Research progress on horticultural therapy in patients with post-stroke cognitive impairment: a narrative review

BACKGROUND: Post‑stroke cognitive impairment (PSCI) affects 64%-75% of stroke survivors, severely limiting daily independence and rehabilitation engagement. Conventional interventions often yield suboptimal outcomes due to poor patient psychological engagement. OBJECTIVE: To review the therapeutic effects of horticultural therapy (HT) on cognition, mood, activities of daily living (ADL), and social participation in PSCI patients, and to explore the potential of combined regimens to shorten treatment duration. METHODS: A narrative review of randomized controlled trials, systematic reviews, and meta‑analyses on HT for PSCI was conducted. HT protocols were categorized into five types based on activity content. RESULTS: HT significantly improves memory, executive function, and orientation through sequential horticultural tasks, while alleviating anxiety and depression via nature contact. It enhances upper‑limb coordination and directly translates to improved ADL. Group‑based HT promotes social reintegration. Plant cultivation and comprehensive programs show the largest effect sizes. Notably, HT combined with cognitive behavioral therapy or intelligent feedback training can achieve significant gains within 4 weeks, suggesting that combined approaches may shorten overall treatment duration. CONCLUSIONS: HT is a feasible, low‑cost adjunctive intervention for PSCI. However, protocol heterogeneity and limited long‑term follow‑up constrain current evidence. Standardized, large‑scale RCTs with extended follow‑up are needed to validate optimal standalone and combined protocols.