Music for stress and anxiety reduction in coronary heart disease patients

106 Pages·2015·0.77 MB·English

Music for stress and anxiety reduction in coronary heart
disease patients (Review)
Bradt J, Dileo C, Potvin N
ThisisareprintofaCochranereview,preparedandmaintainedbyTheCochraneCollaborationandpublishedinTheCochraneLibrary
2013,Issue12
http://www.thecochranelibrary.com
Musicforstressandanxietyreductionincoronaryheartdiseasepatients(Review)
Copyright©2013TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PLAINLANGUAGESUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
SUMMARYOFFINDINGSFORTHEMAINCOMPARISON . . . . . . . . . . . . . . . . . . . 4
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Figure2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Figure4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Figure5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
AUTHORS’CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
CHARACTERISTICSOFSTUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
DATAANDANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Analysis1.1.Comparison1Musicversusstandardcare,Outcome1Psychologicaldistress. . . . . . . . . . 72
Analysis1.2.Comparison1Musicversusstandardcare,Outcome2Anxiety(allmeasures)-patienttype. . . . . 73
Analysis1.3.Comparison1Musicversusstandardcare,Outcome3Anxiety(allmeasures)-musicpreference. . . . 74
Analysis1.4.Comparison1Musicversusstandardcare,Outcome4Stateanxiety(STAI)-patienttype. . . . . . 75
Analysis1.5.Comparison1Musicversusstandardcare,Outcome5StateAnxiety(STAI)-musicpreference. . . . 76
Analysis1.6.Comparison1Musicversusstandardcare,Outcome6StateAnxiety(STAI)-musicpreferenceMIonly. 77
Analysis1.7.Comparison1Musicversusstandardcare,Outcome7Anxiety(non-STAI)-patienttype. . . . . . 78
Analysis1.8.Comparison1Musicversusstandardcare,Outcome8Anxiety(non-STAI)-musicpreference. . . . 79
Analysis1.9.Comparison1Musicversusstandardcare,Outcome9Depression. . . . . . . . . . . . . . 80
Analysis1.10.Comparison1Musicversusstandardcare,Outcome10Mood. . . . . . . . . . . . . . . 81
Analysis1.11.Comparison1Musicversusstandardcare,Outcome11Heartrate-patienttype. . . . . . . . . 82
Analysis1.12.Comparison1Musicversusstandardcare,Outcome12Heartrate-musicpreference. . . . . . . 83
Analysis1.13.Comparison1Musicversusstandardcare,Outcome13Heartratevariability. . . . . . . . . . 84
Analysis1.14.Comparison1Musicversusstandardcare,Outcome14Respiratoryrate-musicpreference. . . . . 85
Analysis1.15.Comparison1Musicversusstandardcare,Outcome15Systolicbloodpressure. . . . . . . . . 86
Analysis1.16.Comparison1Musicversusstandardcare,Outcome16Diastolicbloodpressure. . . . . . . . 87
Analysis1.17.Comparison1Musicversusstandardcare,Outcome17MeanArterialPressure. . . . . . . . . 88
Analysis1.18.Comparison1Musicversusstandardcare,Outcome18OxygenSaturation. . . . . . . . . . 88
Analysis1.19.Comparison1Musicversusstandardcare,Outcome19Pain. . . . . . . . . . . . . . . 89
Analysis1.20.Comparison1Musicversusstandardcare,Outcome20Lengthofhospitalstay. . . . . . . . . 90
Analysis1.21.Comparison1Musicversusstandardcare,Outcome21Opioidintake. . . . . . . . . . . . 90
Analysis1.22.Comparison1Musicversusstandardcare,Outcome22Qualityofsleep. . . . . . . . . . . 91
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
WHAT’SNEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
CONTRIBUTIONSOFAUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
DECLARATIONSOFINTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
SOURCESOFSUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
DIFFERENCESBETWEENPROTOCOLANDREVIEW . . . . . . . . . . . . . . . . . . . . . 103
INDEXTERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Musicforstressandanxietyreductionincoronaryheartdiseasepatients(Review) i
Copyright©2013TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
[InterventionReview]
Music for stress and anxiety reduction in coronary heart
disease patients
JokeBradt1,CherylDileo2,NoahPotvin3
1Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA.
2Department of Music Therapy and The Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple
University,Philadelphia,USA.3DepartmentofCreativeArtsTherapies,CollegeofNursingandHealthProfessions,DrexelUniversity,
Philadelphia,PA,USA
Contactaddress:JokeBradt,DepartmentofCreativeArtsTherapies,CollegeofNursingandHealthProfessions,DrexelUniversity,
1505RaceStreet,rm1041,Philadelphia,PA,19102,[email protected].
