A music intervention to reduce anxiety before vascular angiography procedures

The Effect of Providing Education to Patients Undergoing Coronary Angiography on Vital Signs

PURPOSE

This study was conducted to determine the effect of providing preprocedural education to patients undergoing coronary angiography on their vital signs.

DESIGN

The study was a randomized controlled experimental study with a pretest/post-test control group design.

METHODS

The study was conducted in the Cardiology Service of a hospital in Eskişehir between November 2021 and April 2022. Power analysis identified that it was appropriate to include 79 individuals in the experimental group, 79 individuals in the control group, and a total of 158 individuals. The experimental group was trained using the "Structured Education Manual" prepared by the researchers.

FINDINGS

The education had an influence on the stabilization of vital signs after the procedure compared to preprocedure. When the comparison of vital signs before and after the education was analyzed, systolic blood pressure and diastolic blood pressure differed significantly between 11 measurements in both groups (P < .05). The systolic and diastolic blood pressure of the experimental group measured before the procedure was higher than their other measurements after the procedure. Heart rate, respiratory rate, and saturation value in both groups displayed a statistically significant difference between 11 measurements (P < .05). In the experimental group, heart rate and respiratory rate before the procedure were higher than the postprocedure measurements. The saturation value of the experimental group at 150 minutes after the procedure was higher than the other measurements.

CONCLUSIONS

Education given to patients before undergoing a coronary angiography procedure had a positive effect on the patients' vital signs. It is recommended that patients undergoing a coronary angiography procedure be provided with audio-visual training by nurses before the procedure.

The MULAN Trial - RCT on the use of MUsic in Cath-Lab to reduce ANxiety during peripheral vascular interventions

Background: The purpose was to analyze the use of classical music to reduce procedure-related anxiety while conducting percutaneous transluminal angioplasty in patients with peripheral artery disease. Patients and methods: A total of 155 patients were analyzed in this single center randomized controlled trial. Procedure-related anxiety was assessed by a numerical rating scale (NRS, 0-10) and by recording of physiological parameters at three different points in time. A survey was conducted after the intervention. Results: This study showed that the patients listened to music overcame their procedure-related anxiety more quickly than the patients in the control group. The NRS at second timepoint was significantly reduced in intervention group compared to control group (p<0.01; r=0.2). Most participants stated that they would like to listen to music during possible future interventions. Conclusions: Classical music during endovascular interventions reduced procedure-related anxiety measured as greater reduction in NRS values in intervention group as well as in results of questionnaire performed post procedurally in PAD patients.

Effect of Music Therapy on Pain During Thyroid Fine Needle Aspiration Biopsy; A Randomized Controlled Clinical Trial

INTRODUCTION

High-resolution ultrasonography devices have led to the increased detection of thyroid nodules and the need for fine-needle aspiration biopsy (FNAB). However, FNAB is an invasive procedure that can cause discomfort and pain. Music therapy has been used for centuries to alleviate pain, and our clinical trial was conducted to investigate its impact on pain scores during thyroid FNAB.

MATERIALS AND METHODS

We conducted a randomized, controlled clinical trial, including adult patients undergoing thyroid FNAB. We evaluated the nonpharmacological intervention of listening to music before and during thyroid FNAB. We used a slow, nonlyrical, flowing melody with a tempo of 60 to 80 beats per minute as a therapeutic intervention for managing anxiety and pain. It had low tones, minimal percussion, and a volume of around 60 dB. The Beck Anxiety Inventory and Visual Pain Scale were used.

RESULTS

The study included 529 patients assigned to either the music group (n = 258, 48.7%) or the control group (n = 271, 51.2%). The patients were categorized into subgroups based on either a single nodule (73.63%) or multiple nodules (24.18%). When all patients or single nodule and multiple data are examined separately, the intervention group showed statistically significantly lower pain scores than the control group.

CONCLUSION

Our study is among the first on this topic and the largest in the available literature to demonstrate that listening to music during FNAB significantly reduces pain and anxiety. Music therapy is an effective, safe, and noninvasive intervention that can improve patient care and reduce distress and pain.

Considering Psychological and Cognitive Factors in Interventional Neuroradiology: A Systematic Literature Review

BACKGROUND

Interventional neuroradiology is a relatively recent discipline that diagnoses and treats cerebral vascular diseases. However, specific literature on cognitive and psychological domains of patients undergoing interventional neuroradiology procedures is limited.

PURPOSE

Our aim was to review the existent literature on cognitive and psychological domains in patients undergoing interventional neuroradiology procedures to raise clinicians' awareness of their mental status.

DATA SOURCES

Articles were searched in PubMed, EMBASE, and Scopus from 2000 to 2022 using terms such as "interventional neuroradiology," "psychology," and "cognition" according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

STUDY SELECTION

Of 1483 articles in English, 64 were included and analyzed. Twelve focused on psychological aspects; 52, on cognitive ones.

DATA ANALYSIS

Regarding psychological aspects, it appears that early psychological consultations and "nonpharmacologic" strategies can impact the anxiety and depression of patients undergoing endovascular procedures. Regarding cognitive aspects, it appears that endovascular treatment is safe and generates similar or even fewer cognitive deficits compared with analogous surgical procedures.

DATA SYNTHESIS

Among the 12 articles on psychological aspects, 6/12 were retrospective with one, while 6/12 were prospective. Among the 52 articles on cognitive aspects, 7/54 were retrospective, while 45/52 were prospective.

LIMITATIONS

The main limitation derives from the inhomogeneity of the cognitive and psychological assessment tools used in the articles included in our analysis.

CONCLUSIONS

Our review highlights the need to include cognitive and psychological assessments in clinical practice in case patients eligible for interventional neuroradiology procedures. In the future, much more research of and attention to cognitive and psychologic aspects of neurovascular disease is needed. Systematic incorporation of strategies and tools to access and address pre, peri-, and postprocedural psychological and cognitive components could have major benefits in patient satisfaction, recovery, and the success of endovascular practice.

Improving the patient experience during musculoskeletal interventional procedures

In the patient-centered practice of musculoskeletal interventional radiology, pre-procedure, intra-procedure, and post-procedure factors impact the patient's overall experience. Opportunities to improve the patient experience begin before the patient procedure starts, with smooth scheduling of the appointment, a positive office environment, and appropriate communication by the musculoskeletal interventional radiology staff before the procedure, including clear expectations regarding wait times. The initial conversation between the radiologist and the patient, including the informed consent process, is a crucial opportunity for creating rapport with the patient and generating trust in the radiologist. Being able to interpret a patient's verbal and non-verbal cues during this conversation can reduce anxiety and enhance relaxation. During the procedure, there are interventions which can decrease anxiety and reduce the perception of pain by the patient. These include psychological interventions such as self-induced hypnosis, communication-based interventions such as empathic communication to mold a patient's interpretation of anxiety and painful stimuli, and the use of ancillary tools such as music or video stimulation. Finally, clear post-procedure expectations regarding post-procedure pain and its management and assurances of access to the musculoskeletal interventional radiology team can facilitate an uncomplicated post-procedure recovery.

Characteristics of music intervention to reduce anxiety in patients undergoing cardiac catheterization: scoping review

The characteristics of music interventions for reducing anxiety in patients undergoing cardiac catheterization were mapped. A scoping review was conducted according to the Joanna Briggs Institute methodology. Searches were performed in electronic portals and databases PubMed, CINAHL, PsycINFO, Cochrane, EMBASE, Scopus, LILACS, CAPES Thesis Portal (Brazil), DART-Europe E-theses Portal, Theses Canada Portal, Pro-Quest, and Google Scholar databases, gray literature, with no limitation on the year of publication. Eighteen articles were included in the search. The characteristics of the interventions were heterogeneous and not comprehensively described in the primary studies. The songs were predominantly of a single genre, instrumental, and selected by the interventionist, with a rhythm between 60 and 80 beats per minute. The interventions were delivered in a single session, mostly in the catheterization laboratory, before or during the procedure, by means of digital audio and earphones for over 20 min. The heterogeneity of interventions and incompleteness of information in the studies compromises the advancement of knowledge on the effects of music on health outcomes.

