Sounds of Difference: A Typology of Reactions of People with Dementia to Individualized Music in the Presence of a Monitoring Person

BACKGROUND AND OBJECTIVES

Despite promising effects of individualized music listening (IML) for people with dementia, the individualized nature and heterogeneity of reactions to IML remain underexplored. We aimed to develop an empirically derived typology of directly observed reactions of people with dementia to IML and propose recommendations for tailoring the intervention to the respective types.

RESEARCH DESIGN AND METHODS

An ideal-type analysis was conducted on 108 video recordings of 45 people with mainly severe dementia (78% female, mean age of 83.02 years, all white participants) listening to recorded individualized music. Dimensions were identified for capturing similarities and differences between types.

RESULTS

The analysis yielded 10 types of reactions ("expressing and sharing joy", "self-disclosure stimulated by music", "concentrated, absorbed listening", "blissful enjoyment", "experience of the music as bittersweet", "sharing memories", "releasing tension", "tensing up and rejecting", "predominant search for social exchange", "no interpretable reaction") and 3 dimensions ("valence" from negative to positive, "arousal" from calm to activated, "communicative activity" from defensive/ resistant to proactive), resulting in a three-dimensional coordinate system, providing a holistic representation and facilitating a systematic contrast of identified reaction types to IML.

DISCUSSION AND IMPLICATIONS

Reactions to IML were influenced by the interaction with the project staff, who monitored the sessions. Based on these observations, we propose recommendations for tailoring both the behavior of the monitoring person (e.g., engaging in synchronous activities like clapping along) and the setup of the intervention (e.g., communal vs. individual listening) to each type, which may improve the effects of IML.

The Effect of Listening to Music Presurgery on the Anxiety Level of Individuals who are Planned for Urological Surgery: Randomized Controlled Study

PURPOSE

This study aims to evaluate the effects of listening to music on preoperative anxiety levels in individuals planned for urological surgery.

DESIGN

The study was a pretest-post-test randomized controlled study.

METHODS

This research was conducted with 80 (intervention=40, control=40) individuals who applied to the urology clinic of a university hospital between September 2021 and February 2022 with surgery planned. The data were collected via the information form, state-trait anxiety inventory (STAI= STAI-S: state anxiety, STAI-T: trait anxiety), anxiety specific to surgery questionnaire (ASSQ).

FINDINGS

The mean STAI-S scores for the pretest and post-test intervention group were 37.15 ± 8.04 and 34.67 ± 9.09; while scores for the control group were 36.23 ± 9.44 and 37.23 ± 9.78. While the difference in the intervention group was statistically significant (P = .006), there was no difference observed in the control group (P = .256). The pretest and post-test STAI-T mean scores for the intervention group were 39.73 ± 7.71 and 39.88 ± 8.22; the control group scores were 40.68 ± 4.91 and 41.25 ± 5.87; the difference between the intervention (P = .840) and control (P = .346) groups was not statistically significant. The pretest and post-test surgery-specific anxiety scale mean scores of the intervention group were 18.08 ± 4.52 and 16.55 ± 4.79; the control group were 20.50 ± 7.31 and 20.95 ± 7.69. While the difference in the intervention group was statistically significant (P = .011), no difference (P = .498) was determined in the control group.

CONCLUSIONS

Individuals planned for urological surgery who listened to music for 30 minutes had reduced state and surgery-specific anxiety for 15 minutes after listening, however, this did not affect trait anxiety. The practice of listening to music before surgery may be recommended for individuals who are scheduled for urological surgery to reduce patient anxiety.

Music therapy for health workers to reduce stress, mental workload and anxiety: a systematic review

BACKGROUND

The physical and mental exhaustion of health care workers urgently needs to be addressed as a public health priority. Benefits of music on stress parameters have been extensively reported.

METHODS

We carried out a systematic review to examine the efficacy of music interventions on stress parameters by selecting studies conducted in genuine care stress conditions. To approach the potential benefit of music therapy (MT) versus music medicine (MM), we followed international music-based intervention guidelines.

