Patient preferred live music with adult medical patients: A systematic review to determine implications for clinical practice and future research

Ten Reasons Why Neurologists Should Refer Patients With Alzheimer Dementia to Music Therapy

Background

Alzheimer dementia (AD) constitutes a major societal problem with devastating neuropsychiatric involvement. Pharmaceutical interventions carry a heightened risk of side effects; thus, nonpharmacological interventions such as music-based interventions (MBIs), including music therapy, are recommended.

Recent Findings

The 2023 Neurology release of the Music Based Intervention Toolkit for Brain Disorders of Aging showcased music's emerging role as an intervention to manage symptoms of various brain disorders while defining the building blocks of MBIs to guide research in the exploration of music's therapeutic potential.

Implications for Practice

This study extends beyond the research aspects of the MBI Toolkit to clinical applications by providing neurologists with a summary of MBIs, the MBI Toolkit, how board-certified music therapists (MT-BCs) administered music therapy is a unique MBI, and 10 reasons why they should make referrals to music therapy for their patients with AD.

Biological principles for music and mental health

Efforts to integrate music into healthcare systems and wellness practices are accelerating but the biological foundations supporting these initiatives remain underappreciated. As a result, music-based interventions are often sidelined in medicine. Here, I bring together advances in music research from neuroscience, psychology, and psychiatry to bridge music's specific foundations in human biology with its specific therapeutic applications. The framework I propose organizes the neurophysiological effects of music around four core elements of human musicality: tonality, rhythm, reward, and sociality. For each, I review key concepts, biological bases, and evidence of clinical benefits. Within this framework, I outline a strategy to increase music's impact on health based on standardizing treatments and their alignment with individual differences in responsivity to these musical elements. I propose that an integrated biological understanding of human musicality-describing each element's functional origins, development, phylogeny, and neural bases-is critical to advancing rational applications of music in mental health and wellness.

Effects of music therapy on mood, pain, and satisfaction in the neurologic inpatient setting

PURPOSE

Music therapy (MT) has been used in health care settings for a wide variety of treatment goals. Many inpatients with neurologic impairments struggle with low mood and pain for which MT may be a novel adjunct treatment. The aims of this study were to: (1) evaluate change in mood and pain following a single MT session; (2) explore the impact of an MT program on mood, pain and satisfaction from the perspective of the patient, family and staff.

MATERIALS AND METHODS

A mixed-methods study was conducted. Forty participants completed pre/post MT surveys evaluating mood, pain and satisfaction. Individual semi-structured interviews and focus groups were conducted with 14 MT program participants (inpatients), 5 family members of participants and 16 staff.

RESULTS

There was significant improvement in mood (p < 0.001) and decrease in pain (p < 0.05) from pre-to-post MT with 74% reporting being "very satisfied" with the session. "Benefits of MT" was the overarching theme of the qualitative data. Subthemes were emotional regulation, pain management, effects on self-concept, enjoyment, and social connectedness.

CONCLUSIONS

Improvements in mood and pain were reported from pre-to-post MT session and in interviews. Further evaluation of MT effectiveness against standard of care rehabilitation and cost implications is required.Implications for RehabilitationMusic therapy (MT) is delivered by accredited music therapists (MTAs) in health care settings, including rehabilitation units, as an individual, group or co-treatment therapy.MT can be used for a range of health outcomes, including the treatment of mood and pain, in addition to improving inpatient satisfaction.Early evidence using pre/post MT surveys suggests an improvement in mood and pain following a single therapy session.Qualitative data suggest overall benefit of offering MT services in addition to standard neurorehabilitation therapy, including improvements to emotional regulation, pain management, self-concept, enjoyment, and social connectedness.