Editorialgroup:CochraneHeartGroup.
Publicationstatusanddate:Newsearchforstudiesandcontentupdated(nochangetoconclusions),publishedinIssue12,2013.
Reviewcontentassessedasup-to-date: 4December2013.
Citation: BradtJ,DileoC,PotvinN.Musicforstressandanxietyreductionincoronaryheartdiseasepatients.CochraneDatabaseof
SystematicReviews2013,Issue12.Art.No.:CD006577.DOI:10.1002/14651858.CD006577.pub3.
Copyright©2013TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
ABSTRACT
Background
Individualswithcoronaryheartdisease(CHD)oftensufferfromseveredistressduetodiagnosis,hospitalization,surgicalprocedures,
uncertaintyofoutcome,fearofdying,doubtsaboutprogressinrecovery,helplessnessandlossofcontrol.Suchadverseeffectsputthe
cardiacpatientatgreaterriskforcomplications,includingsuddencardiacdeath.Itisthereforeofcrucialimportancethatthecareof
peoplewithCHDfocusesonpsychologicalaswellasphysiologicalneeds.
Musicinterventionshavebeenusedtoreduceanxietyanddistressandimprovephysiologicalfunctioninginmedicalpatients;however
itsefficacyforpeoplewithCHDneedstobeevaluated.
Objectives
Toupdatethepreviouslypublishedreviewthatexaminedtheeffectsofmusicinterventionswithstandardcareversusstandardcare
aloneonpsychologicalandphysiologicalresponsesinpersonswithCHD.
Searchmethods
WesearchedtheCochraneCentralRegisterofControlledTrials(CENTRAL)onTheCochraneLibrary(2012,Issue10),MEDLINE
(OvidSP,1950 toOctoberweek42012), EMBASE (OvidSP,1974 toOctober week52012), CINAHL(EBSCOhost, 1982 to9
November2012),PsycINFO(OvidSP,1806toOctoberweek52012),LILACS(VirtualHealthLibrary,1982to15November2012),
Social Science Citation Index (ISI, 1974 to 9 November 2012), a number of other databases, and clinical trial registers. We also
conductedhandsearchingofjournalsandreferencelists.Weappliednolanguagerestrictions.
Selectioncriteria
Weincludedallrandomizedcontrolledtrialsandquasi-randomizedtrialsthatcomparedmusicinterventionsandstandardcarewith
standardcarealoneforpersonswithconfirmedCHD.
Musicforstressandanxietyreductionincoronaryheartdiseasepatients(Review) 1
Copyright©2013TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Datacollectionandanalysis
Tworeviewauthorsindependentlyextracteddataandassessedmethodologicalquality,seekingadditionalinformationfromthetrial
researcherswhennecessary.Wepresentresultsusingweightedmeandifferencesforoutcomesmeasuredbythesamescale,andstan-
dardizedmeandifferencesforoutcomesmeasuredbydifferentscales.Weusedpost-interventionscores.Incasesofsignificantbaseline
difference,weusedchangescores(changesfrombaseline).
Mainresults
Weidentifiedfournewtrialsforthisupdate.Intotal,theevidenceforthisreviewrestson26trials(1369participants).Listeningto
musicwasthemaininterventionused,and23ofthestudiesdidnotincludeatrainedmusictherapist.
ResultsindicatethatmusicinterventionshaveasmallbeneficialeffectonpsychologicaldistressinpeoplewithCHDandthiseffectis
consistentacrossstudies(MD=-1.26,95%CI-2.30to-0.22,P=0.02,I²=0%).Listeningtomusichasamoderateeffectonanxiety
inpeoplewithCHD;howeverresultswereinconsistentacrossstudies(SMD=-0.70,95%CI-1.17to-0.22,P=0.004,I²=77%).
Studiesthatusedmusicinterventionsinpeoplewithmyocardialinfarctionfoundmoreconsistentanxiety-reducingeffectsofmusic,
withanaverageanxiety reductionof5.87unitsona20to80pointscorerange(95%CI-7.99to-3.75,P<0.00001, I²=53%).