RESULTS

Five outcomes were considered in our studies: stress, anxiety, mental workload, burnout risk and psychosomatic symptoms. Corresponding measures, including psychological, physiological questionnaires or stress biological parameters, showed significant results for the majority of them in music groups. Implications of music types, designs and limitations are discussed. Only one study compared MM and MT with an advantage for customized playlists over time.

CONCLUSIONS

In spite of heterogeneity, music interventions seem to significantly decrease stress parameters. The individual, customized supports with MT may be a crucial condition for this specific professional category. The impact of MT versus MM, the number of music sessions and the effect over time need to be explored.

Effects of Music on the Quality of Life of Family Caregivers of Terminal Cancer Patients: A Randomised Controlled Trial

The aim of this study was to investigate the effects of listening to self-chosen music on the quality of life of family caregivers of cancer patients receiving palliative home care. A total of 82 family caregivers were assigned either to the intervention group (n = 41) or to the control group (n = 41) in this double-blind, multicentre, randomised controlled clinical trial. The recruitment period was between July 2020 and September 2021. The intervention group received individualised pre-recorded music in daily 30 min sessions for 7 consecutive days. The control group was given a recorded repetition of the basic therapeutic training education also in 30 min sessions for 7 consecutive days. The primary endpoint assessed was the caregivers' quality of life (Quality of Life Family Version and European Quality of Life visual analogue scale) before and after the intervention. The secondary endpoint was their perceived satisfaction with the intervention (Client Satisfaction Questionnaire). The music intervention was successful, producing a tangible improvement in the caregivers' quality of life (p < 0.01) and satisfaction with the care provided (p = 0.002). The intervention was not only effective but produced no adverse effects. This study encourages the use of self-chosen music as a complementary intervention in nursing care for family caregivers of palliative cancer patients.

[The Role and Function of Music Therapy in Child-Friendly Healthcare]

Child-friendly healthcare relates to the development and application by professionals of integrated methods specifically for children in any healthcare activity context. Music therapy is one of these methods. Three roles (noise masker, emotional adjustment, and cognitive learning) and two functions (activity participation and non-verbal expression and decision making) of child-friendly-healthcare-related music therapy are presented in this article. Also, suggestions and insights regarding how to optimize the effectiveness of music therapy in the context of pediatric healthcare are provided.

Music-based intervention impacts for people with eating disorders: A narrative synthesis systematic review

Eating disorders (EDs) can be life-threatening and cause long-term adverse biopsychosocial effects. Treatment options are limited and treatment seeking barriers exist. The objective of this systematic review was to examine the therapeutic impacts of music-based intervention (MBIs) for people with diagnosed EDs. Five bibliographic databases (PsycInfo, MEDLINE, CINAHL, CENTRAL, Open Dissertations) were searched. Eligible studies examined therapeutic outcomes of MBIs in people with EDs, using quantitative and/or qualitative methods. From 939 studies identified, 16 met the inclusion criteria (N = 349; age:12-65-years-old), and were categorized as: music therapy (5 studies), music medicine (4 studies), and "other MBIs" (7 studies), that is, the intervention included music and was delivered by a non-music therapist health worker and/or musician. A narrative synthesis of the studies was undertaken. Participants were diagnosed with anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder otherwise not specified, or mixed symptoms. MBIs varied widely and were associated with improved mood regulation, emotional well-being, and management of meal-related distress. Vodcast (video podcast) interventions were associated with healthful eating in non-inpatient populations. Studies were assessed using critical appraisal tools. Generalizability of findings is limited due to small samples and suboptimal description of MBIs. Longitudinal research is warranted with larger samples and informed by frameworks for quality reporting of complex MBIs. Review findings may encourage music therapists to further develop and examine how music therapy can help people with EDs to live healthier lives.

