Music has the potential to make everything better, doesn’t it? Arguably, this is so in any and all situations. In difficult circumstances, it can help us endure. Music can take the edge off the pain, in both body and mind. No wonder there is a keen interest in exploring its potential to help us in various healthcare settings and this has been the subject of many Cochrane reviews.
On my Dad’s death, a few years ago, I was given the diaries he had kept as a very young man, from 1943 to 1946. I was charmed to find his business card, which identifies him as a ‘swing pianist’; something which occupied many of his evenings and weekends before he joined the Royal Navy as a seventeen year old in 1943. The diaries were the first we knew of him joining ENSA, the Entertainments National Service Association (also dubbed “Every Night Something Awful”), and music and dances seemed a constant backdrop to years of wartime service which took him from the D-Day landings to India, Egypt and the Far East. He escaped serious injury but was hospitalized in Madras with amoebic dysentery and later gave a sketchy record of having an operation on his foot. Other than recording, with proper naval accuracy, the times of his operation and of regaining consciousness, his focus was on the gifts of cigarettes on the days that followed. Such was the post-op experience of the average 1940’s serviceman!
“When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest.”
Henry David Thoreau
Image: Wellcome Library, London
My Dad didn’t record how he felt about his operation, but would music have helped quell any anxiety he may have felt as he was waiting to go to theatre? A Cochrane review on music interventions for preoperative anxiety suggests it might and possibly better than sedative drugs. However, only one trial compared listening to pre-recorded music with a sedative drug and whilst 20 trials contributed evidence on music and anxiety the quality of the evidence was low and future research may well change the results.
Poor quality evidence is a problem in the majority of Cochrane reviews evaluating the effectiveness of music in a variety of healthcare settings and necessitates a cautious interpretation of results, whilst encouraging findings may prompt future (and, we hope, better) research.
The review on music for stress and anxiety reduction on coronary heart disease patients was updated last month, with four new studies bringing the total to 26 trials with 1369 people. Just three trials used trained music therapists. There are indications that listening to music may benefit people with coronary heart disease, lowering systolic blood pressure and heart rate and also reducing anxiety in people with myocardial infarction upon hospitalization. The evidence was poor though, with small trials at high risk of bias and poorly reported.
“One good thing about music: when it hits you, you feel no pain.” Bob Marley
Hospitals are generally stressful places, of course, even aside from the problem that’s put you there in the first place. A review exploring the influence of the sensory environment of health-related outcomes of hospital patients included 85 randomized trials on the use of music in hospital. Listening to music compared favourably with the use of a blank tape and headphones or ‘standard care’ in reducing anxiety before medical procedures, though headphones with or without music were similarly better than standard care during medical procedures. No clear effect was demonstrated on physiological measures such as heart rate, nor on the use of medicines. Overall, the reviewers conclude that the addition of music at least does no harm, and may have a beneficial effect in certain circumstances (possibly by way of reducing unpleasant noise), particularly for patient-reported outcomes such as anxiety. The evidence was of variable quality and poor reporting was a common problem.
Interestingly, the reviewers evaluating music interventions for people with cancer, which included 16 low quality trials, note that careful consideration must be given to the implementation of music listening interventions. Whilst their results indicate that music listening can have a beneficial effect on anxiety and several physiological responses in people with cancer, the results of one study suggest that listening to music through headphones may be contraindicated during painful procedures because it prevents the patient from hearing instructions or comments by the surgeon. This may greatly increase patients’ anxiety and, therefore, their pain.
“There are two means of refuge from the miseries of life: music and cats.” Albert Schweitzer
It’s disappointing that the review looking at evidence on music therapy for end-of-life care was able to include only five small controlled trials, at high risk of bias; insufficient evidence to draw reliable conclusions about the effects of music therapy on the quality of life of people at the end of life.
“After silence, that which comes nearest to expressing the inexpressible is music.”
Aldous Huxley
Five small studies in the review on music therapy for depression suggest that it is well-tolerated and associated with improvements in mood, at least in the short term, but again the evidence is poor quality and it’s not possible to be clear about whether this is an effective treatment for depression. There’s much better evidence in the review on music therapy for people with schizophrenia, from eight studies using a combination of music-making and music listening, which show that “music therapy as an addition to standard care helps people with schizophrenia to improve their global state, mental state (including negative symptoms) and social functioning if a sufficient number of music therapy sessions are provided by qualified music therapists.” The minimum number of sessions needed for the person to benefit remains unclear though the results suggest that at least 20 may be needed; the reviewers note that this may vary between individuals.
A review on music therapy for acquired brain injury has promising evidence from two small studies, at low risk of bias, that rhythmic auditory stimulation as a music therapy intervention may help improve gait velocity, cadence, stride length and stride symmetry in stroke patients. More randomized controlled trials are needed, though, before recommendations can be made for clinical practice.
In my last blog, I looked at The Napkin Project, which is helping people with dementia reconnect with their memories and if you haven’t come across Alive Inside, the documentary about what happened when social worker Dan Cohen took iPods to residents with Alzheimer’s in a US nursing home, you can catch up with it here.
Many of you may be gearing up to enjoy some live music this Saturday, to celebrate Burns Night, and you may love nothing better than to hear a bagpipe. Hospitals may wish to avoid this though. We should always take note of the potential for adverse effects of interventions and Shakespeare warned, commenting on likes and dislikes,
“…others, when the bagpipe sings i’ the nose Cannot contain their urine.” (Merchant Of Venice, act 4, sc. 1)
Links:
Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD006908. DOI: 10.1002/14651858.CD006908.pub2.
Cochrane summary http://summaries.cochrane.org/CD006908/can-music-interventions-replace-sedatives-for-reduction-of-preoperative-anxiety
Bradt J, Dileo C, Potvin N. Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD006577. DOI: 10.1002/14651858.CD006577.pub3.
Cochrane summary and podcast http://summaries.cochrane.org/CD006577/music-to-reduce-stress-and-anxiety-for-people-with-coronary-heart-disease
Drahota A, Ward D, Mackenzie H, Stores R, Higgins B, Gal D, Dean TP. Sensory environment on health-related outcomes of hospital patients. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD005315. DOI: 10.1002/14651858.CD005315.pub2.
Cochrane summary http://summaries.cochrane.org/CD005315/sensory-environment-on-health-related-outcomes-of-hospital-patients
Bradt J, Dileo C, Grocke D, Magill L. Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD006911. DOI: 10.1002/14651858.CD006911.pub2.
Cochrane summary and podcast http://summaries.cochrane.org/CD006911/can-music-interventions-benefit-cancer-patients
Bradt J, Dileo C. Music therapy for end-of-life care. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD007169. DOI: 10.1002/14651858.CD007169.pub2.
Cochrane summary http://summaries.cochrane.org/CD007169/music-therapy-for-end-of-life-care
Maratos A, Gold C, Wang X, Crawford M. Music therapy for depression. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004517. DOI: 10.1002/14651858.CD004517.pub2.
Cochrane summary and podcast http://summaries.cochrane.org/CD004517/music-therapy-for-depression
Mössler K, Chen X, Heldal TO, Gold C. Music therapy for people with schizophrenia and schizophrenia-like disorders. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD004025. DOI: 10.1002/14651858.CD004025.pub3.
Bradt J, Magee WL, Dileo C, Wheeler BL, McGilloway E. Music therapy for acquired brain injury. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD006787. DOI: 10.1002/14651858.CD006787.pub2.
Evidently Cochrane 