Examining the Effects of Music-Based Interventions on Pain and Anxiety in Hospitalized Children: An Integrative Review

The effect of serious game on the level of anxiety, fear, knowledge of hospitalized children and level of anxiety in their parents

BACKGROUND

Serious games can be used to increase the knowledge level of hospitalized children and reduce their anxiety levels and fear of medical procedures.

OBJECTIVES

This randomized controlled study was conducted to examine the effects of the developed serious game on children's anxiety, fear and knowledge levels and their parents' anxiety levels.

METHODS

For this randomized controlled trial, a pre-test-post-test experimental study method was used, guided by the CONSORT checklist. The sample consisted of 70 children aged 8-12 years and their parents. Sociodemographic Data Collection Form, Fear Scale of Medical Treatment, Clinical Knowledge Form, State-trait Anxiety Inventory for Children and for Adults were used to data collection.

RESULTS

As a result of the study, it has been found that serious gaming affects the state and trait anxiety levels, medical treatment fear levels and clinical knowledge levels of hospitalized children aged 8-12 years. It was determined that the state anxiety of the parents of the children participating in the study decreased, their trait anxiety is not affected.

CONCLUSION

In children aged 8-12 years, the use of serious game increased knowledge and decreased anxiety and fear of medical procedures. Larger studies involving parents are needed.

APPLICATION TO PRACTICE

Nurses are healthcare professionals who play a key role in managing anxiety through non-pharmacological interventions. Opportunities should be created for nurses to use artificial intelligence in their own initiatives and transfer it to the clinical environment. It is the first Turkish serious game developed by nurses.

Effect of music therapy on relieving the pain and distress of children undergoing venipuncture: A systematic review and meta-analysis

BACKGROUND

Venipuncture is a routine procedure in pediatrics that often elicits pain and triggers adverse emotional responses. The stress, both psychological and physiological, that accompanies this procedure can significantly impair pediatric patients' compliance with medical regimens. To mitigate these effects, music therapy as a non-pharmacological approach known for its safety has been increasingly employed in pediatric settings. There is empirical evidence supporting the efficacy of music therapy in reducing procedural pain and in easing negative emotions experienced by pediatric patients.

OBJECTIVE

This study aimed to evaluate the effectiveness of music therapy in managing pain, anxiety and distress in pediatric patients undergoing venipuncture procedures.

METHODS

A comprehensive search was conducted on PubMed, Embase, Web of Science, Cochrane Library, Scopus, CINAHL, EBSCO and FMRS databases for articles published up to December 20, 2024. Two reviewers independently selected studies and extracted articles that met strict inclusion and exclusion criteria. Quality assessments of the included studies were performed according to the Cochrane risk assessment tool, data analysis was performed using RevMan 5.3 software.

RESULTS

A total of 16 studies including 657 participants in the intervention group and 707 participants in the control group were selected for the final analysis. The results demonstrated a significant difference between the music groups and control groups for children's self-reported pain (standard mean difference SMD = -0.42, 95 % CI -0.58 to -0.27, P < 0.05), observer-reported pain (SMD = -0.52, 95 % CI -0.87 to -0.17, P < 0.05) and distress (SMD = -0.70, 95 % CI -1.27 to -0.13, P = 0.02). However, no significant difference was observed in anxiety (SMD = -0.10, 95 % CI -0.32 to 0.13, P = 0.41).

CONCLUSIONS

Pediatric patients undergoing venipuncture procedures would benefit from music interventions for pain and distress relief. However, no statistically significant effect was found on anxiety.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42024509600.

Impact of Noise on Medical Anxiety in Hospitalized Children with Pneumonia: A Retrospective Study

PURPOSE

Noise levels may have an impact on the level of fear and anxiety in hospitalized children, which, in turn, may affect the effectiveness of treatment. This retrospective study aimed to investigate the impact of noise levels on medical anxiety in hospitalized children with pneumonia.

