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Meghani S, Frishkopf M, Park T, Montgomery CL, Norris C, Papathanassoglou E. Music-based interventions and theoretical mechanisms in post-ICU survivors: A critical narrative synthesis. Intensive Crit Care Nurs 2024; 86:103777. [PMID: 39182325 DOI: 10.1016/j.iccn.2024.103777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/08/2024] [Accepted: 07/17/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Hospitalization in the ICU can have long-term physiological and psychological impacts, affecting functional recovery and quality of life of post-ICU patients. Despite systematic reviews showing the impact of music interventions on physiological and psychological outcomes in ICU patients, their applicability and effectiveness in the post-ICU context remain unclear. AIM This review aimed to summarize: a) the types and characteristics of music/sound of interventions used in the rehabilitation of ICU patients, b) evidence on the feasibility, safety and acceptability of sound and music interventions for post ICU survivors, c) the types of post-ICU outcomes explored and the effects of sound and music interventions on any type of outcome in post-ICU survivors, and d) potential mechanisms or theoretical frameworks underlying the effects of sound and music interventions. METHOD We combined current systematic review search methods with a critical narrative approach to synthesize a diverse body of evidence. RESULTS Results showed that music interventions positively affect the psychological well-being and health outcomes of post-ICU patients. Outcomes included improvements in stress, anxiety, mood, movement, sleep, and pain, despite differences in patient populations and intervention design. No safety concerns were reported. The identified theoretical frameworks described physiological, neurobiological and/or psycho-social pathways as key mediators, however, these mechanisms are not completely understood. CONCLUSION Research evidence supports the positive effects of music interventions in post-ICU patients. Further experimental studies are required, especially in adult post-ICU populations to elucidate the characteristics, components, feasibility, and long-term effects of sound/music interventions. IMPLICATION TO PRACTICE 1. Music interventions help in post-ICU patients' recovery benefitting stress, anxiety, PTSD, mood, movement, sleep, and pain. 2. Integrating theoretical frameworks into music interventions can expand outcome measures to include physiological markers alongside psychological ones, improving quality of life. 3. Further rigorous interventional studies are required to identify the effectiveness of sound and music interventions in post-ICU patients.
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Affiliation(s)
- Shaista Meghani
- Faculty of Nursing, University of Alberta Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Michael Frishkopf
- Canadian Centre for Ethnomusicology (CCE), Faculty of Medicine and Dentistry, Department of Music, Faculty of Arts, University of Alberta, 3-98 Fine Arts Building, Edmonton, AB T6G 2C9, Canada.
| | - Tanya Park
- College of Healthcare Sciences, James Cook University, Nguma-bada Campus, Cairns, Queensland, Australia.
| | - Carmel L Montgomery
- Faculty of Nursing, University of Alberta, 3-141 ECHA, 11405 87 Avenue NW, Edmonton, AB T6G 1C9, Canada.
| | - Colleen Norris
- Faculty of Nursing, University of Alberta, 5-246 ECHA, 11405 87 Avenue NW, Edmonton, AB T6G 1C9, Canada.
| | - Elizabeth Papathanassoglou
- Faculty of Nursing, University of Alberta, Scientific Director, Neurosciences Rehabilitation & Vision Strategic Clinical Network TM Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
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Jorgensen T, Wallingford G. Bringing Music and Its Benefits to Patients at the Bedside: An ENDEARing Approach. J Gen Intern Med 2024:10.1007/s11606-024-08969-3. [PMID: 39085580 DOI: 10.1007/s11606-024-08969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Tyler Jorgensen
- Dell Medical School at The University of Texas at Austin, Austin, TX, USA.
| | - Greg Wallingford
- Dell Medical School at The University of Texas at Austin, Austin, TX, USA
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Menza R, Bongiovanni T, Leutwyler H, Tang J, Johnson JK, Howie-Esquivel J. Music-Based Interventions for Symptom Management in Critically Ill, Mechanically Ventilated Adults: A Scoping Review of the Literature. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 39046944 DOI: 10.1089/jicm.2023.0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background: Patients in intensive care units experience high symptom burden during mechanical ventilation (MV). Pharmacologic symptom management is associated with side effects and increased morbidity. Music-based interventions (MBIs) have been associated with reductions in both anxiety in MV adults and pain for critically ill adults, yet their use for the management of other burdensome symptoms has not been evaluated. The purpose of this scoping review is to map the state of evidence for the use of prerecorded music listening MBIs for symptom management in MV adults. Methods: A systematic search of the literature was conducted across four electronic databases (PubMed, EMBASE, CINAHL, and Web of Science) for experimental designed studies that measured the efficacy of MBIs for the management of physical and psychological symptoms including anxiety, sedation/agitation, dyspnea, distress, delirium, sleep, stress, fear, loneliness, or depression in critically ill, MV adults between January 1, 1998, and April 18, 2023. Results: A total of 643 abstracts and 29 clinical trials were included. Overall, the risk of bias, assessed using the Evidence Project tool, was moderate. MBIs were mostly delivered with headphones using music selected either by investigators or from a limited selection. MBIs were associated with reduced pain, agitation, dyspnea, distress and anxiety, and improved tolerance of MV and sedative weaning. Outcomes of delirium were mixed. No studies explored sleep disturbances, fear, or loneliness. Conclusions: Use of MBIs improved symptom experience for critically ill adults during MV. Future studies employing unrestricted patient-preferred music selections and exploring outcomes of sleep quality, psychological distress, and delirium are needed in this highly symptomatic patient population.
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Affiliation(s)
- Rebecca Menza
- Trauma Surgery Department, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Tasce Bongiovanni
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Heather Leutwyler
- School of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Julin Tang
- Department of Anesthesia, University of California San Francisco, San Francisco, California, USA
| | - Julene K Johnson
- University of California San Francisco Institute for Health & Aging, San Francisco, California, USA
| | - Jill Howie-Esquivel
- School of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA
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4
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Arnold CA, Bagg MK, Harvey AR. The psychophysiology of music-based interventions and the experience of pain. Front Psychol 2024; 15:1361857. [PMID: 38800683 PMCID: PMC11122921 DOI: 10.3389/fpsyg.2024.1361857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
In modern times there is increasing acceptance that music-based interventions are useful aids in the clinical treatment of a range of neurological and psychiatric conditions, including helping to reduce the perception of pain. Indeed, the belief that music, whether listening or performing, can alter human pain experiences has a long history, dating back to the ancient Greeks, and its potential healing properties have long been appreciated by indigenous cultures around the world. The subjective experience of acute or chronic pain is complex, influenced by many intersecting physiological and psychological factors, and it is therefore to be expected that the impact of music therapy on the pain experience may vary from one situation to another, and from one person to another. Where pain persists and becomes chronic, aberrant central processing is a key feature associated with the ongoing pain experience. Nonetheless, beneficial effects of exposure to music on pain relief have been reported across a wide range of acute and chronic conditions, and it has been shown to be effective in neonates, children and adults. In this comprehensive review we examine the various neurochemical, physiological and psychological factors that underpin the impact of music on the pain experience, factors that potentially operate at many levels - the periphery, spinal cord, brainstem, limbic system and multiple areas of cerebral cortex. We discuss the extent to which these factors, individually or in combination, influence how music affects both the quality and intensity of pain, noting that there remains controversy about the respective roles that diverse central and peripheral processes play in this experience. Better understanding of the mechanisms that underlie music's impact on pain perception together with insights into central processing of pain should aid in developing more effective synergistic approaches when music therapy is combined with clinical treatments. The ubiquitous nature of music also facilitates application from the therapeutic environment into daily life, for ongoing individual and social benefit.
