A clinical randomized controlled trial of music therapy and progressive muscle relaxation training in female breast cancer patients after radical mastectomy: Results on depression, anxiety and length of hospital stay

Effectiveness of nurse-led progressive muscle relaxation on stress, anxiety, and depression in parents of adolescents with mental illness: A randomized controlled trial

BACKGROUND

Prevention of depression, stress, and anxiety is a serious concern of the World Health Organization and has been a research topic over the last decades. There is a close association found between children's mental health problems and parental stress, valid for biological and foster families. Evidence suggests that parents with children with disabilities are more stressed, depressed, or anxious than parents who do not have such children. In addition, the progressive muscle relaxation technique (PMR) is the easiest to learn and administer among the relaxation methods available for lowering stress, anxiety, and depression.

MATERIALS AND METHODS

A randomized clinical trial (RCT) was adopted with an equivalent group pre-test and post-test design. The experimental group (n = 31) received ten sessions of Jacobson PMR, and the control group (n = 30) received treatment as usual (TAU). Data analysis: The researcher used frequency, percentage, mean, standard deviation, median, and interquartile range to describe the study subjects' demographic profile and clinical profile. Mann-Whitney U test, Kruskal-Wallis H test, and Spearman's Rho were used to find an association between socio-demographic and clinical variables in parents' stress, anxiety, and depression levels. Further, Spearman's Rho was used to find a correlation between stress anxiety and depression. In addition, the Chi-square test and Fisher's exact test were used to compare control and experimental groups with important socio-demographic and clinical variables. Further, Fridman's analysis of variance (ANOVA) was used to assess PMR's effectiveness on group stress, anxiety, and depression. Finally, the Mann-Whitney U test was used to compare stress, anxiety, and depression levels between groups.

RESULTS

Analysis revealed clinically and statistically significant (P < 0.05) reductions in the stress and anxiety scores of the parents after five sessions of the PMR technique. In addition, findings reveal that there is a statistically significant reduction (P < 0.001) in depression, anxiety, and stress scores after ten sessions of the PMR program among parents of adolescents with mental illness.

CONCLUSION

The PMR program adopted in this study was highly effective in reducing stress, anxiety, and depression among parents of adolescents with mental illness.

Prospective trajectories of depression predict mortality in cancer patients

An ever-growing body of empirical evidence has demonstrated the relationship between depression and cancer. The objective of this study was to examine whether depression trajectories predict mortality risk above and beyond demographics and other general health-related factors. Participants (n = 2,345) were a part of the Health and Retirement Study. The sample consisted of patients who were assessed once before their cancer diagnosis and thrice after. Depressive symptoms and general health-related factors were based on self-reports. Mortality risk was determined based on whether the patient was alive or not at respective time points. Latent Growth Mixture Modeling was performed to map trajectories of depression, assess differences in trajectories based on demographics and general health-related factors, and predict mortality risk. Four trajectories of depression symptoms emerged: resilient (69.7%), emerging (13.5%), recovery (9.5%), and chronic (7.2%). Overall, females, fewer years of education, higher functional impairment at baseline, and high mortality risk characterized the emerging, recovery, and chronic trajectories. In comparison to the resilient trajectory, mortality risk was highest for the emerging trajectory and accounted for more than half of the deaths recorded for the participants in emerging trajectory. Mortality risk was also significantly elevated, although to a lesser degree, for the recovery and chronic trajectories. The data highlights clinically relevant information about the depression-cancer association that can have useful implications towards cancer treatment, recovery, and public health.

An Integrated Care Approach to Improve Well-Being in Breast Cancer Patients

BACKGROUND

Breast cancer (BC) treatment has recently been revolutionized by the introduction of newer targeted agents, that helped tailoring therapies around the single patient. Along with increased survival rates, a careful evaluation of diet, lifestyle habits, physical activity, emotional and psychological experiences linked to the treatment journey, is now mandatory. However, a true proposal for an omnicomprehensive and "integrative" approach is still lacking in literature.

METHODS

A scientific board of internationally recognized specialists throughout different disciplines designed a shared proposal of holistic approach for BC patients.

RESULTS

A narrative review, containing information on BC treatment, endocrinological and diet aspects, physical activity, rehabilitation, integrative medicine, and digital narrative medicine, was developed.

CONCLUSIONS

In the context of a patient-centered care, BC treatment cannot be separated from a patient's long-term follow-up and care, and an organized interdisciplinary collaboration is the future in this disease's cure, to make sure that our patients will live longer and better.

TRIAL REGISTRATION

NCT05893368: New Model for Integrating Person-based Care (PbC) in the Treatment of Advanced HER2-negative Breast Cancer (PERGIQUAL). Registration date: 29th May 2023.

The Effect of Music on Anxiety, Pain Levels, and Physiological Parameters in Women Undergoing Brachytherapy: A Randomized Controlled Trial

OBJECTIVES

This study was conducted to investigate the effect of music on anxiety, pain, and physiologic parameters in women undergoing brachytherapy.

DATA SOURCES

The study was conducted with a randomized controlled design between June and December 2022. Music intervention was practiced to the patients in the experimental group (n = 30), while no practice was given to the control group (n = 25). In the study, the data were collected using the Descriptive Information Form, Hospital Anxiety and Depression Scale, visual analog scale, and vital signs (temperature, pulse rate, blood pressure, respiratory rate, SpO2) recording form. Intergroup and intragroup averages were evaluated by the mixed-design analysis of variance. Variables with pre-post intervention designs were evaluated with the one-way analysis of covariance. There was no significant difference in physiological parameters between the groups (P > . 05). Although the mean anxiety scores decreased in the music group and increased in the control group, there was no statistically significant difference (P > .05). A significant difference was found in the pain levels of the patients in repeated measurements made in intragroup evaluations (P < .001). The depression mean of the music intervention group was significantly lower than the control group (P ≤ .05).

CONCLUSION

It was concluded that the music played during the brachytherapy process had positive effects on feeling less pain and management of depressive symptoms but did not affect anxiety and physiological parameters. Since each patient is different, the effects of music therapy can vary individually.

IMPLICATIONS FOR NURSING PRACTICE

Nurses should apply different strategies to investigate session frequencies and durations for different patient groups and treatment stages in cancer care.

Effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress and quality of life among women with cancer receiving chemotherapy: A pilot randomized controlled trial

Beneficial effects of music intervention and progressive muscle relaxation alone on psychological issues were reported, however, studies evaluating their combined effects are limited. This study aimed to investigate the feasibility, acceptability and preliminary effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress, and quality of life among breast and gynaecological cancer patients receiving chemotherapy.

METHODS

The study was carried out from March to May 2022 in an oncology hospital in Vietnam. A single-blinded randomized controlled trial was conducted among 24 women with breast and gynaecological cancer undergoing chemotherapy. The intervention group (n = 12) received a face-to-face training program about music listening and progressive muscle relaxation skills. They then performed the self-practice daily at home for three weeks. The control group (n = 12) received standard care, including health assessment, regular health advice and nutrition consultation. Ten participants in the intervention group were interviewed with open-ended questions to explore the acceptability of the intervention. Anxiety, depression and stress were measured using the Depression Anxiety Stress Scale, while The Functional Assessment of Cancer Therapy-General was used to evaluate the quality of life. The outcome measurements were collected at baseline (T0), post-intervention (3rd week, T1) and follow-up (6th week, T2). Appropriate descriptive statistics were used to depict the outcome measures across study time points.

RESULTS

A total of 24 patients were eligible to join, and 20 of them completed the study. Greater reductions in anxiety, depression and stress were observed in the intervention group than in the control group at T1 and T2. Greater improvements on quality of life were found in the intervention group than control group at T1 and T2 with respect to T0. The content analysis supported the acceptable intervention of participants through two themes, perceived beneficial effects on psychological and physical health and willingness to keep practising in the future.