The Effect of Music on Preoperative Anxiety in an Operating Room: a Single-Blind Randomized Controlled Trial

OBJECTIVE

This study aimed to determine the effect of music as an intervention on relieving preoperative anxiety in patients with dental fear in an outpatient operating room (OR) before intravenous sedation (IVS).

METHODS

Sixty adult patients with dental fear undergoing dental surgery under IVS were divided into 2 groups (music and nonmusic). The music group listened to music in the waiting room until immediately before the initiation of IVS whereas the nonmusic group did not. Patient anxiety was objectively measured using heart rate variability (HRV) analysis to assess the low-frequency/high-frequency ratio as an indication of sympathetic or parasympathetic nervous system activity. Subjective preoperative anxiety was evaluated with a visual analog scale (VAS).

RESULTS

Heart rate variability analysis failed to demonstrate any significant difference between the 2 groups from baseline to start of IVS. There were also no significant differences between the 2 groups regarding changes in VAS scores.

CONCLUSION

Music intervention was not found to reduce preoperative anxiety in patients with dental fear before IVS in the dental outpatient OR as determined by HRV analysis or VAS scores.

The effects of music & auditory beat stimulation on anxiety: A randomized clinical trial

Background and objectives

Music and auditory beat stimulation (ABS) in the theta frequency range (4–7 Hz) are sound-based anxiety treatments that have been independently investigated in prior studies. Here, the anxiety-reducing potential of calm music combined with theta ABS was examined in a large sample of participants.

Methods

An open-label randomized controlled trial was conducted with participants taking anxiolytics (n = 163). Participants were randomly assigned using the Qualtrics randomizer algorithm, to a single session of sound-based treatment in one of four parallel arms: combined (music & ABS; n = 39), music-alone (n = 36), ABS-alone (n = 41), or pink noise (control; n = 47). Pre- and post-intervention somatic and cognitive state anxiety measures were collected along with trait anxiety, personality measures and musical preferences. The study was completed online using a custom application.

Results

Based on trait anxiety scores participants were separated into moderate and high trait anxiety sub-groups. Among participants with moderate trait anxiety, we observed reductions in somatic anxiety that were greater in combined and music-alone conditions than in the pink noise condition; and reductions in cognitive state anxiety that were greater in the combined condition than in the music-alone, ABS-alone, and pink noise conditions. While we also observed reductions in somatic and cognitive state anxiety in participants with high trait anxiety, the conditions were not well differentiated.

Conclusions

Sound-based treatments are effective in reducing somatic and cognitive state anxiety. For participants with moderate trait anxiety, combined conditions were most efficacious.

Neurology Telemusic Program at the Time of the COVID-19 Pandemic: Turning Hospital Time Into Aesthetic Time During Crisis

Strict precautions during the COVID-19 pandemic left patients isolated during already stressful hospital stays. Research indicates that listening to music recruits regions in the brain involved with social interaction and reduces feelings of loneliness. We formed a team of clinicians and clinical musicians to bring music to the bedside, as “psychological first aid.” Our goal was to reduce feelings of anxiety and isolation in patients admitted to the Northwestern Memorial Hospital's neurosciences unit. Participants were offered 30–40-min live music sessions over FaceTime by a violist in consultation with a music therapist and a certified music practitioner. Music used for the interventions was personalized. Participants were evaluated with the Music Assessment Tool where they indicated their musical preferences and music to which they objected. Following the intervention, participants answered a questionnaire assessing how music impacted their emotional state based on a 1–10 Likert scale. Scores were then averaged across all patients and were calculated as percentages. Eighty-seven sessions were completed during a 3-month period. Despite different degrees of disability, most patients engaged aesthetically with the music. The likelihood to recommend (LTR) for the program was 98%; participants tended to highly agree that the intervention improved their emotional state (92%); that it provided a pleasurable experience (92.4%); and that it reduced their stress and anxiety (89.5%). This pilot project showed that the telemusic intervention was feasible for our neurosciences patients during the COVID-19 pandemic. Our results are consistent with previous in-person hospital-based music interventions and highlight the importance of such programs when in-person interventions are not possible. This pilot project serves as a prelude to further investigate mechanisms by which music interventions can support admitted neurology patients.

Neurophysiological effects of various music genres on electroencephalographic (EEG) cerebral cortex activity

Background

Music has been associated with therapeutic properties for thousands of years across a vast number of diverse regions and cultures. This study expands upon our current understanding of music’s influence on human neurophysiology by investigating the effects of various music genres on cerebral cortex activity using electroencephalography (EEG).

Methods

A randomized, controlled study design was used. EEG data were recorded from 23 healthy adults, ages 19–28, while listening to a music sequence consisting of five randomized songs and two controls. The five studied music genres include: Classical, Tribal Downtempo, Psychedelic Trance (Psytrance), Goa Trance, and Subject Choice.

Results

Controls were associated with lower percentages of beta frequencies and higher percentages of alpha frequencies than the music genres. Psytrance was associated with higher percentages of theta and delta frequencies than the other music genres and controls. The lowest percentages of beta frequencies and highest percentages of alpha frequencies occurred in the occipital and parietal regions. The highest percentages of theta and delta frequencies occurred in the frontal and temporal regions. Subjects with prior music training exhibited increased percentages of delta frequencies in the frontal region. Subject gender and music preference did not have a significant influence on frequency band percentages.

Conclusions

Findings from this study support those of previous music therapy studies and provide novel insights regarding music’s influence on human neurophysiology. These findings also support the hypothesis that music may promote changes in cerebral cortex activity that have similarities to non-rapid eye movement (NREM) sleep, while the listener remains awake.

Effect of music on patients with cardiovascular diseases and during cardiovascular interventions : A systematic review

BACKGROUND

The therapeutic effects of music have been known for thousands of years. Recently, studies with music interventions in patients with cardiovascular diseases yielded controversial results. The aim of this review is to provide an overview of the effects of receptive music intervention on the cardiovascular system.

METHODS

We searched in PubMed, SCOPUS and CENTRAL for publications between January 1980 and May 2018. Primary endpoints were heart rate, heart rate variability and blood pressure. Secondary endpoints comprised respiratory rate, anxiety and pain. The quality of the studies was assessed by using the CONSORT statement and the Cochrane risk of bias assessment tool. A meta-analysis and subgroup analyses concerning music style, gender and region were planned.

RESULTS

A total of 29 studies comprising 2579 patients were included and 18 studies with 1758 patients investigated the effect of music on patients undergoing coronary angiography or open heart surgery. Other studies applied music to children with congenital heart diseases, pregnant women with hypertension or patients with unstable angina. Due to high methodological study heterogeneity, a meta-analysis was not performed. The study quality was assessed as medium to low. In ten studies with higher quality comprising 1054 patients, music intervention was not associated with significant changes in the cardiovascular endpoints compared to the control group. The subgroup analyses did not demonstrate any relevant results.

CONCLUSION

Currently no definite effect of receptive music intervention on the cardiovascular system can be verified. Further research is needed to assess music as an inexpensive and easy applicable form of therapy.