METHODS

Children hospitalized for pneumonia in our hospital from January 2020 to December 2023 were consecutively enrolled in this study. They were divided into high- and low-noise groups according to the environmental noise level, using 60 dB as a threshold value. Demographic, clinical, and psychological data were collected from medical records and patient assessments. Statistical analyses, including post-hoc analysis, were performed to conduct relevant research.

RESULTS

A total of 106 patients, including 66 patients with low noise and 40 patients with high noise, were included. Results revealed that children in the high-noise group exhibited significantly higher scores on the Brief Illness Perception Questionnaire compared to those in the low-noise group (32.56 ± 7.14 vs. 29.18 ± 6.25, t = 2.557, P = 0.012), as well as higher scores on the Face, Legs, Activity, Cry, Consolability (FLACC) behavioral pain scale (2.34 ± 0.96 vs. 2.01 ± 0.67, t = 2.081, P = 0.040), indicating higher levels of medical anxiety and pain perception in the high-noise group.

CONCLUSION

This study demonstrates that noise levels in the hospital environment have a substantial impact on the fears and perceptions of hospitalized children with pneumonia. High-noise levels were associated with increased medical anxiety and pain perception in pediatric patients.

The Impact of Music Therapy in a Pediatric Oncology Setting: An Italian Observational Network Study

BACKGROUND

Music Therapy (MT) is a non-pharmacological, art-based intervention that employs music experiences within a therapeutic alliance to attend to clients' physical, emotional, cognitive, and social requirements. This is the first study aiming at investigating the impact of MT on the psychological facets of children suffering from cancer.

METHODS

The study, combining the AQR and m-YPAS assessment tools, evaluated behavioral, sound-musical, and interactive parameters in pediatric oncology patients undergoing MT sessions during hospitalization. Fifty patients admitted to the Paediatric Oncology and Haematology Unit at Policlinico S. Orsola Hospital in Bologna, Italy, were enrolled, irrespective of their treatment regimen. Data collection occurred on the first day of the MT session between 3 p.m. and 5 p.m., with observations conducted by independent observers. In addition to traditional statistical analysis, network analysis was used to explore the combined interactions of all parameters, effectively discerning the distinctive roles played by each one during therapy sessions and their influence on all others.

RESULTS

Network analysis highlighted distinct patterns of interactions among parameters during the various sessions, emphasizing the role of positive emotions and a calm setting, the child's ability to take the initiative in sessions, their sense of agency, and the parent's role in guiding them. Significant differences were recorded at each time point between all variables considered.

CONCLUSIONS

The results of this innovative study may pave the way for future multicenter studies aimed at further exploring the role of MT in children undergoing both curative and palliative treatments for cancer.

The psychophysiology of music-based interventions and the experience of pain

In modern times there is increasing acceptance that music-based interventions are useful aids in the clinical treatment of a range of neurological and psychiatric conditions, including helping to reduce the perception of pain. Indeed, the belief that music, whether listening or performing, can alter human pain experiences has a long history, dating back to the ancient Greeks, and its potential healing properties have long been appreciated by indigenous cultures around the world. The subjective experience of acute or chronic pain is complex, influenced by many intersecting physiological and psychological factors, and it is therefore to be expected that the impact of music therapy on the pain experience may vary from one situation to another, and from one person to another. Where pain persists and becomes chronic, aberrant central processing is a key feature associated with the ongoing pain experience. Nonetheless, beneficial effects of exposure to music on pain relief have been reported across a wide range of acute and chronic conditions, and it has been shown to be effective in neonates, children and adults. In this comprehensive review we examine the various neurochemical, physiological and psychological factors that underpin the impact of music on the pain experience, factors that potentially operate at many levels - the periphery, spinal cord, brainstem, limbic system and multiple areas of cerebral cortex. We discuss the extent to which these factors, individually or in combination, influence how music affects both the quality and intensity of pain, noting that there remains controversy about the respective roles that diverse central and peripheral processes play in this experience. Better understanding of the mechanisms that underlie music's impact on pain perception together with insights into central processing of pain should aid in developing more effective synergistic approaches when music therapy is combined with clinical treatments. The ubiquitous nature of music also facilitates application from the therapeutic environment into daily life, for ongoing individual and social benefit.