CONCLUSIONS

Implementing music intervention combined with progressive muscle relaxation is feasible and had a trend in reducing anxiety, depression and stress levels. A larger scale randomized controlled trial is needed to confirm the effect of the intervention on outcomes.

TRIAL REGISTRATION

This trial was registered on ClinicalTrials.gov with ID: NCT05262621.

Soothe the savage beast: Patient perceptions of the benefits of music therapy in an inpatient rehabilitation facility

INTRODUCTION

Despite the known benefits of music therapy (MT) and its potential applications in an inpatient rehabilitation facility (IRF), there remains a lack of access to MT in a significant number of hospitals in the United States. Exploration of stakeholder (e.g., physician, therapist, and patient) perceptions as a potential barrier to uptake has been limited.

OBJECTIVE

To assess the favorability of patients admitted to an IRF toward MT through the domains of knowledge, attitudes, and beliefs. We hypothesized that patient domain scores would reflect a favorable perception of MT across rehabilitation diagnoses.

DESIGN

Descriptive and cross-sectional survey.

SETTING

Free-standing, acute IRF.

PATIENTS

A total of 119 English-speaking, adult patients across three impairment categories (general rehabilitation, spinal cord injury, and brain injury) were recruited over a 3-month period and during each patient's hospital stay.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

A modified version of the Global Complementary/Alternative and Music Therapy Assessment (GCAMTA) measured the domains of knowledge, attitudes, and beliefs.

RESULTS

An overall response rate of 79.3% was achieved. Most patients (n = 95; 79.8%) scored in either the favorable or neutral ranges of the instrument. Age correlated negatively (r = -0.193, p < .05) with total score, whereas highest level of education correlated positively (rs  = 0.222, p < .05). There were no significant differences in scores across impairment categories (V = 0.068, p = .232). Knowledge scores, controlling for education and age, predicted 30.4% of the variance in attitudes and beliefs scores (R2  = 0.304, p < .001).

CONCLUSIONS

It is unlikely that patient perceptions are a barrier to MT uptake. Younger, more educated patients have higher knowledge, attitudes, and beliefs about MT. Increasing patient knowledge about MT may improve their attitudes and beliefs, thereby further optimizing this therapy for widespread use.

Significance of music therapy in treating depression and anxiety disorders among people with cancer

Globally, cancer cases and mortality have recently escalated and have attracted global concern. The clinical diagnosis and manifestation of cancer can result in significant mental health issues like depression and anxiety disorders. The tendency of people with cancer to suffer from psychological disorders such as anxiety and depression is usually high. A significant number of deaths related to cancer may likely not be from the killer disease but from psychological disorders associated with the illness. The utilization of music as a remedial approach to healing mental disorders cannot be overstated. Thus, identifying the impacts of music therapy in dealing with depression and anxiety disorders among people with cancer is relevant, as the majority of methods used in treating cancer have some side effects which may trigger psychological disorders in cancer patients. Ultimately, this study explored the significance of music therapy in treating depression and anxiety disorders among people with cancer. To achieve the aim of this study, the authors employed a narrative literature review to investigate the significance of music therapy in addressing depression and anxiety disorders among people with cancer. The type of literature review employed in this study is to provide an understanding of the selected research papers. The review found that music therapy significantly reduces depression and anxiety disorders among breast cancer, lung cancer, prostate cancer, and colorectal cancer patients. It is needful for healthcare providers to incorporate music therapy interventions while treating people with cancer. This will help reduce cancer deaths resulting from psychological disorders rather than the killer disease, cancer. However, the standardized procedures and evaluation criteria for applying music-based intervention strategies in oncology medicine still need to be further established and improved.

Acute Relaxation Response Induced by Tibetan Singing Bowl Sounds: A Randomized Controlled Trial

The prevalence of anxiety has increased dramatically due to COVID-19, so effective preventive interventions are welcome. The main objective of our study was to compare the acute relaxation response (RR) induced by Tibetan singing bowl (TSB) sound-based treatment against progressive muscle relaxation (PMR) and a control waiting list group (CWL) in a single treatment session in an adult nonclinical anxious population. In this cross-sectional randomized control trial, 50 participants selected based on high state anxiety were randomly assigned to one of the experimental groups. Pre/post self-reported anxiety, electroencephalographic activity (EEG), and heart rate variability (HRV) were recorded at baseline (T1), minute 15 (T2), minute 30 (T3), and minute 45 (T4). The TSB group showed significant reductions in alpha power (from T2 to T4) and increased HRV (from T3 to T4) compared with the PMR and CWL groups. Moreover, TSB and PMR both showed significant reductions in self-reported anxiety compared with CWL, with this effect being more evident in the TSB group. We concluded that a single session of TSB treatment was able to induce a more evident psychological/physiological relaxation response compared with PMR and CWL. TSB could be a relevant acute intervention in stressful situations or crisis intervention and while waiting for conventional interventions.

Psychological interventions for women with non-metastatic breast cancer

BACKGROUND

Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015.

OBJECTIVES

To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer.  SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles.

SELECTION CRITERIA

Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer.

DATA COLLECTION AND ANALYSIS

Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes.

MAIN RESULTS

We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months.  Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies.

AUTHORS' CONCLUSIONS

Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.

Music therapy effect on anxiety reduction among patients with cancer: A meta-analysis

Introduction

The study aimed to investigate the effect of music therapy on anxiety alleviation among cancer patients.

Methods

A comprehensive literature research was performed in four electronic databases (PubMed, Embase, Cochrane Library, and Web of Science). Fifteen randomized controlled trials (RCTs) were included. The risk of bias for the RCTs was evaluated by the Cochrane Risk of Bias tool. Anxiety levels were extracted to synthesize the combined effect by using meta-analysis. All analyses were performed using R version 4.0.4.

Results

In total, 15 RCTs met the inclusion criteria involving 1320 cancer patients (662 patients in the experimental group and 658 patients in the controlled group). The majority of interventions were performed with recorded music lasting for 15-60 minutes. Compared with standard care, music intervention had a moderate superiority of anxiety alleviation (SMD: -0.54, 95% CI: [-0.92, -0.16]).

Discussion

Music intervention could reduce cancer-related anxiety moderately. Nevertheless, the result should be interpreted with caution as high heterogeneity in this pooled study. Well-designed trials with higher quality were still warranted in the future.

The effect of music on pain and anxiety in patients receiving chemotherapy during COVID-19

OBJECTIVE

This research has been conducted to determine the effect of music on pain and anxiety levels of patients receiving chemotherapy during COVID-19.

METHODS

The research has been carried out in a real trial model with 92 adult patients (45 in the experimental group who received chemotherapy and 47 in the control group). The data have been collected by the researcher with Google Forms (using State and Trait Anxiety Inventory [STAI] and visual analogue scale [VAS]) through the links sent to the phones of participants on the day they received chemotherapy, between March 2020 and July 2020.

RESULTS

The mean scores obtained from the post-test STAI (53.11 ± 4.77) and VAS (3.44 ± 2.53) in the experimental group have been determined to statistically significantly decrease when compared to the pre-test measurement data (STAI: 54.26 ± 4.26; VAS: 4.22 ± 2.41) (p < 0.05). No statistically significant difference has been determined between pre-test and post-test mean scores of the patients in the control group.

CONCLUSION

It has been observed that music applications reduce the pain and anxiety levels of patients receiving chemotherapy during the COVID-19 process. It can be recommended to use music applications in the management of pain and anxiety symptoms.

Psychological Impact of Type of Breast Cancer Surgery: A National Cohort Study

Background

The present study assessed the impact of different types of breast surgery on rates of psychological disorders in breast cancer patients.

Methods

This nationwide cohort study, based on Korean Health Insurance Review and Assessment Service claims data, included 26,259 breast patients who underwent surgery from June 1, 2017, to December 31, 2018. Associations between the incidence of psychological disorders and variables were evaluated by time dependent Cox regression analyses.