Noninvasive Approaches for Anxiety Reduction During Interventional Radiology Procedures

Periprocedural anxiety is a major cause of morbidity, particularly for interventional radiology procedures that often depend on conscious sedation. Management of anxiety and pain during image-guided procedures has traditionally relied on pharmacologic agents such as benzodiazepines and opioids. Although generally safe, use of these medications risks adverse events, and newer noninvasive, nonpharmacologic techniques have evolved to address patient needs. In this review, we explore the roles of hypnosis, structured empathic attention, anodyne imagery, music, video glasses, and mobile applications in reducing procedural anxiety and pain with the goal of improving patient satisfaction, operational efficiency, and clinical outcomes.

The effects of music therapy in patients undergoing septorhinoplasty surgery under general anesthesia

Introduction

Music has been used for several years as a relaxation method to reduce stress and anxiety. It is a painless, safe, inexpensive and practical nonpharmacologic therapeutic modality, widely used all over the world.

Objectives

We aimed to evaluate the effect of music therapy on intraoperative awareness, patient satisfaction, awakening pain and waking quality in patients undergoing elective septorhinoplasty under general anesthesia.

Methods

This randomized, controlled, prospective study was conducted with 120 patients undergoing septorhinoplasty within a 2 months period. The patients were randomly selected and divided into two groups: group music (music during surgery) and control group (without music during surgery). All patients underwent standard general anesthesia. Patients aged 18–70 years who would undergo a planned surgery under general anesthesia were included. Patients who had emergency surgery, hearing or cognitive impairment, were excluded from the study.

Results

A total of 120 patients were enrolled, and separated into two groups. There were no statistically significant differences between the groups in terms of demographic characteristics, anesthesia and surgery durations (p > 0.05). In the music group, sedation agitation scores were lower than those in the control group at the postoperative period (3.76 ± 1.64 vs. 5.11 ± 2.13; p < 0.001). In addition; in patients of the music group, the pain level (2.73 ± 1.28 vs. 3.61 ± 1.40) was lower (p < 0.001), requiring less analgesic drugs intake.

Conclusion

Music therapy, which is a nonpharmacologic intervention, is an effective method, without side effects, leading to positive effects in the awakening, hemodynamic parameters and analgesic requirements in the postoperative period. It is also effective in reducing the anxiety and intraoperative awareness episodes of surgical patients.

Music Interventions in Percutaneous Coronary Procedures: A Meta-Analysis

To clarify the effectiveness of music intervention for improving the well-being of patients undergoing coronary procedures for coronary heart disease, we conducted full-text searches of various databases (MEDLINE, Cochrane Library, CINAHL, ProQuest, and Airiti Library; 1966-2019) to identify randomized controlled trials and quasi-experimental studies of music intervention in recipients of angiography or percutaneous coronary intervention. Outcome measures included anxiety, discomfort, pain, heart rate, and blood pressure. The Cochrane methodology, Jadad Quality Score, and ROBINS-I were employed to evaluate evidence from 10 studies. Music intervention reduced anxiety (effect size: Z = 2.15, p = .03; six studies) and discomfort of lying (Z = 2.40, p = .02; two studies), but did not affect pain (Z = 0.94; two studies), heart rate (Z = 0.94; five studies), or blood pressure (systolic, Z = 1.27; diastolic, Z = 1.32; four studies) (all p > .05). The heterogeneity among studies was high. Large-scale, transcultural, high-quality trials are warranted to confirm the benefit of music intervention in patients undergoing coronary procedures.

Physician-patient interactions and communication with conscious patients during simulated cath lab procedures: an exploratory study

Background

This exploratory study investigates the feasibility for observing and evaluating intraoperative communication practices using simulation techniques. Complex procedures are increasingly performed on patients under local anaesthesia, where patients are fully conscious. Interventional cardiac procedures are one such example where patients have reported high levels of anxiety undergoing procedures. Although communication styles can serve to alleviate patient anxiety during interventions, leading to a better patient experience, there has been little observational research on communication, while patient perspectives in intraoperative contexts have been underexplored.

Methods

In this mixed-methods study, observational analysis was conducted on 20 video-recorded simulated scenarios, featuring physician operators (of varied experience levels), communication and interactions with a simulated patient (trained actor), in a controlled and highly realistic catheter laboratory setting. Two independent raters and the simulated patient embedded in scenarios retrospectively rated physician communication styles and interactions with the patient via four key parameters. Patient perspectives of communication were further explored via a quantitative measure of anxiety and semistructured qualitative interviews.

Results

While independent ratings of physician-patient communications demonstrated few discernible differences according to physicians' experience level, patient ratings were consistently higher for experienced physicians and lower for novice physicians for the four interaction styles. Furthermore, the patient's anxiety scores were differentiable according to operators' experience level. Thematic analysis provided further insights into how patient perspectives, including affective dimensions are characterised, and how physician interactions can amplify or attenuate feelings of anxiety through tone of voice, continuity in communication during the procedure, communicating while multitasking and connecting with the patient.

Conclusions

Our findings indicate underlying patient assumptions about physicians' experience levels, intraoperative communication styles and impact on anxiety. While observational methods can be applied to simulated intraoperative clinical contexts, evaluation techniques such as observational rating tools need to incorporate patient perspectives about undergoing conscious surgery.

Effects of music therapy on anxiety and physiologic parameters in angiography: a systematic review and meta-analysis

Background

Given the anxiety patients experience during angiography, evidence supporting the efficacy of music therapy during these angiographic procedures is potentially of clinical value.

Objective

To analyze the existing literature forthe use of music therapy during cerebral, coronary, and peripheral angiography to determine whether it improves patient anxiety levels, heart rate, and blood pressure during the procedure.

Methods

PubMed, Embase, and Scopus were searched to identify studies of interest. Inclusion criteria included studies reporting using music therapy in either cerebral, coronary, or peripheral angiography. Studies focused on a pediatric population; animal studies and case reports were excluded. Participant demographics, interventions, and outcomes were collected by two study authors. Bias and study quality of randomized controlled trials (RCTs) were assessed using the Cochrane Risk of Bias Tool. Separate meta-analyses of the RCTs were performed to compare State Trait Anxiety Inventory (STAI), heart rate (HR), and systolic and diastolic blood pressure (SBP and DBP) in the music intervention group versus control group. Heterogeneity was determined by calculating I2 values, and a random-effects model was used when heterogeneity exceeded 50%.

Results

The preprocedure to postprocedure improvement in STAI was significantly greater in the experimental group than the control group (p=0.004), while the decrease in HR, SBP, and DBP was not significant.

Conclusions

Recorded music and/or music therapy in angiography significantly decreases patients’ anxiety levels, while it has little to no effect on HR and BP. This meta-analysis is limited by the relatively few RCTs published on this subject.

PROSPERO registration number

CRD42018099103

Does Jacobson's relaxation technique reduce consumption of psychotropic and analgesic drugs in cancer patients? A multicenter pre-post intervention study

Background

Cancer patients often suffer from emotional distress as a result of the oncological process. The purpose of our study was to determine whether practice of Jacobson’s relaxation technique reduced consumption of psychotropic and analgesic drugs in a sample of cancer patients.

Methods

This was a multicenter pre–post intervention design. Participants were 272 patients aged over 18 years attending 10 Spanish public hospitals with oncological pathologies and anxiety symptoms. The intervention consisted of a protocol of abbreviated progressive muscle relaxation training developed by Bernstein and Borkovec. This was followed up by telephone calls over a 1-month period. The intervention was performed between November 2014 and October 2015. Sociodemographic variables related to the oncological process, mental health variables, and intervention characteristics were measured.

Results

A reduction in the consumption of psychotropic and analgesic drugs was observed throughout the follow-up period. Improvement was observed throughout the 4-week follow-up for all the parameters assessed: anxiety, relaxation, concentration, and mastery of the relaxation technique.