Music Nursing as Complementary Therapy Improves Anxiety, Fatigue, and Quality of Life in Children with Acute Leukaemia: A Retrospective Study

OBJECTIVE

To explore the effects of music nursing as a complementary therapy on anxiety, fatigue, and quality of life in children with acute leukemia (AL).

METHODS

This study included 150 children with AL admitted to our hospital from August 2021 to August 2023 and divided them into two groups based on treatment: the control (n = 76, received routine nursing) and observation (n = 74, received music nursing on the basis of routine nursing) groups. Comparison of groups was performed in terms of general information, anxiety, fatigue, and quality of life at admission (T0) and 1 month after admission (T1).

RESULTS

No significant differences were observed in the general data between the two groups (P > 0.05). Anxiety, fatigue, and quality of life of the two groups also showed no significant differences at T0 (P > 0.05). The observation group showed significantly lower anxiety than the control group at T1 (P < 0.05). At T1, the observation group exhibited a lower fatigue degree compared with the control group (P < 0.05). At T1, the observation group attained higher scores on physiological and emotional dimensions of the quality of life compared with the control group, and the differences were statistically significant (P < 0.05).

CONCLUSION

Music nursing for AL children, which has a certain clinical application value, can effectively reduce their anxiety and fatigue and improve their quality of life.

The effect of buzzy®, DistrACTION® cards on reducing pediatric pain and fear during blood collection in the rheumatology polyclinic: A randomized controlled trial

PURPOSE

The aim of this study was to compare the effectiveness of Buzzy® and DistrACTION® Cards in reducing children's pain and fear while taking venous blood samples.

METHODS

This research was designed as a randomized controlled experimental study. The study population consisted of children aged 6-12 years admitted to the Pediatric Rheumatology Diseases Polyclinic in a Faculty of Medicine in Germany. The sample of the study consisted of 96 children (Buzzy® = 32, DistrACTION® Cards = 32, control = 32) who met the patient selection criteria and agreed to participate in the study. The data were obtained using a Child and Family Information Form, the Children Fear Scale (CFS), and the Faces Pain Scale-Revised (FPS-R). The data were evaluated using the Pearson chi-square test, Kruskal-Wallis test, One-way ANOVA test with Bonferroni correction, and Fisher-Freeman-Halton.

FINDINGS

In the study, the average age of the children was 9.21 ± 2.15 years. The Buzzy® group had the lowest pain and procedural fear scores (self-report = 0.88 ± 1.13, 0.31 ± 0.47; parent report = 0.75 ± 0.98, 0.34 ± 0.48, and researcher report = 0.81 ± 1.00, 0.31 ± 0.54, respectively) than the DC, and control groups.

CONCLUSIONS

The Buzzy® method was effective in reducing venipuncture pain and fear in children.

PRACTICE IMPLICATIONS

Nurses can use the Buzzy® methods to help reduce venipuncture pain and fear in children. The clinical trial registration number is NCT05560074. (https://clinicaltrials.gov/ct2/show/study/NCT05560074).