Effect of Self-Chosen Music in Alleviating the Burden on Family Caregivers of Patients with Advanced Cancer: A Randomised Controlled Trial

The experience of caregiver burden among family members of patients with advanced cancer is a common problem. The aim of this study was to determine whether the burden may be alleviated by means of a therapeutic approach based on self-chosen music. This randomised controlled trial (ClinicalTrials.gov, NCT04052074. Registered 9 August 2019) included 82 family caregivers of patients receiving home palliative care for advanced cancer. The intervention group (n = 41) listened to pre-recorded, self-chosen music for 30 min/day for seven consecutive days, while the control group (n = 41) listened to a recording of basic therapeutic education at the same frequency. The degree of burden was assessed by the Caregiver Strain Index (CSI), calculated before and after the seven-day intervention. According to this measure, caregiver burden fell significantly in the intervention group (CSI change: -0.56, SD 2.16) but increased in the control group (CSI change: +0.68, SD 1.47), with a significant group x moment interaction F(1, 80) = 9.30, p = 0.003, η²_p = 0.11. These results suggest that, in the short term at least, the use of therapy based on self-chosen music alleviates the burden on family caregivers of palliative cancer patients. Moreover, this therapy is easy to administer at home and does not present any problems in practice.

Auditory Cueing of Pre-Learned Skills and Role of Subcortical Information Processing to Maximize Rehabilitative Outcomes Bridging Science and Music-Based Interventions

Auditory entrainment of motor function is a fundamental tool in neurologic music therapy with many studies demonstrating improved clinical outcomes in people with movement disorders such as Parkinson's Disease, acquired brain injuries, and stroke. However, the specific mechanisms of action within neural networks and cortical regions that are aroused and influenced by auditory entrainment still need to be identified. This paper draws from some contemporary neuroscience studies that indicate the role of the cerebellum and other subcortical systems in modulating pre-learned motor schema and proposes a possible rationale for the success of auditory entrainment within neurologic music therapy.

Underlying Music Mechanisms Influencing the Neurology of Pain: An Integrative Model

Pain is often debilitating, and is associated with many pathologies, as either a cause or consequence. Pharmacological interventions, such as opioids, to manage pain may lead to potential problems, such as addiction. When pain is controlled and managed, it can prevent negative associated outcomes affiliated with disease. Music is a low-cost option that shows promise in the management of painful circumstances. Music therapy has provided potent options for pain relief across a variety of ages and populations. As a nonpharmacological alternative or complement lacking side effects, music interventions are growing in clinical application and research protocols. This article considers the neurological implications of varying kinds of pain to provide working considerations that preempt the use of music and music-therapy applications in treating pain.

Review of Perioperative Music Medicine: Mechanisms of Pain and Stress Reduction Around Surgery

Clinical-experimental considerations and an approach to understanding the autonomic basis of improved surgical outcomes using Perioperative Music Medicine (PMM) are reviewed. Combined surgical, psycho-physiological, and experimental perspectives on Music Medicine (MM) and its relationship to autonomic nervous system (ANS) function are discussed. Considerations are given to the inter-related perioperative effects of MM on ANS, pain, and underlying vagal and other neural circuits involved in emotional regulation and dysregulation. Many surgical procedures are associated with significant pain, which is routinely treated with post-operative opioid medications, which cause detrimental side effects and delay recovery. Surgical trauma shifts the sympathetic ANS to a sustained activation impairing physiological homeostasis and causing psychological stress, as well as metabolic and immune dysfunction that contribute to postoperative mortality and morbidity. In this article, we propose a plan to operationalize the study of mechanisms mediating the effects of MM in perioperative settings of orthopedic surgery. These studies will be critical for the implementation of PMM as a routine clinical practice and to determine the potential limitations of MM in specific cohorts of patients and how to improve the treatment.

[What happens if algorithmic music meets medicine]

Since ancient times there has been recognition of music's therapeutic powers, inherent in the properties of sound and its effects on human beings at a psychophysical level. Literature showed the development of therapeutic applications of music in numerous clinical settings. Music-listening itself can qualify as an effective therapeutic means within clinical contexts. Numerous studies document the potentialities of this practice. Whilst, it appears to be difficult to study the phenomenon of music from a scientific point of view, it may be possible to attempt moving music closer to science. Algorithms are of help in this process. Only recently has algorithmic music been used within the context of composing music with therapeutic aims helping to create songs for precise therapeutic aims: music characteristics can be altered and re-modelled and, above all, simplified. It was exactly this intent that recently brought into being an algorithm, Melomics-Health, which composes music with a "therapeutic" logic. Melomics-Health allows us to study the effect of specific musical parameters and structures on individuals (including neuro-scientific aspects) with the possibility to correlate effectiveness and efficiency to those precise musical aspects and to re-model the latter based on these findings. The use of algorithms applied to music as therapy constitutes a new starting point, an attempt to bring art and science closer together, to increase awareness and effectiveness in the use of music in therapeutic contexts; a new perspective integrating art, science and technology in the service of medicine, in clinical work and research.