Conclusions

The practice of abbreviated Jacobson’s relaxation technique can help to decrease the consumption of psychotropic and analgesic drugs. Patients experienced positive changes in all the evaluated parameters, at least during the 1-month follow-up. To confirm these findings, additional long-term studies are needed that include control groups.

Trial registration

ISRCTN 81335752, DOI 10.1186/ISRCTN81335752 17. Date of registration: 22/11/2016 (retrospectively registered).

Effects of music listening on anxiety and physiological responses in patients undergoing awake craniotomy

OBJECTIVE

The purpose of this study was to explore the effects of music listening on the level of anxiety and physiological responses for awake craniotomy.

METHODS

An experimental design with randomization was applied in this study. Participants in experimental group (19 patients) selected and listened music at their preferences in the waiting room and throughout the entire surgical procedure in addition to usual care while control group (19 patients) only gave usual care. State-Trait Anxiety Inventory (STAI), heartbeat, breathing, and blood pressure were collected for analysis.

RESULTS

The results of this study showed that after music listening, there was significant decrease in the level of anxiety (p<.001). The findings also showed that the music intervention significantly reduced heartbeat rate 84.5 (p<.004), systolic pressure 42 (p<.001), and diastolic pressure 38 (p<.001) over time. We concluded that music listening is associated with a decreased level of anxiety and distress after awake craniotomy patients.

CONCLUSION

The results of this study can provide perioperative nursing care in providing music listening when patients were in the waiting room and during surgery to reduce the anxiety so as to reach the goal of human care and improve perioperative nursing care.

Music listening alleviates anxiety and physiological responses in patients receiving spinal anesthesia

OBJECTIVE

The aim of this study was to explore the effects of listening to music on the anxiety levels and physiological responses of surgical patients receiving spinal anesthesia.

METHODS

An experimental design was used in the study with an experimental group (n=50) and a control group (n=50). The experimental group received 30min of musical intervention and routine nursing care in the Post-Anesthesia Care Unit (PACU) while the control group received only routine nursing care.

RESULTS

The study found significant differences in both anxiety and physiological indices between the two groups. The mean score of the State-Trait Anxiety Inventory (STAI) in the study group decreased from a pre-test score of 59.0 to a post-test score of 31.20 (t=28.63, p<0.001). Physiological indices such as heart rate (t=2.61, p=0.012), respiration rate (t=2.29, p=0.026), systolic blood pressure (t=2.30, p=0.026), and diastolic blood pressure (t=3.02, p=0.004) decreased significantly as well. Control group was not seeing significant changes from pre-op values.

CONCLUSION

Listening to music while in the recovery room may decrease the level of anxiety in surgical patients receiving spinal anesthesia. The results of this study can serve as a reference for PACU nurses in utilizing music listening programs to achieve the goal of holistic care.

Psychological treatment of comorbid asthma and panic disorder in Latino adults: Results from a randomized controlled trial

Confusion between panic and asthma symptoms can result in serious self-management errors. A cognitive behavior psychophysiological therapy (CBPT) intervention was culturally adapted for Latinos consisting of CBT for panic disorder (PD), asthma education, differentiation between panic and asthma symptoms, and heart rate variability biofeedback. An RCT compared CBPT to music and relaxation therapy (MRT), which included listening to relaxing music and paced breathing at resting respiration rates. Fifty-three Latino (primarily Puerto Rican) adults with asthma and PD were randomly assigned to CBPT or MRT for 8 weekly sessions. Both groups showed improvements in PD severity, asthma control, and several other anxiety and asthma outcome measures from baseline to post-treatment and 3-month follow-up. CBPT showed an advantage over MRT for improvement in adherence to inhaled corticosteroids. Improvements in PD severity were mediated by anxiety sensitivity in CBPT and by depression in MRT, although earlier levels of these mediators did not predict subsequent improvements. Attrition was high (40%) in both groups, albeit comparable to CBT studies targeting anxiety in Latinos. Additional strategies are needed to improve retention in this high-risk population. Both CBPT and MRT may be efficacious interventions for comorbid asthma-PD, and CBPT may offer additional benefits for improving medication adherence.

Exploring the effect of sound and music on health in hospital settings: A narrative review

BACKGROUND

Sound in hospital space has traditionally been considered in negative terms as both intrusive and unwanted, and based mainly on sound levels. However, sound level is only one aspect of the soundscape. There is strong evidence that exploring the positive aspect of sound in a hospital context can evoke positive feelings in both patients and nurses. Music psychology studies have also shown that music intervention in health care can have a positive effect on patient's emotions and recuperating processes. In this way, hospital spaces have the potential to reduce anxiety and stress, and make patients feel comfortable and secure. This paper describes a review of the literature exploring sound perception and its effect on health care.

DATA SOURCES AND REVIEW METHODS

This review sorted the literature and main issues into themes concerning sound in health care spaces; sound, stress and health; positive soundscape; psychological perspective of music and emotion; music as a complementary medicine for improving health care; contradicting arguments concerning the use of music in health care; and implications for clinical practice. Using Web of Science, PubMed, Scopus, ProQuest Central, MEDLINE, and Google, a literature search on sound levels, sound sources and the impression of a soundscape was conducted. The review focused on the role and use of music on health care in clinical environments. In addition, other pertinent related materials in shaping the understanding of the field were retrieved, scanned and added into this review.

RESULTS

The result indicated that not all noises give a negative impression within healthcare soundscapes. Listening to soothing music was shown to reduce stress, blood pressure and post-operative trauma when compared to silence. Much of the sound conveys meaningful information that is positive for both patients and nurses, in terms of soft wind, bird twitter, and ocean sounds.

CONCLUSIONS

Music perception was demonstrated to bring about positive change in patient-reported outcomes such as eliciting positive emotion, and decreasing the levels of stressful conditions. Whilst sound holds both negative and positive aspects of the hospital ecosystem and may be stressful, it also possesses a soothing quality that induces positive feelings in patients. Conceptualizing the nature of sound in the hospital context as a soundscape, rather than merely noise can permit a subtler and socially useful understanding of the role of sound and music in the hospital setting, thereby creating a means for improving the hospital experience for patients and nurses.

Music before Dental Surgery Suppresses Sympathetic Activity Derived from Preoperative Anxiety: A Randomized Controlled Trial

The aim of this study was to estimate the relieving effect of music intervention on preoperative anxiety by using heart rate variability (HRV) analysis. In this randomized controlled trial, 86 adult patients were scheduled to undergo impacted tooth extraction under intravenous sedation and local anesthesia and were classified as either fearful or nonfearful based on a questionnaire. Thereafter, the patients were subdivided into 2 groups: those who listened to music from the time that they arrived at the outpatient clinic until immediately before entering the operating room and those who did not listen to music. The effect of music intervention was evaluated by assessing 1) the low-frequency/high-frequency ratio of HRV, in which positive changes indicate increased sympathetic nervous activity, and 2) the coefficient of component variance for high frequency, in which positive changes indicate increased parasympathetic nervous activity, assessed by means of HRV analysis. Subjective preoperative anxiety was evaluated on a visual analog scale. For fearful patients, the mean magnitude of low-frequency/high frequency changes from baseline among those who listened to music was significantly lower as compared with those who did not listen to music (in the private room: -1.45 ± 1.88 vs. 1.05 ± 1.88, P = 0.0096, 95% confidence interval of effect size = -4.52 to -0.48, Cohen's d = -0.75; in the operating waiting room: -2.18 ± 2.39 vs. -0.10 ± 3.37, P = 0.011, 95% confidence interval of effect size = -3.94 to -0.22, Cohen's d = -0.71, respectively). Visual analog scale scores were also significantly different. Coefficient of component variance for high frequency and heart rate did not differ significantly between the 2 groups. From the perspective of autonomic nervous activity, music intervention is useful for relieving anxiety in patients with dental fear before they enter a dental outpatient operating room. Music intervention may relieve anxiety by reducing sympathetic nervous activity, while parasympathetic nervous activity is not involved (UMIN000016882). Knowledge Transfer Statement: The results of this study revealed that music intervention is useful for clinicians when planning preoperative anxiety management of patients with dental fear who undergo impacted tooth extraction under intravenous sedation and local anesthesia. As a bridging intervention, music intervention enables stress management to continue uninterrupted from the patient's arrival at the dental outpatient clinic to intravenous sedation until completion of the dental surgery. With consideration of cost-effectiveness, absence of adverse physical effects, immediate effect, safety in terms of not using drugs, and lack of concerns about recovery, this information could lead to more appropriate decisions regarding anxiety management in dentistry.

