title: Sensory environment on health-related outcomes of hospital patients.
abstract: BACKGROUND
  Hospital environments have recently received renewed interest, with considerable investments into building and renovating healthcare estates. Understanding the effectiveness of environmental interventions is important for resource utilisation and providing quality care.
  
  
  OBJECTIVE
  To assess the effect of hospital environments on adult patient health-related outcomes.
  
  
  METHODS
  We searched: the Cochrane Central Register of Controlled Trials (last searched January 2006); MEDLINE (1902 to December 2006); EMBASE (January 1980 to February 2006); 14 other databases covering health, psychology, and the built environment; reference lists; and organisation websites. This review is currently being updated (MEDLINE last search October 2010), see Studies awaiting classification.
  
  
  METHODS
  Randomised and non-randomised controlled trials, controlled before-and-after studies, and interrupted times series of environmental interventions in adult hospital patients reporting health-related outcomes.
  
  
  METHODS
  Two review authors independently undertook data extraction and 'Risk of bias' assessment. We contacted authors to obtain missing information. For continuous variables, we calculated a mean difference (MD) or standardized mean difference (SMD), and 95% confidence intervals (CI) for each study. For dichotomous variables, we calculated a risk ratio (RR) with 95% confidence intervals (95% CI). When appropriate, we used a random-effects model of meta-analysis. Heterogeneity was explored qualitatively and quantitatively based on risk of bias, case mix, hospital visit characteristics, and country of study.
  
  
  RESULTS
  Overall, 102 studies have been included in this review. Interventions explored were: 'positive distracters', to include aromas (two studies), audiovisual distractions (five studies), decoration (one study), and music (85 studies); interventions to reduce environmental stressors through physical changes, to include air quality (three studies), bedroom type (one study), flooring (two studies), furniture and furnishings (one study), lighting (one study), and temperature (one study); and multifaceted interventions (two studies). We did not find any studies meeting the inclusion criteria to evaluate: art, access to nature for example, through hospital gardens, atriums, flowers, and plants, ceilings, interventions to reduce hospital noise, patient controls, technologies, way-finding aids, or the provision of windows. Overall, it appears that music may improve patient-reported outcomes such as anxiety; however, the benefit for physiological outcomes, and medication consumption has less support. There are few studies to support or refute the implementation of physical changes, and except for air quality, the included studies demonstrated that physical changes to the hospital environment at least did no harm.
  
  
  CONCLUSIONS
  Music may improve patient-reported outcomes in certain circumstances, so support for this relatively inexpensive intervention may be justified. For some environmental interventions, well designed research studies have yet to take place.
authors.affiliation: UK Cochrane Centre, National Institute for Health Research, Oxford, UK. amy.drahota@port.ac.uk
authors.forename: Amy
authors.initials: A
authors.lastname: Drahota
authors.forename: Derek
authors.initials: D
authors.lastname: Ward
authors.forename: Heather
authors.initials: H
authors.lastname: Mackenzie
authors.forename: Rebecca
authors.initials: R
authors.lastname: Stores
authors.forename: Bernie
authors.initials: B
authors.lastname: Higgins
authors.forename: Diane
authors.initials: D
authors.lastname: Gal
authors.forename: Taraneh P
authors.initials: TP
authors.lastname: Dean
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor; D006272:Health Facility Environment; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007374:Interior Design and Furnishings; D008029:Lighting; D009146:Music / Q000523:psychology; D009812:Odorants; D010043:Outcome and Process Assessment, Health Care; D016032:Randomized Controlled Trials as Topic; D013696:Temperature