Exploring Music Therapists' Experiences With and Perceptions About Copyrighted Music: A Thematic Analysis

Patient-preferred music is often copyrighted music; prior research, however, has paid scant attention to music therapists' understanding and use of copyrighted music. To fill a gap in the literature, this exploratory study sought to understand music therapists' experiences and perceptions about permissible therapeutic uses of copyrighted music. Semi-structured interviews were conducted with 18 board-certified music therapists working in the United States. Collectively, these participants had over 300 years of professional experience. The interview transcripts were analyzed using an inductive approach to thematic analysis. Five main themes were identified: (1) copyright concerns created a complex psychological burden; (2) therapeutic needs warranted use of copyrighted music; (3) perceptions varied on permissible therapeutic practices using copyrighted music; (4) varied sources informed an understanding of copyright law; and (5) copyright clarity was needed to reduce the psychological burden. These themes suggest that psychological stress was produced by copyright uncertainty coupled with attempts by participants to satisfy diverse interests and protect multiple stakeholders, including patients, employers, their profession, and the law. Our findings suggest that a lack of clarity about permissible uses of copyrighted music can complicate music therapists' decision-making about appropriate therapeutic interventions. Clarity on permissible therapeutic uses of music could yield benefits for music therapists, patients, and the community.

Active Music Therapy Following Acute Stroke: A Single-Arm Repeated Measures Study

Experiencing a stroke can lead to difficulties with emotion regulation and mood disorders like depression. It is well documented that poststroke depression (PSD) affects a third of all stroke survivors. Higher levels of depression and depressive symptoms are associated with less efficient use of rehabilitation services, poor functional outcomes, negative impacts on social participation, and increased mortality. Mood in the acute phases of stroke recovery may be a key factor influencing the depression trajectory with early depression predicting poor longitudinal outcomes. The purpose of the study was to examine the effect of one active music therapy (AMT) treatment on mood following a first-time ischemic stroke during acute hospitalization. Forty-four adults received AMT defined as music-making interventions that elicit and encourage active participation. The Faces Scale was used to assess mood immediately prior to and following the treatment. A significant change in mood was found following one treatment. Comment analysis indicated that participants viewed music therapy as a positive experience. Findings here support the use of brief AMT to provide early psychological support to stroke survivors. Continued investigation into the role of music therapy in early stroke recovery is recommended.

Pilot Study on Music in the Waiting Room of Outpatient Pain Clinics

BACKGROUND

This study explores live and recorded music listening in the outpatient pain clinic. There is evidence demonstrating the effectiveness of live and recorded music in a hospital setting but a comparison study of this kind has yet to be conducted.

METHODS

A multimethod survey study design was used. A questionnaire utilizing rating scales was self-administered across two outpatient pain clinic waiting rooms. Patients were included through convenience sampling. In one clinic, a playlist of recorded music curated by two of the authors was provided. In the second clinic, a music therapy student played live music using guitar, flute, and voice. The questionnaire gathered data on music's impact on pain and emotional states, as well as attitudes toward music in the waiting room. Quantitative data was analyzed using descriptive statistics and qualitative data, gathered in the questionnaires open ended question, was analyzed using thematic analysis.

RESULTS

The questionnaire was completed by 200 adult patients. Patients reported lowered levels of anxiety, stress, and pain in both clinics, as well as a shorter waiting time and more caring experience. Patients in the live music clinic reported that music lowered levels of stress, nervousness, agitation, and pain more than in the recorded music clinic.

CONCLUSIONS

Participants in this study identified that music is a useful tool in the pain clinic waiting room. This study contributes to evidence that music should be considered as a complimentary treatment for people living with pain and in the wider hospital setting. Additional research is warranted with a control group, pre- and posttesting, and studies of music in hospitals in a range of cultural contexts.

Copyright as a Barrier to Music Therapy Telehealth Interventions: Qualitative Interview Study

Background

Music therapy is a multifaceted discipline that harnesses the power of music to treat a wide range of patient populations. A therapist who plays music in a private room for a patient is not subject to copyright restrictions on public performances. However, in the wake of the COVID-19 pandemic, music therapy is no longer strictly confined to the face-to-face setting. This study explores music therapists’ perceptions of copyright law with respect to their ability to provide mediated services to their clients.

Objective

The objectives of our study were two-fold. The first was to investigate whether concerns about copyright law are hampering the diffusion of telehealth innovations, and the second was whether these concerns are causing music therapists to avoid therapeutically beneficial telehealth interventions.