Beneficial Effect of Preferential Music on Exercise Induced Changes in Heart Rate Variability

INTRODUCTION

Music is known to reduce pain, anxiety and fear in several stressful conditions in both males and females. Further, listening to preferred music enhances the endurance during running performance of women rather than listening to non-preferred music. In recent years Heart Rate Variability (HRV) has been used as an indicator of autonomic nervous activity.

AIM

This study was aimed to assess the effectiveness of preferential music on HRV after moderate exercise.

MATERIALS AND METHODS

This was an experimental study done in 30 healthy students aged between 20-25 years, of either sex. HRV was measured at rest, 15 minutes of exercise only and 15 minutes of exercise with listening preferential music in same participants. Data was analysed by One-Way ANOVA and Tukey HSD Post-hoc Test. Statistical significance was taken to be a p-value of less than 0.05.

RESULTS

Low frequency and high frequency component was significantly increased followed by only exercise. Music minimized increase in both high and low frequency component followed by exercise. However, only high frequency change was statistically significant. LF/HF ratio was significantly increased followed by only exercise. Music significantly minimized increase in LF/HF ratio.

CONCLUSION

This study provides the preliminary evidence that listening to preferential music could be an effective method of relaxation, as indicated by a shift of the autonomic balance towards the parasympathetic activity among medical students.

Virtual Reality in Health System: Beyond Entertainment. A Mini-Review on the Efficacy of VR During Cancer Treatment

Virtual reality (VR), a computer-generated virtual environment, has been increasingly used in the entertainment world becoming a very new evolving field, but VR technology has also found a variety of applications in the biomedical field. VR can offer to subjects a safe environment within which to carry on different interventions ranging from the rehabilitation of discharged patients directly at home, to the support of hospitalized patients during different procedures and also of oncological inpatient subjects. VR appears as a promising tool for support and monitoring treatments in cancer patients influencing psychological and physiological functions. The aim of this systematic review is to provide an overview of all the studies that used VR intervention on cancer patients and analyze their main findings. Nineteen studies across nearly a thousand articles were identified that explored effects of VR interventions on cancer patients. Although these studies varied greatly in setting and design, this review identified some overarching themes. Results found that VR improved patients' emotional well-being, and diminished cancer-related psychological symptoms. The studies explored various relevant variables including different types of settings (i.e., during chemotherapy, during pain procedures, during hospitalization). Here, we point to the need of a global and multi-disciplinary approach aimed at analyzing the effects of VR taking advantage of the new technology systems like biosensors as well as electroencephalogram monitoring pre, during, and after intervention. Devoting more attention to bio-physiological variables, standardized procedures, extending duration to longitudinal studies and adjusting for motion sickness related to VR treatment need to become standard of this research field.

Effects of Music Listening on Pre-treatment Anxiety and Stress Levels in a Dental Hygiene Recall Population

BACKGROUND

Waiting for a medical procedure can exert significant feelings of state anxiety in patients. Music listening has been shown to be effective in decreasing anxiety levels. No study so far examined the potential anxiety and stress-reducing effect of a music intervention on pre-treatment anxiety and stress in patients waiting for dental hygiene treatment. Knowing whether the anxiety-reducing effect of music would also be detectible in the context of preventive routine medical procedures in healthy individuals would widen the area of application of music from the hospital or clinical environment to medical offices in general.

PURPOSE

Waiting for a medical treatment can induce anxiety and may lead to the experience of stress. We set out to examine the effect of music on pre-treatment anxiety in a healthy patient sample waiting for a dental treatment.

METHODS

In a randomized controlled clinical trial, 92 consecutive volunteer patients (mean age, 57 years) waiting for their scheduled dental hygiene treatment were randomly allocated to either an experimental (n = 46, listening to music for 10 min) or a control group (n = 46, waiting in silence). State and habitual anxiety, subjective stress, and mood measures were assessed before and after music listening or silence, respectively.

RESULTS

State anxiety levels in the music group decreased significantly after intervention as compared to the control group (F(1/90) = 8.06; p = 0.006). Participants' trait anxiety and dental anxiety were not found to moderate this effect.

CONCLUSIONS

Listening to music prior to dental hygiene treatment decreases anxiety levels to a greater extent than waiting in silence.

The effect of a researcher designated music intervention on hospitalised psychiatric patients with different levels of anxiety

AIMS AND OBJECTIVES

The purpose of this study was to investigate the effects of a music intervention on hospitalised psychiatric patients with different levels of anxiety.

BACKGROUND

In clinical practice, psychiatric inpatients and nurses routinely suffer from anxiety. A music intervention may possibly be useful, but knowledge as to how useful and how effective it is in patients with different levels of anxiety is limited.

DESIGN

The study design was a three-group, repeated-measures experimental study.

METHODS

Subjects were 22 psychiatric patients who were divided into three groups based on their level of anxiety. They listened to 20 minutes of music each day for 10 days and were assessed using the Beck Anxiety Inventory before and after the music intervention and at a one-week follow-up; an electroencephalogram and finger temperature were monitored before and during the music intervention.

RESULTS

Anxiety levels of all three groups showed a significant difference (p = 0·0339) after the intervention. The difference alpha and beta electroencephalogram percentages for all three groups showed a significant difference (p = 0·04; p = 0·01). The finger temperature showed a non-significant difference (p = 0·41).

CONCLUSIONS

A music intervention can effectively alleviate the anxiety of hospitalised psychiatric patients who suffer from all levels of anxiety.

RELEVANCE TO CLINICAL PRACTICE

The study recommends a practice in alleviating anxiety. Effective lower-cost interventions to reduce anxiety in psychiatric inpatient settings would be of interest to nurses and benefit patients.

Educational Video Intervention Effects on Periprocedural Anxiety Levels Among Cardiac Catheterization Patients: A Randomized Clinical Trial

Purpose: To explore the effectiveness of an educational video intervention in lowering periprocedural anxiety among Jordanian patients hospitalized for cardiac catheterization (CATH). There are many potential reasons of anxiety related to CATH including involvement of the heart and the actual test procedure. Methods: A randomized controlled trial took place in a specialized heart institute in Jordan. The sample size was 186 patients who had undergone CATH procedure. Patients anxiety levels were measured by physiological parameters of anxiety (blood pressure, heart rate, and respiratory rate) and by the Spielberger State Anxiety Inventory (SAI). Results: After video education, there was a significant difference in periprocedural perceived anxiety between the groups: preprocedural anxiety levels (M = 39.03, SD = 5.70) for the experimental group versus (M = 49.34, SD = 6.00) for the control, p < .001, and postprocedural perceived anxiety for the experimental group (M = 29.18, SD = 5.42) versus (M = 41.73, SD = 5.41) for the control. Conclusion: Providing an educational video intervention about CATH may effectively decrease periprocedural anxiety levels.

