{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:38:04Z","timestamp":1786628284318,"version":"build-2736575974"},"reference-count":42,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HERD"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study examined perspectives of rehabilitation professionals and environmental designers to identify benefits, challenges, and design considerations for outdoor therapy spaces.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The therapeutic potential of nature-based environments has gained recognition among researchers, healthcare practitioners, and designers, highlighting an opportunity to leverage outdoor environments in physical and occupational therapy. However, our understanding of the benefits, challenges, and considerations for implementation remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This exploratory qualitative study used thematic analysis of in-depth semistructured interviews following Braun and Clarke's six-phase framework. Interviews were conducted remotely with a purposive sample of 23 rehabilitation professionals (physical therapists, occupational therapists, horticultural therapists, and medical staff) and design practitioners (landscape architects, architects, and planners) involved in outdoor rehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five primary themes were identified related to benefits, challenges, and design considerations: holistic health impact, real-world activities as therapy, the control-choice paradox, hazards and discomforts, and logistical and management barriers. Two distinct spatial typologies emerged: publicly owned, dispersed sites and privately owned, centralized sites. Nineteen environmental features were identified as high priority, with terrain variety (91%), environmental variety and choice (87%), and graduated challenge (70%) most frequently cited. Rehabilitation professionals emphasized practical concerns and therapeutic functionality, while designers prioritized sensory diversity and spatial arrangement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Outdoor rehabilitation environments offer holistic health benefits and real-world therapeutic opportunities but require careful planning to address logistical barriers and environmental challenges. Successful implementation depends on early engagement of therapists and the establishment of supportive organizational cultures. Cross-disciplinary collaboration between therapists and designers is essential.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19375867261474206","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:21:48Z","timestamp":1786364508000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the Benefits and Challenges of Outdoor Therapy Environments: Integrating Perspectives From Rehabilitation and Design Professionals"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1440-7361","authenticated-orcid":false,"given":"Karen","family":"Joyce","sequence":"first","affiliation":[{"name":"Martha Van Rensselaer Hall, Cornell University"},{"name":"Sage Creative LLC, Lyons, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5674-1321","authenticated-orcid":false,"given":"Mardelle McCuskey","family":"Shepley","sequence":"additional","affiliation":[{"name":"Martha Van Rensselaer Hall, Cornell University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1403494810396400"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.landurbplan.2015.02.005"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.4135\/9781036232078.n9"},{"key":"e_1_3_3_5_1","volume-title":"Occupational therapists","author":"Bureau of Labor Statistics","year":"2023","unstructured":"Bureau of Labor Statistics. (2023). Occupational therapists. Occupational Outlook Handbook. https:\/\/www.bls.gov\/ooh\/healthcare\/occupational-therapists.htm."},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/01942638.2023.2204924"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/193758671100400303"},{"key":"e_1_3_3_8_1","volume-title":"Environmental stress","author":"Evans G. W.","year":"1982","unstructured":"Evans G. W. (1982). Environmental stress. Cambridge University Press."},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/07380577.2024.2372739"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/03080226221126893"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(92)90360-3"},{"key":"e_1_3_3_12_1","unstructured":"Haering M. (2016). 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