Acceptability and Feasibility of Perioperative Music Listening: A Rapid Qualitative Inquiry Approach

Perioperative music decreases pain, anxiety, and analgesia requirements while increasing patient satisfaction. We investigated the acceptability of perioperative music at a women's and children's hospital in Singapore, seeking to uncover barriers and facilitators to implementation in routine practice over a 12-week period. We used an undergraduate-led Rapid Qualitative Inquiry approach that includes data collection from multiple sources, iterative analysis, and additional data collection when necessary. Participants consisted of anesthesiologists and nurses working in the preoperative area, operating room, and postoperative recovery areas. In Stage 1, nurses and anesthesiologists answered a survey assessing attitudes and knowledge about perioperative music and attended a presentation introducing the intervention. In Stage 2, the results of the Stage 1 survey were disclosed, and nurses and anesthesiologists completed a second survey (Stage 1 survey questions with an additional query about implementation). Twenty-nine nurses were interviewed with semi-structured questions on barriers and facilitators to implementation. In Stage 3, nurses retook the Stage 2 survey after one month of implementation. The implementation of perioperative music was both acceptable and feasible in Singapore. The nurses' and anesthesiologists' acceptability increased over time with mostly positive qualitative feedback. Implementation barriers, including patient interest, timing of patient turnover, and added staff workload, appeared minor and could potentially be overcome by utilizing the intervention in the preoperative instead of postoperative area, deploying music in operating rooms with slower turnover, and evenly distributing staff workload. Local implementation stakeholders may make additional recommendations for scaling-up perioperative music interventions to fit other workflows while improving the patient experience.

The Expanding Scope, Inclusivity, and Integration of Music in Healthcare: Recent Developments, Research Illustration, and Future Direction

This paper is in three sections. Section One presents a historical overview of international initiatives that have expanded the role of music in healthcare, from the initial formalization of music therapy to its more research-based rehabilitation focus to recent decades that have seen an increasing role for professional and community musicians, paraprofessional music services, music-oriented service organizations, and a very large increase in medical funding for music effects. "Music Care" is a particular and comprehensive concept promoted by the Room 217 Foundation in Canada, featuring an inclusive and integrated approach to optimizing the use of music in healthcare settings. It is part of an expanding landscape of global practices and policies where music is used to address specific issues of care. Section Two is provided as an illustration of the growing scope of the concept of using music in healthcare. It reports on a multi-year project that engaged 24 long-term care homes in conducting individualized action research projects using the fundamental approach of "Music Care", empowering all caregivers, formal and informal, musicians and non-musicians, to use music to improve quality of life and care. Section Two presents only high-level results of the study focused on using music care to reduce resident isolation and loneliness. Section Three draws on the results from the study reported in Section Two to inform the potential and path to the future of music optimization in any healthcare setting.

Music versus midazolam during preoperative nerve block placements: a prospective randomized controlled study

BACKGROUND AND OBJECTIVES

Music medicine is a non-pharmacologic intervention that is virtually harm-free, relatively inexpensive and has been shown to significantly decrease preoperative anxiety. In this study we aim to compare the use of music to midazolam as a preoperative anxiolytic prior to the administration of an ultrasound-guided single-injection peripheral nerve block.

METHODS

In this randomized controlled study we compared the anxiolytic effects of intravenous midazolam (1-2 mg) with noise-canceling headphone-delivered music medicine. All patients received a preoperative ultrasound-guided single-injection peripheral nerve block indicated for a primary regional anesthetic or postoperative analgesia.