Results

Of the 26,259 patients, 9394 (35.8%) underwent total mastectomy (TM) and 16,865 (64.2%) underwent partial mastectomy (PM); of the former, 4056 (43.2%) underwent breast reconstruction surgery (RS). A total of 4685 patients (17.84%) were newly diagnosed with psychological disorders after surgery. Multivariable analysis showed that axillary lymph node dissection was significantly associated with increased rates of overall psychological disorders (p < 0.0001), depression (p = 0.0462), anxiety (p < 0.0001) and insomnia (p < 0.0001). The rates of overall psychological disorders (p = 0.0002) and insomnia (p = 0.01) were significantly lower in patients who underwent TM than PM. RS tended to associated with reduced rates of overall psychological disorders in patients who underwent TM. Subgroup analysis showed that, compared with PM, RS after TM significantly associated with a reduced incidence of overall psychological disorders and insomnia in younger patients (< 50 years) and those who underwent sentinel lymph node biopsy.

Conclusion

In contrast to general belief, rates of overall psychological disorders and insomnia were lower in patients who underwent TM than PM. Moreover, RS after TM confers psychological benefit in younger patients with early stage breast cancer compared with PM.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00268-022-06585-y.

Benson Relaxation Technique Combined With Music Therapy for Fatigue, Anxiety, and Depression in Hemodialysis Patients: A Randomized Controlled Trial

This study aimed to investigate the effects of the Benson relaxation technique combined with music therapy on fatigue, anxiety, and depression levels of patients undergoing hemodialysis. This randomized controlled study was conducted with 61 patients (30 patients in the intervention group, 31 patients in the control group) in a province located in Turkey. This 8-week, randomized, clinical trial was carried out in 2 hemodialysis units. After the patients in both groups were informed about the study, the Piper Fatigue Scale and the Hospital Anxiety and Depression Scale were administered to the patients. All subdomain scores of the Piper Fatigue Scale in the intervention group were significantly lower at weeks 4, 8, and 10 than those of the control group (P < .05). The intervention group had significantly lower Anxiety subscale scores than those of the control group at week 10 (P < .05). Similarly, Depression subscale scores were significantly lower in the intervention group at weeks 8 and 10 than those in the control group (P < .05). The findings suggest that Benson relaxation technique combined with music therapy is an effective approach to manage fatigue, anxiety, and depression symptoms related to hemodialysis.

Effect of slow tempo music on markers of anxiety during cataract surgery: Randomized control trial

PURPOSE:

This study aims to objectively measure the effect of slow tempo music on various markers for anxiety.

MATERIALS AND METHODS:

This is a repeated measure randomized control trial of patients with age-related cataracts undergoing cataract extraction through phacoemulsification under local anesthesia. Patients were randomized into two groups: music group where a standardized piano music was played and control group. Salivary alpha-amylase (sAA) levels were measured at the beginning and at the end of surgery. Blood pressure and heart rate were also measured at 5 min before surgery and at four other standardized points during and after surgery. Visual Analog Scale for anxiety was also gauged: preoperatively, perioperatively, and 15 min postoperatively.

RESULTS:

Ninety-two patients were randomized equally to the music group and control group. Paired sample t-test showed a reduction in the level of sAA during surgery in the music group (P = 0.019). The odds ratio for a drop in sAA with music was 4.407 (P = 0.001). Lower systolic blood pressure was observed in the music group: at delivery of local anesthesia (P = 0.047), at first incision (P = 0.023), and during sculpting (P = 0.15). Similarly, diastolic blood pressure was lower at first incision (P = 0.019) in the music group. The visual analog scale for anxiety during surgery was found to be lower in the music group (P = 0.046).

CONCLUSION:

A slow tempo music during cataract surgery was shown to significantly reduce several indicators for anxiety at various points during cataract surgery.

The Effect of Progressive Relaxation Exercise on Physiological Parameters, Pain and Anxiety Levels of Patients Undergoing Colorectal Cancer Surgery: A Randomized Controlled Study

PURPOSE

This study aimed to determine the effect of progressive relaxation exercises on physiological parameters, pain, anxiety, and serum cortisol levels in patients undergoing colorectal cancer surgery.

DESIGN

This study is a randomized controlled study and has been registered at the Clinical Trial Registry Center (ID: NCT04731428).

METHODS

The study was conducted on 63 patients (experimental group = 31, control group = 32), who were scheduled for elective laparoscopic-colorectal surgery in the general surgery clinic of a university hospital in Istanbul between March 2018 and May 2019 and met the inclusion criteria. The patients in the experimental group were given progressive relaxation exercises for 15 minutes preoperatively and on postoperative days 1, 2, and 3 after breathing exercise training. The routine treatments and care process of the patients in the control group were maintained. The preoperative and postoperative pain and anxiety levels of both groups were evaluated. Blood pressure, heart rate and respiratory rate, oxygen saturation, and serum cortisol levels were measured at certain time intervals before and after the relaxation exercise.

FINDINGS

The patients in the experimental group had lower postoperative pain and anxiety levels and a lower rate of using opioid analgesic on postoperative day 0 compared to the control group. Progressive relaxation exercise had no statistically significant effect on serum cortisol or physiological parameters (P > .05).

CONCLUSIONS

Progressive relaxation exercise did not affect cortisol levels and vital signs but decreased pain and anxiety, and relatively increased tissue oxygenation, appearing an effective, safe, and practicable nursing intervention.

Perception of music and its cultural elements on acute post-mastectomy pain management among Nigerian women: an exploratory qualitative study

PURPOSE

This study aimed to explore the cultural elements of music in relation to pain management among women who have undergone mastectomy.

METHOD

An exploratory qualitative study with in-depth interviews. Using the purposive sampling technique, 20 participants were recruited for the study. The interviews were conducted face to face at the surgical out-patient clinic and female surgical ward. Data collection continued until data saturation was reached. The inductive approach was used to analyse the data, and the concepts were organised into themes. The consolidated criteria for reporting qualitative research guidelines (COREQ) were used to report this study.

RESULTS

The participants were between 28 and 83 years old and mostly diagnosed with stage III breast cancer. Three main themes emerged from the data analysis, including pain experienced after mastectomy, culture and music, and the perception of music for postoperative pain management after mastectomy.

CONCLUSION

In this study, the knowledge of participants and the utilisation of music for pain management remains inadequate, but the participants perceived that music could be useful for pain control after mastectomy when the language and religion of the patient and the meaningfulness of the music were considered when introducing and selecting the music. This study will help open and extend the conversation about the utilisation and cultural elements of music that can be used clinically for pain management after mastectomy.

Effect of Benson and progressive muscle relaxation techniques on sleep quality after coronary artery bypass graft: A randomized controlled trial

OBJECTIVE

This study aimed to investigate the effect of Benson relaxation (BR) and progressive muscle relaxation (PMR) techniques on the sleep quality of patients undergoing coronary artery bypass graft (CABG) surgery.

METHOD

This study was a three-arm, parallel, randomized controlled trial. 120 patients who underwent CABG surgery at two academic hospitals in an urban area of Iran were randomly allocated into three groups (40 per group): the BR, PMR, and control groups. Patients in the BR and the PMR groups performed relevant exercises twice a day for four weeks. Sleep quality was measured before and immediately after the intervention using Pittsburgh Sleep Quality Index.

RESULTS

Within-group comparison in the BR (t = 3.51, p = 0.001) and the PMR (t = 4.58, p < 0.001) group showed that the overall sleep quality showed a significant improvement after the intervention when compared to baseline. The between-group comparison showed that both the BR and PMR groups showed significant improvements in subjective sleep quality (F = 3.75, p = 0.02), habitual sleep efficiency (F = 4.81, p = 0.01), and overall sleep quality (F = 5.53, p = 005) when compared to the control group after the intervention. However, no statistically significant differences were identified among the three study groups in terms of sleep latency, sleep duration, sleep disturbances, sleeping medication, and daytime dysfunction after the intervention (p > 0.05).

