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Effects of nature-based mindfulness on pain and wellbeing for adults with persistent pain: A systematic literature review

Smith, Fliss; Howie, Louie; Malsingh, Jonathan; O’Mant, Ashley; Shakespeare, Simon; Tunney, Kim

Effects of nature-based mindfulness on pain and wellbeing for adults with persistent pain: A systematic literature review Thumbnail


Fliss Smith
Senior Lecturer in Physiotherapy (Physical Activity, Health and Wellbeing)

Louie Howie

Jonathan Malsingh

Ashley O’Mant

Simon Shakespeare

Kim Tunney


Background: Persistent pain (PP) is a complex mechanism affecting 35% to 51.3% of adults in the United Kingdom and is associated with significant reductions in quality of life. Understanding of PP and how best to treat it has developed over the past 50 years, but there is still a vacuum of research to inform novel applications for self-management. Mindfulness techniques and nature exposure have separately been found to have beneficial effects on general well-being and health. The integration of the two could produce much needed self-management strategies, improving quality of life in this patient group. Objectives: To determine if nature-based mindfulness (NBM) interventions improve pain and quality of life in adults with PP. Methods: Systematic literature review. Seven electronic databases were searched to identify quantitative papers investigating nature-based mindfulness and persistent pain. Included articles were appraised using the PEDro tool. Results: A total of 362 studies were identified. Of these, three were included in the final review. All studies reported statistically significant improvements in self-reported scores for pain (p ≤ 0.001–0.006) and depression (p ≤ 0.001–0.000). Other outcomes, such as stress and fatigue produced mixed results. Conclusion: Despite showing statistical significance in multiple outcomes, the minimal clinically important difference was not reached across all measures. Heterogeneity of interventions and outcomes, as well as methodological issues of internal and external validity, preclude definitive conclusions. Further research is required, employing explicit mindfulness interventions and outcome measures with greater relevance and specificity, as well as further investigation of theoretical mechanisms.

Journal Article Type Review
Acceptance Date Jun 10, 2024
Online Publication Date Jun 17, 2024
Deposit Date Jun 18, 2024
Publicly Available Date Jun 18, 2024
Journal Physical Therapy Reviews
Print ISSN 1083-3196
Electronic ISSN 1743-288X
Publisher Taylor & Francis
Peer Reviewed Peer Reviewed
Public URL
Additional Information Peer Review Statement: The publishing and review policy for this title is described in its Aims & Scope.; Aim & Scope:; Received: 2022-12-23; Accepted: 2024-06-10; Published: 2024-06-17


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