RESULTS

The change in the State Trait Anxiety Inventory-6 (STAI-6) anxiety scores from after to before the procedure were similar in both groups (music group -1.6 (SD 10.7); midazolam group -4.2 (SD 11); p=0.14; mean difference between groups -2.5 (95% CI -5.9 to 0.9), p=0.1). Patient satisfaction scores with their procedure experience were higher in the midazolam group (p=0.01); however, there were no differences in physician satisfaction scores of their procedure experience between groups (p=0.07). Both patient and physician perceptions on difficulties in communication were higher in the music group than in the midazolam group (p=0.005 and p=0.0007, respectively).

CONCLUSIONS

Music medicine may be offered as an alternative to midazolam administration prior to peripheral regional anesthesia. However, further studies are warranted to evaluate whether or not the type of music, as well as how it is delivered, offers advantages over midazolam that outweigh the increase in communication barriers.

CLINICAL TRIAL REGISTRY

Clinicaltrials.gov #NCT03069677.

Music Therapy and Other Music-Based Interventions in Pediatric Health Care: An Overview

Background: In pediatric health care, non-pharmacological interventions such as music therapy have promising potential to complement traditional medical treatment options in order to facilitate recovery and well-being. Music therapy and other music-based interventions are increasingly applied in the clinical treatment of children and adolescents in many countries world-wide. The purpose of this overview is to examine the evidence regarding the effectiveness of music therapy and other music-based interventions as applied in pediatric health care. Methods: Surveying recent literature and summarizing findings from systematic reviews, this overview covers selected fields of application in pediatric health care (autism spectrum disorder; disability; epilepsy; mental health; neonatal care; neurorehabilitation; pain, anxiety and stress in medical procedures; pediatric oncology and palliative care) and discusses the effectiveness of music interventions in these areas. Results: Findings show that there is a growing body of evidence regarding the beneficial effects of music therapy, music medicine, and other music-based interventions for children and adolescents, although more rigorous research is still needed. The highest quality of evidence for the positive effects of music therapy is available in the fields of autism spectrum disorder and neonatal care. Conclusions: Music therapy can be considered a safe and generally well-accepted intervention in pediatric health care to alleviate symptoms and improve quality of life. As an individualized intervention that is typically provided in a person-centered way, music therapy is usually easy to implement into clinical practices. However, it is important to note that to exploit the potential of music therapy in an optimal way, specialized academic and clinical training and careful selection of intervention techniques to fit the needs of the client are essential.

The Effects of Music on Pain: A Meta-Analysis

BACKGROUND

Numerous meta-analyses have been conducted on the topic of music and pain, with the latest comprehensive study published in 2006. Since that time, more than 70 randomized controlled trials (RCTs) have been published, necessitating a new and comprehensive review.

OBJECTIVE

The aim of this meta-analysis was to examine published RCT studies investigating the effect of music on pain.

METHODS

The present study included RCTs published between 1995 and 2014. Studies were obtained by searching 12 databases and hand-searching related journals and reference lists. Main outcomes were pain intensity, emotional distress from pain, vital signs, and amount of analgesic intake. Study quality was evaluated according to the Cochrane Collaboration guidelines.

RESULTS

Analysis of the 97 included studies revealed that music interventions had statistically significant effects in decreasing pain on 0-10 pain scales (MD = -1.13), other pain scales (SMD = -0.39), emotional distress from pain (MD = -10.83), anesthetic use (SMD = -0.56), opioid intake (SMD = -0.24), non-opioid intake (SMD = -0.54), heart rate (MD = -4.25), systolic blood pressure (MD = -3.34), diastolic blood pressure (MD = -1.18), and respiration rate (MD = -1.46). Subgroup and moderator analyses yielded additional clinically informative outcomes.

CONCLUSIONS

Considering all the possible benefits, music interventions may provide an effective complementary approach for the relief of acute, procedural, and cancer/chronic pain in the medical setting.