CONCLUSION

The study showed that a four-week program of both PMR and BR can be effective in the overall improvement of sleep quality in patients following CABG. Further research is required to replicate the findings of the present study.

Music interventions for improving psychological and physical outcomes in people with cancer

BACKGROUND

This is an update of the review published on the Cochrane Library in 2016, Issue 8. Having cancer may result in extensive emotional, physical and social suffering. Music interventions have been used to alleviate symptoms and treatment side effects in people with cancer. This review includes music interventions defined as music therapy offered by trained music therapists, as well as music medicine, which was defined as listening to pre-recorded music offered by medical staff.

OBJECTIVES

To assess and compare the effects of music therapy and music medicine interventions for psychological and physical outcomes in people with cancer.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 3) in the Cochrane Library, MEDLINE via Ovid, Embase via Ovid, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, CAIRSS, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the RILM Abstracts of Music Literature, http://www.wfmt.info/Musictherapyworld/ and the National Research Register. We searched all databases, except for the last two, from their inception to April 2020; the other two are no longer functional, so we searched them until their termination date. We handsearched music therapy journals, reviewed reference lists and contacted experts. There was no language restriction.

SELECTION CRITERIA

We included all randomized and quasi-randomized controlled trials of music interventions for improving psychological and physical outcomes in adults and pediatric patients with cancer. We excluded patients undergoing biopsy and aspiration for diagnostic purposes.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted the data and assessed the risk of bias. Where possible, we presented results in meta-analyses using mean differences and standardized mean differences. We used post-test scores. In cases of significant baseline difference, we used change scores. We conducted separate meta-analyses for studies with adult participants and those with pediatric participants. Primary outcomes of interest included psychological outcomes and physical symptoms and secondary outcomes included physiological responses, physical functioning, anesthetic and analgesic intake, length of hospitalization, social and spiritual support, communication, and quality of life (QoL) . We used GRADE to assess the certainty of the evidence.

MAIN RESULTS

We identified 29 new trials for inclusion in this update. In total, the evidence of this review rests on 81 trials with a total of 5576 participants. Of the 81 trials, 74 trials included adult (N = 5306) and seven trials included pediatric (N = 270) oncology patients. We categorized 38 trials as music therapy trials and 43 as music medicine trials. The interventions were compared to standard care. Psychological outcomes The results suggest that music interventions may have a large anxiety-reducing effect in adults with cancer, with a reported average anxiety reduction of 7.73 units (17 studies, 1381 participants; 95% confidence interval (CI) -10.02 to -5.44; very low-certainty evidence) on the Spielberger State Anxiety Inventory scale (range 20 to 80; lower values reflect lower anxiety). Results also suggested a moderately strong, positive impact of music interventions on depression in adults (12 studies, 1021 participants; standardized mean difference (SMD): -0.41, 95% CI -0.67 to -0.15; very low-certainty evidence). We found no support for an effect of music interventions on mood (SMD 0.47, 95% CI -0.02 to 0.97; 5 studies, 236 participants; very low-certainty evidence). Music interventions may increase hope in adults with cancer, with a reported average increase of 3.19 units (95% CI 0.12 to 6.25) on the Herth Hope Index (range 12 to 48; higher scores reflect greater hope), but this finding was based on only two studies (N = 53 participants; very low-certainty evidence). Physical outcomes We found a moderate pain-reducing effect of music interventions (SMD -0.67, 95% CI -1.07 to -0.26; 12 studies, 632 adult participants; very low-certainty evidence). In addition, music interventions had a small treatment effect on fatigue (SMD -0.28, 95% CI -0.46 to -0.10; 10 studies, 498 adult participants; low-certainty evidence). The results suggest a large effect of music interventions on adult participants' QoL, but the results were highly inconsistent across studies, and the pooled effect size was accompanied by a large confidence interval (SMD 0.88, 95% CI -0.31 to 2.08; 7 studies, 573 participants; evidence is very uncertain). Removal of studies that used improper randomization methods resulted in a moderate effect size that was less heterogeneous (SMD 0.47, 95% CI 0.06 to 0.88, P = 0.02, I² = 56%). A small number of trials included pediatric oncology participants. The findings suggest that music interventions may reduce anxiety but this finding was based on only two studies (SMD -0.94, 95% CI -1.9 to 0.03; very low-certainty evidence). Due to the small number of studies, we could not draw conclusions regarding the effects of music interventions on mood, depression, QoL, fatigue or pain in pediatric participants with cancer. The majority of studies included in this review update presented a high risk of bias, and therefore the overall certainty of the evidence is low. For several outcomes (i.e. anxiety, depression, pain, fatigue, and QoL) the beneficial treatment effects were consistent across studies for music therapy interventions delivered by music therapists. In contrast, music medicine interventions resulted in inconsistent treatment effects across studies for these outcomes.

AUTHORS' CONCLUSIONS

This systematic review indicates that music interventions compared to standard care may have beneficial effects on anxiety, depression, hope, pain, and fatigue in adults with cancer. The results of two trials suggest that music interventions may have a beneficial effect on anxiety in children with cancer. Too few trials with pediatric participants were included to draw conclusions about the treatment benefits of music for other outcomes. For several outcomes, music therapy interventions delivered by a trained music therapist led to consistent results across studies and this was not the case for music medicine interventions. Moreover, evidence of effect was found for music therapy interventions for QoL and fatigue but not for music medicine interventions. Most trials were at high risk of bias and low or very low certainty of evidence; therefore, these results need to be interpreted with caution.

The effect of progressive relaxation exercises on treatment-related symptoms and self-efficacy in patients with lung cancer receiving chemotherapy

BACKGROUND

Patients with lung cancer receiving chemotherapy experience many symptoms, simultaneously or separately, that limit their daily living activities. This study aimed to determine the effect of progressive relaxation exercises on treatment-related symptoms and self-efficacy in patients with lung cancer receiving chemotherapy.

MATERIALS AND METHODS

This randomized controlled experimental study was conducted in a university hospital chemotherapy outpatient clinic in Turkey. The study sample consisted of 84 patients, randomly allocated to an experimental group (n = 42) and a control group (n = 42). The experimental group received applied training in progressive relaxation exercises using an MP3 player. The control group received only standard nursing interventions in the chemotherapy unit. Data were collected from patients using a personal information form, a telephone counseling follow-up form, the Memorial Symptom Assessment Scale and the Strategies Used by People to Promote Health Scale. Data collection tools were administered at four different times (at first interview and three times on the seventh day of the end of the chemotherapy cycle) and weekly telephone follow-ups were performed.

RESULTS

The symptom scores (frequency, severity and level of distress) significantly decreased in the experimental group, compared with the control group (p = 0.0001). Similarly, self-efficacy scores significantly improved in the experimental group (p = 0.001).

CONCLUSION

Progressive relaxation exercises were potentially effective in promoting symptom management and improving the level of self-efficacy.

Effect of instrumental music on anxiety and depression among hemodialysis patients: A randomized controlled trial

BACKGROUND

Hemodialysis patients suffer from mental disorders such as anxiety and depression. One of the known nonpharmacological methods to eliminate these disorders is music therapy. The present study aimed to investigate the effect of instrumental music on state depression and anxiety in hemodialysis patients.

MATERIALS AND METHODS

This study was a clinical trial. The population was hemodialysis patients in Hamedan in 2017 and 50 patients were selected and randomly divided into experimental and control groups. The duration each time of the instrumental music intervention for the experimental group was 3 weeks, 3 times a week for 20 min. Data were measured by beck depression inventory and SpeilBerger State-Trait Anxiety Inventory-Y1 before the intervention and immediately after the last intervention and analyzed using Yates correction, Chi-square test, Mann-Whitney U-test, independent t-test, and Wilcoxon test.