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Affiliation(s)
- Carolyn A. Arnold
- Department of Anaesthesiology and Perioperative Medicine, Monash University, Melbourne, VIC, Australia
- Caulfield Pain Management and Research Centre, Alfred Health, Melbourne, VIC, Australia
| | - Matthew K. Bagg
- School of Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
- Centre for Pain IMPACT, Neuroscience Research Institute, Sydney, NSW, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Alan R. Harvey
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
- School of Human Sciences and Conservatorium of Music, The University of Western Australia, Perth, WA, Australia
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5
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Boehm LM, Bird CM, Warren AM, Danesh V, Hosey MM, McPeake J, Potter KM, Su H, Eaton TL, Powers MB. Understanding and Managing Anxiety Sensitivity During Critical Illness and Long-Term Recovery. Am J Crit Care 2023; 32:449-457. [PMID: 37907373 DOI: 10.4037/ajcc2023975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Anxiety sensitivity is a fear of symptoms associated with anxiety (eg, rapid respiration and heart rate, perspiration), also known as "fear of fear." This fear is a misinterpretation of nonthreatening symptoms as threatening across 3 domains: physical ("When my heart rate increases, I'm afraid I may have a heart attack"), social ("If people see me perspire, I fear they will negatively evaluate me"), and cognitive ("When I feel these symptoms, I fear it means I'm going crazy or will lose control and do something dangerous like disconnect my IV"). These thoughts stimulate the sympathetic nervous system, resulting in stronger sensations and further catastrophic misinterpretations, which may spiral into a panic attack. Strategies to address anxiety sensitivity include pharmacologic and nonpharmacologic interventions. In intensive care unit settings, anxiety sensitivity may be related to common monitoring and interventional procedures (eg, oxygen therapy, repositioning, use of urine collection systems). Anxiety sensitivity can be a barrier to weaning from mechanical ventilation when patients are uncomfortable following instructions to perform awakening or breathing trials. Fortunately, anxiety sensitivity is a malleable trait with evidence-based intervention options. However, few health care providers are aware of this psychological construct and available treatment. This article describes the nature of anxiety sensitivity, its potential impact on intensive care, how to assess and interpret scores from validated instruments such as the Anxiety Sensitivity Index, and treatment approaches across the critical care trajectory, including long-term recovery. Implications for critical care practice and future directions are also addressed.
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Affiliation(s)
- Leanne M Boehm
- Leanne M. Boehm is an assistant professor, Vanderbilt University School of Nursing, Nashville, Tennessee; and an investigator, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Claire M Bird
- Claire M. Bird is a postdoctoral fellow, Baylor University Medical Center, Dallas, Texas
| | - Ann Marie Warren
- Ann Marie Warren is a research center director, Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas; and an adjunct professor, Texas A&M University College of Medicine, Bryan
| | - Valerie Danesh
- Valerie Danesh is a research investigator, Center for Applied Health Research, Baylor Scott & White Research Institute; and an assistant professor, Baylor College of Medicine, Temple, Texas
| | - Megan M Hosey
- Megan M. Hosey is an assistant professor, Division of Pulmonary and Critical Care Medicine, and the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joanne McPeake
- Joanne McPeake is a research fellow, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - Kelly M Potter
- Kelly M. Potter is a research assistant professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Han Su
- Han Su is an assistant professor, Vanderbilt University School of Nursing; and an investigator, CIBS Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tammy L Eaton
- Tammy L. Eaton is an associate investigator, VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan
| | - Mark B Powers
- Mark B. Powers is a research center director, Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas; and an adjunct professor, Texas A&M University College of Medicine, Bryan
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6
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Valevicius D, Lépine Lopez A, Diushekeeva A, Lee AC, Roy M. Emotional responses to favorite and relaxing music predict music-induced hypoalgesia. FRONTIERS IN PAIN RESEARCH 2023; 4:1210572. [PMID: 38028433 PMCID: PMC10630160 DOI: 10.3389/fpain.2023.1210572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The hypoalgesic effect of music has long been established. However, the characteristics of music which are important for reducing pain have not been well-studied. Some research has compared subject-selected preferred music to unfamiliar music selected by researchers, and has typically found a superior effect from preferred music. In this study, we sought to discover what aspects of listeners' relationship with their preferred music was important in producing a hypoalgesic effect. Methods We conducted a thermal pain and music listening experiment with 63 participants (14 male, 49 female, mean age = 21.3), in which music excerpts were paired with thermal stimulations. Pain ratings of intensity and unpleasantness, as well as emotional response variables, were rated on visual analog scales. We also conducted brief structured interviews about participants' favorite music, on which we conducted thematic content analysis. Themes and emotion variables were analyzed for their effects on pain ratings. Results We first replicated the finding that favorite music outperforms experimenter-selected relaxing music in reducing pain unpleasantness (MD = -7.25, p < 0.001) and that the difference in hypoalgesia was partially mediated by an increase in musical chills (ab = -2.83, p < 0.01). We then conducted a theme analysis on the interview transcripts and produced four themes relating to emotional experience: moving/bittersweet, calming/relaxing, happy/cheerful, and energizing/activating. We found suggestive evidence that moving/bittersweet favorite music reduces pain unpleasantness through increased music pleasantness (ab = -5.48, p < 0.001) and more musical chills (ab = -0.57, p = 0.004). Discussion We find that music pleasantness and musical chills are salient predictors of music-induced hypoalgesia, and that different categories of favorite music derived from qualitative analysis may engage these emotional pathways to different degrees.