Clinical Efficacy, Safety, and Feasibility of Using Video Glasses during Interventional Radiologic Procedures: A Randomized Trial

PURPOSE

To evaluate the clinical efficacy, safety, and feasibility of implementing video glasses in a variety of interventional radiologic (IR) procedures.

MATERIALS AND METHODS

Between August 2012 and August 2013, 83 patients undergoing outpatient IR procedures were randomized to a control group (n = 44) or an experimental group outfitted with video glasses (n = 39). State-Trait Anxiety Inventory (STAI) scores, sedation and analgesia doses, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), pain scores, and procedure times were obtained. Complications and adverse events related to the use of video glasses were recorded. Postprocedural staff surveys and patient satisfaction surveys were completed.

RESULTS

Women had greater preprocedural anxiety than men (P = .0056), and patients undergoing vascular interventions had greater preprocedural anxiety than those undergoing nonvascular interventions (P = .0396). When assessed after the procedure, patients who wore video glasses had significantly reduced levels of anxiety (-7.7 vs -4.4, respectively; P = .0335) and average MAP (-6.3 vs 2.1, respectively; P = .0486) compared with control patients. There was no significant difference in amount of sedation and analgesia, HR, RR, pain score, or procedure time between groups. No significant adverse events related to the use of video glasses were observed. Postprocedural surveys showed that video glasses were not distracting and did not interfere or pose a safety issue during procedures. Patients enjoyed using the video glasses and would use them again for a future procedure.

CONCLUSIONS

Video glasses can be safely implemented during IR procedures to reduce anxiety and improve a patient's overall experience.

The effect of need-based spiritual/religious intervention on spiritual well-being and anxiety of elderly people

Anxiety and spiritual distress are the most common problems among the patients admitted in intensive care units. The elderly are more vulnerable to this problem due to impairment of their adaptation mechanisms. Hence, helping to reduce anxiety is one of the most effective nursing interventions. Therefore, this study aimed at investigating the effect of need-based spiritual/religious interventions on spiritual well-being (SWB) and anxiety of the elderly admitted to coronary care unit (CCU). This quasi-experimental study with pre- and posttest control group design was conducted on 66 patients admitted to CCU of Imam Reza hospital in Lar, southern Iran, in 2014. After obtaining informed consents, the data were collected using the Spielberger State-Trait Anxiety Inventory, the SWB Scale, and a demographic questionnaire. The questionnaires were completed through interviewing the patients before and after the intervention. The participants of the intervention group underwent 60- to 90-minute sessions of spiritual and religious need-based interventions for 3 consecutive days. The results showed a significant increase in the mean scores of SWB in the intervention group after the intervention (P = .001). Also, a significant decrease was found in mean scores of trait and state anxiety in the intervention group in comparing to control group (P < .001). Moreover, a significant correlation was observed between the mean scores of SWB and state and trait anxiety. Spiritual/religious interventions could enhance SWB and reduce anxiety in the elderly admitted to CCU.

Effect of music on postoperative pain in patients under open heart surgery

Background:

Music, as a non-pharmacological and inexpensive nursing intervention, can be used easily as a complementary technique in reducing pain along with other methods. While some studies have demonstrated pain to decrease after music, others found music to be ineffective on pain.

Objectives:

The aim of this study was to investigate the effect of music on postoperative pain in patients under open heart surgery.

Patients and Methods:

A quasi-experimental study was performed on 60 patients under open heart surgery referred to ICU of Shahid Beheshti hospital in Kashan city. Patients were randomly divided into two groups including experimental and control groups. Patients in music group listened to nonverbal music for 30 minutes after surgery by headphones. The control group did not receive any intervention other than routine care. Before and after intervention, pain intensity was measured and recorded by visual analog scale in two groups. Data was analyzed using Chi-Square and t-tests.

Results:

Before intervention, the mean of pain intensity was 6.32 ± 0.21 and 6.10 ± 0.21 for experimental and control groups, respectively; and the difference was not significant (P = 0.21). After intervention, the mean of pain intensity was 3.11 ± 0.12 and 5.81 ± 0.38 for experimental and control groups, respectively; and the difference was significant (P = 0.04).

Conclusions:

Listening to the relaxant music can reduce postoperative pain. It is suggested that relaxant music be used as a complementary method in patients in order to reduce prospective pain.

Effects of Music Listening on Pre-treatment Anxiety and Stress Levels in a Dental Hygiene Recall Population

BACKGROUND

Waiting for a medical procedure can exert significant feelings of state anxiety in patients. Music listening has been shown to be effective in decreasing anxiety levels. No study so far examined the potential anxiety and stress-reducing effect of a music intervention on pre-treatment anxiety and stress in patients waiting for dental hygiene treatment. Knowing whether the anxiety-reducing effect of music would also be detectible in the context of preventive routine medical procedures in healthy individuals would widen the area of application of music from the hospital or clinical environment to medical offices in general.

PURPOSE

Waiting for a medical treatment can induce anxiety and may lead to the experience of stress. We set out to examine the effect of music on pre-treatment anxiety in a healthy patient sample waiting for a dental treatment.

METHODS

In a randomized controlled clinical trial, 92 consecutive volunteer patients (mean age, 57 years) waiting for their scheduled dental hygiene treatment were randomly allocated to either an experimental (n = 46, listening to music for 10 min) or a control group (n = 46, waiting in silence). State and habitual anxiety, subjective stress, and mood measures were assessed before and after music listening or silence, respectively.

RESULTS

State anxiety levels in the music group decreased significantly after intervention as compared to the control group (F(1/90) = 8.06; p = 0.006). Participants' trait anxiety and dental anxiety were not found to moderate this effect.

CONCLUSIONS

Listening to music prior to dental hygiene treatment decreases anxiety levels to a greater extent than waiting in silence.

Influence of Music on Preoperative Anxiety and Physiologic Parameters in Women Undergoing Gynecologic Surgery

The aim of this study was to determine the influence of music on anxiety levels and physiologic parameters in women undergoing gynecologic surgery. This study employed a pre- and posttest experimental design with nonrandom assignment. Ninety-seven women undergoing gynecologic surgery were included in the study, where 49 were allocated to the control group (nonmusic group) and 48 were assigned to the experimental group (music group). Preoperative anxiety was measured using the State Trait Anxiety Inventory (STAI) while noninvasive instruments were used in measuring the patients’ physiologic parameters (blood pressure [BP], pulse [P], and respiration [R]) at two time periods. Women allocated in the experimental group had lower STAI scores ( t = 17.41, p < .05), systolic ( t = 6.45, p < .05) and diastolic ( t = 2.80, p < .006) BP, and P rate (PR; t = 7.32, p < .05) than in the control group. This study provides empirical evidence to support the use of music during the preoperative period in reducing anxiety and unpleasant symptoms in women undergoing gynecologic surgery.

Effects of a multimodal preparation package on vital signs of patients waiting for coronary angiography

Background:

Patients waiting for coronary angiography are often anxious and worried, experiencing considerable emotional problems before the procedure, which can result in an increase in blood pressure (BP), heart rate, respiratory rate and the myocardial oxygen demand. Such maladaptive responses may not only increase the patients need for sedative drugs, but also could increase the length of post angiography hospitalization. Therefore, it is important to implement some supportive actions to decrease the patients’ anxiety and to stabilize their vital signs before coronary angiography.

Objectives:

This study aimed to investigate the effects of a multimodal preparation package on vital signs of patients undergoing coronary angiography.

