stage

2.7. Ethics statement
Before the data collection, the experimental protocol and participant consent procedure were approved
by the Taipei Medical University-Joint Institutional
Review Board (case No. 201204015). The written
informed consent, in accordance with institutional
guidelines, was completed by each participant before
the data collection.
2.8. Procedure
All participants attended the gardening program
once a week, for one hour in each session. Participants were guided to tend different plants by a
registered occupational therapist in a garden located
within Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare. For the long-term
plant condition, participants tended tomato and string
beans, which were not harvested by the end of the gardening program. Participants in the short-term plant

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2.9. Data analysis

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The response was defined as the change in score on
quality of life between the before and after measures,
the higher the response the greater the improvement.
Thus, a total of 13 responses, including score changes
in 12 areas and one total score, were collected for each
participant. Additionally, 3 factors, each at 2 levels,
were analyzed using the 23 factorial design. Minitab
(16th edition) was used as the statistical software. For
gender, male was marked as 1 and female marked as
-1. For time after stroke onset, stage 1 was marked as
1 and stage 2 was marked as –1. For plant life cycle,
long-term life cycle was marked as –1 and short-term
life cycle was marked as 1. Due to the fact that some
participants could not complete all experimental conditions, the data were analyzed using imbalanced 23
factorial design with replication (number of available
participants).

Fig. 1. Pareto chart for social role. Plant: factor A, Gender: factor
B, Time after stroke onset: factor C.

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3. Results

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condition tended water spinach and lettuce. At the end
of the gardening program, all short-term plants were
harvested by the patients themselves. For each plant
condition, the duration of the gardening program was
3 months.
Quality of life was evaluated before and after the
gardening program by two registered occupational
therapists. These two therapists were familiar with
the instruments and used the same scoring guidelines. In addition, they were blind to the research
hypotheses. Twelve areas were evaluated including:

energy level, family roles, language, mobility, mood,
personality, self-care, social roles, thinking, vision,
upper-extremity function and work productivity. The
score for each area was obtained by summing the
scores on all items in each of these areas. The total
quality of life score for each participant was obtained
by summing the results from the 12 areas to obtain a
health-related quality of life score.

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The significant results of social role and family role
as determined by 23 replicated factorial analyses are
presented as follows.
3.1. Social role
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According to the analysis for the
factorial
design, the Pareto chart (Fig. 1), Normal plot (Fig. 2),
and Half normal plot (Fig. 3) showed significant

Fig. 2. Normal plot for social role. Plant: factor A, Gender: factor

B, Time after stroke onset: factor C.

effects of variable A (plant) (F = 8.22, p = 0.015) and
AB interaction (plant and gender) (F = 8.8, p = 0.013)
on improvement of the social role area. Based on
further analysis of the main effect (Fig. 4), participants tending short-term plants demonstrated greater
improvement in the social role area than those who
tended long-term plants. The interaction plot (Fig. 5)
showed that females demonstrated more improvement than males when tending short-term plants.
Based on the cube plot (Fig. 6), the optimal level
combination of the social role response was found
in female participants in the stage 2 tending shortterm plants. Based on the correlation coefficients in
Table 1, the regression function is as follows:

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Fig. 3. Half normal plot for social role. Plant: factor A, Gender:
factor B, Time after stroke onset: factor C.

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Fig. 6. The design for the social role area shown geometrically in
the cube plot. Optimal level combination appeared on plant (1),
gender (–1), and onset time (–1).
Table 1
The estimated effects and coefficients for the social role area
Factor

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Plant
Gender
stroke
plantXgender
plantXstroke

genderXstroke
plantXgenderXstroke

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Fig. 4. Main effects plot for social role. Plant: factor A (1, shortterm; –1, long-term), gender: factor B (1, male; –1, female), time
after stroke onset: factor C (1, stage 1; –1, stage 2).

Fig. 5. Interaction plot for social role. Plant: factor A (1, shortterm; –1, long-term), gender: factor B (1, male; –1, female), time
after stroke onset: factor C (1, stage 1; –1, stage 2).

