Vocal Music Therapy for Chronic Pain: A Mixed Methods Feasibility Study

Psychological wellbeing with music therapy: the moderating role of health awareness, and strategic health management in post Covid-19 era

BACKGROUND

Psychological problems are common among the people of every community. These psychological issues are leading people to mental health issues. Human well-being is required to be improved appropriately for the better health of the public. The objective of this research is to determine the influence of music therapy on the sustainable psychological well-being of the Chinese community. Furthermore, this research determines that moderating role of health awareness and strategic health management between music therapy and sustainable psychological well-being.

METHOD

The research used a sample of 384 collected with a random sampling method. For data collection, a cross-sectional method was adopted to collect data on a Likert scale questionnaire. The Health Awareness Scale, Music Therapy Scale, Sustainable Health Management Scale and Sustainable Psychological Wellbeing Scale was used in this research.

RESULTS

The findings of the research highlighted that there is a significant and positive influence of music therapy on the sustainable psychological well-being of the Chinese community. This research also concluded that there is a significant and positive moderating role of health awareness and strategic health management between music therapy and sustainable psychological well-being. The findings of this research are new and novel in the literature on psychological well-being.

CONCLUSION

This research has some theoretical and practical implications to advance the literature and practice for sustainable psychological well-being respectively. In clinical practice, music therapy can be effectively used to improve the psychological well-being of individuals with sustainability. The information related to health awareness and practice for strategic health management is also necessary for the clinical patients to improve their psychological well-being.

Motivation and music interventions in adults: A systematic review

ABSTRACTMusic is increasingly used in a wide array of settings, from clinical recovery to sports or well-being interventions. Motivation related to music is often considered as a possible working mechanism for music to facilitate these processes, however this has not previously been systematically evaluated. The current systematic review considered studies that involved music (therapy) interventions, together with motivation-related measures such as wanting to practise, liking the musical activities, or patient adherence to an intervention. Our objective was to examine whether music is related to increased motivation in task performance and/or rehabilitation settings, and whether this is in turn related to better clinical or training outcomes. Seventy-nine studies met the inclusion criteria, the majority of which (85%) indicated an increased level of motivation with music as compared to without. Moreover, in those studies where motivation was increased, clinical or other outcomes were improved in most cases (90%). These results support the notion of motivation as an underlying mechanism of music-based interventions, but more robust evidence is needed to ascertain which mechanisms are crucial in increasing motivation from a behavioural, cognitive, and neurobiological point of view, as well as how motivational mechanisms relate to other factors of effectiveness in music-based paradigms.

Effectiveness of Medical Music Therapy Practice: Integrative Research Using the Electronic Health Record: Rationale, Design, and Population Characteristics

Background: Several clinical trials support the efficacy of music therapy (MT) for improving outcomes in hospitalized patients, but few studies have evaluated the real-world delivery and integration of MT across multiple medical centers. This article describes the rationale, design, and population characteristics of a retrospective study examining the delivery and integration of MT within a large health system. Methods: A retrospective electronic health record (EHR) review was conducted of hospitalized patients seen by and/or referred to MT between January 2017 and July 2020. MT was provided across ten medical centers, including an academic medical center, a freestanding cancer center, and eight community hospitals. Discrete demographic, clinical, and MT treatment and referral characteristics were extracted from the EHR, cleaned, and organized using regular expressions functions, and they were summarized using descriptive statistics. Results: The MT team (average 11.6 clinical fulltime equivalent staff/year) provided 14,261 sessions to 7378 patients across 9091 hospitalizations. Patients were predominantly female (63.7%), White (54.3%) or Black/African American (44.0%), 63.7 ± 18.5 years of age at admission, and insured under Medicare (51.1%), Medicaid (18.1%), or private insurance (14.2%). Patients' hospitalizations (median length of stay: 5 days) were primarily for cardiovascular (11.8%), respiratory (9.9%), or musculoskeletal (8.9%) conditions. Overall, 39.4% of patients' hospital admissions included a mental health diagnosis, and 15.4% were referred to palliative care. Patients were referred by physicians (34.7%), nurses (29.4%), or advanced practice providers (24.7%) for coping (32.0%), anxiety reduction (20.4%), or pain management (10.1%). Therapists provided sessions to patients discharged from medical/surgical (74.5%), oncology (18.4%), or intensive care (5.8%) units. Conclusions: This retrospective study indicates that MT can be integrated across a large health system for addressing the needs of socioeconomically diverse patients. However, future research is needed to assess MT's impact on health care utilization (i.e., length of stay and rates of readmission) and immediate patient-reported outcomes.