RESULTS

No significant difference between the intervention and control groups was observed before the study in terms of demographic variables (P > 0.05). In the intervention group, the mean and standard deviation of the depression score before the intervention was 8.99 ± 23.68 and after the intervention reached 7.54 ± 14.88, which shows that the variable was significant (P = 0.001); however, no significant difference was observed in the control group. In the intervention group, the mean of state anxiety before the intervention was 10.05 ± 53.76 and after the intervention reached 9.76 ± 42.48, which was statistically significant (P = 0.004), while no significant difference was observed in the control group.

CONCLUSION

The results indicate the positive effect of instrumental music on reducing anxiety and depression in hemodialysis patients. It is recommended that this therapy be used as a nursing method to reduce state anxiety and depression in hemodialysis patients.

Effect of progressive muscle relaxation on adaptation to old age and quality of life among older people in a nursing home: a randomized controlled trial

BACKGROUND

Changes occurring in the aging process, the presence of decline in physical and cognitive functions, and the limitations of participation in activities affect adaptation to old age and the quality of life. This study aimed to examine the effect of progressive muscle relaxation (PMR) exercises on adaptation to old age and the quality of life of older people.

METHODS

A randomized controlled trial design was used. The sample consisted of 45 older residents (21 intervention subjects, 24 controls) from a nursing home in a city of Turkey. The intervention group received progressive muscle-relaxation sessions twice weekly for 8 weeks, while the control group received routine care. All PMR exercises were led by the researcher. All participants were evaluated at baseline and after 8 weeks using the Assessment Scale of Adaptation Difficulty for the Elderly and the Nottingham Health Profile.

RESULTS

As a result of PMR exercises performed for 8 weeks, the Assessment Scale of Adaptation Difficulty for the Elderly and Nottingham Health Profile total mean scores of the intervention group improved significantly (P < 0.001). No statistically significant difference was observed, however, when comparing the intervention and control groups in terms of the level of adjustment to old age and health-related quality of life, either at baseline or following the intervention (P > 0.05).

CONCLUSION

The results of this study indicate that progressive muscle relaxation can increase adaptation to old age and the quality of life and of older people in a nursing home.

The Feasibility and Efficacy of Self-help Relaxation Exercise in Symptom Distress in Patients With Adult Acute Leukemia: A Pilot Randomized Controlled Trial

AIMS

To examine the feasibility and efficacy of self-help relaxation exercises in alleviating symptom distress in adult patients with acute leukemia (AL).

METHODS

A pilot randomized controlled trial was used. Thirty adult patients with AL who were hospitalized in a teaching hospital were enrolled and randomly divided into a wait-list control group or an intervention group. The intervention group received self-help relaxation exercise twice per day for 4 weeks. The feasibility indicators, patients' symptom distress were assessed by a blinded data collector.

RESULTS

Twenty-nine patients completed the study. The recruitment rate, retention rate, and adherence rate was 65.2%, 93.3%, and 98.2%, respectively. The intervention group had a significantly decreased distress score for pain symptoms (F_{1, 27} = 6.594, P = .016, the partial η² = 0.20, 90% confidence interval = 0.02-0.39).

CONCLUSIONS

Self-help relaxation exercises were feasible for the AL patients and significantly reduced their pain symptoms. Minor revision of the protocol for future definitive trials is needed.

Effects of non-pharmacological interventions on preoperative anxiety and postoperative pain in patients undergoing breast cancer surgery: A systematic review

BACKGROUND

Poorly managed preoperative anxiety and pain were reported to slow the postoperative recovery of breast cancer patients. Thus, proactive management using non-pharmacological interventions becomes essential for decreasing opioid or anxiolytics consumption, anxiety level, pain intensity, postoperative complications and improving patients' haemodynamics and satisfaction with care.

PURPOSE

To identify, analyse and synthesise the effects of non-pharmacological interventions on preoperative anxiety and acute postoperative pain in women undergoing breast cancer surgery.

METHOD

For this systematic review, 12 databases including Ovid Nursing, PsycInfo, British Nursing Index, CINAHL, Cochrane Library were searched to identify relevant studies. A total of 6,012 articles were identified from the search, six RCTs and one quasi-experimental study that met the inclusion criteria were included after eligibility screening. Narrative synthesis was used to analyse data extracted from the included articles. The review adhered to the PRISMA guideline.

RESULTS

Twelve outcomes were measured in the included studies, including preoperative anxiety, and acute postoperative pain. Music, massage, aromatherapy and acupuncture were the interventions delivered. Music had a small-to-large effect size and aromatherapy had a small effect size on reducing preoperative anxiety. Also, music had a large effect size whilst acupuncture had a medium effect size on minimising postoperative pain in women undergoing breast cancer surgery.

CONCLUSION

Music, aromatherapy and acupuncture appeared to be effective for reducing preoperative anxiety and postoperative pain in women undergoing breast cancer surgery. However, the small number of studies available for each intervention prevents conclusive statements about which the most effective method.

IMPLICATION FOR CLINICAL PRACTICE

A nursing care pathway that standardises the use of non-pharmacological interventions for the management of both preoperative anxiety and postoperative pain in breast cancer surgery patients should be developed.

Effectiveness of different music interventions on managing symptoms in cancer survivors: A meta-analysis

PURPOSE

Music-based interventions can provide non-pharmacological, low-cost treatment for symptoms. This meta-analysis's purpose is to examine music-based interventions' effectiveness on psychological distress symptoms (anxiety, stress, and depressive symptoms), aspects of positive psychology (benefit-finding and resilience), and quality of life (QoL).

METHODS

This meta-analysis was conducted according to PRISMA guidelines and meta-analytic methods suggested by Hedges and Olkin (1985). A systematic literature search between 2000 and 2020 was conducted using CINAHL, MEDLINE, PsycINFO, PubMed, and Web of Science databases. Studies and intervention characteristics were independently coded. The Quality Assessment Tool for Quantitative Studies, Cochrane Collaboration's Tool for Assessing Risk of Bias, Begg and Mazumdar's rank correlation, and Egger's regression test evaluated publication bias.

RESULTS

Twenty-nine of thirty-five eligible studies were included in the statistical analysis. The overall (g = 0.34, SE = 2.27, p < 0.05) and psychological distress symptoms sub-outcome type (g = 0.47, SE = 0.18, p < 0.05) models with moderator analyses were statistically significant.

CONCLUSIONS

Culturally appropriate music-based interventions conducted in the clinical setting that used passive listening with headphones, occurring ≥ 3-times a week over ≥ 2 months, positively impacted gynecology survivors undergoing chemotherapy and surgical treatments. Specifically, interventions that were ≥ 35-minutes, listening to folk or mixed-music positively impacted psychological distress symptoms, whereas new-age music negatively impacted psychological distress symptoms, positive psychology, and QoL outcomes. Future research should examine positive psychology characteristics (perceived levels of positive adjustment, change, and coping) and include larger cohorts with various cancer populations across all cancer survivorship continuum. Culturally appropriate interventions could lead to greater adherence, compliance, and clinical effectiveness and increase the findings' significance and generalizability.