Furthermore,studiesthatusedpatient-selectedmusicresultedingreateranxiety-reducing effectsthatwereconsistent acrossstudies
(SMD=-0.89,95%CI-1.42to-0.36,P=0.001,I²=48%).Findingsindicatethatlisteningtomusicreducesheartrate(MD=-3.40,
95%CI-6.12to-0.69,P=0.01),respiratoryrate(MD=-2.50,95%CI-3.61to-1.39,P<0.00001)andsystolicbloodpressure(MD
=-5.52mmHg,95%CI-7.43to-3.60,P<0.00001).Studiesthatincludedtwoormoremusicsessionsledtoasmallandconsistent
pain-reducingeffect(SMD=-0.27,95%CI-0.55to-0.00,P=0.05).Theresultsalsosuggestthatlisteningtomusicmayimprove
patients’qualityofsleepfollowingacardiacprocedureorsurgery(SMD=0.91,95%CI0.03to1.79,P=0.04).
Wefoundnostrongevidenceforheartratevariabilityanddepression.Onlyonestudyconsideredhormonelevelsandqualityoflifeas
anoutcomevariable.Asmallnumberofstudiespointedtoapossiblebeneficialeffectofmusiconopioidintakeaftercardiacprocedures
orsurgery,butmoreresearchisneededtostrengthenthisevidence.
Authors’conclusions
ThissystematicreviewindicatesthatlisteningtomusicmayhaveabeneficialeffectonanxietyinpersonswithCHD,especiallythose
withamyocardialinfarction.Anxiety-reducingeffectsappeartobegreatestwhenpeoplearegivenachoiceofwhichmusictolistento.
Furthermore,listeningtomusicmayhaveabeneficialeffectonsystolicbloodpressure,heartrate,respiratoryrate,qualityofsleepand
paininpersonswithCHD.However,theclinicalsignificanceofthesefindingsisunclear.Sincemanyofthestudiesareathighriskof
bias,thesefindingsneedtobeinterpretedwithcaution.Moreresearchisneededintotheeffectsofmusicinterventionsofferedbya
trainedmusictherapist.
PLAIN LANGUAGE SUMMARY
Musictoreducestressandanxietyforpeoplewithcoronaryheartdisease
Individuals with coronary heartdisease often suffer from severe distress, putting them at greater risk for complications, including
suddencardiacdeath.Itisthereforeimportant thatthecare ofpeoplewith coronary heartdisease focusesonpsychological aswell
asphysiologicalneeds.Musicinterventionshavebeenusedformanyyearstoreduceanxietyanddistressandimprovephysiological
responsessuchasheartrateandrespiratoryrateinmedicalpatients.
ThisreviewisanupdateofapreviousCochranereviewfrom2009whichsuggestedthatmusicinterventionsmayhaveabeneficial
effectonanxietyandphysiologicalresponsesinpeoplewithcoronaryheartdiseasebutthequalityoftheevidencewasnotstrongand
theclinicalsignificanceunclear.
Forthisreview,wesearchedforadditionaltrialsontheeffectofmusicinterventionsonstressandanxietyinpeoplewithcoronaryheart
disease.WesearchedforstudiespublishedupuntilNovember2012aswellasongoingstudiesuntilNovember2012.Weconsidered
allstudiesinwhichanyformofparticipationinmusic(e.g.listeningtomusic,singing,playingmusic)wascomparedwithanyform
ofstandardtreatmentandincludedpersonswithconfirmedcoronaryheartdisease.Weidentifiedfournewtrialsforthisupdate.
Thisreviewincludes26trialswithatotalof1369participants.Thetrialsweresmallinsize.Thefindingssuggestthatlisteningtomusic
mayhaveabeneficialeffectonsystolicbloodpressureandheartrateinpeoplewithcoronaryheartdisease.Listeningtomusicalso
Musicforstressandanxietyreductionincoronaryheartdiseasepatients(Review) 2
Copyright©2013TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
appearstobeeffectiveinreducinganxietyinpeoplewithmyocardialinfarction,especiallywhentheyaregivenachoiceofwhichmusic
tolistento.Listeningtomusicmayalsoreducepainandrespiratoryrate.Howeverthesizeoftheeffectsonpainandrespiratoryrateis
small.Therefore,itsclinicalimportanceisunclear.Finally,listeningtomusicappearstoimprovepatients’qualityofsleepfollowinga
cardiacprocedureorsurgery.Wefoundnoevidenceofeffectfordepressionorheartratevariability,andinconsistentresultsformood.
Noadverseeffectsofmusicinterventionswerereported.Themajorityofthestudiesexaminedtheeffectsoflisteningtopre-recorded
music.Moreresearchisneededontheeffectsofmusicinterventionsofferedbyatrainedmusictherapist.Overall,thequalityofthe
evidenceisnotstrongthustheresultsshouldbeinterpretedwithcaution.