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Affiliation(s)
- Darius Valevicius
- Roy Pain Imaging Lab, Department of Psychology, McGill University, Montréal, QC, Canada
| | - Anaïs Lépine Lopez
- Roy Pain Imaging Lab, Department of Psychology, McGill University, Montréal, QC, Canada
| | - Ajar Diushekeeva
- Roy Pain Imaging Lab, Department of Psychology, McGill University, Montréal, QC, Canada
| | - April Chaewon Lee
- Roy Pain Imaging Lab, Department of Psychology, McGill University, Montréal, QC, Canada
| | - Mathieu Roy
- Roy Pain Imaging Lab, Department of Psychology, McGill University, Montréal, QC, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montréal, QC, Canada
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7
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Vijay A, Hauser JM. "This Won't Hurt a Bit": Is There a Role for Music in Bedside Procedures? Crit Care Explor 2023; 5:e0900. [PMID: 37038394 PMCID: PMC10082227 DOI: 10.1097/cce.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Music has played a long and storied role in clinical healing. However, the integration of music into clinical practice has been slow to gain traction, despite a recent meta-analysis demonstrating association of music interventions with clinically meaningful improvements in health-related quality of life. There is growing evidence that music has an active role in reducing patient pain and anxiety as well as affecting physiologic parameters, such as heart rate and blood pressure, in an ICU setting. Past studies have shown that incorporation of music into procedures in the operating room, radiology suites, and catheterization labs has reduced concurrent pharmacologic sedation requirements. In the age of patient-centered personalized medicine, we propose a call to action to implement an easily accessible, attainable checklist item offering a personal choice of music for patients during standardized bedside procedural training, to reduce anxiety, pain, and pharmacologic sedation and potentially improve clinical outcomes.
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Affiliation(s)
- Aishwarya Vijay
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Joshua M Hauser
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
- Jesse Brown VA Medical Center, Chicago, IL
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8
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Modrykamien AM. Enhancing the awakening to family engagement bundle with music therapy. World J Crit Care Med 2023; 12:41-52. [PMID: 37034022 PMCID: PMC10075048 DOI: 10.5492/wjccm.v12.i2.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/19/2022] [Accepted: 02/02/2023] [Indexed: 03/07/2023] Open
Abstract
Survivors of prolonged intensive care unit (ICU) admissions may present undesirable long-term outcomes. In particular, physical impairment and cognitive dysfunction have both been described in patients surviving episodes requiring mechanical ventilation and sedation. One of the strategies to prevent the aforementioned outcomes involves the implementation of a bundle composed by: (1) Spontaneous awakening trial; (2) Spontaneous breathing trial; (3) Choosing proper sedation strategies; (4) Delirium detection and management; (5) Early ICU mobility; and (6) Family engagement (ABCDEF bundle). The components of this bundle contribute in shortening length of stay on mechanical ventilation and reducing incidence of delirium. Since the first description of the ABCDEF bundle, other relevant therapeutic factors have been proposed, such as introducing music therapy. This mini-review describes the current evidence supporting the use of the ABCDEF bundle, as well as current knowledge on the implementation of music therapy.
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Affiliation(s)
- Ariel M Modrykamien
- Department of Pulmonary and Critical Care, Baylor University Medical Center, Dallas, TE 75246, United States
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9
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Rossetti A, Loewy J, Chang-Lit W, van Dokkum NH, Baumann E, Bouissou G, Mondanaro J, O’Connor T, Asch-Ortiz G, Mitaka H. Effects of Live Music on the Perception of Noise in the SICU/PICU: A Patient, Caregiver, and Medical Staff Environmental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3499. [PMID: 36834194 PMCID: PMC9958835 DOI: 10.3390/ijerph20043499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Intensive Care Units (ICUs) require a multidisciplinary team that consists of, but is not limited to, intensivists (clinicians who specialize in critical illness care), pharmacists and nurses, respiratory care therapists, and other medical consultants from a broad range of specialties. The complex and demanding critical care environment provides few opportunities for patients and personal and professional caregivers to evaluate how sound effects them. A growing body of literature attests to noise's adverse influence on patients' sleep, and high sound levels are a source of staff stress, as noise is an ubiquitous and noxious stimuli. Vulnerable patients have a low threshold tolerance to audio-induced stress. Despite these indications, peak sound levels often register as high, as can ventilators, and the documented noise levels in hospitals continue to rise. This baseline study, carried out in two hospitals' Surgical and Pediatric Intensive Care Units, measured the effects of live music on the perception of noise through surveying patients, personal caregivers and staff in randomized conditions of no music, and music as provided by music therapists through our hospital system's environmental music therapy program.
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Affiliation(s)
- Andrew Rossetti
- The Louis Armstrong Center for Music and Medicine, Mount Sinai Health System, Icahn School of Medicine, New York, NY 10003, USA
| | - Joanne Loewy
- The Louis Armstrong Center for Music and Medicine, Mount Sinai Health System, Icahn School of Medicine, New York, NY 10003, USA
| | | | | | - Erik Baumann
- International Association for Music and Medicine, Lima 15074, Peru
| | | | - John Mondanaro
- Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai Hospital, New York, NY 10019, USA
| | - Todd O’Connor
- The Mount Sinai Kravis Children’s Hospital, New York, NY 10029, USA
| | - Gabriela Asch-Ortiz
- Morgan Stanley Children’s Hospital, New York-Presbyterian, New York, NY 10032, USA
| | - Hayato Mitaka
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98195, USA
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10
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Tan MZY. Gymnopédie: music in the ICU. Intensive Care Med 2023; 49:267-268. [PMID: 36434100 DOI: 10.1007/s00134-022-06935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Mark Z Y Tan
- ST6 Anaesthesia and Intensive Care Medicine, Northwest Deanery, Health Education England Northwest, Manchester, UK.
- NIHR Academic Clinical Fellow, Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK.
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11
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Nurses' Perceptions of the Management of Acute Pain in Emergency Departments: Cross-sectional Study. CLIN NURSE SPEC 2022; 36:254-263. [PMID: 35984978 DOI: 10.1097/nur.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM This study aimed to describe registered nurses' perceptions of acute pain management in emergency departments. DESIGN The study design was a cross-sectional survey carried out in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. One hundred one nurses from 5 different emergency departments participated in the survey. METHODS Data were analyzed using descriptive methods, nonparametric tests, and principal component analysis. RESULTS Continuing education was significantly related to pain management. Nurses who had received continuing pain management education thought more often that challenges in pain management impact patients' acute pain management than those who had not received education. Nurses reported that patients received inadequate pain medication. The most used nonpharmacological methods were ice therapy and postural care. The nurses reported that music and conversation with the patient ameliorated the patients' acute pain. Nurses stated that their lack of knowledge concerning pain management and workload affected their acute pain management. CONCLUSION Study results emphasize the need to develop ongoing pain management education for registered nurses and in addition to further research of nonpharmacological alleviation method in emergency departments.