Effects of non-pharmacological interventions on pain intensity of children with burns: A systematic review and meta-analysis

Pain is one of the complications associated with burns, which can lead to anxiety and sleeplessness in children. Various studies evaluated the effects of non-pharmacological interventions on burn wound care. The present study was conducted to determine the effects of non-pharmacological interventions on pain intensity of children with burns. A comprehensive systematic search was conducted in various international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Non-pharmacological', 'Virtual reality', 'Pain', 'Burn', 'Wound' and 'Child' from the earliest to December 1, 2022. The risk of bias in the final articles was also assessed with the Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Finally, a total of 1005 burn patients were included in 19 studies. The age range of the patients was from 0.5 to 19 years. Of the participants, 50.05% were in the intervention group. All studies had a randomised clinical trial design. The results found that non-pharmacological interventions significantly reduced pain intensity in children (ES: -0.73, 95% CI: -1.08 to -0.38, Z = 4.09, I2 :79.8, P < .001). Virtual reality (VR) (ES: -0.54, 95% CI: -1.19 to -0.18, Z = 2.90, I2 :72.9%, P = .004) and non-VR (ES: -0.86, 95% CI: -1.45 to -0.27, Z = 2.86, I2 :91.4%, P = .04) interventions decreased pain intensity significantly in children based sub-group analysis. Non-pharmacological interventions significantly reduced the pain intensity of dressing removal (ES: -0.77, 95% CI: -1.34 to -0.20, Z = 66.3, I2 :91.8%, P = .008), dressing application (ES: -0.53, 95% CI: -0.97 to -0.09, Z = 2.37, I2 :60.8%, P = .02), and physical therapy (ES: -1.18, 95% CI: -2.10 to -0.26, Z = 2.51, I2 :88.0%, P = .01). Also, interventions reduced the pain of burn wound care (ES: -0.29, 95% CI: -1.01 to 0.44, Z = 0.78, I2 :72.6%, P = .43), but it was statistically insignificant. In sum, the result of the present study indicated that using non-pharmacological interventions significantly reduced pain intensity in children. The reduction of pain intensity was greater in non-VR than in VR interventions. Future studies should focus on comparing VR interventions with non-VR and single versus multi-modal distraction to clarify the effectiveness of each.

The effect of non-verbal music on anxiety in hospitalized children

BACKGROUND

In recent years, the positive effect of non-pharmacological methods such as listening to music in reducing the level of anxiety of hospitalized patients has been reported. This study aimed to determine the effect of non-verbal music on anxiety in hospitalized children.

METHODS

In this study, 52 hospitalized children aged 6 to 12 years were randomly divided into Test and control groups. Research data collection tools included the Spielberger questionnaire to assess the level of anxiety in children. Statistical analysis of data was performed using Chi-square and t-tests by SPSS 23 software.

RESULTS

Daily listening to non-verbal music for 20 minutes after the second and third days significantly reduced the anxiety score and the number of breaths per minute of hospitalized children (P ≤ 0.01). The trend of changes in anxiety score was measured for three consecutive days and vital signs except body temperature decreased significantly in the test group (P ≤ 0.01).

CONCLUSION

According to the results of this study, listening to non-verbal music by hospitalized children can be used as an effective practical method to reduce the level of anxiety and subsequently reduce vital signs.

Music therapy and psychological-clinical impact in surgery: a systematic review

BACKGROUND

Music therapy is a discipline that makes use of music, active or passive, to produce beneficial effects on the psyche of subjects. The field of use of music therapy has recently been broadened with the introduction of music therapy interventions to treat various problems, such as anxiety and stress, arising from pre- and post-operative psychophysical conditions. This review aims to examine the use of music therapy and its outcomes in the context of surgery in recent years.

METHODS

The main procedure was to search for studies on various scientific platforms such as PubMed, Medline, PsycINFO and CINAHL.Many studies pertaining to the topic in question were examined and from the variety of articles available, thirty-four were selected that fully reflected the focus of this review.

CONCLUSIONS

The use of music therapy is still little exploited in hospital conditions such as the one reported in this review, but despite its reduced use compared to other treatments, it has proved to be an effective technique for reducing anxiety and stress prior to surgery and for improving psychophysical conditions following surgery. Above all, the absence of side effects is emphasised since it is a nonpharmacological treatment. Further research is needed for additional confirmation of the effectiveness of music therapy mainly because this method is still being explored worldwide.