Wedidnotidentifyanyconflictsofinterestsintheincludedstudies.
Musicforstressandanxietyreductionincoronaryheartdiseasepatients(Review) 3
Copyright©2013TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
CoMu SUMMARY OF FINDINGS FOR THE MAIN COMPARISON [Explanation]
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Collaction Outcomes Illustrativecomparativerisks*(95%CI) Relativeeffect NoofParticipants Qualityoftheevidence Comments
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bis
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np
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&(R 1.26lower
Se
ons,view (2.30to0.22lower)
L)
td. Anxiety(allmeasures) The mean anxiety (all 353 ⊕(cid:13)(cid:13)(cid:13)
NRS,VAS,HADS,STAI measures) in the inter- (10studies) verylow1,2,3
ventiongroupswas
0.70standarddeviations
lower
(1.17to0.22lower)
State anxiety (MI pa- The mean state anxiety 243 ⊕⊕(cid:13)(cid:13)
tients) (MIpatients) intheinter- (6studies) low1
STAI ventiongroupswas
5.87lower
(7.99to3.75lower)
4
CM
ou
ps
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t©str Heartrate Themeanheartrateinthe 828 ⊕(cid:13)(cid:13)(cid:13)
201ess bpm interventiongroupswas (13studies) verylow1,2,3
3Tand 3.62lower
hean (6.28to0.95lower)
Cx
oie
chratyre Respiratoryrate Themeanrespiratoryrate 442 ⊕(cid:13)(cid:13)(cid:13)
nedu breathsperminute intheinterventiongroups (7studies) verylow1,4
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raco (3.61to1.39lower)
tioro
nn
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bh
lisea pressure in the interven- (11studies) low1
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byise 5.52lower
Johase (7.43to3.60lower)
np
Wileyatients Pain The mean pain in the in- 562 ⊕(cid:13)(cid:13)(cid:13)
&(R VAS,NRS terventiongroupswas (8studies) verylow1,3,5
Se
ons,view 0.43standarddeviations
L) lower
td
. (0.80to0.05lower)
*Thebasisfor theassumedrisk(e.g.themediancontrol groupriskacross studies) isprovidedinfootnotes. Thecorresponding risk(andits95%confidence interval) isbasedonthe
assumedriskinthecomparisongroupandtherelativeeffectoftheintervention(andits95%CI).
CI:Confidenceinterval;
GRADEWorkingGroupgradesofevidence
Highquality:Furtherresearchisveryunlikelytochangeourconfidenceintheestimateofeffect.
Moderatequality:Furtherresearchislikelytohaveanimportantimpactonourconfidenceintheestimateofeffectandmaychangetheestimate.
Lowquality:Furtherresearchisverylikelytohaveanimportantimpactonourconfidenceintheestimateofeffectandislikelytochangetheestimate.
Verylowquality:Weareveryuncertainabouttheestimate.
1Themajorityofthetrialswereassessedasbeingathighriskofbias
2ResultswereinconsistentacrossstudiesasevidencedbyI²=77%.
3Wideconfidenceinterval
4ResultswereinconsistentacrossstudiesasevidencedbyI²=79%.
5
CoMu 5ResultswereinconsistentacrossstudiesasevidencedbyI²=81%.
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6
BACKGROUND ofamusicinterventionbyatrainedmusictherapist,thepresence
ofatherapeuticprocess,andtheuseof’live’musicexperiences.
Thesemusicexperiencesinclude:(1)listeningtolive,improvised
orpre-recordedmusic;(2)performingmusiconaninstrument;
Descriptionofthecondition
(3)improvisingmusicspontaneouslyusingvoiceorinstruments
Coronaryheartdisease(CHD)istheleadingcauseofdeathworld- orboth;(4)composingmusic;and(5)musiccombinedwithother
wide.AccordingtotheWorldHealthOrganization(WHO),17.3 modalities(e.g.movement,imageryandart).
million people worldwide die of cardiovascular diseases (CVD) Several investigators have examined the effects of music on a
eachyear.By2030,theWHOpredicts25millionCVDdeaths variety of outcomes in people with CHD, including heart rate
globally (WHO 2012). Heartdisease hasno geographical, gen- (Barnason1995;Davis-Rollans1987),respiratoryrate,bloodpres-
der,orsocioeconomicboundaries(Chockalingam1999).People sure(Barnason1995),myocardialoxygendemand(White1999),
withCHDoftensufferfromseveredistressduetodiagnosis,hos- hormonelevels(Vollert2002),anxiety(Barnason1995;Bolwerk
pitalization,surgicalprocedures,uncertaintyofoutcome,fearof 1990),andpain(Zimmerman1996).