Effect

Coef

SE Coef

T

P

1.4333
0.6167
0.5667
–1.4833
–0.2333

–0.0500
0.4500

0.0167
0.7167
0.3083
0.2833
–0.7417
–0.1167
–0.0250
0.2250

0.25
0.25
0.25
0.25
0.25
0.25
0.25
0.25

0.07
2.87
1.23
1.13
–2.97
–0.47
–0.10
0.90

0.948
0.015
0.243
0.281
0.013
0.650
0.922
0.387

yˆ = 0.0167 + 0.7167x1+ 0.3083x2+ 0.2833x3
+ (–0.7417)x1 x2 + (–0.1167)x1 x3 + (–0.0250)
x2 x3+ 0.225 x1 x2 x3 . . . r2 = 0.5781
where yˆ is the predicted quality of life improvement, x1 is the variable representing factor A (plant),
x2 is the variable representing factor B (gender), and
x3 is the variable representing factor C (time after
stroke onset). The x1 x2 , x1 x3 , and x2 x3 represent
the two-way interactions. The three-way interaction
is represented by x1 x2 x3 . In this fitted regression
model, x1 , x2 , and x3 were all defined on a coded
scale from -1 to 1.
3.2. Family role
According to the analysis with the 23 factorial
design, the significant effects of variable AB interaction (plant and gender) (F = 13.57, p = 0.004) and
AC interaction (plant and time after stroke onset)
(F = 6.08, p = 0.031) on improvement in the family role area were revealed in the Pareto chart
(Fig. 7), Normal plot (Fig. 8), and Half normal plot

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Fig. 9. Half normal plot for family role. Plant: factor A, Gender:
factor B, Time after stroke onset: factor C.

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Fig. 7. Pareto chart for family role. Plant: factor A, Gender: factor

B, Time after stroke onset: factor C.

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(Fig. 9). The main effects of three factors are shown
in Fig. 10. The interaction plot (Fig. 11) showed
that males demonstrated greater improvement than
females while tending long-term plants. Additionally, patients in the stage 1 tending long-term plants

demonstrated greater improvement than those in the
stage 2. The cube plot for the design of family roles
in Fig. 12 revealed that the optimal level combination of family role area appeared in two situations:
female patients in the stage 2 tending short-term pants
and male patients in the stage 1 tending long-term
plants. Based on the correlation coefficients shown
in Table 2, the regression function was as follows:

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Fig. 8. Normal plot for family role. Plant: factor A, Gender: factor
B, Time after stroke onset: factor C.

yˆ = (–0.1208) + (–0.0708)x1 + (–0.0542)x2
+ (–0.0375)x3 + (–0.5042)x1 x2 + (–0.3375)x1 x3
+ (–0.2208) x2 x3 + (–0.0208) x1 x2 x3 r2 = 0.6966

Fig. 10. Main effects plot for family role. Plant: factor A (1, shortterm; –1, long-term), gender: factor B (1, male; –1, female), time
after stroke onset: factor C (1, stage 1; –1, stage 2).

where yˆ is the predicted quality of life improvement,
x1 is the variable representing factor A (plant), x2

is the variable representing factor B (gender), and
x3 is the variable representing factor C (time after
stroke). In this fitted regression model, x1 x2 represents the interactions between x1 and x2 , x1 x3
represents the interaction between x1 and x3 , and
x2 x3 represents the two-way interaction between
x2 and x3 . The three-way interaction is represented by x1 x2 x3 . The variables of x1 , x2 , and
x3 were all defined on a coded scale from –1
to 1.

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Table 2
The estimated effects and coefficients for the family role area
Constant
plant

gender
stroke
plantXgender
plantXstroke
genderXstroke
plantXgenderXstroke

Coef

SE Coef

T

P

–0.1417
–0.1083
–0.0750
–1.0083
–0.6750
–0.4417
–0.0417

–0.1208
–0.0708
–0.0542
–0.0375
–0.5042
–0.3375
–0.2208

–0.0208

0.1369
0.1369
0.1369
0.1369
0.1369
0.1369
0.1369
0.1369

–0.88
–0.52
–0.40
–0.27
–3.68
–2.47
–1.61
–0.15

0.396
0.615
0.700
0.789
0.004
0.031
0.135
0.882

lettuce) were harvested by the participants at the end

of the gardening program. This harvest could provide
participants with a chance to share the vegetables with
friends and thereby enhance their social interactions.
However, it still needs further investigation to explore
the reason of gender differences on the improvement
in social role.

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Fig. 11. Interaction plot for family role. Plant: factor A (1, shortterm; –1, long-term), gender: factor B (1, male; –1, female), time
after stroke onset: factor C (1, stage 1; –1, stage 2).

Effect

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4.2. Family role

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The significant interaction of plant and gender
using the 2k replicated factorial design showed that
while tending long-term plants, males tended to show
greater improvement in the family role than females.

