A Conceptual Framework Encompassing the Psychoneuroimmunoendocrinological Influences of Listening to Music in Patients With Heart Failure

Music-based interventions and theoretical mechanisms in post-ICU survivors: A critical narrative synthesis

BACKGROUND

Hospitalization in the ICU can have long-term physiological and psychological impacts, affecting functional recovery and quality of life of post-ICU patients. Despite systematic reviews showing the impact of music interventions on physiological and psychological outcomes in ICU patients, their applicability and effectiveness in the post-ICU context remain unclear.

AIM

This review aimed to summarize: a) the types and characteristics of music/sound of interventions used in the rehabilitation of ICU patients, b) evidence on the feasibility, safety and acceptability of sound and music interventions for post ICU survivors, c) the types of post-ICU outcomes explored and the effects of sound and music interventions on any type of outcome in post-ICU survivors, and d) potential mechanisms or theoretical frameworks underlying the effects of sound and music interventions.

METHOD

We combined current systematic review search methods with a critical narrative approach to synthesize a diverse body of evidence.

RESULTS

Results showed that music interventions positively affect the psychological well-being and health outcomes of post-ICU patients. Outcomes included improvements in stress, anxiety, mood, movement, sleep, and pain, despite differences in patient populations and intervention design. No safety concerns were reported. The identified theoretical frameworks described physiological, neurobiological and/or psycho-social pathways as key mediators, however, these mechanisms are not completely understood.

CONCLUSION

Research evidence supports the positive effects of music interventions in post-ICU patients. Further experimental studies are required, especially in adult post-ICU populations to elucidate the characteristics, components, feasibility, and long-term effects of sound/music interventions.

IMPLICATION TO PRACTICE

1. Music interventions help in post-ICU patients' recovery benefitting stress, anxiety, PTSD, mood, movement, sleep, and pain. 2. Integrating theoretical frameworks into music interventions can expand outcome measures to include physiological markers alongside psychological ones, improving quality of life. 3. Further rigorous interventional studies are required to identify the effectiveness of sound and music interventions in post-ICU patients.

Effectiveness of Karate in Oncology Patients: A Quasi-Experimental Study

Cancer is a global health concern and affects patient quality of life, anxiety, depression, and sleep. Physical exercise shows promise in alleviating these effects. Karate is a holistic intervention that could be used to improve several outcomes related to cancer disease, but to date its effect remains unexplored. This quasi-experimental pre-/poststudy evaluated the effects of a 6-month karate program conducted twice a week for 60 minutes each session on quality of life, anxiety, depression, sleep quality, and psychosomatic symptoms in 22 patients with posttherapy oncology. Significant improvements in quality of life (P = .006), anxiety (P < .001), depression (P < .001), and sleep quality (P = .011) were observed. Multidimensional psychophysical evaluation showed significant reductions in symptoms (P < .05). High participant satisfaction was reported across all dimensions. This pilot study shows the potential benefits in oncology patients, but more research is necessary to confirm these findings.

Clinical application of virtual reality in patients with cardiovascular disease: state of the art

Virtual reality offers a multisensory experience to patients, allowing them to hear, watch, and interact in a virtual environment. Immersive virtual reality is particularly suitable for the purpose of completely isolating patients from the external environment to transport them away from the suffering related to the disease. On this state of the art, we summarize the available literature on the effectiveness of virtual reality on various physical and psychological outcomes in patients with atherosclerotic cardiovascular disease. Virtual reality has been employed in the cardiovascular field in various settings such as cardiac rehabilitation, interventional cardiology, and cardiac surgery. This technology offers promising opportunities to improve several outcomes related to cardiovascular disease, but further research is needed to entirely capture its benefits and to standardize the intervention.

Effectiveness of Rhythmic Auditory Stimulation on Gait in Parkinson Disease: A Systematic Review and Meta-analysis

Parkinson disease is a neurodegenerative disease present in approximately 2% of the population older than 65 years. Rhythmic auditory stimulation in the early 1990s aimed to improve individual mobility in terms of gait speed, stride length, and cadence. Our systematic review and meta-analysis aimed to summarize and evaluate the evidence of the effects of rhythmic auditory stimulation on gait speed, stride length, and cadence in patients with Parkinson disease. A systematic review and meta-analysis of randomized controlled trials was conducted to determine the efficacy of rhythmic auditory stimulation in patients with Parkinson disease. Five studies were included in the review (209 patients). Rhythmic auditory stimulation resulted, on average, a gait speed improvement of 0.53 standard deviation (SD) units (95% CI, 0.23 to 0.83; P = .0005), a stride length improvement of 0.51 SD units (95% CI, 0.18 to 0.84; P = .003) greater than that in the control group. All trials contained a risk of bias due to a lack of blinding. The quality of evidence was low. No adverse events were identified. Rhythmic auditory stimulation may have a beneficial effect on gait speed and stride length in patients with Parkinson disease. Future studies should consider a power analysis to recruit an adequate number of subjects and minimize the risk of sample bias. Further research should provide the additional results required for an acceptable estimate of the effects of rhythmic auditory stimulation on gait in patients with Parkinson disease.

