Exploration of Musculoskeletal Diseases

Table 2. Strengths and limitations of evidence for horticultural therapy in fibromyalgia.

Strengths	Limitations
Consistent direction of benefit across studies	Very small number of FM-specific studies
Improvements reported in pain, sleep, mood, and QoL	Many studies have small sample sizes
HT appears safe and well-tolerated	Heterogeneous interventions and outcome measures
Findings align with multidisciplinary approach	Limited long-term follow-up
Some controlled and randomized studies available	Few studies include inactive control groups
Biological plausibility supported by mechanistic studies	Causality cannot be established
Potentially scalable and low-cost intervention	Effect of HT often cannot be separated from exercise, socialization, or psychological support

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FM: fibromyalgia; HT: horticultural therapy; QoL: quality of life.

Declarations

Author contributions

JBS: Conceptualization, Methodology, Investigation, Writing—original draft, Writing—review & editing. The author read and approved the submitted version.

Conflicts of interest

The author declares that she has no competing interests.

Ethical approval

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