dying,doubtsaboutprogressinrecovery,helplessnessandlossof
control (Barnason 1995; Bolwerk 1990; Guzzetta 1989; Malan
1992).Thisstressislikelytostimulatethereleaseofepinephrine
Howtheinterventionmightwork
andnorepinephrine,resultinginincreasedheartrate,respiratory
rate,arterialbloodpressure,myocardialoxygendemandandanxi- AsdiscussedinarecentlypublishedCochranesystematicreviewon
etylevels.Suchadverseeffectsputthecardiacpatientatgreaterrisk theeffectsofmusicinterventionsonpre-operativeanxiety(Bradt
forcomplications,includingsuddencardiacdeath(White1999). 2013), a common theory regarding the anxiety-reducing effects
Itisthereforeofcrucialimportancethatthecareofpeoplewith ofmusicisthatmusiccanhelppeoplefocustheirattentionaway
CHDfocusesonpsychologicalaswellasphysiologicalneeds. fromstressfuleventstosomethingpleasantandsoothing(Mitchell
2003;Nilsson2008). Eventhoughthisisanimportantmecha-
nisminanxietyreduction,itisimportanttoemphasizethatmusic
doesmorethanrefocusingpeople’sattention.Itprovidesanaes-
Descriptionoftheintervention
theticexperiencethatcanoffercomfortandpeacewhileawaiting
Thereisagreatdealofliterature,bothquantitative andqualita- a cardiac procedure or surgery or the outcome of a myocardial
tive, regarding the use of music to reduce stress and anxiety in infarction. In music interventions provided by a trained music
non-medicalpatients,andthisprovidesthecontextandrationale therapist,themusictherapistfurthermoreadapts thelivemusic
foritshypothesizedeffectsinpeoplewithCHD.Moreover,with interactionstothein-the-momentneedsoftheparticipants.This
non-medicalpatients,musicisusedbothaloneandasanadjunct oftenprovidesadeeplyhumanizingandvalidatingexperiencefor
totraditionalstress-reductionapproachesintherapyandforself- thepatient.Theactofmakingmusictogethercanprovideastrong
helpprocedures.Effectsofmusicfor stressreduction havebeen senseofsupport.Moreover,theactiveandcreativeengagementin
documentedinphysiological(e.g.heartrate,bloodpressure,hor- music making (e.g. singing songs, improvising music) stands in
monal levels),neurological (e.g. electroencephalographic(EEG) starkcontrastwithpassivelysubmittingoneselftocardiacproce-
readings) and psychological domains (e.g. selfreport, the Spiel- duresorsurgery.Thismayresultinanincreasedsenseofcontrol
bergerState-TraitAnxietyInventory(STAI))(Dileo2007).Inad- andempowerment.
dition,theeffectsofbothmusicandmusictherapyinterventions Ithasbeenpostulatedthatmusicinducesrelaxationthroughits
havebeendocumentedinarangeofothermedicalpatients,for impactonautomatedandcentralnervousresponses(Gillen2008).
example,pre-surgical,oncology,pediatric,andpre-proceduralpa- More specifically,it isbelievedthattheanxiolytic effectof mu-
tients(Dileo1999;Dileo2005).Moreover,anxietyandstressre- sicisachievedthroughitssuppressiveactiononthesympathetic
duction is one of the primary outcomes investigated in music nervoussystem,leadingtodecreasedadrenergicactivityandde-
medicine andmusictherapyresearchwithmedicalpatients. Ef- creasedneuromusculararousal(Chlan1998;Gillen2008).Mu-
fects similar to those reported in the current review have been sicfurthermoretriggersthelimbicsysteminthebraintorelease
observed,andmeta-analysesoftheseeffectshavebeenconducted endorphins;theseneurotransmittersplayanimportantroleinen-
(Bradt2010b;Bradt2011;Dileo2005;Standley1986;Standley hancingasenseofwell-being(Arslan2008;Lee2005).However,
2000). Gillen2008hassuggestedthatmoreresearchisneededtoexamine
Dileo 2007 makes a clear distinction between music interven- thephysiologicalmechanismsthatexplaintheanxiolyticeffectsof
tions administered by medical or healthcare professionals (mu- music.
sicmedicine)andthoseimplementedbytrainedmusictherapists
(musictherapy).Interventionsarecategorizedas’musicmedicine’
whenpassivelisteningtopre-recordedmusicisofferedbymedical
Whyitisimportanttodothisreview
personnel.Incontrast,musictherapyrequirestheimplementation
Musicforstressandanxietyreductionincoronaryheartdiseasepatients(Review) 7
Copyright©2013TheCochraneCollaboration.PublishedbyJohnWiley&Sons,Ltd.
