The impact of care farms and green care on health-related quality of life: a systematic review guiding cost-effectiveness analysis

Background: Care farms are increasingly commissioned by public sector and health sector organizations to provide support to vulnerable people. It is a complex intervention that provides farming activities for therapeutic purposes. The evidence base assessing the effectiveness of care farms is relatively recent and to date no systematic review has been conducted to assess the impact of care farms using health-related-quality-of-life measures. Aim: This systematic review aims to identify any existing literature evaluating the impact of care farms and green care interventions in adult populations, with a specific focus on health-relatedquality- of-life measures that could be used for a cost-effectiveness or cost-utility analysis. Methods: 19 general health and social science databases were searched systematically in November 2013. Care farm and green care interventions, for adults measuring HRQOL outcome were included and assessed for methodological quality using the Cochrane’s six item risk of bias checklist. Results: Five studies with four hundred and eighty-four participants were included in this review. Two studies favoured the interventions, whereas three studies did not find strong evidence that the intervention had an effect on participants’ health-related-quality-of-life at post-intervention follow-up. These results indicated that care farms and green care may benefit certain populations such as breast and lung cancer patients, the elderly, and people with affective disorders. Conclusions: Given the small number of available studies and their methodological limitations we cannot make unequivocal conclusions about the impact of care farms on health-relatedquality- of-life. With this caveat, some evidence suggests that care farms and green care interventions can improve quality of life for some participants. However, this review highlights the need to conduct more high quality trials with larger sample sizes and longer term follow-up.