This might be explained by the features of tomatoes
and string beans, the long-term plants adopted in this
research. Although at the end of the gardening program, these two plants had not been harvested, fruit
had begun growing on the stems. It is possible that
the tomatoes and string beans were more likely to
give people obvious visual feedback stimuli than the
short-term plants (water spinach and lettuce). Rosenblitt and Soler [42] observed more sensation seeking
behavior, especially for visual sensation, in men than
in women. Therefore, we speculated that the obvious
appearance of fruit could give male participants more
confidence that they could be productive gardeners
and be less of a burden on their families.
The significant interaction of plant and time after
stroke onset showed that when tending long-term
plants, participants in the CVA stage 1 tended to show
greater improvement in their quality of life scores
than those in the stage 2. As reported in several previous studies, acute stage CVA patients are more likely
to suffer feelings of depression than chronic stage
patients [43–45] due to the sudden impact of stroke
on their lives. The feelings of depression may cause
acute patients to see themselves as a burden on their
families. In this study, after tending long-term plants,
participants with stroke less than 18 months showed
that their perception of family burden decreased more

4. Discussion

440

4.1. Social role

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Significant effects of plant type and gender/plant
interaction were found for improvement in quality
of life under social role. For all participants, the
care of short-term plants was linked to improved
social role. This difference between short and long
term plant care could be due to the shorter harvest
period of short-term plants. However, when gender
was considered simultaneously, females showed better responses than males to short-term plants. In our
observation, the short-term plants (water spinach and

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Fig. 12. The design for family role shown geometrically in the
cube plot. Optimal level combination appeared in two situations:
plant (1), gender (–1), onset time (–1), plant (–1), gender (1), onset
time (1)

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1) Baseline condition:
Each participant had a different baseline condition, which may have resulted in different speeds
of improvement. However, it is hard to control the
baseline condition. Therefore, we measured the difference between the pre-test and the post-test to
reflect improvement from the onset to the end of
gardening program for each participant.
2) Natural disease progression:
The variables we measured may have been affected
by the variation of natural disease progression, particularly in the areas of physical, mental, and functional
performance, which could cause variation in quality of life improvement. Using a large number of
participants may reduce the effect of natural disease
progression, because it is unlikely that all participants
develop this progression during measurement period.
Due to the availability of participants qualifying the
selection criteria of the study, the study results were
obtained based on a relatively small number of participants. It is recommended to increase the number
of participants in the future.
3) Limits to randomization:

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In interpreting the findings, it is important to consider the following limitations:

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Once a case was selected, the variables of gender
and disease severity were defined. The only variable
we could select for this case was the plant life cycle.
Randomly arranging the participants into different
groups tending long-term and short-term plants could
further reduce the errors. However, the ideal condition should be the full randomization of all factors.

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5. Conclusion

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in Fig. 12). Additionally, the optimal level of social
role improvement was seen in female participants
sustained a CVA over 18 months tending short-term
plants. It should be noticed that the effects of plant
features and gender-related differences enhanced the
social role of participants in this sample. In addition,

based on our analysis, in the future to improve the
quality of life for people with CVA, especially in the
family role, practitioners are recommended to consider plant features, gender differences, and the time
after CVA onset when arranging gardening programs.
Although sample size in this research was small,
significant results were obtained. This study shows
that tending different types of plants resulted in
significant differences in the beneficial effects of
gardening on quality of life for people with CVA.
Gender-related differences and the time after CVA
onset need to be taken into consideration in future
studies. Based on this finding, we think that further
experiments examining factors related to participants’ preferences would be useful in identifying
the key factors in motivation enhancement. It is also
suggested that future studies employ longer periods
of gardening to further examine whether the visual
effect of the appearance of fruit is significant. There
are factors in the gardening process that can influence the quality of life of people who have sustained a
CVA. The current findings provide future researchers
with directions for further investigation in this area.

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significantly than people sustained a CVA over 18
months. Based on our findings, the visually obvious
fruit, tomatoes and string beans, may increase the
confidence of participants and improve their quality
of life in the family role area.

490

9

This research provides further evidence for the use
of gardening programs with people who are recovering from CVA. Higher levels of quality of life were
shown by female participants sustained a CVA over
18 months tended short-term plants (see cube plot

Acknowledgments
The funding was supported by Shuang Ho Hospital, Taipei Medical University. The number of this
research project is 101SHH-HCP-04.

Conflict of interest
None to declare.

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