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Chen L, Yin J, Zheng Y, Zhao C, Zhang H, Li J, Ji D, Zhang Y. The effectiveness of music listening for critically ill patients: A systematic review. Nurs Crit Care 2022. [DOI: 10.1111/nicc.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lixia Chen
- Faculty of Nursing Xi'an Jiaotong University Health Science Center Xi'an China
| | - Juan Yin
- School of Nursing Dalian University Dalian China
| | - Yanan Zheng
- School of Nursing Dalian University Dalian China
| | | | - Han Zhang
- Nursing Department Affiliated Zhongshan Hospital of Dalian University Dalian China
| | - Jianhua Li
- Nursing Department Affiliated Zhongshan Hospital of Dalian University Dalian China
| | - Daihong Ji
- Nursing Department Affiliated Zhongshan Hospital of Dalian University Dalian China
| | - Yin‐Ping Zhang
- Faculty of Nursing Xi'an Jiaotong University Health Science Center Xi'an China
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13
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Richard-Lalonde M, Feeley N, Cossette S, Chlan LL, Gélinas C. Acceptability and Feasibility of a Patient-Oriented Music Intervention to Reduce Pain in the Intensive Care: Protocol for a Randomized Crossover Pilot Trial (Preprint). JMIR Res Protoc 2022; 12:e40760. [PMID: 37163350 DOI: 10.2196/40760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/20/2023] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Many patients experience pain in the intensive care unit (ICU) despite receiving pain medication. Research has shown that music can help reduce pain. Music interventions studied so far have not used music streaming to generate playlists based on patient preferences while incorporating recommended tempo and duration. Previous research has focused on postoperative ICU patients able to self-report, which is underrepresentative of the ICU population that might benefit from a music intervention for pain management. We developed a new patient-oriented music intervention (POMI) that incorporates features based on theoretical, empirical, and experiential data intended to be used in the ICU. Such a music intervention should consider the expertise of ICU patients, family members, and nursing staff, as well as the practicality of the intervention when used in practice. OBJECTIVE The primary objectives of this study are to (1) evaluate the acceptability and feasibility of the POMI to reduce pain in ICU patients and (2) evaluate the feasibility of conducting a crossover pilot randomized controlled trial (RCT) for intervention testing in the ICU. A secondary objective is to examine the preliminary efficacy of the POMI to reduce pain in ICU patients. METHODS A single-blind 2×2 crossover pilot RCT will be conducted. Patients will undergo 1 sequence of 2 interventions: the POMI which delivers music based on patients' preferences via headphones or music pillow for 20-30 minutes and the control intervention (headphones or pillow without music). The sequence of the interventions will be inverted with a 4-hour washout period. Timing of the interventions will be before a planned bed turning procedure. Each patient will undergo 1 session of music. Twenty-four patients will be recruited. Patients able to self-report (n=12), family members of patients unable to self-report (n=12), and nursing staff (n=12) involved in the bed turning procedure will be invited to complete a short questionnaire on the POMI acceptability. Data will be collected on the feasibility of the intervention delivery (ie, time spent creating a playlist, any issue related to headphones/pillow or music delivery, environmental noises, and intervention interruptions) and research methods (ie, number of patients screened, recruited, randomized, and included in the analysis). Pain scores will be obtained before and after intervention delivery. RESULTS Recruitment and data collection began in March 2022. As of July 5, 2022, in total, 22 patients, 12 family members, and 11 nurses were recruited. CONCLUSIONS Methodological limitations and strengths are discussed. Study limitations include the lack of blinding for patients able to self-report. Strengths include collecting data from various sources, getting a comprehensive evaluation of the intervention, and using a crossover pilot RCT design, where participants act as their own control, thus reducing confounding factors. TRIAL REGISTRATION ClinicalTrials.gov NCT05320224; https://clinicaltrials.gov/ct2/show/NCT05320224. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40760.
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14
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Nonpharmacological interventions for agitation in the adult intensive care unit: A systematic review. Aust Crit Care 2022; 36:385-400. [PMID: 35513998 DOI: 10.1016/j.aucc.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Person-centred nonpharmacological strategies should be used whenever possible to reduce agitation in the intensive care unit due to issues related to an overreliance on physical restraints and psychoactive drugs. However, the effect of nonpharmacological interventions to reduce agitation is unclear. OBJECTIVES The objectives of this study were to systematically review studies that evaluate the effectiveness of nonpharmacological interventions designed to prevent and minimise or manage patient agitation in the adult intensive care unit. METHODS This systematic review was conducted following the Joanna Briggs Institute's Systematic Review of Effectiveness method and a priori PROSPERO protocol. Quantitative studies were identified from seven databases, including MEDLINE, EmCare, CINAHL, Web of Science, PsycINFO, Scopus, and Cochrane Library. In addition, grey literature from several repositories and trial registers was searched. The primary outcome of interest was the effect on prevention, minimisation, and management of agitation. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS Eleven studies were included (n = 882). Meta-analyses of two studies demonstrated significantly lower levels of agitation (measured with the Richmond Agitation Sedation Scale) in the group receiving a multicomponent nonpharmacological intervention than in those receiving usual care. Individual studies showed a significant effect of nature-based sounds, music, foot reflexology, healing touch, and aromatherapy. The type of the endotracheal suction system did not affect levels of agitation. Overall, the certainty of the findings was rated very low. Harms and adverse effects were not reported in any studies. CONCLUSIONS Nonpharmacological interventions have the potential to reduce levels of agitation in the intensive care unit. However, inconsistencies in reporting, low quality of methodological designs, and small sample sizes impact the certainty of the results. Future trials must include larger sample sizes, use rigorous methods to improve knowledge in this field, and consider a range of other outcomes.
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Lunde SJ, Vuust P, Garza-Villarreal EA, Kirsch I, Møller A, Vase L. Music-Induced Analgesia in Healthy Participants Is Associated With Expected Pain Levels but Not Opioid or Dopamine-Dependent Mechanisms. FRONTIERS IN PAIN RESEARCH 2022; 3:734999. [PMID: 35445208 PMCID: PMC9013883 DOI: 10.3389/fpain.2022.734999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/21/2022] [Indexed: 01/30/2023] Open
Abstract
Music interventions accommodate the profound need for non-pharmacological pain treatment. The analgesic effect of listening to music has been widely demonstrated across studies. Yet, the specific mechanisms of action have still to be elucidated. Although the endogenous opioid and dopamine systems have been suggested to play an important role, a direct link has not been established. In addition, the involvement of placebo mechanisms is likely while largely unexplored. We examined the analgesic effect of music in healthy participants (n = 48) using a 3 × 3 within-subjects design with pharmacological manipulations and a matched, auditory control for music. Participants were exposed to thermal pain stimuli while listening to three auditory excerpts: music (active condition), nature sound (matched, auditory contextual condition), and noise (neutral control condition). The participants rated their expected and perceived pain levels in relation to each of the auditory excerpts. To investigate the involvement of the endogenous opioid and dopamine systems, the test session was performed three times on separate days featuring a double-blind randomized oral administration of naltrexone (opioid antagonist), haloperidol (dopamine antagonist), and an inactive agent (control). Our results support an analgesic effect of music. Contrary to current hypotheses, neither of the antagonists attenuated the effect of music. Yet, the participants' expectations for pain relief predicted their perceived pain levels during the auditory excerpts—even when controlling for a gradual learning effect. In conclusion, we demonstrate that the analgesic effect of music is at least partially mediated by expectations of an analgesic effect—a core mechanism in placebo effects—but not by opioid and dopamine-dependent mechanisms.