Effectiveness of Music to Improve Anxiety in Hemodialysis Patients: A Systematic Review and Meta-analysis

Anxiety affects many hemodialysis patients. The response to treatment varies and often requires patients to take therapeutics for long periods; thus, many patients look for complementary approaches. There have been reports of music alleviating anxiety in hemodialysis patients. However, the efficacy of music needs to be evaluated. The objective of this study was to conduct a systematic review and meta-analysis to compare the effects of participation in standard care combined with music with standard care alone. This was a systematic review and meta-analysis of randomized controlled trials to determine the efficacy of music to lower anxiety in hemodialysis patients. Five studies were included in the review (290 patients). Listening to music resulted, on average, in an anxiety reduction that was -0.52 standard deviation units greater (95% confidence interval, -1.02 to -0.03 lower, P = .003) than in the standard care group. No adverse events were identified. All trials contained a risk of bias due to lack of blinding. The heterogeneity showed an I = 75%. The strength of evidence was very low. No adverse events were identified. Few trials were available for inclusion, with small sample sizes and significant heterogeneity. Within these considerable limitations there was a demonstrated decrease in anxiety for hemodialysis patients receiving standard care augmented with music. The effect size was moderate. Results were inconsistent across studies. We are uncertain about the estimate. The likelihood that effect will be substantially different is very high. Further research has a large potential for reducing uncertainty about the effects of the music interventions.

Narrative-Based Practice

Narrative-based practice has been developed to bring the health care aspects of illness and treatment closer to the psychosocial and life experiences of a patient. It gives value to the lived experience by using writing tools, spoken words, poetry, drawing, and photography. Nephrology has become one of the first health care fields, likely due to its large patient burden of both critical and chronic disease, to use narrative-based practice. The use of narrative-based practice in renal care explores the lived experience through structured and semistructured interviews with patients, caregivers, and health care providers. The principle topics discussed are the lack of a "disease identity" that would allow patients to identify themselves with a specific state of illness, the "uncertainty" of living with an illness characterized by continuous progression and regression, and the living with the "unspeakable" looming specter of death. This review highlights the powerful significance of qualitative knowledge gained with the narrative method. Increased awareness of these aspects of patients' lived experiences can help nurses improve the quality and effectiveness of the therapeutic relationship between patient and health care professional and may offer a promising approach, within this relationship, to decreasing patient feelings of isolation.

Beneficial Effects of Listening to Classical Music in Patients With Heart Failure: A Randomized Controlled Trial

BACKGROUND

Practical recommendations on nonpharmacologic non-device/surgical interventions in patients with heart failure (HF) are well known. Although complementary treatments may have beneficial effects, there is no evidence that these on their own improve mortality, morbidity, or quality of life. We examined the effects of listening to recorded classical music on HF-specific quality of life (QOL), generic QOL, sleep quality, anxiety, depression, and cognitive state in patients with HF in the home-care setting.

METHODS AND RESULTS

Multicenter randomized controlled trial. One hundred fifty-nine patients with HF were randomized on a 1:1 basis in 2 groups: experimental (music) and control. Patients were evaluated after 30, 60, 90 days (experimental period) and at 6 months. Patients randomized to the music group listened to music from a large preselected playlist, at least 30 minutes per day, for 3 months on an MP3 player. Patients in the control group received standard care. HF-specific QOL, generic QOL, self-care, somatic perception of HF symptoms, sleep quality, anxiety and depression, and cognitive abilities were assessed throughout the use of specific scales. On average, patients in the music group showed greater improvements in terms of HF-specific QOL (P < .001), generic-QOL (P = .005), quality of sleep (P = .007), anxiety and depression levels (P < .001 for both), and cognitive performances (P = .003).

CONCLUSIONS

Listening to recorded classical music is a feasible, noninvasive, safe, and inexpensive intervention, able to improve QOL in patients with HF in the home-care setting.

Effects of Listening to Live Singing in Patients Undergoing Hemodialysis: A Randomized Controlled Crossover Study

Background:

Participation in music therapy is associated with improved psychological and physical indices among chronically ill patients. Listening to music during hemodialysis treatments positively affects patients’ hemodynamics, laboratory values, quality of life, and physical symptoms. The effect of live singing during hemodialysis treatments, however, has not previously been studied.

Methods:

A total of 24 participants with a diagnosis of end-stage kidney disease participated in the study. The vocalist was a musically trained dialysis nurse. Twelve of the patients listened to 15 min of live singing during 6 consecutive hemodialysis sessions, while the other 12 underwent standard hemodialysis. After a washout period of 2 days, the two groups were reversed.

Results:

Listening to live music was associated with improvements in systolic and diastolic blood pressure, better quality of sleep, fewer cramps, and reduced anxiety/depression, pain, and itching ( p < .05, all values).

Conclusions:

Listening to live music during hemodialysis is an effective and potentially low-cost therapy for the dialysis care team to employ during hemodialysis treatments.