ArticleNursing in critical care2025
Effects of Outdoor Therapy on Delirium in Patients With Prolonged Intensive Care Unit Stays: A Single-Centre Retrospective Study.
Article in Nursing in critical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Development of a cognitive rehabilitation intervention to support patients during and after intensive care admission: a stakeholder-informed study.BMC health services research · 2026Article
- Case Series: Episodes of Care in an Intensive Care Garden-Does Fresh Air Matter?Nursing in critical care · 2026Article
- ICU Nurses' Perceptions of Family-Inclusive Outdoor Excursions: Enhancing Family Engagement and Humanisation in Intensive Care.Nursing in critical care · 2026Article
- Effects of Outdoor Therapy on Delirium in Patients With Prolonged Intensive Care Unit Stays: A Single-Centre Retrospective Study.Nursing in critical care · 2025Article
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9 authors.
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Abstract
backgroundDelirium commonly occurs during prolonged intensive care unit (ICU) stays, yet the clinical benefit of escorted outdoor exposure for critically ill adults remains uncertain.
aimThe aim of this study was to determine whether supervised outdoor therapy is associated with reduced delirium severity among adults with ICU stays ≥ 7 days. STUDY
designWe performed a single-centre, retrospective cohort study in Japan, including adults with an ICU length of stay ≥ 7 days from 1 January 2019 to 31 December 2022. Delirium was assessed twice-daily using the Intensive Care Delirium Screening Checklist (ICDSC). We evaluated (1) within-patient change from 16:00 on the day before to 16:00 on the day of the first outdoor-therapy session; (2) ICDSC score at ICU discharge comparing patients who did vs. did not receive outdoor therapy using multiple imputation integrated with propensity-score matching; and (3) dose-response using multivariable linear regression with session count, adjusting for prespecified covariates including the highest ICDSC score and psychotropics prescribed through the first session.
resultsAmong patients (n = 391) receiving outdoor therapy, the median ICDSC score decreased from 4 to 2 on the day of the first session (p < 0.001). After propensity-score matching, the outdoor-therapy group had lower ICDSC scores at ICU discharge than matched controls (median: 3.0 [IQR 1.0-5.0] vs. 4.0 [2.0-6.0]; p = 0.013; Cliff's δ = -0.329). In the adjusted regression, a greater number of outdoor sessions was associated with a lower discharge ICDSC score (standardised β = -0.113; p = 0.025).
conclusionsSupervised outdoor therapy was associated with lower delirium severity in adults with prolonged ICU stays. These findings support the integration of outdoor exposure within multimodal delirium management while prospective multicentre studies define standardised protocols and optimal dosing. RELEVANCE TO CLINICAL PRACTICE: Incorporating brief, supervised outdoor sessions into multidisciplinary ICU workflows may provide a practical, non-pharmacological adjunct for delirium care, pending confirmation in protocolised prospective trials.
trial registrationUniversity Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR) (ID: UMIN000049057; registered on 1 October 2022; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055872).
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