Although there are no hypothesized responses to music unique Typesofinterventions
tothispopulation,theeffectsofmusiconheartrate,respiratory Thereviewincludedallstudiesinwhichanyformofparticipation
rate,bloodpressure,andanxietyhavebeenwidelystudiedbothin inmusic(e.g.listeningtomusic,singing,playingmusic)wascom-
peoplewithorwithoutmedicalconditions.Theseoutcomeshave paredwithanyformofstandardtreatment.Studiesusingmusic
heightenedsignificancewhenitcomestocardiacpatients,anda therapyinterventions,asdefinedbytheauthors,aswellasmusic
systematicreviewoftheexistingdataisthereforemuchneeded. medicineinterventions,asdefinedbytheauthors,wereconsidered
Thepreviousversionofthisreviewfoundthatmusiclisteningmay forinclusion.Wedidnotuselengthorfrequencyofmusicsessions
haveabeneficialeffectforpeoplewithCHDandmayreduceblood asinclusioncriteriaforthisreview.
pressure and heart rate. Listening to music also appeared to be
effectiveinreducinganxietyinpeoplewithmyocardialinfarction
Typesofoutcomemeasures
(MI) upon hospitalization. It has therefore been recommended
thatmusiclisteningbeofferedasastressmanagementintervention
topeoplewithMIuponhospitalization.
Primaryoutcomes
1. Psychologicaldistressincludinganxiety,depression,and
mood;
2. Qualityoflife.
OBJECTIVES
Secondaryoutcomes
Toupdatethepreviouslypublishedreviewthatexaminedtheef-
1. Heartrate;
fects of music interventions with standard care versus standard
2. Respiratoryrate;
carealoneonpsychologicalandphysiologicalresponsesinpersons
3. Systolicbloodpressure;
withCHD.
4. Diastolicbloodpressure;
5. Meanarterialpressure;
6. Myocardialoxygendemand;
METHODS 7. Oxygensaturation;
8. Peripheralskintemperature;
9. Hormonelevels;
10. Pain;
Criteriaforconsideringstudiesforthisreview 11. Opioidintake;
12. Qualityofsleep;
13. Lengthofhospitalization;
14. Durationofcardiacprocedure.
Typesofstudies
Wheremorethanonemeasureperoutcomewasusedforpsycho-
Allrandomized clinical trialsandquasi-randomized trials(trials logicaldistress,qualityoflife,andpain,wegavepreferencetomea-
thatallocateparticipantstoatreatmentbyusingamethodthatis sures taken using validated instruments. Primary outcomes and
notrandomsuchasalternategroupassignmentordateofbirth) painwereratedbytheparticipant. Physiologicalresponseswere
inanylanguage,publishedandunpublished,wereeligibleforin- recordedbyanobserverwhomayormaynothavebeenblinded.
clusion.
Searchmethodsforidentificationofstudies
Typesofparticipants
Thereviewincludedstudiesofmen,women,andchildren,inpa-
Electronicsearches
tientoroutpatient,withconfirmedcoronaryheartdisease(CHD).
Theoriginalreviewincludedseveralstudieswithparticipantswho Weupdatedthepreviously-runsearchesfrom2008(Appendix1)
didnothaveconfirmedCHD(e.g.,cardiacdiagnosticprocedures). and searchedthefollowing databases between5 November and
Forthisupdatewelimitedtheinclusioncriteriatostudieswhere 15November2012:
allparticipants hadconfirmedCHD. Therefore,studies involv- • CochraneCentralRegisterofControlledTrials
ingcardiacproceduresfordiagnostic purposesaswellasstudies (CENTRAL)onTheCochraneLibrary(2012,Issue10);
withparticipantswithsuspectedmyocardialinfarctionwerenot • MEDLINE(OvidSP,1950toOctoberweek42012);
includedinthisreview.Weimposednorestrictionsastoage,gen- • EMBASE(OvidSP,1974toOctoberweek52012);
der,orethnicity. • CINAHL(EBSCOhost,1982to9November2012);
Musicforstressandanxietyreductionincoronaryheartdiseasepatients(Review) 8
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