Methods

Semistructured interviews were conducted with credentialed music therapists (n=18) in the United States between May 2020 and June 2020. With participants’ consent, we used video conference technology to record and transcribe the in-depth interviews. The median interview length was 45 (SD 16.37) minutes. This theoretically informed study employed thematic analysis of the interview data.

Results

The COVID-19 pandemic accelerated the adoption of telehealth interventions to facilitate therapy outside of private face-to-face environments: environments where music therapy practices are largely shielded from copyright infringement concerns. Five main themes emerged, including therapists’ uncertainty about permissible uses of music and therapists’ erring on the side of caution causing lost opportunities for care. Our interview data suggest music therapists have altered telehealth interventions in suboptimal ways to avoid copyright liability in a physically distanced environment.

Conclusions

Some music therapists “drag their feet” on offering therapeutically appropriate telehealth services to clients because of copyright concerns. Our findings suggest innovative mediated therapies were shied away from or abandoned. These findings offer a novel contribution to the public health literature by highlighting copyright law as an unexpected and unwelcome barrier to the diffusion of music therapy practices in technology-mediated settings.

Change Mechanisms in Patient-Preferred Live Music: An Exploratory Interpretivist Study

Although there is empirical support for patient-preferred live music (PPLM) in addressing affective states and pain for adults in medical settings, there is a lack of data regarding why PPLM might be effective. Identifying the underlying processes and events of change mechanisms within PPLM has the potential to improve education and clinical training, distinguish music therapy from other music interventions, and augment treatment outcomes for service users. The practitioner's expertise constitutes a component of evidence-based practice and could be used to identify change mechanisms that result in PPLM being effective. Therefore, the purpose of this exploratory interpretivist study was to understand practitioners' perceptions of PPLM change mechanisms for adults in medical settings. I conducted in-depth individual semi-structured interviews with 10 practitioners who had provided protocol-based PPLM in adult medical settings as a component of published research projects. Incorporating member checking and trustworthiness, I used an inductive approach to thematic analysis to analyze data. I identified 3 major themes: Choices within PPLM, Music-based aspects of PPLM, and Positive outcomes resultant of PPLM. These themes were supported by 17 subthemes. The subthemes helped to explain relationships between results and I developed a visual model to conceptualize PPLM change mechanisms. While previous objectivist literature has found PPLM to be an effective intervention for adults in medical settings, the results of the current study provide an evidence-based and practitioner-centric approach to PPLM change mechanisms. Implications for clinical practice, limitations of the study, and suggestions for future research are provided.

Feasibility of Patient-Created Orff Chant as a Music-Based Intervention in Supportive Cancer Care

A cancer diagnosis and subsequent treatment can produce distress symptoms, including pain, anxiety, fatigue, and altered mood. These symptoms can have a negative psychological and physiological impact on patients. Patients may need to engage in supportive care with opportunities for emotional responses associated with the disease and chemotherapy treatment to ameliorate distress symptoms. The purpose of the current study was to assess the feasibility of 2 music-based interventions, 1 traditional and 1 novel, and explore the preliminary efficacy of these interventions as supportive care of cancer patients in outpatient treatment rooms. Supportive care options were: standard care (control), patient-selected singing with accompaniment (traditional), and patient-created chant using the Orff process (novel). Distress outcomes measured were: pain and fatigue using a 0-10 numerical rating scale, the State-Trait Anxiety Inventory (state form), and the Profile of Mood States 2 Short Form (for mood and fatigue). After obtaining consent, participants engaged in a single-session of 1 of 3 conditions lasting approximately 30 min. Feasibility measures indicated that the traditional and novel interventions were appropriate for the setting. Results indicated that although not always statistically significant, there were positive changes in pain, fatigue, anxiety, and mood for the 2 music-based conditions over standard care. Conclusions indicate the patient-selected condition was more impactful for pain, anxiety, and mood, while the patient-created chant using the Orff process was more impactful for fatigue. These conclusions might be clinically relevant for therapists pending cancer-related symptoms present during the assessment.