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Affiliation(s)
- Sigrid Juhl Lunde
- Division for Psychology and Neuroscience, Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- *Correspondence: Sigrid Juhl Lunde
| | - Peter Vuust
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- The Royal Academy of Music Aarhus/Aalborg, Aarhus, Denmark
| | - Eduardo A. Garza-Villarreal
- Laboratorio Nacional de Imagenología por Resonancia Magnética, Institute of Neurobiology, Universidad Nacional Autonoma de Mexico Campus Juriquilla, Queretaro, Mexico
- Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Irving Kirsch
- Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Arne Møller
- Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET Center, Institute of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark
| | - Lene Vase
- Division for Psychology and Neuroscience, Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
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Ting B, Tsai CL, Hsu WT, Shen ML, Tseng PT, Chen DTL, Su KP, Jingling L. Music Intervention for Pain Control in the Pediatric Population: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:991. [PMID: 35207263 PMCID: PMC8877634 DOI: 10.3390/jcm11040991] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
Abstract
Music intervention (MI) has been applied as an effective adjunctive treatment for pain control in various clinical settings. However, no meta-analysis has yet been published on the analgesic effects of MI in infants and children. We performed a systematic review of PubMed, EMBASE, Web of Science, and Cochrane Library databases to identify randomized controlled trials (RCTs) with the keywords "pain" AND "music therapy" from inception to January 2022. Primary outcomes were pain intensity and vital signs. Standardized mean difference (SMD) values and the corresponding 95% confidence intervals (CIs) were computed using a random effect model. Subgroup analyses with age groups, types of pain, and music styles were conducted. A total of 38 RCTs involving 5601 participants met the selection criteria. MI significantly decreased the pain levels (SMD = -0.57, p < 0.001), both in the newborn group (p = 0.007) and in the infant/children group (p < 0.001). MI significantly reduced heart rate (SMD = -0.50, p < 0.001) and respiratory rate (SMD = -0.60, p = 0.002) and increased peripheral capillary oxygen saturation (SMD = 0.44, p < 0.001). In subgroup analyses of types of pain, MI had significant effects on prick pain (p = 0.003), chronic and procedural pain (p < 0.001), and postoperative pain (p = 0.018). As for music styles, significant analgesic effects were observed for classical music (p < 0.001), kids' music (p < 0.001), and pop music (p = 0.001), but not for world music (p = 0.196), special composition (p = 0.092), and multiple music combinations (p = 0.420). In conclusion, our analysis provides supportive evidence about the efficacy of MI, especially classical, kids', and pop music, in controlling prick, procedural, and postoperative pain in the pediatric population.
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Affiliation(s)
- Berne Ting
- Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung 404, Taiwan;
- Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung 404, Taiwan; (C.-L.T.); (D.T.-L.C.)
| | - Chia-Lin Tsai
- Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung 404, Taiwan; (C.-L.T.); (D.T.-L.C.)
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung 404, Taiwan;
| | - Wei-Ti Hsu
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung 404, Taiwan;
- Department of Anesthesiology, China Medical University Hospital, Taichung 404, Taiwan
| | | | - Ping-Tao Tseng
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan;
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung 811, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
| | - Daniel Tzu-Li Chen
- Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung 404, Taiwan; (C.-L.T.); (D.T.-L.C.)
- M.D.-Ph.D. Program, College of Medicine, China Medical University, Taichung 404, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan
| | - Kuan-Pin Su
- Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung 404, Taiwan; (C.-L.T.); (D.T.-L.C.)
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung 404, Taiwan;
- M.D.-Ph.D. Program, College of Medicine, China Medical University, Taichung 404, Taiwan
- An-Nan Hospital, China Medical University, Tainan 709, Taiwan
| | - Li Jingling
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung 404, Taiwan;
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Chen YF, Chang MY, Chow LH, Ma WF. Effectiveness of Music-Based Intervention in Improving Uncomfortable Symptoms in ICU Patients: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111500. [PMID: 34770015 PMCID: PMC8582781 DOI: 10.3390/ijerph182111500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 12/01/2022]
Abstract
Background: Intensive care unit (ICU) patients experience multiple uncomfortable symptoms, which may be alleviated using music-based intervention, a nondrug treatment. This umbrella review aims to combine the data of systematic reviews and/or meta-analyses to evaluate the effectiveness of music-based intervention in improving uncomfortable symptoms in ICU patients. Methods: A comprehensive literature search was performed on the PubMed, Embase, Cochrane Library, Airiti Library, CINAHL, ProQuest, and Web of Science databases, and Epistemonikos. The search had no language restrictions, and articles on the improvement of symptoms using music-based intervention in adult ICU patients were included. This review protocol was registered on PROSPERO (CRD42021240327). Results: This umbrella review retrieved 5 systematic reviews and 41 original studies, including 39 randomized controlled trials, and 2 nonrandomized controlled trials. Diverse music was the most common music type used for music-based intervention, the intervention music was typically decided by the study participants (61%), and most subjects underwent one intervention session (78%). Furthermore, most music intervention sessions lasted for 30 min (44%). The positive results included decreased anxiety, decreased pain, decreased agitation, decreased anesthesia dose and sedative use, decreased chances of delirium, decreased feelings of uncomfort, and improved sleep quality. Conclusions: A systematic review on the effectiveness of music-based intervention in improving uncomfortable symptoms in ICU patients revealed that 20–30 min intervention sessions showed the best improvement in the uncomfortable symptoms in patients. This study provides a basis for using music-based intervention to relieve the uncomfortable symptoms in critically ill ICU patients, and a reference for empirical clinical practice.
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Affiliation(s)
- Yu-Fen Chen
- Department of Public Health, China Medical University, Taichung 406040, Taiwan;
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Mei-Yu Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Lok-Hi Chow
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Research Division, Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Wei-Fen Ma
- Ph.D. Program for Health Science and Industry, China Medical University, Taichung 406404, Taiwan
- School of Nursing, China Medical University Hospital, Taichung 406040, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung 404332, Taiwan
- Correspondence: ; Tel.: +886-4-2205-3366 (ext. 7107); Fax: +886-04-2299-0348
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Kakar E, Ista E, Klimek M, Jeekel J. Implementation of music in the perioperative standard care of colorectal surgery: study protocol of the IMPROVE Study. BMJ Open 2021; 11:e051878. [PMID: 34711596 PMCID: PMC8557300 DOI: 10.1136/bmjopen-2021-051878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Perioperative music intervention has been proven effective in reducing anxiety, pain, neurohormonal stress response and medication requirement. Unfortunately, there is a gap between new effective interventions and their (interventions) integration in standard care protocols. The aim of this preimplementation and postimplementation study is to investigate the adherence to a music intervention in a tailored, multilevel, systematic implementation strategy and the initial impact of the implementation on postoperative pain in patients undergoing colorectal surgery. METHODS AND DESIGN A monocentre prospective preimplementation and postimplementation study was set up using The Consolidated Framework for Implementation Research to conduct a systematic implementation of music intervention in three phases. Primary outcomes are adherence to the music intervention and the initial impact of the music intervention implementation on postoperative pain scores on the first postoperative day. At least 100 patients will be included in the study. Secondary outcomes include adherence to the implementation strategy, penetration of music intervention in the standard care, assessment of the determinants for implementation, impact of the implemented music intervention on pain during the entire admission, anxiety, medication usage, complications, hospital and intensive care unit (ICU) length of stay. ETHICS AND DISSEMINATION The Medical Ethics Review Board of Erasmus MC University Medical Centre Rotterdam, The Netherlands, has approved this protocol. The study is being conducted in accordance with the Declaration of Helsinki. Results of this trial will be published in peer-reviewed scientific journals and conference presentations. TRIAL REGISTRATION Dutch Trial Register NL8071.