Patients and Methods:

A matched trial was conducted on 66 patients waiting for coronary angiography. Patients were assigned in intervention (n = 33) and control (n = 33) groups. A multimodal preparation package was implemented in intervention group, two hours before angiography. The data collection instrument consisted of questions on demographic characteristics and a table for recording the patients’ vital signs including systolic BP (SBP) and diastolic BP (DBP), heart rate, respiratory rate and body temperature. Vital signs were measured three times, the day before angiography, 30 minutes before and 30 minutes after the angiography, using a thermometer and a monitoring device. Data analysis was performed using the Kolmogo-Smirnov test, t test and Mann-Whitney U test.

Results:

From the total number of 66 patients, the 63.3% were male and married. No significant differences were observed between the mean of SBP and DBP and also the heart rate in the intervention and control groups, on the day before angiography. However, the mean SBP and DBP and heart rate of the intervention group were significantly lower compared to the control group, both 30 minutes before and 30 minutes after angiography. The intervention did not significantly change the respiration rate and temperature in the intervention group.

Conclusions:

The study showed that preparation package was effective in decreasing SBP and DBP, as well as heart rate. Therefore, using multimodal comprehensive preparation packages, such as the package used in the present report, is suggested.

Effects of music therapy on pain and anxiety in patients undergoing port catheter placement procedure

BACKGROUND

Patients scheduled to invasive medical procedures experience high levels of anxiety, which may lead to increased perceptions of pain and vital sign instability throughout.

AIMS

To examine the effect of a music intervention (MI) on stress hormones, physiologic parameters, pain, and anxiety state before and during port catheter placement procedures (PCPPs).

METHODS

We conducted a prospective, randomized, controlled study in 100 oncology patients, who were randomly assigned to an MI group (n=50) or a control group (n=50). The effects of music were assessed by determination of serum cortisol and adrenocorticotropic hormone (ACTH) levels, heart and respiratory rate (HR, RR) and systolic and diastolic blood pressure (SBP, DBP), on arrival in the surgical intervention room, as well as immediately prior to and immediately after the PCPP, in both groups. Furthermore, pain and anxiety levels were identified using visual analogue scale and state-trait anxiety inventory scales.

RESULTS

On arrival, there were no differences between the patients in terms of serum cortisol and ACTH levels, HR, RR, SBP, DBP and anxiety levels. There were significant reductions in hormone levels (p<0.05 for all), HR (p<0.001), RR (p<0.001), SBP (p<0.05) and DBP (p<0.05), immediately prior to and immediately after the PCPP in participants in the MI group compared to those in the control group. Furthermore, music led to a significant reduction in pain (p<0.05) and anxiety scores (p<0.05) in the MI group compared to control group.

CONCLUSION

During invasive medical procedures, MI significantly decreases stress hormone levels, physiological parameters, acute procedural pain and anxiety.

Effects of music on systolic blood pressure, diastolic blood pressure, and heart rate: a meta-analysis

There are a handful of studies that have been done investigating the effect of music on various vital signs, namely systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Many studies have also assessed effects of music on self-reported anxiety level, attributing some degree of music-induced anxiety relief to the beneficial impacts of music on vital signs. Several randomised studies have shown varying effects of music on these vital parameters and so a meta-analysis was done to compare the effect of music on them. The fixed effects model was used as studies were homogenous. A two-sided alpha error < 0.05 was considered to be statistically significant. Compared to those who did not receive music therapy, those who did receive music therapy had a significantly greater decrease in SBP before and after (difference in means, -2.629, confidence interval (CI), -3.914 to -1.344, P < 0.001), a significantly greater decrease in DBP (difference in means, -1.112, CI, -1.692 to -0.532, P < 0.001), and a significantly greater decrease in HR (difference in means, -3.422, CI, -5.032 to -1.812, P < 0.001).

Effects of music listening on adult patients' pre-procedural state anxiety in hospital

EXECUTIVE SUMMARY:

BACKGROUND

Anticipation of an invasive procedure in hospital is likely to provoke feelings of anxiety and stress in patients. An unfamiliar environment, loss of control, perceived or actual physical risk, dependence on strangers and separation from friends and family are all factors that can contribute to the development of such feelings. Recently, there has been considerable interest in the anxiolytic potential of music listening in a variety of clinical settings, yet thus far, little is known about the impact of music listening on the pre-procedural patient population. A systematic review of all literature to date was indicated to improve understanding of outcomes and impact of music listening on pre-procedural anxiety, thus helping nurses decide whether or not to incorporate music listening into practice and to highlight a need, or otherwise, for a related primary research agenda.

OBJECTIVE

The objective of this review was to determine the best available evidence on the effectiveness of music listening in reducing adult hospital patients' pre-procedural state anxiety.

INCLUSION CRITERIA

Types of studies This review included randomised controlled trials and quasi-experimental research designs that examined the efficacy of music listening in reducing state anxiety among pre-procedural hospital patients published between January 1985 and February 2006. The search was limited to publications after 1985 to coincide with the increasing interest and use of complementary therapies within health care during the 1980s and 1990s. Types of participants Participants of interest to the review were adult day patients, ambulatory patients and inpatients who were about to undergo any type of clinical procedure. Types of intervention The review focused on studies that investigated pre-procedural music listening employed and prescribed as a potentially therapeutic activity. It excluded any other form of music therapy. Types of outcome measures The primary outcome measures examined were alterations in state anxiety and a variety of physiological variables such as blood pressure and respiration and heart rates.

SEARCH STRATEGY

A search for published and unpublished literature between January 1985 and February 2006 was conducted using all major electronic databases. A three-step search strategy was devised which consisted of using high-precision MeSH terminology and keywords to ensure that all material relevant to the review was captured. CRITICAL APPRAISAL: The methodological quality of included studies was assessed by two reviewers, who appraised each study independently, using the standard Joanna Briggs Institute (JBI) critical appraisal tools.

DATA EXTRACTION AND SYNTHESIS

Data were extracted from the studies that were identified as meeting the criteria for methodological quality using a data-extraction tool developed for the review. Studies were grouped by outcome measure and summarised using tabular and narrative formats.

RESULTS

The review demonstrated that state anxiety is defined and measured using both psychological and physiological parameters. Music listening had a consistently positive and statistically significant effect on reducing psychological parameters of pre-procedural state anxiety. However, the results from the measurement of various pre-procedural physiological parameters failed to reveal any consistent positive changes in patients who had listened to music. This calls into question the adequacy of the theories in this area which link anxiety and the automated and central nervous systems and the effect that music listening may have on these processes and physiological responses.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

1 In order to reduce anxiety, it is likely that patients will benefit psychologically from having the opportunity to listen to music in the immediate pre-procedural period. 2 Patients do not appear to experience any alteration in physiological status as a result of listening to music. 3 Further research is indicated in order to replicate existing studies, to strengthen the evidence to support such interventions and to establish intervention parameters. 4 Further research is needed analysing the physiological mechanisms by which music listening is believed to reduce state anxiety and the contribution of the automated and other nervous systems to this reduction.

Is there a role for music in reducing anxiety in plastic surgery minor operations?

Introduction

It is well documented that music plays a role in reducing anxiety levels. Its role in reducing intra-operative anxiety levels in surgical patients while awake is less well known. We report the effects of music on intra-operative patient anxiety in both the elective and trauma plastic surgical setting.

Methods

Two groups of patients undergoing local anaesthetic surgical procedures were identified: those where music was played in the operating theatre (Group 1) and those where it was not (Group 2). Ninety-six patients were included. Subjectively anxiety was evaluated by the patient with a visual analogue scale (VAS) and objectively by the respiratory rate (RR), both pre and post-operatively. The unpaired t-test was used to evaluate the statistical significance of differences between the groups.