SIO-ASCO guideline on integrative medicine for cancer pain management: implications for racial and ethnic pain disparities

Racial and ethnic disparities in pain management pose major challenges to equitable cancer care delivery. These disparities are driven by complex interactions between patient-, provider-, and system-related factors that resist reductionistic solutions and require innovative, holistic approaches. On September 19, 2022, the Society for Integrative Oncology and the American Society of Clinical Oncology published a joint guideline to provide evidence-based recommendations on integrative medicine for cancer pain management. Integrative medicine, which combines conventional treatments with complementary modalities from cultures and traditions around the world, are uniquely equipped to resonate with diverse cancer populations and fill existing gaps in pain management. Although some complementary modalities, such as music therapy and yoga, lack sufficient evidence to make a specific recommendation, other modalities, such as acupuncture, massage, and hypnosis, demonstrated an intermediate level of evidence, resulting in moderate strength recommendations for their use in cancer pain management. However, several factors may hinder real-world implementation of the Society for Integrative Oncology and the American Society of Clinical Oncology guideline and must be addressed to ensure equitable pain management for all communities. These barriers include, but are not limited to, the lack of insurance coverage for many complementary therapies, the limited diversity and availability of complementary therapy providers, the negative social norms surrounding complementary therapies, the underrepresentation of racial and ethnic subgroups in the clinical research of complementary therapies, and the paucity of culturally attuned interventions tailored to diverse individuals. This commentary examines both the challenges and the opportunities for addressing racial and ethnic disparities in cancer pain management through integrative medicine.

Music Therapy for Pain in Black and White Cancer Patients: A Retrospective Study

CONTEXT

Racial pain disparities present challenges to cancer symptom management. Music therapy has demonstrated benefits for pain and is a promising treatment option for diverse populations due to music's multicultural presence. However, Black cancer patients are under-represented in music therapy trials.

OBJECTIVES

This study compared pain severity, treatment approaches, and responses to music therapy between Black and white cancer patients. The findings will be used to generate hypotheses for future music therapy research to address racial disparities in pain management.

METHODS

We conducted a retrospective program evaluation of Black and white patients who received music therapy at an NCI-Designated Comprehensive Cancer Center. We used the Edmonton Symptom Assessment Scale (ESAS) to assess pain. We abstracted opioid use, music therapy referral reasons, and treatment approaches from the electronic health record.

RESULTS

Among 358 patients, 18% were Black, 42% reported moderate-to-severe pain, and 47% received opioids. Black patients reported higher baseline pain than white patients, but similar proportions of Black and white patients received opioids. Greater proportions of Black patients received music therapy referrals for pain (73% vs. 56%, P = 0.04) and engaged in active techniques (92% vs. 82%, P = 0.04). Black and white patients reported clinically meaningful pain reduction of similar magnitude after music therapy. Black patients discussed spirituality more commonly during music therapy, whereas white patients focused on family bonds.

CONCLUSION

Black and white patients reported clinically meaningful pain reduction through varying music therapy approaches. Our findings may help inform cultural adaptations of music therapy to address racial pain disparities in oncology.

Neurovegetative and Emotional Modulation Induced by Mozart's Music

INTRODUCTION

Since decades, the "Mozart effect" has been studied. However, the diverse effects of Mozart's music components have not been yet defined. Authors aimed to identify a differential response to short-term exposure to Mozart's music, or to its rhythmic signature only, on subjective and objective measures.

METHODS

The Mozart Sonata in A major K 331 (Mozart), the same piece consisting only of beat (Destructured), and duration-matched silence were administered to 25 healthy young adults, stood supine in a relaxing setting. The Italian Mood Scale questionnaire was administered before and after each listening. Heart rate variability (HRV) metrics were calculated from ECG recording, and breath flow was registered during experiments.

RESULTS

After Destructured, there was no change of fatigue and tension. After Mozart, fatigue was significantly reduced (and a tendency appeared for tension), whereas vigor was not. Breathing rate tended to be higher during Mozart. The nonlinear parameter HFD of HRV analysis, even though not significantly, was slightly lower during Destructured; Poincaré plots SD1 and SD2 tended to be lower during Mozart.

DISCUSSION/CONCLUSION

Mozart's music may allow to maintain arousal during relaxing condition. Psychological response of music and physiological dynamics were not necessarily entangled. Musical pieces based on individual physiological signature may lead musical psychological interventions.

Mixed methods research in complementary and alternative medicine: a scoping review

OBJECTIVE

To update the current characteristics about the scope and quality of mixed methods research (MMR) in complementary and alternative medicine (CAM) after nearly 10 years.