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Affiliation(s)
- Ellaha Kakar
- General Surgery and Intensive Care Unit, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
- Intensive Care Unit, Erasmus MC, Rotterdam, Netherlands
| | - Erwin Ista
- Intensive Care Unit, Erasmus MC, Rotterdam, Netherlands
- Pediatric surgery, Intensive Care Unit, Internal Medicine, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
- Internal Medicine, Erasmus MC, Rotterdam, Netherlands
| | - M Klimek
- Anesthesiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Johannes Jeekel
- General Surgery and Intensive Care Unit, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
- Neuroscience, Erasmus MC, Rotterdam, Netherlands
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19
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Kakar E, Van Mol M, Jeekel J, Gommers D, van der Jagt M. Study protocol for a multicentre randomised controlled trial studying the effect of a music intervention on anxiety in adult critically ill patients (The RELACS trial). BMJ Open 2021; 11:e051473. [PMID: 34642197 PMCID: PMC8513337 DOI: 10.1136/bmjopen-2021-051473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Anxiety is common in critically ill patients and has likely become more prevalent in the recent decade due to the imperative of the recent Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients (PADIS) to use low levels of sedation and strive for wakefulness. However, management of anxiety has not been included in the PADIS guidelines, and there is lack of evidence to treat it in spite of its growing importance. Administration of sedative and analgesic medication is often chosen to reduce anxiety, especially when associated with agitation. Sedatives are associated with prolonged mechanical ventilation, delirium and muscle wasting and are therefore preferably minimised. Previous studies have suggested positive effects of music interventions on anxiety in the critically ill. Therefore, we aim to study the effect of music intervention on anxiety in adult critically ill patients. METHODS AND DESIGN A multicentre randomised controlled trial was designed to study the effect of a music intervention on the level of anxiety experienced by adult patients admitted to the intensive care unit (ICU). One hundred and four patients will be included in three centres in the Netherlands. Patient recruitment started on 24-08-2020 and is ongoing in three hospitals. The primary outcome is self-reported anxiety measured on the visual analogue scale. Secondary outcomes include anxiety measured using the six-item State-Trait Anxiety Inventory, sleep quality, agitation and sedation level, medication requirement, pain, delirium, complications, time spend on mechanical ventilation, physical parameters and ICU memory and experience. ETHICS AND DISSEMINATION The Medical Ethics Review Board of Erasmus MC University Medical Centre Rotterdam, The Netherlands, has approved this protocol. The study is being conducted in accordance with the Declaration of Helsinki. Results of this trial will be published in peer-reviewed scientific journals and conference presentations. TRIAL REGISTRATION NUMBER NCT04796389.
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Affiliation(s)
- Ellaha Kakar
- General surgery, Erasmus MC, Rotterdam, South-Holland, The Netherlands
- Intensive Care Adults, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Margo Van Mol
- Intensive Care Adults, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | | | - Diederik Gommers
- Intensive Care Adults, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Mathieu van der Jagt
- Intensive Care Adults, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
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20
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Analysis of the Effect of Intensive Care Based on Lean Nursing Intervention. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:7805124. [PMID: 34630996 PMCID: PMC8494574 DOI: 10.1155/2021/7805124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/28/2021] [Accepted: 09/16/2021] [Indexed: 01/19/2023]
Abstract
In order to improve the effect of intensive care, this paper proposes a lean nursing intervention method and evaluates the lean nursing intervention through a controlled experiment. According to the actual situation of intensive care, this paper starts with the research from several aspects of patients' ICU nursing time, patients' satisfaction, patients' pathological knowledge familiarity, patients' autonomous nursing, and enthusiasm of patients and their families. Moreover, this paper collects and displays experimental results through mathematical statistics, gives patients lean management concepts and methods based on routine care, and finds that it has good management effects. Thus, lean management concepts and methods can effectively improve the anxiety state of critically ill patients, improve the patient's knowledge of disease, and reduce adverse nursing events to improve patient nursing satisfaction, which is worthy of further promotion in the clinic.
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21
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Brosh K, Roditi E, Wasser LM, Aryan A, Hanhart J, Potter MJ. Effect of Music Selection on Anxiety Level during Intravitreal Injections for Individuals of Varying Cultures. Ophthalmic Epidemiol 2021; 29:582-587. [PMID: 34293998 DOI: 10.1080/09286586.2021.1955390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To investigate music selection as a treatment for anxiety during Intravitreal injections (IVI) for individuals of varying cultures.Methods: 106 individuals were enrolled in this randomized controlled study. Individuals were randomized into one to three categories: (1) a control group in which the IVI procedure was performed without music (n = 35), (2) an experimental group in which the music was selected by the physician (n = 36), (3) an experimental group in which the music was selected by the patient (n = 35). After the procedure, all patients responded to a questionnaire regarding their level of experienced anxiety, pain and discomfort (grade 0-10). The primary outcome was anxiety level during the procedure.Results: The experimental group in which patients selected music had higher number of patients with low anxiety score compared to the other groups (anxiety score <4 in 19,18 and 27 patients, respectively, p = .04). Interestingly, patients who answered the questionnaire in Arabic were less likely to desire music on subsequent injections compared to Hebrew and English speakers (52% Vs 78% Vs 100%, p = .02). Music was deemed by both experimental groups as an effective method to induce relaxation (average score of 6.6 and 7.2 in group 2 and 3, respectively). Preference for music on subsequent injections was increased in both experimental groups compared to the control group (P < .01). Patients in the third group preferred music selection on future injections more than the other groups (P < .01).Conclusion: Music selection may be an effective way to reduce anxiety levels during IVI. Preference for music during future injections is higher in patients who were exposed to music during IVI and may be influenced by culture.