Live concerts reduce cancer inpatients' anxiety

In Italy a new experience of music medicine called "The Music Givers" is spreading among Oncology Units; it aims to organise weekly live concerts (length 45-60 min) followed by a buffet. Purpose of the present study is to evaluate the effect of the format of The Music Givers on cancer in-patients' anxiety. State-Trait Anxiety Inventory (STAI-Y) was administered to 111 in-patients before and after the concerts. After the concerts we observed a 3.87 point decrease in state anxiety (p < .001) and statistically significant differences in most of the domains assessed by STAI-Y. These results invite a reflection on the importance of offering to inpatients events such as live music concerts, in order to improve their psychological condition during hospitalisation.

Music preferences of mechanically ventilated patients participating in a randomized controlled trial

Mechanical ventilation (MV) is a life-saving measure and supportive modality utilized to treat patients experiencing respiratory failure. Patients experience pain, discomfort, and anxiety as a result of being mechanically ventilated. Music listening is a non-pharmacological intervention used to manage these psychophysiological symptoms associated with mechanical ventilation. The purpose of this secondary analysis was to examine music preferences of 107 MV patients enrolled in a randomized clinical trial that implemented a patient-directed music listening protocol to help manage the psychophysiological symptom of anxiety. Music data presented includes the music genres and instrumentation patients identified as their preferred music. Genres preferred include: classical, jazz, rock, country, and oldies. Instrumentation preferred include: piano, voice, guitar, music with nature sounds, and orchestral music. Analysis of three patients' preferred music received throughout the course of the study is illustrated to demonstrate the complexity of assessing MV patients and the need for an ongoing assessment process.

The effects of music therapy on vital signs, feeding, and sleep in premature infants

OBJECTIVES

Recorded music risks overstimulation in NICUs. The live elements of music such as rhythm, breath, and parent-preferred lullabies may affect physiologic function (eg, heart and respiratory rates, O2 saturation levels, and activity levels) and developmental function (eg, sleep, feeding behavior, and weight gain) in premature infants.

METHODS

A randomized clinical multisite trial of 272 premature infants aged ≥32 weeks with respiratory distress syndrome, clinical sepsis, and/or SGA (small for gestational age) served as their own controls in 11 NICUs. Infants received 3 interventions per week within a 2-week period, when data of physiologic and developmental domains were collected before, during, and after the interventions or no interventions and daily during a 2-week period.

RESULTS

Three live music interventions showed changes in heart rate interactive with time. Lower heart rates occurred during the lullaby (P < .001) and rhythm intervention (P = .04). Sucking behavior showed differences with rhythm sound interventions (P = .03). Entrained breath sounds rendered lower heart rates after the intervention (P = .04) and differences in sleep patterns (P < .001). Caloric intake (P = .01) and sucking behavior (P = .02) were higher with parent-preferred lullabies. Music decreased parental stress perception (P < .001).

CONCLUSIONS

The informed, intentional therapeutic use of live sound and parent-preferred lullabies applied by a certified music therapist can influence cardiac and respiratory function. Entrained with a premature infant's observed vital signs, sound and lullaby may improve feeding behaviors and sucking patterns and may increase prolonged periods of quiet-alert states. Parent-preferred lullabies, sung live, can enhance bonding, thus decreasing the stress parents associate with premature infant care.

Description of an Audio-Based Paced Respiration Intervention for Vasomotor Symptoms

Millions of women experience menopause-related hot flashes or flushes that may have a negative effect on their quality of life. Hormone therapy is an effective treatment, however, it may be contraindicated or unacceptable for some women based on previous health complications or an undesirable risk-benefit ratio. Side effects and the unacceptability of hormone therapy have created a need for behavioral interventions to reduce hot flashes. A variety of complex, multimodal behavioral, relaxation-based interventions have been studied with women (n = 88) and showed generally favorable results. However, currently extensive resource commitments reduce the translation of these interventions into standard care. Slow, deep breathing is a common component in most interventions and may be the active ingredient leading to reduced hot flashes. This article describes the content of an audio-based program designed to teach paced breathing to reduce hot flashes. Intervention content was based on skills training theory and music entrainment. The audio intervention provides an efficient way to deliver a breathing intervention that may be beneficial to other clinical populations.