Unicare Bakke is a rehabilitation centre that is beautifully located on the countryside, south of Halden in Norway. I started working there as a physiotherapist in 2000 and over the years I recognized that we didn´t use the beautiful outdoors and surroundings as much as we could. The potential was huge, but something needed to be done for a change to come.

I looked for educations within the field and found the masters program “Outdoor environment for health and wellbeing” at the Swedish university of agriculture (SLU). In 2018 I took my degree and at the same time I became the leader for the project “Outdoor rehabilitation for everyone at Unicare Bakke”. This was a two years project with two major aims, improving the physical accessibility in the outdoors and creating new routines on how to use it. The project steps were as follows:

  1. Identify the users
  2. Survey the needs and wishes of the users
  3. Survey the outdoor area
  4. Create an action plan
  5. Implement the action plan
  6. Evaluate the result.

 The first big improvement was that we created a lot of paved paths on our lawns. This made the outdoor environment more accessible for all patients, regardless of level of function. Especially people in wheelchairs could move around on their own much easier. We also built a lot of furniture that were placed all over the outdoors, so it would be easy to rest. The second big improvement was about routines, we started with weekly outdoor rehabilitation for all patients.

The project was successful, and we still have the same routine, 5 years after we started. The project taught us many important things, the most important was the importance of including the staff, the patients and relatives in the process, from mapping the outdoors, surveying their wishes and needs to suggestions of improvements. If everyone feels that they are part of the project, new routines are easier to implement. Another aspect of importance is working parallel with improving the outdoors and implementing new routines, they have to go hand in hand in order to be successful. 

Picture to the left: The outdoors at Unicare Bakke before the project. Photo: Norgeskart
Picture to the right: Sketch of improvements in the outdoors. Sketch: Lotta Lundmark Alfredsson
Picture below: The outdoor after creating paths. Photo: John Bacon

What I did in the project at Unicare Bakke is also a good description of what I do in my own company BRANAK. I have been involved in large projects, together with other professionals, where big changes have been done in the outdoors, in order to improve the accessibility and the routines and I have been involved in smaller projects where I have worked on my own.

In addition to working with the described projects I also teach. I regularly hold lectures for students who study the same Masters program as I did, I have held lectures for architects, for assistant nurses students and I teach at the program Grønn helse at Norges grønne fagskole Vea. When I teach, I usually present environmental psychological theories about the health promoting effects of being outdoors and in nature. I also present the importance of working interprofessional in this field. Health care staff, patients and relatives know much about the needs and wishes of the patients and landscape architects and architects know much about possible solutions in buildings and outdoors. Together they can create something really good.

 When I took the M Sc I missed a school book in the field, there was no such one in Swedish. Therefore, I and three others took the initiative to a book and the result came last fall, the book “Vård, omsorg och rehabilitering utomhus”. The book is a compilation of theory, practice and new perspectives in the field and has more than 50 authors, from researchers to patients and professionals. We hope that the book can help the field to move forward when it comes to moving health care outdoors and in the long run creating improved quality of life for patients and others.

Lotta Lundmark Alfredsson (MSc)

Lotta Lundmark Alfredsson (MSc)

Physiotherapist at Unicare Bakke & Owner of BRANAK

Lotta Lundmark Alfredsson is a physiotherapist with a M Sc in landscape architecture/ environmental psychology. She shares her time between a part time employment at the rehabilitation centre Unicare Bakke in Norway and her own company, BRANAK in Sweden, where she helps health care organizations that want to move activities outdoors.