Role of Arts Therapy in Patients with Breast and Gynecological Cancers: A Systematic Review and Meta-Analysis

Background: Women with breast and gynecological cancers often experience adverse symptoms such as anxiety, depression, pain, and fatigue. Objective: The purpose of this meta-analysis was to clarify the role of arts therapy (based on music, painting, and dance) in quality of life and reported symptoms among women with breast and gynecological cancers. Methods: Articles on arts therapy were retrieved from relevant electronic databases through to May 2020. The outcomes (quality of life and symptoms such as anxiety, depression, pain, and fatigue) were estimated according to standard or validated scales that assessed psychological status and activities of daily living. The effect sizes for arts therapy were combined to show the standardized mean difference (SMD) and corresponding confidence interval (CI), and a random-effects model was used for computation. Results: In total, 19 randomized controlled studies were included in this meta-analysis. The pooled SMDs for arts therapy were statistically significant for quality of life (0.58; 95% CI: 0.02-1.13; p = 0.04), anxiety (-1.10; 95% CI: -1.88 to -0.32), depression (-0.71; 95% CI: -1.19 to -0.23), pain (-1.01; 95% CI; -1.97 to -0.08), and fatigue (-0.59; 95% CI: -1.18 to -0.00). However, the summary SMDs for arts therapy was not significant for sleep disturbance, anger, vigor, tension, confusion, and stress. Conclusion: This meta-analysis shows that arts therapy has favorable effects on improving quality of life and depression among patients with breast and gynecological cancers. Arts therapy also has positive effects on improving anxiety, pain, and fatigue symptoms among patients with breast cancer. Further studies are required to confirm the effect of arts therapy on anxiety, pain, and fatigue in patients with gynecological cancer.

A Model of an Integrative Approach to Breast Cancer Patients

BACKGROUND

Breast cancer (BC) survivors have physical and psychological needs that require convincing responses by health care providers. The quality of life issue and clinical unmet needs are among the main reasons pushing a number of patients toward "natural" therapies that are often misleading and alternative to mainstream cancer care. Integrative Oncology (IO) tries to respond to many of those needs, by combining lifestyle counseling, body-mind activities, and complementary evidence-informed therapies with anticancer standard treatments.

METHODS

In our model at Fondazione Policlinico Gemelli (FPG), every woman diagnosed with a BC waiting for surgery or candidate to neoadjuvant chemotherapy undergoes a preliminary psycho-oncological distress evaluation and a brief lifestyle interview. Anthropometric measurements, body composition analysis, and individual levels of physical activity are recorded. Patients are given evidence based recommendations about the advisable diet and physical activity in a prehabilitation setting. A physician provides patients with information about integrative care plans to treat symptoms related to the disease or its treatments. Therapeutic approaches include acupuncture, mindfulness-based protocols, qigong, massage therapy, and classes of music/art therapy.

RESULTS

Between September 2018 and February 2020, the Center for Integrative Oncology at FPG has carried out 1249 lifestyle counseling sessions, 1780 acupuncture treatments, 1340 physiotherapy sessions, 3261 psycho-oncological consultations, 218 herbal medicine counseling sessions. Moreover, 90 BC patients completed the mindfulness based stress reduction (MBSR) protocol and 970 patients participated in qigong, art therapy, and music therapy classes.

CONCLUSIONS

Our integrative approach aims to achieve a person-centered medicine by improving symptoms management, adherence to oncological protocols, and eventually overall quality of life.

Voluntary Muscle Relaxation Can Mitigate Fatigue and Improve Countermovement Jump Performance

Pinto, BL and McGill, SM. Voluntary muscle relaxation can mitigate fatigue and improve countermovement jump performance. J Strength Cond Res 34(6): 1525-1529, 2020-When muscles contract, they create force and stiffness. Thus, muscle activation and relaxation must be strategically sequenced to coordinate and control movement, to enhance athletic variables such as speed and strength. However, research has favored investigation of muscle activation over relaxation. Athletes such as runners, swimmers, and boxers often shake their limbs to allow the muscle to oscillate freely, immediately before a bout. The purpose was to investigate whether shaking the lower limbs with the intention to voluntarily relax the muscles of the limb has an effect on countermovement jump (CMJ) performance. Subjects performed 10 maximal effort CMJs with 30 seconds of rest between each jump. During the rest period, they either performed the relaxation technique or control condition (standing still). Statistical significance was considered at p < 0.05. Subjects significantly improved jump height, compared with their first jump of the day, when performing the relaxation technique. To further investigate the mechanism of enhancement, subjects were grouped into responders and nonresponders. The responder group significantly decreased their jump height and concentric phase impulse (relative to the first jump) during the control condition compared with the nonresponder group, indicating fatigue. When performing the relaxation technique, the responder group improved their jump height and mitigated fatigue by significantly increasing their unweighting impulse and unweighting force. The relaxation technique improved CMJ performance, specifically in those that fatigue with consecutive bouts, by enhancing unweighting, that requires muscle relaxation, rather than propulsion that requires activation. This technique can be useful for training or competition.

Beneficios de la musicoterapia como opción integrativa en el tratamiento oncológico

Objetivo: Identificar la eficacia de los tratamientos musicoterapéuticos que aborden la sintomatología en pacientes con cáncer y que constaten algún tipo de beneficio psicológico, fisiológico, espiritual, social o intelectual. Método: Se realizó un análisis documental que supuso un estudio comparativo de evidencias científicas. Resultados: La musicoterapia minimiza los efectos fisiológicos de tratamientos específicos oncológicos como la quimioterapia, se usa como complemento de la morfina o el sufentanilo disminuyendo el dolor e influye en la vida emocional del paciente. Conclusiones: Es una disciplina que demuestra evidencias positivas en situaciones de tipo emocional reduciendo la depresión, la ansiedad y el estrés, ayudando en la relajación y mejorando el umbral del dolor, postulándose como una opción no-farmacológica que debiera conducir a una implantación cada vez más normalizada en los centros hospitalarios.

The effect of progressive muscle relaxation on the postpartum depression risk and general comfort levels in primiparas

In the postpartum period, mode of delivery, planned pregnancy, rapid changes in estrogen and progesterone hormone concentrations, quality of care, and environmental conditions affect the postpartum depression and comfort of the women. This study was conducted to evaluate the effect of progressive muscle relaxation (PMR) on the postpartum depression risk and general comfort levels in primiparas. A quasi-experimental design was used with pretest, post-test, and control group. The intervention and control groups consisted of 35 women each. PMR was applied to intervention group for 8 weeks. There was a statistically significant difference between Edinburgh Postnatal Depression Scale pretest and third follow-up scores of the intervention group (p < .05). There was a statistically significant difference between the intervention and control groups in the mean General Comfort Questionnaire scores at the first, second, and third follow-ups (p < .05). PMR may be effective on decreasing the postpartum depression risk and increasing general comfort. PMR could be administered through home visits to help women in postpartum period cope with their mental health problems after discharge.

Impact of a Music Intervention on Quality of Life in Breast Cancer Patients Undergoing Chemotherapy: A Randomized Clinical Trial

Background: Music can influence human behavior and may be used as a complementary therapy in health care. Objectives: To assess the effect of music interventions on symptoms, adverse events, and quality of life (QoL) of breast cancer patients undergoing chemotherapy (CT). Design: Nonblinded, randomized clinical trial. Women with breast cancer undergoing adjuvant CT were randomized into 2 groups—Group Music (GM) or Group Control (GC)—and followed during the first 3 cycles of treatment. Measurements: Sociodemographic data, WHOQOL-BREF, BDI-II, BAI, and Chemotherapy Toxicity Scale were assessed. Patients were evaluated after each session of the first 3 CT cycles. GM underwent a 30-minute musical intervention before CT. There was no intervention in the GC. Continuous data were analyzed by Student’s t test, and χ² test was used to compare qualitative variables. Results: Higher QoL scores on functional scales were observed for the GM in comparison to the GC after the first and third sessions of CT. Depression (P < .001) and anxiety scores (P < .001) and vomiting (P < .01) incidence were lower for the GM in the third session of CT. All the participants in the GM reported positive changes in life in the Subjective Impression of the Subject questionnaire, as well as improvement in fatigue and reduced stress levels. Conclusions: Improvements in QoL, anxiety, depression, and incidence of vomiting were associated with the music intervention, suggesting a positive effect of the music intervention on adverse events of cancer CT.

