Music medicine during hospital care

This week the UK press covered a report that looked at the effect of music during surgery. You can read about the coverage on the BBC here and listen to an interview with the author of the report here on BBC Radio 4’s Today program.

The report was authored and carried out by Apul Parikh, cosmetic surgeon at John Radcliffe Hospital Oxford. As far as I can tell, this is not a published paper but rather a report into series of medical trials on 100 patients where half had surgery in the standard operating environment under local anaesthetic and half had the same experience except that they heard music in the theatre.

The results were an improvement in anxiety levels during surgery and during recovery, as measured by a standard anxiety scale and by respiration rates (lower in the music group).

The findings are in line with a series of reports into the effects of music medicine which have been summarised by the Cochrane reports. I have written about these reports before and you can read the full blog on music medicine trials here. Essentially, the reports looked at clinical trials of music medicine and found the following:

1)      Music for heart disease. There were 23 trials identified by the review. Music therapy was found to lower heart rate, systolic and diastolic blood pressure, and anxiety. However, the ‘quality’ of the evidence was described as weak.

2)      Music for ventilated patients. Eight trials were identified. Music therapy was found to lower heart rate, respiration rate, and anxiety.

3)      Music for end of life care. Five studies were identified which included 175 patients. Music therapy was found to improve quality of lfe.

4)     Music for acquired brain injury. Seven studies with 184 participants were identified, although these typically included a range of therapeutic interventions. Music therapy was associated with improving gate velocity, stride length and stride symmetry,

5)      Music in oncology. The largest group of trials at 30 were found in this category, comprising over 1891 patients. Music therapy was found to reduce heart rate, lower respiration rates, blood pressure, and to reduce pain and improve mood and quality of life.

At the time of the Cochrane reports the authors emphasised the need for more randomised controlled trials in music medicine, in order to clearly deliniate the effects of music in hopsital and clinic settings. There was a need to take more rigorous details of patient details such as gender, age, prefered coping strategies and medical history. There was also a call for more clear information about delivery treatment issues, such as dosage, frequency, timing, and length, in order to give translational information for clinical practice. Does this new study get us any closer to these goals?

As interesting as the new result may be, and as much as the findings are in line with previous similar literature (LePage et al. 2001; Stevens, 1990), I fear there are still several issues regarding the report that could be improved. I can find no patient details, either to describe the demographics of the participants, their medical history or their surgical interventions. These details may exist of course, but at this stage it is hard to draw any conclusions regarding the trial population.

There is also little detail about the music that was heard during the trials. Dr Parikh is quoted as say that easy listening and classical were the popular types of music such as Vivaldi and Frank Sinatra, which suggests to me that people may have been able to chose the music they prefered. It would be interesting to know more about this, as there is a growing understanding that patient choice of music is critical since our responses to music are so individual (based on our tastes, music listening history and life experiences). Was there a limited choice or free choice?

I recently had a MRI scan and was offered the chance to listen to music, from a limited selection of artists similar to that offered in the study. It is interesting and rather exciting to see that various hospitals are beginning to offer music for patient comfort, especially in MRI where specialised equipment (e.g. non metal headphones) would be necessary. But I have not heard of a standard clinical setting that allows a patient to bring their own music, except in the case of surgeons who can play their own favourite music while operating. Does anyone know of any cases? I would be interested to hear from you.

My final concern is that there seems to be not a great deal of controlled research investigating the effects of music in these environments. And I, for one, would really like to see more. One of the basic issues with the most recent study is that there is no control for the presence of music. This makes it impossible to say whether the effects were related to the music in particular; they could have been the result of simply adding sound to the environment.

Music medicine is still in its relative infancy, but as a complementary approach (NB. not alternative!) it is growing in popularity and in its evidence base. My hope for the future is that studies will adopt the practices of rigorous randomised controlled trials so we can better understand how music affects different people in various medical settings and therfore, allow us to learn how we can optimally use music to increase comfort and relieve anxiety.