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Affiliation(s)
- Koby Brosh
- Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Eduardo Roditi
- Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Lauren M Wasser
- Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Ahmad Aryan
- Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Joel Hanhart
- Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
| | - Michael J Potter
- Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University - Hadassah School of Medicine, Jerusalem, Israel
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Nordness MF, Hayhurst CJ, Pandharipande P. Current Perspectives on the Assessment and Management of Pain in the Intensive Care Unit. J Pain Res 2021; 14:1733-1744. [PMID: 34163231 PMCID: PMC8214553 DOI: 10.2147/jpr.s256406] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 12/02/2022] Open
Abstract
Critical illness is often painful, both from the underlying source of illness, as well as necessary procedures performed for the monitoring and care of these patients. Pain is often under-recognized in the critically ill, especially among those who cannot self-report, so accurate assessment and management continue to be major consideration in their care. Pain management in the intensive care unit (ICU) is an evolving practice, with a focus on accurate and frequent pain assessment, and targeted pharmacologic and non-pharmacologic treatment methods to maximize analgesia and minimize sedation. In this review, we will evaluate several validated methods of pain assessment in the ICU and present management options. We will review the evidence-based recommendations put forth by the largest critical care societies and several high-quality studies related to both the in-hospital approach to pain, as well as the short- and long-term consequences of untreated pain in ICU patients. We conclude with future directions.
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Affiliation(s)
- Mina F Nordness
- Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina J Hayhurst
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pratik Pandharipande
- Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Kakar E, Venema E, Jeekel J, Klimek M, van der Jagt M. Music intervention for sleep quality in critically ill and surgical patients: a meta-analysis. BMJ Open 2021; 11:e042510. [PMID: 33972331 PMCID: PMC8112429 DOI: 10.1136/bmjopen-2020-042510] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Sleep disruption occurs frequently in hospitalised patients. Given the potential of music intervention as a non-pharmacological measure to improve sleep quality, we aimed to assess and quantify current literature on the effect of recorded music interventions on sleep quality and quantity in the adult critical care and surgical populations. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, MEDLINE Ovid, Cochrane Central, Web of Science and Google Scholar. ELIGIBILITY CRITERIA FOR STUDIES Randomised controlled trials assessing the effect of music on sleep quality in critically ill and surgical patients. METHODS The electronic databases were systematically searched from 1 January 1981 to 27 January 2020. Data were screened, extracted and appraised by two independent reviewers. Primary outcomes were sleep quality and quantity, assessed with validated tools. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Random effects meta-analysis was performed, and pooled standardised mean differences (SMDs) with 95% CIs were reported. RESULTS Five studies (259 patients) were included in qualitative (risk of bias) and quantitative analysis (meta-analysis). Pooled data showed a significant effect of recorded music on subjective sleep quality in the critical care and surgical population (SMD=1.21 (95% CI 0.50 to 1.91), p<0.01, excluding one non-English study; SMD=0.87 (95% CI 0.45 to 1.29), p<0.01). The SMD of 1.21 corresponded to a 27.1% (95% CI 11.2 to 42.8) increase in subjective sleep quality using validated questionnaires. A significant increase in subjective sleep quantity of 36 min was found in one study. Objective measurements of sleep assessed in one study using polysomnography showed significant increase in deeper sleep stage in the music group. CONCLUSIONS Recorded music showed a significant improvement in subjective sleep quality in some critical care and surgical populations. Therefore, its use may be relevant to improve sleep, but given the moderate potential for bias, further research is needed. PROSPERO REGISTRATION NUMBER CRD42020167783.
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Affiliation(s)
- Ellaha Kakar
- Department of Surgery and Intensive Care Unit, Erasmus MC, Rotterdam, The Netherlands
| | - Esmée Venema
- Maastricht University, Maastricht, The Netherlands
| | - Johannes Jeekel
- Department of Surgery and Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anaesthesiology, Erasmus MC, Rotterdam, The Netherlands
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Dusek JA, Rivard RL, Griffin KH, Finch MD. Significant Pain Reduction in Hospitalized Patients Receiving Integrative Medicine Interventions by Clinical Population and Accounting for Pain Medication. J Altern Complement Med 2021; 27:S28-S36. [PMID: 33788611 DOI: 10.1089/acm.2021.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Prior research has reported that integrative medicine (IM) therapies reduce pain in inpatients, but without controlling for important variables. Here, the authors extend prior research by assessing pain reduction while accounting for each patient's pain medication status and clinical population. Methods: The initial data set consisted of 7,106 inpatient admissions, aged ≥18 years, between July 16, 2012, and December 15, 2014. Patients' electronic health records were used to obtain data on demographic, clinical measures, and pain medication status during IM. Results: The final data set included first IM therapies delivered during 3,635 admissions. Unadjusted average pre-IM pain was 5.33 (95% confidence interval [CI]: 5.26 to 5.41) and post-IM pain was 3.31 (95% CI: 3.23 to 3.40) on a 0-10 scale. Pain change adjusted for severity of illness, clinical population, sex, treatment, and pain medication status during IM was significant and clinically meaningful with an average reduction of -1.97 points (95% CI: -2.06 to -1.86) following IM. Adjusted average pain was reduced in all clinical populations, with largest and smallest pain reductions in maternity care (-2.34 points [95% CI: -2.56 to -2.14]) and orthopedic (-1.71 points [95% CI: -1.98 to -1.44]) populations. Pain medication status did not have a statistically significant association on pain change. Decreases were observed regardless of whether patients were taking narcotic medications and/or nonsteroidal anti-inflammatory drugs versus no pain medications. Conclusions: For the first time, inpatients receiving IM reported significant and clinically meaningful pain reductions during a first IM session while accounting for pain medications and across clinical populations. Future implementation research should be conducted to optimize identification/referral/delivery of IM therapies within hospitals. Clinical Trials.gov #NCT02190240.
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Affiliation(s)
- Jeffery A Dusek
- UH Connor Integrative Health Network, University Hospitals, Cleveland, OH, USA.,Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Rachael L Rivard
- UH Connor Integrative Health Network, University Hospitals, Cleveland, OH, USA.,Center for Evaluation and Survey Research, HealthPartners Institute, Minneapolis, MN, USA
| | - Kristen H Griffin
- Children's Minnesota Research Institute, Children's Minnesota, Minneapolis, MN, USA
| | - Michael D Finch
- Children's Minnesota Research Institute, Children's Minnesota, Minneapolis, MN, USA
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25
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Bainbridge CM, Bertolo M, Youngers J, Atwood S, Yurdum L, Simson J, Lopez K, Xing F, Martin A, Mehr SA. Infants relax in response to unfamiliar foreign lullabies. Nat Hum Behav 2021; 5:256-264. [PMID: 33077883 PMCID: PMC8220405 DOI: 10.1038/s41562-020-00963-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/11/2020] [Indexed: 12/14/2022]
Abstract
Music is characterized by acoustic forms that are predictive of its behavioural functions. For example, adult listeners accurately identify unfamiliar lullabies as infant-directed on the basis of their musical features alone. This property could reflect a function of listeners' experiences, the basic design of the human mind, or both. Here, we show that US infants (N = 144) relax in response to eight unfamiliar foreign lullabies, relative to matched non-lullaby songs from other foreign societies, as indexed by heart rate, pupillometry and electrodermal activity. They do so consistently throughout the first year of life, suggesting that the response is not a function of their musical experiences, which are limited relative to those of adults. The infants' parents overwhelmingly chose lullabies as the songs that they would use to calm their fussy infant, despite their unfamiliarity. Together, these findings suggest that infants may be predisposed to respond to common features of lullabies found in different cultures.