METHODS

A 5-stage approach for conducting a scoping review was adopted. Articles published on the top 10 journals in CAM with the highest impact factor in 2020 were screened for MMR. Information of included articles were extracted, and then synthesized to illustrate the current state. Methodological quality was evaluated according to the Mixed Method Appraisal Tool (MMAT) 2018 version.

RESULTS

A total of 55 (55/2991, 2%) articles using mixed methods were retrieved, including 17 medical studies and 38 ethnobotanical studies. We performed an in-depth analysis on the 17 medical studies, which studied cancer, stress, pain, fatigue, exercises, mindfulness intervention, herbal medicine use, art and acupuncture. Thirteen pilot studies applied MMR to evaluate the feasibility of interventions or programs (13/17, 76%); phenomenology was inferred as the most common philosophical assumptions (13/17, 76%); the most applied type of MMR was convergent design (16/17, 94%); integration often took place at integration (12/17, 71%). Among the 16 eligible studies for quality appraisal, majority were rated as good (14/16, 88%), whereas two studies were rated as poorly described. Primarily, a poor rating was due to incomplete reporting of data analysis and citations in qualitative components; lack of confounder controlling and the sampling strategy in quantitative components; poor description of integration and justification for mixed methods. Comparing with the previous review, fewer MMR were published in 2020 in CAM, but the proportion of studies that clearly reported MMR has increased by 4 times (4%→15%).

CONCLUSION

CAM researchers need to realize the benefits that MMR can have on conducting further health care research. Our findings highlight that applying MMR will be helpful to understand the complex dynamics and interdisciplinary nature of complex intervention. In addition, addressing a standardized reporting criteria for MMR is recommended.

Effects of Music Therapy on Quality of Life in Adults with Sickle Cell Disease (MUSIQOLS): A Mixed Methods Feasibility Study

Purpose

To investigate the feasibility, acceptability, and preliminary efficacy of a 6-session music therapy protocol on self-efficacy, quality of life, and coping skills in adults with sickle cell disease (SCD).

Patients and Methods

Using a mixed-methods intervention design, adults with SCD (ages 21–57; mean age 32.33) were randomized (1:1) to either 1) a 6-session music therapy (MT) intervention (n = 12) or 2) waitlist control (WLC) (n = 12) using stratified randomization where factors were age in years (≤30 vs >30), and sex (male, female). All participants completed two weeks of daily electronic pain diary entries and self-efficacy, quality of life, and coping skills measures before and after their assigned study condition to explore preliminary efficacy. MT participants were taught music exercises accessed via smartphone and subsequently interviewed to determine feasibility and acceptability.

Results

The enrollment rate was 89%. All study measures were completed, with high rates of electronic pain diary completion at baseline (70%) and 2-week follow-up (66%). Interviews revealed two overall themes related to MT participants’ experience: 1) participants learned new self-management skills and 2) MT improved participants’ ability to cope with pain. MT participants demonstrated 100% attendance. In preliminary analyses, MT participants demonstrated significant improvements (means ± SD) in self-efficacy (5.42 ± 5.43, p = 0.008, d = 1.20), PROMIS sleep disturbance (−1.49 ± 6.68, p = 0.023, d = −0.99), PROMIS pain interference (−2.10 ± 4.68, p = 0.016, d = −1.06), and ASCQ-Me social functioning impact scores (2.97 ± 6.91, p = 0.018, d = 1.05) compared to WLC participants.

Conclusion

Preliminary findings support the feasibility and acceptability of music therapy for home use in adults with SCD. While music therapy may assist adults with SCD in improving self-efficacy and quality of life, subsequent, fully-powered clinical research is needed to determine its efficacy.

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Efficacy of Group Music Therapy Based on Emotion-Regulation Skills on Male Inpatients With Alcohol Dependence: A Randomized, Controlled Pilot Trial

Objective: This study aimed to determine the benefits and feasibility of using group music therapy based on emotion-regulation skills to treat male inpatients with alcohol dependence (AD). Methods: We recruited male inpatients with alcohol dependence and randomly assigned those eligible for enrollment to either the study group or the control group. The study group received group music therapy along with treatment-as-usual (TAU), while the control group received only treatment-as-usual. Primary outcomes, including anxiety levels, sleep quality, and alcohol craving, were assessed at baseline and after 2 weeks of treatment. Secondary outcomes included feasibility measures such as dropout rates. We evaluated the acceptability of group music therapy based on semi-structured interviews and feedback from patients and therapists. Results: The average attendance rate of the study group patients who underwent group music therapy was 70.77%, and the drop-out rate was 7.69%. Based on intention-to-treat analysis, we found no differences in baseline assessments (p > 0.05). Assessment after 2 weeks of treatment showed that study group patients were less anxious, slept better, and had reduced alcohol cravings than control group patients. However, these differences were not statistically significant. Participants reported that group music therapy made them feel more relaxed and improved their mood. Conclusion: Group music therapy based on emotion-regulation skills is feasible with potential for efficacy and can be used to treat men with alcohol dependence in a closed inpatient environment. Further long-term research is required to gain a better understanding of the efficacy of using group music therapy to treat alcohol dependence.