Music Therapy for Surgical Patients: Approach for Managing Pain and Anxiety

Music therapy (MT) in the inpatient setting has demonstrated positive outcomes worldwide. There was no protocol to utilize MT at this organization. The purpose of this project was to incorporate and evaluate MT as an adjunct intervention to address pain and anxiety in adult surgical step-down patients. Evidence-based practice change using the 8A's method integrated individualized MT provided by a board-certified music therapist to hospitalized patients over a 3-month period. Training was provided to 35 nurses and unit-assigned social worker on the utilization of MT for patients exhibiting pain or anxiety symptoms. The clinical social worker and staff nurses provided referrals for MT directly to the music therapist. Evaluation of MT included paired t-test and Wilcoxon signed-rank score comparisons of the numerical pain rating scale and the DSM-5 Patient Reported Outcome Measurement Information System Anxiety short form before and after the MT encounter. Among patients who received MT (n = 42), there was a statistically significant reduction in both pain (pre (Equation is included in full-text article.)= 6.07, post (Equation is included in full-text article.)= 3.45, t = 7.046, P = < .001) and anxiety (pre (Equation is included in full-text article.)= 56.47, post (Equation is included in full-text article.)= 46.52, t = 7.787, P ≤ .001). The reduction in pain (moderate to mild) and anxiety (mild to none) was also clinically significant.

The Effects of Laughter Therapy for the Relief of Employment-Stress in Korean Student Nurses by Assessing Psychological Stress Salivary Cortisol and Subjective Happiness

Objectives

Korean student nurses may be exposed to stress caused by their future employment (employment stress). The aim of this study was to investigate the effects of a Laughter Program on psychological stress, by assessing salivary cortisol and the subjective happiness of student nurses in order to relieve employment stress.

Methods

A quasi-experimental, non-equivalent, control-group, and pre-test/post-test was conducted in 4^th year student nurses (n = 48) from 2 universities in Korea at a time when participants’ final exams and job searches were simultaneously occurring. Physiological stress (salivary cortisol), and psychological stress measured using modified Cornell Medical Index questionnaire and the Subjective Happiness Scale were used to determine the effects of the program.

Results

The results of the study showed that the Laughter Program was effective in relieving employment stress and increasing the subjective well-being of student nurses. Psychological stress (p < 0.001), salivary cortisol levels (p < 0.001), and subjective happiness (p < 0.001) were statistically significantly improved after the intervention compared with before the Laughter Program.

Conclusion

This study is an effective evidence-based intervention to reduce student nurses employment stress and improve subjective happiness.

Prevention of depression in patients with cancer: A systematic review and meta-analysis of randomized controlled trials

Depression and depressive symptoms are prevalent in patients with cancer. Depression is underdiagnosed and therefore, patients often receive inadequate treatment for depression. We have assessed the evidence of primary prophylactic treatment for depression in patients with cancer. The systematic review was prospectively registered at PROSPERO and was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Five electronic databases were searched on the 31st of May 2018 and two independent reviewers screened the papers. Randomized controlled trials of adult patients with cancer treated prophylactically with an antidepressive intervention of any kind using validated assessment tools to measure depression or depressive symptoms were included. No language or publication year restrictions were applied. Seven out of eighteen studies reported a statistically significant prophylactic effect on depression. The studies were classified into three groups based on the type of intervention. The meta-analyses showed a significant difference in favour of pharmacotherapy (RR 0.34, 95% CI 0.18; 0.63), psychotherapy (SMD -0.23,95% CI -0.46; 0.00), and other interventions (SMD -0.17, 95% CI -0.31; -0.03). Only one study had overall low risk of bias and the rest had high risk of bias predominantly due to blinding, incomplete data, or allocation concealment. Preventive measures have been examined in patients with cancer, but no convincing evidence for any specific intervention is present. Depression in patients with cancer can be prevented and prophylactic treatment should be given during oncological treatment but further high quality studies testing safe interventions are still needed.

Effectiveness of music therapy and progressive muscle relaxation in reducing stress before exams and improving academic performance in Nursing students: A randomized trial

BACKGROUND

Nursing students experiencing high stress levels before exams could suffer worse academic performance.

OBJECTIVE

We evaluated an intervention combining Progressive Muscle Relaxation (PMR) and music therapy on the decrease of before exams stress and the improvement of academic results.

DESIGN AND METHODS

Randomized controlled trial including students from the Nursing Degree during the first semester of the 2017-2018 academic year. All participants were randomized to the control (CG) or the experimental group (EG). The CG took the exam as usual whereas in the EG, PMR and music therapy were performed before exams. Blood samples were drawn to investigate variations in biochemical parameters. The academic performance was assessed by the score obtained in the "Clinical Nursing" exam.

RESULTS

We included 112 students (75% females, mean age 24.3 ± 6.2 years, 56 students in every group). There were no differences in any parameter during the first measurement. Regarding the second measurement, we observed a reduction in heart rate for the EG and an increase in blood pressure, heart rate, and cortisol for the CG. Indeed, these parameters were significantly higher compared to the EG. The EG had a mean score of 5.07 ± 1.59 in the Clinical Nursing exam, which was significantly higher compared to the CG (4.42 ± 1.58, p = 0.033). The proportion of fails in the CG was also higher (62.5% vs. 42.9%, p = 0.037).

CONCLUSION

In this study including students from the Nursing degree, the combination of PMR and music therapy was effective for the control and decrease of stress before exams, and also demonstrated improvements in academic results.

The effect of progressive muscle relaxation on anxiety and sleep quality in burn patients: A randomized clinical trial

BACKGROUND AND OBJECTIVES

Burn patients experience a high level of anxiety and poor sleep quality due to their special physical and psychological conditions. The present study aimed to investigate the effect of progressive muscle relaxation on anxiety and sleep quality in burn patients.

METHODOLOGY AND PARTICIPANTS

In this randomized controlled clinical trial, a total of 80 patients admitted to burn ward were enrolled using convenient sampling and randomly assigned to one of the experimental or control groups. In the experimental group, patients were intervened using Jacobson's relaxation technique 20-30min daily for three consecutive days. During this period, the control group received only routine care and treatment. Patients' anxiety and their sleep quality were measured and recorded before and after the intervention using the Spielberger State-Trait Anxiety Inventory (STAI) and St Mary's Hospital Sleep Quality Questionnaire (SMHSQ) respectively. Eventually, data analysis was conducted using SPSS version 20.0 software (IBM Corp., Armonk, N.Y., USA).

RESULTS

The findings of the present study showed a statistically significant decrease in anxiety and improvement in sleep quality in the experimental group compared to the control group (P<0.05).

CONCLUSION

Relaxation as a complementary method can be used along with modern medicine to reduce anxiety and improve sleep quality in burn patients.

Effects of progressive muscle relaxation combined with music on stress, fatigue, and coping styles among intensive care nurses

AIM

To examine the effects of progressive muscle relaxation combined with music on stress, fatigue and coping styles amongst intensive care unit (ICU) nurses.

DESIGN

A randomised controlled trial of 56 nurses aged 18  years and older, with at least three months experience. The intervention group (n = 28) received a 20 minute session comprising progressive muscle relaxation combined with music for a total of eight weeks in the form of group sessions, while the control group (n = 28) received only a single-time face-to-face attention-matched education (20  minutes). The data collection tools were administered at baseline, at week four, eight and twelve.

SETTING

Internal Medicine, Anaesthesia, and Coronary Intensive care Unit of a training and research hospital.

MAIN OUTCOME MEASURES

Primary outcome: Stress level. Secondary outcome: Fatigue severity and coping styles.

RESULTS

Stress scores in the intervention group decreased significantly at week 8 and week 12 (p < 0.05). Similarly, the fatigue scores were observed to be significantly lower in the intervention group at week 8 and week 12 in comparison to those in the control group (p < 0.05). The scores of coping styles, obtained for the acceptance sub-dimension were significantly higher in the intervention group compared to the control group at week 4, 8, and 12 (p < 0.05). The use of instrumental support, venting and the emotional support scores were observed to be significantly higher in the intervention group compared to the control group at week 12 (p < 0.05).