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Affiliation(s)
| | - Mila Bertolo
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Julie Youngers
- Department of Psychology, Harvard University, Cambridge, MA, USA
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Atwood
- Department of Psychology, Harvard University, Cambridge, MA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Lidya Yurdum
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Jan Simson
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Kelsie Lopez
- Department of Psychology, Harvard University, Cambridge, MA, USA
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, USA
| | - Feng Xing
- Department of Psychology, Harvard University, Cambridge, MA, USA
- Department of Education, Johns Hopkins University, Baltimore, MD, USA
| | - Alia Martin
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Samuel A Mehr
- Department of Psychology, Harvard University, Cambridge, MA, USA.
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand.
- Data Science Initiative, Harvard University, Cambridge, MA, USA.
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26
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Kakar E, Billar RJ, van Rosmalen J, Klimek M, Takkenberg JJM, Jeekel J. Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis. Open Heart 2021; 8:openhrt-2020-001474. [PMID: 33495383 PMCID: PMC7839877 DOI: 10.1136/openhrt-2020-001474] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives Previous studies have reported beneficial effects of perioperative music on patients’ anxiety and pain. We performed a systematic review and meta-analysis of randomised controlled trials investigating music interventions in cardiac surgery. Methods Five electronic databases were systematically searched. Primary outcomes were patients’ postoperative anxiety and pain. Secondary outcomes were hospital length of stay, opioid use, vital parameters and time on mechanical ventilation. PRISMA guidelines were followed and PROSPERO database registration was completed (CRD42020149733). A meta-analysis was performed using random effects models and pooled standardised mean differences (SMD) with 95% confidence intervals were calculated. Results Twenty studies were included for qualitative analysis (1169 patients) and 16 (987 patients) for meta-analysis. The first postoperative music session was associated with significantly reduced postoperative anxiety (SMD = –0.50 (95% CI –0.67 to –0.32), p<0.01) and pain (SMD = –0.51 (95% CI –0.84 to –0.19), p<0.01). This is equal to a reduction of 4.00 points (95% CI 2.56 to 5.36) and 1.05 points (95% CI 0.67 to 1.41) on the State-Trait Anxiety Inventory and Visual Analogue Scale (VAS)/Numeric Rating Scale (NRS), respectively, for anxiety, and 1.26 points (95% CI 0.47 to 2.07) on the VAS/NRS for pain. Multiple days of music intervention reduced anxiety until 8 days postoperatively (SMD = –0.39 (95% CI –0.64 to –0.15), p<0.01). Conclusions Offering recorded music is associated with a significant reduction in postoperative anxiety and pain in cardiac surgery. Unlike pharmacological interventions, music is without side effects so is promising in this population.
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Affiliation(s)
- Ellaha Kakar
- Surgery, Erasmus MC, Rotterdam, South-Holland, Netherlands .,Neuroscience, Erasmus MC, Rotterdam, South-Holland, The Netherlands
| | - Ryan J Billar
- Pediatric Surgery, Erasmus MC, Rotterdam, South-Holland, Netherlands
| | | | - Markus Klimek
- Anesthesiology, Erasmus MC, Rotterdam, South-Holland, Netherlands
| | - Johanna J M Takkenberg
- CardioThoracic Surgery, Erasmus University Medical Center, Rotterdam, South-Holland, Netherlands
| | - Johannes Jeekel
- Surgery, Erasmus MC, Rotterdam, South-Holland, Netherlands.,Neuroscience, Erasmus MC, Rotterdam, South-Holland, The Netherlands
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27
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Valero-Cantero I, Martínez-Valero FJ, Espinar-Toledo M, Casals C, Barón-López FJ, Vázquez-Sánchez MÁ. Complementary music therapy for cancer patients in at-home palliative care and their caregivers: protocol for a multicentre randomised controlled trial. BMC Palliat Care 2020; 19:61. [PMID: 32359361 PMCID: PMC7196216 DOI: 10.1186/s12904-020-00570-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background Patients with advanced cancer, receiving at-home palliative care, are subject to numerous symptoms that are changeable and often require attention, a stressful situation that also impacts on the family caregiver. It has been suggested that music therapy may benefit both the patient and the caregiver. We propose a study to analyse the efficacy and cost utility of a music intervention programme, applied as complementary therapy, for cancer patients in palliative care and for their at-home caregivers, compared to usual treatment. Method A randomised, double-blind, multicentre clinical trial will be performed in cancer patients in at-home palliative care and their family caregivers. The study population will include two samples of 40 patients and two samples of 41 caregivers. Participants will be randomly assigned either to the intervention group or to the control group. The intervention group will receive a seven-day programme including music sessions, while the control group will receive seven sessions of (spoken word) therapeutic education. In this study, the primary outcome measure is the assessment of patients’ symptoms, according to the Edmonton Symptom Assessment System, and of the overload experienced by family caregivers, measured by the Caregiver Strain Index. The secondary outcomes considered will be the participants’ health-related quality of life, their satisfaction with the intervention, and an economic valuation. Discussion This study is expected to enhance our understanding of the efficacy and cost-utility of music therapy for cancer patients in palliative care and for their family caregivers. The results of this project are expected to be applicable and transferrable to usual clinical practice for patients in home palliative care and for their caregivers. The approach described can be incorporated as an additional therapeutic resource within comprehensive palliative care. To our knowledge, no previous high quality studies, based on a double-blind clinical trial, have been undertaken to evaluate the cost-effectiveness of music therapy. The cost-effectiveness of the project will provide information to support decision making, thereby improving the management of health resources and their use within the health system. Trial registration The COMTHECARE study is registered at Clinical Trials.gov, NCT04052074. Registered 9 August, 2019.
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Affiliation(s)
| | | | - Milagrosa Espinar-Toledo
- "Rincón de la Victoria" Clinical Management Unit, Malaga-Guadalhorce Health District, Malaga, Spain
| | - Cristina Casals
- MOVE-IT Research group and Department of Physical Education, Faculty of Education Sciences. Biomedical Research and Innovation Institute of Cadiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cadiz, Cádiz, Spain.
| | - Francisco Javier Barón-López
- Department of Preventive Medicine, Public Health and Science History. Institute of Biomedical Research in Malaga (IBIMA), University of Malaga, Malaga, Spain
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