Adherence to and the Maintenance of Self-Management Behaviour in Older People with Musculoskeletal Pain-A Scoping Review and Theoretical Models

(1) Background: Adherence to and the maintenance of treatment regimens are fundamental for pain self-management and sustainable behavioural changes. The first aim was to study older adults’ (>65 years) levels of adherence to and maintenance of musculoskeletal pain self-management programmes in randomized controlled trials. The second aim was to suggest theoretical models of adherence to and maintenance of a behaviour. (2) Methods: The study was conducted in accordance with the recommendations for a scoping review and the PRISMA-ScR checklist. Capability, motivation and opportunity were used to categorize the behavioural change components in the theoretical models. (3) Results: Among the four studies included, components targeting adherence were reported in one study, and maintenance was reported in two studies. Adherence was assessed by the treatment attendance rates, and maintenance was assessed by the follow-up data of outcome measures. For adherence, the capability components were mostly about education and the supervision, grading and mastery of exercise to increase self-efficacy. The motivation components included the readiness to change, self-monitoring and goal setting; and the opportunity components included booster sessions, feedback and social support. For maintenance, the capability components consisted of identifying high-risk situations for relapse and problem-solving skills. The motivation components included self-regulation and self-efficacy for problem solving, and the opportunity components included environmental triggers and problem solving by using social support. (4) Conclusion: There are several behavioural change components that should be used to increase older adults’ levels of adherence to and maintenance of a pain self-management behaviour.

Eficacia de los programas de musicoterapia: un metanálisis cualitativo

Resumen El aumento de enfermedades transmisibles justifica la necesidad de verificar la eficacia no farmacológica de los tratamientos alternativos. La música promueve las interacciones sociales y el trabajo en grupo, ayuda en varios aspectos del aprendizaje humano, la emoción y la memoria, y puede convertirse en una herramienta terapéutica complementaria. El objetivo de este estudio fue analizar la evidencia de la eficacia de la musicoterapia como tratamiento no farmacológico mediante un diseño descriptivo retrospectivo utilizando como parámetros de búsqueda: “musicoterapia” o “programas musicales” y “salud” en las bases de datos Scopus y Web of Science. Entre los principales resultados, destacamos que los programas de intervención que utilizan la música como tratamiento coadyuvante no farmacológico en enfermedades no transmisibles ofrecen resultados positivos y significativos sobre la mejora de las patologías en las que interviene. A partir de estos resultados, sería importante ampliar la formación de los profesionales de la salud en la aplicación de técnicas basadas en el arte y específicamente en la musicoterapia.

Effects of music therapy on depression: A meta-analysis of randomized controlled trials

Background

We aimed to determine and compare the effects of music therapy and music medicine on depression, and explore the potential factors associated with the effect.

Methods

PubMed (MEDLINE), Ovid-Embase, the Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Clinical Evidence were searched to identify studies evaluating the effectiveness of music-based intervention on depression from inception to May 2020. Standardized mean differences (SMDs) were estimated with random-effect model and fixed-effect model.

Results

A total of 55 RCTs were included in our meta-analysis. Music therapy exhibited a significant reduction in depressive symptom (SMD = −0.66; 95% CI = -0.86 to -0.46; P<0.001) compared with the control group; while, music medicine exhibited a stronger effect in reducing depressive symptom (SMD = −1.33; 95% CI = -1.96 to -0.70; P<0.001). Among the specific music therapy methods, recreative music therapy (SMD = -1.41; 95% CI = -2.63 to -0.20; P<0.001), guided imagery and music (SMD = -1.08; 95% CI = -1.72 to -0.43; P<0.001), music-assisted relaxation (SMD = -0.81; 95% CI = -1.24 to -0.38; P<0.001), music and imagery (SMD = -0.38; 95% CI = -0.81 to 0.06; P = 0.312), improvisational music therapy (SMD = -0.27; 95% CI = -0.49 to -0.05; P = 0.001), music and discuss (SMD = -0.26; 95% CI = -1.12 to 0.60; P = 0.225) exhibited a different effect respectively. Music therapy and music medicine both exhibited a stronger effects of short and medium length compared with long intervention periods.

Conclusions

A different effect of music therapy and music medicine on depression was observed in our present meta-analysis, and the effect might be affected by the therapy process.