Results

The mean pre-operative VAS score was similar in both groups (5.7 in Group 1 and 5.8 in Group 2). The mean preoperative RR was 15 breaths per minute in both groups. Post-operatively, the VAS score and RR were both lower in Group 1 (VAS: 3.5 vs 4.9; p<0.01 and RR: 11 vs 13 breaths per minute; p<0.05).

Conclusions

In the era of the patient centred approach to clinical care, it is crucial to minimise patient anxiety. Music appears to reduce intra-operative anxiety in awake patients in both the elective and trauma plastic surgical setting. Easy listening music and chart classics appear to be suitable genres according to patients. We believe there is a role for a large, multicentre, randomised control study to examine the benefits of music in all local anaesthetic procedures across different specialties.

Sensory environment on health-related outcomes of hospital patients

BACKGROUND

Hospital environments have recently received renewed interest, with considerable investments into building and renovating healthcare estates. Understanding the effectiveness of environmental interventions is important for resource utilisation and providing quality care.

OBJECTIVES

To assess the effect of hospital environments on adult patient health-related outcomes.

SEARCH METHODS

We searched: the Cochrane Central Register of Controlled Trials (last searched January 2006); MEDLINE (1902 to December 2006); EMBASE (January 1980 to February 2006); 14 other databases covering health, psychology, and the built environment; reference lists; and organisation websites. This review is currently being updated (MEDLINE last search October 2010), see Studies awaiting classification.

SELECTION CRITERIA

Randomised and non-randomised controlled trials, controlled before-and-after studies, and interrupted times series of environmental interventions in adult hospital patients reporting health-related outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently undertook data extraction and 'Risk of bias' assessment. We contacted authors to obtain missing information. For continuous variables, we calculated a mean difference (MD) or standardized mean difference (SMD), and 95% confidence intervals (CI) for each study. For dichotomous variables, we calculated a risk ratio (RR) with 95% confidence intervals (95% CI). When appropriate, we used a random-effects model of meta-analysis. Heterogeneity was explored qualitatively and quantitatively based on risk of bias, case mix, hospital visit characteristics, and country of study.

MAIN RESULTS

Overall, 102 studies have been included in this review. Interventions explored were: 'positive distracters', to include aromas (two studies), audiovisual distractions (five studies), decoration (one study), and music (85 studies); interventions to reduce environmental stressors through physical changes, to include air quality (three studies), bedroom type (one study), flooring (two studies), furniture and furnishings (one study), lighting (one study), and temperature (one study); and multifaceted interventions (two studies). We did not find any studies meeting the inclusion criteria to evaluate: art, access to nature for example, through hospital gardens, atriums, flowers, and plants, ceilings, interventions to reduce hospital noise, patient controls, technologies, way-finding aids, or the provision of windows. Overall, it appears that music may improve patient-reported outcomes such as anxiety; however, the benefit for physiological outcomes, and medication consumption has less support. There are few studies to support or refute the implementation of physical changes, and except for air quality, the included studies demonstrated that physical changes to the hospital environment at least did no harm.

AUTHORS' CONCLUSIONS

Music may improve patient-reported outcomes in certain circumstances, so support for this relatively inexpensive intervention may be justified. For some environmental interventions, well designed research studies have yet to take place.

Effects of music therapy on mood in stroke patients

PURPOSE

To investigate the effects of music therapy on depressive mood and anxiety in post-stroke patients and evaluate satisfaction levels of patients and caregivers.

MATERIALS AND METHODS

Eighteen post-stroke patients, within six months of onset and mini mental status examination score of over 20, participated in this study. Patients were divided into music and control groups. The experimental group participated in the music therapy program for four weeks. Psychological status was evaluated with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) before and after music therapy. Satisfaction with music therapy was evaluated by a questionnaire.

RESULTS

BAI and BDI scores showed a greater decrease in the music group than the control group after music therapy, but only the decrease of BDI scores were statistically significant (p=0.048). Music therapy satisfaction in patients and caregivers was affirmative.

CONCLUSION

Music therapy has a positive effect on mood in post-stroke patients and may be beneficial for mood improvement with stroke. These results are encouraging, but further studies are needed in this field.

Reporting Guidelines for Music-based Interventions

Music-based interventions are used to address a variety of problems experienced by individuals across the developmental lifespan (infants to elderly adults). In order to improve the transparency and specificity of reporting music-based interventions, a set of specific reporting guidelines is recommended. Recommendations pertain to reporting seven different components of music-based interventions including intervention theory, intervention content, intervention delivery schedule, interventionist, treatment fidelity, setting, and unit of delivery. Recommendations are intended to support CONSORT and TREND statements for transparent reporting of interventions while taking into account the variety, complexity, and uniqueness of music-based interventions.

The Effect of Music Therapy on Hospitalized Psychiatric Patients’ Anxiety, Finger Temperature, and Electroencephalography

Purpose: This study aimed to explore the effectiveness of music therapy in reducing anxiety in hospitalized psychiatric patients.

Methodology: The authors used a randomized clinical trial design and randomly allocated the 24 enrolled participants to the experimental or the control group. Patients in the experimental group received music therapy in a therapy room at a set time for 30 min each morning for 11 days. The authors administered the Beck Anxiety Inventory (BAI) and measured skin temperature and brain waves to determine anxiety level before, during, and after music therapy. Results: Experimental group participants had lower scores on the BAI than control participants, after the music therapy ( z = −2.0, p < .05) and at 1-week follow-up ( z = −2.2, p < .05), indicating that they were experiencing significantly less anxiety. The mean BAI anxiety score fell in the experimental group from 23.9 ( SD = 9.9) at baseline to 13.9 ( SD = 8.8), after music therapy, and 12.7. ( SD = 10.5) at follow-up. The experimental group demonstrated a significant elevation in the average alpha electroencephalographic (EEG) percentage (from 38.1% to 46.7%) and a reduction in the average beta EEG percentage (from 61.9% to 53.4%) after the music therapy. After adjusting for change in patient finger temperature on the first day, mean change in finger temperature did not differ significantly between the experimental and control groups. Conclusions: Music therapy can relieve anxiety in hospitalized psychiatric patients and help them achieve a state of relaxation.

Impact of relaxation training on patient-perceived measures of anxiety, pain, and outcomes after interventional electrophysiology procedures

BACKGROUND

Electrophysiology procedures vary in invasiveness, duration, and anesthesia utilized. While complications are low and efficacy high, cases are elective and patient experiences related to anxiety, pain, and perceived outcomes are not well studied. We sought to determine if a 30-minute audio compact disc (CD) that teaches relaxation techniques and wellness perception prior to an elective procedure impacts validated measures of anxiety, pain, and procedural outcomes.

METHODS

Sixty-one patients were randomly assigned to a control group (CG) (N(CG) = 31) or interventional group (IG) (N(IG) = 30). Both groups answered a baseline Hospital Anxiety and Depression Scale (HADS-A) survey consisting only of anxiety assessment questions. The IG listened to the CD the night prior to their procedure. Heart rate and blood pressure were monitored on admission and prior to the procedure. Postprocedure, both groups completed two HADS-A surveys as well as two Patient Experience Surveys (PES). There was no statistical difference in the demographics and the rate of procedural complications between the groups. The statistical significance of our data was determined using a Student's t-test and χ(2) test.

RESULTS

At baseline, both groups had equal amounts of anxiety prior to their procedures (P = 0.2). The patients in the IG had lower systolic blood pressures during admission and prior the administration of analgesics in comparison to the CG. Postprocedure, results from administering the HADS-A demonstrated that the IG had 33% lower anxiety (P = 0.02) than CG patients.

CONCLUSION

The implementation of basic relaxation teaching techniques prior to planned electrophysiology procedures lowers systolic blood pressure and postprocedural anxiety.