It’s...Complicated: A Theoretical Model of Music-Induced Harm

While literature exists supporting the use of music for health promotion, scholars have also noted the potential for music-induced harm and other maladaptive effects of music. Harm is a multifaceted construct that can include affective, behavioral, cognitive, identity, interpersonal, physical, and spiritual aspects. As music also represents a multifaceted experience, the relationship between music and harm is complex and can include numerous contextual-, deliverer-, music-, and recipient-based factors. Music-induced harm (MIH) also needs to be clearly defined to understand and protect against it. Therefore, the purpose of this article was to explore the numerous factors influencing how music can result in harm and develop a theoretical model that could be used to inform safe music practices. Drawing from existing models of emotional responses to music, music intervention reporting guidelines, therapeutic functions of music, and holistic wellness, we explored how the interplay between the deliverer, music, and recipient can result in various types of MIH in diverse contexts. We then developed the MIH model to integrate these factors and connect the model with the existing literature. The MIH model highlights the relevance of academic and clinical training, credentialing, occupational regulation, continuing education, and professional organizations that provide accredited curricular oversight to protect people from MIH. Implications for clinical application, limitations, and suggestions for future research are provided.

Standardizing music characteristics for the management of pain: A systematic review and meta-analysis of clinical trials

PURPOSE

To evaluate if music characteristics like tempo, harmony, melody, instrumentation, volume, and pitch, as defined by musical theory, are described in randomized clinical trials (RCTs) evaluating the effects of music-listening on the quantified pain perception of adults, and if these characteristics influence music's overall therapeutic effect.

METHODS

A systematic review and meta-analysis of RCTs evaluating music-listening for pain management on adults was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. The databases Pubmed, Scopus, SCIELO, SpringerLink, Global Health Library, Cochrane, EMBASE, and LILACS were searched. Studies published between 2004 and 2017 with quantified measurements of pain were included. Quality was evaluated using the Scottish Intercollegiate Guidelines Network methodology checklist for RCT, and effect sizes were reported with standardized mean differences.

RESULTS

A total of 85 studies were included for qualitative analysis but only 56.47% described at least one music characteristic. Overall meta-analysis found a significant effect, with high heterogeneity, of music for pain management (SMD -0.59, I2 = 85%). Only instrumentation characteristics (lack of lyrics, of percussion or of nature sounds), and 60-80 bpm tempo were described sufficiently for analysis. All three instrumentation characteristics had significant effects, but only the lack of lyrics showed an acceptable heterogeneity.

CONCLUSIONS

Results show that music without lyrics is effective for the management of pain. Due to insufficient data, no ideal music characteristics for the management of pain were identified suggesting that music, as an intervention, needs standardization through an objective language such as that of music theory.

Reporting quality of music intervention research in healthcare: A systematic review

INTRODUCTION

Concomitant with the growth of music intervention research, are concerns about inadequate intervention reporting and inconsistent terminology, which limits validity, replicability, and clinical application of findings.

OBJECTIVE

Examine reporting quality of music intervention research, in chronic and acute medical settings, using the Checklist for Reporting Music-based Interventions. In addition, describe patient populations and primary outcomes, intervention content and corresponding interventionist qualifications, and terminology.

METHODS

Searching MEDLINE, PubMed, CINAHL, HealthSTAR, and PsycINFO we identified articles meeting inclusion/exclusion criteria for a five-year period (2010-2015) and extracted relevant data. Coded material included reporting quality across seven areas (theory, content, delivery schedule, interventionist qualifications, treatment fidelity, setting, unit of delivery), author/journal information, patient population/outcomes, and terminology.

RESULTS

Of 860 articles, 187 met review criteria (128 experimental; 59 quasi-experimental), with 121 publishing journals, and authors from 31 countries. Overall reporting quality was poor with <50% providing information for four of the seven checklist components (theory, interventionist qualifications, treatment fidelity, setting). Intervention content reporting was also poor with <50% providing information about the music used, decibel levels/volume controls, or materials. Credentialed music therapists and registered nurses delivered most interventions, with clear differences in content and delivery. Terminology was varied and inconsistent.

CONCLUSIONS

Problems with reporting quality impedes meaningful interpretation and cross-study comparisons. Inconsistent and misapplied terminology also create barriers to interprofessional communication and translation of findings to patient care. Improved reporting quality and creation of shared language will advance scientific rigor and clinical relevance of music intervention research.