The anxiety- and pain-reducing effects of music interventions: a systematic review

AORN Journal,  April, 2008  by Ulrica Nilsson

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* music,

* therapy,

* preoperative,

* intraoperative,

* postoperative,

* perioperative,

* surgery,

* anaesthesia,

* anesthesia,

* pain, and

* anxiety.

The search was conducted using terms both separately and in combination with each other.

The search returned a total of 173 articles, distributed as follows:

* 13 from AMED,

* 77 from CINAHL, and

* 83 from Medline.

After removing duplicate articles, the researcher reviewed a total of 69 articles, screening them for eligibility. Thirteen of the 69 articles were excluded because they reported the use of live music performed by a music therapist; music was used only in combination with other nonpharmacological methods (eg, guided imagery, massage); or use of sound instead of music (eg, hemispheric, binaural sound). Eighteen articles were excluded because of nonrandomization, lack of clarity in the methods or results, or because inclusion and exclusion criteria were not reported. Five articles were excluded because the study results were reported in more than one article.

In addition, a manual search was performed using the reference lists from the retrieved articles. An additional nine studies were found through this search, a manual search of relevant journals, and the researcher's knowledge of the literature and research in this field.

Only RCTs written in English were included. Additionally, the patient population was limited to adult patients (ie, older than 17 years); and music interventions were limited to those performed preoperatively, intraoperatively, and/or postoperatively. Outcome measures of the included studies were pain, anxiety, and stress indicators. The music interventions in the reviewed articles consisted of recorded music. This literature search identified 42 relevant RCTs that met the inclusion criteria (Table 1).

QUALITY ASSESSMENT

The author used a 3-point scale to assess five main features of the methodological quality of the 42 studies. These features included

* outcome measure questionnaires, rated

** 2 if validity and reliability has been demonstrated in 90% or more of the outcome measures,

** 1 if validity and reliability has been demonstrated in 89% or less of the outcome measures, or

** if validity and reliability was not demonstrated;

* blinding, rated

** 2 for double-blind studies,

** 1 for single-blind studies, or

** 0 for no blinding;

* concealment of allocation at enrollment, rated

** 2 for truly randomized allocation,

** 1 for semisecure randomization, or

** 0 for nonsecure randomization or unclearly demonstrated randomization;

* completeness of follow up, rated

** 2 for 100% follow up or intent-to-treat analysis,

** 1 for 80% to 90% follow up, or

** 0 for follow up less than 80% or when information was unclear; and

* sample size calculation, rated

** 2 if a sample size calculation was performed or

** if a sample size calculation was not performed.

These criteria for quality assessment were taken from Rubin and Hotopf's systematic review exploring postoperative fatigue; (15) however, the researcher added the criteria "sample size calculation." The calculation of sample size helps maximize the chances of detecting a statistically and clinically significant difference between the interventions when a difference really exists. (16) Using this assessment tool, a total quality score was assigned to each article. Ratings could range from 0 (ie, the worst quality) to 10 (ie, the best quality).