CONCLUSION

The results indicated that progressive muscle relaxation combined with music appears to be effective in decreasing stress and fatigue, and in improving the coping styles amongst intensive care nurses. Future studies should be conducted on a larger scale to make conclusions with higher probability.

Outcomes of music therapy interventions in cancer patients-A review of the literature

BACKGROUND

Effectiveness of music-based interventions (MI) on cancer patients' anxiety, depression, pain and quality of life (QoL) is a current research theme. MI are highly variable, making it challenging to compare studies.

OBJECTIVE AND METHODS

To summarize the evidence on MI in cancer patients, 40 studies were reviewed following the PRISMA statement. Studies were included if assessing at least one outcome among anxiety, depression, QoL and pain in patients aged ≥ 18, with an active oncological/onco-haematological diagnosis, participating to any kind of Music Therapy (MT), during/after surgery, chemotherapy or radiotherapy.

RESULTS

A positive effect of MI on the outcomes measured was supported. Greater reductions of anxiety and depression were observed in breast cancer patients. MI involving patients admitted to a hospital ward were less effective on QoL.

CONCLUSION

The increasing evidence about MI effectiveness, tolerability, feasibility and appreciation, supports the need of MI implementation in Oncology, Radiotherapy and Surgery wards, and promotion of knowledge among health operators.

Effects of Psychoeducation and Stress Coping Techniques on Posttraumatic Stress Disorder Symptoms

This study examined the effects of psychoeducation and stress management techniques on Posttraumatic Stress Disorder (PTSD) symptoms in Libya. The 41 Libyan patients who volunteered to take part in the study were first assessed using the PTSD Checklist. They attended workshops on PTSD symptoms, stress management techniques, and communication skills on three successive days after which they were asked to answer the Coping Inventory for Stressful Situations two weeks after they completed the workshops. Among the 39% of the participants who were diagnosed with PTSD prior to the intervention, 15% met the diagnostic criteria for PTSD after the intervention. The preintervention scores were consistently higher than the postintervention scores, and there were significant differences in the PTSD Checklist total score and the re-experiencing, avoidance, and hyperarousal symptom scores. This study concluded that in mass-trauma events such as war and natural disasters, PTSD education can reduce the PTSD symptoms of those affected. Whether the benefits of psychoeducation on the participants are long term or short term is recommended for further study due to the limitations imposed by the willingness of the participants to participate, the amount of time they are willing to stay with the program, and the duration of the psychoeducation program itself.

The effect of progressive muscle relaxation on cancer patients' self-efficacy

BACKGROUND AND PURPOSE

Self-efficacy is considered as one of the influential parameters affecting the health of patients. This study aimed to investigate the effect of relaxation techniques on self-efficacy of patients suffering from cancer.

MATERIALS AND METHODS

This study was a clinical trial in which 80 patients suffering from cancer were randomly assigned to two groups of experimental and control. Data collection instruments consisted of demographic information and Strategies Used by People to Promote Health questionnaires. In the experimental group, the patients performed relaxation techniques once a day for 30 min over two months. In the control group, the patients received the routine care.

RESULTS

A statistically significant difference was observed between the mean self-efficacy indices in the experimental group (p = 0.001). There was no significant difference in the control group (p = 0.3).

CONCLUSION

Muscle relaxation can enhance self-efficacy of cancer patients. Therefore, it can be used as an alternative method for patients who are willing to use this technique.

Effectiveness of self-empowerment-affirmation-relaxation (Self-EAR) program for postpartum blues mothers: A randomize controlled trial

Background and Objecvites:

Approximately 55-85% of women worldwide have experienced postpartum blues (PPB) during 6-9 weeks after delivery without receiving the counseling program; more than 20% of them have developed into postpartum depression. Study objectives were to evaluate the effect of the Self-EAR program to improve the postpartum blues scores and serum allopregnanolone level among newly blues mothers.

Methods:

During June 2015 to May 2016, the randomized controlled trial was conducted among 76 Nulliparous blues mothers who were screened with Stein’s postpartum blues scores ≥ 3. All participants were randomly assigned either to the intervention group (Self-EAR program) and the control group (standard postpartum care program). The Self-EAR program was transformed into audio files which were installed in an MP3 digital device before providing it to the intervention group in order to be implemented at home three times per day for four weeks. Participants were assessed at baseline, 1-month, 2-month and 3-month follow-up for serum allopregnanolone level. Data were analyzed by using descriptive statistic, chi-square test, t-test, and repeated measure analysis of variance.

Result:

After the 3-month follow-up, the results revealed positive effects of the Self-EAR program on postpartum blues scores (p-value=0.002) and serum allopregnanolone concertation (p-value=0.001). The participants in the intervention group had experienced significantly lower postpartum blues scores; on the other hand, they had significantly higher serum allopregnanolone level when compared with the control group.

Conclusions:

The findings suggested that the Self-EAR program was effective to improve postpartum blues scores and allopregnanolone level among newly postpartum blues mothers.

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.

Meta-analysis evaluating music interventions for anxiety and pain in surgery

BACKGROUND

This study aimed to evaluate anxiety and pain following perioperative music interventions compared with control conditions in adult patients.

METHODS

Eleven electronic databases were searched for full-text publications of RCTs investigating the effect of music interventions on anxiety and pain during invasive surgery published between 1 January 1980 and 20 October 2016. Results and data were double-screened and extracted independently. Random-effects meta-analysis was used to calculate effect sizes as standardized mean differences (MDs). Heterogeneity was investigated in subgroup analyses and metaregression analyses. The review was registered in the PROSPERO database as CRD42016024921.

RESULTS

Ninety-two RCTs (7385 patients) were included in the systematic review, of which 81 were included in the meta-analysis. Music interventions significantly decreased anxiety (MD -0·69, 95 per cent c.i. -0·88 to -0·50; P < 0·001) and pain (MD -0·50, -0·66 to -0·34; P < 0·001) compared with controls, equivalent to a decrease of 21 mm for anxiety and 10 mm for pain on a 100-mm visual analogue scale. Changes in outcome corrected for baseline were even larger: MD -1·41 (-1·89 to -0·94; P < 0·001) for anxiety and -0·54 (-0·93 to -0·15; P = 0·006) for pain. Music interventions provided during general anaesthesia significantly decreased pain compared with that in controls (MD -0·41, -0·64 to -0·18; P < 0·001). Metaregression analysis found no significant association between the effect of music interventions and age, sex, choice and timing of music, and type of anaesthesia. Risk of bias in the studies was moderate to high.

CONCLUSION

Music interventions significantly reduce anxiety and pain in adult surgical patients.

Musical intervention on anxiety and vital parameters of chronic renal patients: a randomized clinical trial

OBJECTIVE

to evaluate the therapeutic effect of music on anxiety and vital parameters in patients with chronic kidney disease when compared to patients receiving conventional care in hemodialysis clinics.

METHOD

randomized clinical trial conducted in three renal replacement therapy clinics. Sixty people with chronic kidney disease undergoing hemodialysis were randomly allocated to an experimental group and a control group, 30 persons per group). State anxiety was evaluated in both groups by the State-Trait Anxiety Inventory. A t-test was used to verify the effect of the experimental manipulation on the variables.

RESULTS

we found a statistically significant difference between the groups regarding the degree of anxiety experienced during hemodialysis sessions. The experimental group presented a statistically significant reduction of anxiety scores (p = 0.03), systolic blood pressure (p < 0.002), diastolic blood pressure (p < 0.002), heart rate (p < 0.01) and respiratory rate (p < 0.006) after listening to music.

CONCLUSION

music represents a potential resource for nursing intervention to reduce state anxiety during hemodialysis sessions. Brazilian Registry of Clinical Trials: RBR-64b7x7.