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Covid-19 and absence of music therapy: Impact on mother-child dyad during invasive procedures in pediatric oncology
Abstract
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https://authors.elsevier.com/a/1dU%7EqivMu9WwG During COVID-19 pandemic, Italian pediatric oncology departments were obliged to adopt restrictive measures to minimize the risk of in-hospital infections in frail patients and staff members. Access to the wards was significantly reduced and music therapy (MT) activities were suspended. The aim of this study was to compare the level of anxiety and sedation in pediatric patients undergoing invasive procedure before (T1), during(T2) and after(T3) the pandemic, with and without the presence of MT.
From January to September 2020, all children aged 2-15 with oncological and hematological diseases undergoing to invasive procedure were enrolled. During T1 and T3 children received preoperative preparation with MT by a certified music-therapist. In T2 they received music or video by clinical staff. Preoperative anxiety scores were measured with the m- YPAS scale. Interviews with mothers were performed. The average consumption of drugs used was analyzed.
Significant differences in preoperative anxiety levels between scores in T1, T2 (p.value = 0,0000014) and in T2, T3 (p.value = 0,0000031) were observed. No difference between T1-T3 (p.value = 0,96). Higher dosage of midazolam in T2 (1,14 mg 0,189) compared to T1 (0, 71 mg 0,399) and T2 (1,14 mg 0,189) were observed. Mothers also recorded higher scores on anxiety and stress without music therapy.
... Eight of the included studies were from Italy (Antonelli et al., 2019;C. Preti & G. F. Welch, 2013;Giordano et al., 2020Giordano et al., , 2021Longhi et al., 2015;Preti & Welch, 2011, 2012, six from the US (Bush et al., 2021;Colwell et al., 2013;Millett & Gooding, 2018;Ortiz et al., 2019;Scheufler et al., 2021;Yates et al., 2018), three from Sweden (Uggla et al., 2016(Uggla et al., , 2018(Uggla et al., , 2019, two from the UK (Blackburn, 2020a(Blackburn, , 2020b, and one study each from India (Sundar et al., 2016) ...
... Hence, outcomes of positive affect are understood to influence both psychological and physiological parameters (Uggla et al., 2016). Also, based on observations and self-reports, live music therapy was reported to reduce emotional distress and anxiety, and to support sedation (Giordano et al., 2020(Giordano et al., , 2021Millett & Gooding, 2018;Ortiz et al., 2019;Scheufler et al., 2021;van der Heijden et al., 2018), to decrease the intensity of agitation and fear and to increase both peacefulness and the intensity of joy (Văduva & Balla, 2019). While elevating mood, musical activities also motivate the patients to physically engage (Yates et al., 2018). ...
... Only two studies exhibited a core focus (C. Preti & G. F. Welch, 2013;, while a few other texts presented some professional considerations mainly from a music therapist perspective (Bush et al., 2021;Colwell et al., 2013;Giordano et al., 2020Giordano et al., , 2021Ortiz et al., 2019;Scheufler et al., 2021;Uggla et al., 2016Uggla et al., , 2018Uggla et al., , 2019. The musicians represented in the two core studies were from Italy and the UK and were hired by either a charity or a special hospital programme. ...
Purpose
The objective of this scoping review is to compile and examine characteristics and impacts of live music interventions on the health and wellbeing of children, families, and health care professionals in paediatric hospital care.
Methods
We searched four scientific databases for peer-reviewed publications of empirical studies of all study designs. The first author screened the publications, with spot-checks for eligibility by the second and third authors. Data extraction and quality assessment were made by the first author with support from the second and third. Additionally, the included studies were screened for quality appraisal. The analysis followed an inductive, interpretive approach for synthesis.
Results
Quantitative features were screened and compiled, and qualitative inductive analyses of findings were elaborated into categories connected to research questions. The reported impacts were thematized through emergent features of importance and prerequisites beneficial for successful interventions. Recurrent outcomes present themes of positive affect, copingand reduced hospitalization. Emotional regulation, play and participation, age, session design, adaptivity, and familiarity present benefits, barriers, and facilitators for outcomes.
Conclusions
Findings from collected empirical research display philosophy, practice, and relations as keys for characteristics, impacts, and implications of live music interventions in paediatric hospital care. The communicative aspects of music appear at the core of importance.
... Other research, such as that conducted by Nelson et al., evaluated the effects of music-assisted relaxation training on adolescents before surgery and showed significant reductions in pain and anxiety [33]. Even during the COVID-19 pandemic, Giordano F studied the impact of the absence of music therapy before invasive procedures and demonstrated the benefits of music therapy in reducing preprocedural anxiety in mother-baby pairs [34]. A Cochrane systematic review and meta-analysis of 26 trials found that music intervention reduced anxiety by 5.75 units greater (p < 0.0001) than standard care [14]. ...
... Some studies have reported that music interventions reduce sedative requirements in patients undergoing regional anesthesia when combined with sedation, using both midazolam [21,22] and propofol, and also in critically ill patients in intensive care units [9,13]. ...
Background:
Patients undergoing surgery and general anesthesia often experience anxiety, fear and stress, with negative bodily responses. These may be managed by the pre-procedural application of anxiolytic, analgesic, and anesthetic drugs that have, however, potential risks or side effects. Music therapy (MT) can be used as a complementary no-drug intervention alongside standard surgical care before, during and after medical procedures. The aim of this study was to evaluate the effects of preoperative MT intervention compared to premedication with midazolam on levels of anxiety, sedation and stress during general anesthesia for elective stomatology surgery.
Methods:
A two-arm randomized and controlled single-center, parallel-group, pre-post event study was conducted. In total, 70 patients affected by stage I or II (both clinically and instrumentally N0) micro-invasive oral cancer and undergoing elective surgery under general anesthesia were assigned to the control group (CG) or to the music therapy group (MTG). MTG patients received preoperative music therapy intervention (MT) from a certified music therapist before surgery, while the CG patients did not receive MT but instead received premedication with intravenous midazolam, 0.02 mg/kg. Anesthesia was the same in both groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded at the entrance to the operating room, just before the induction of anesthesia and every 5 min until the end of surgery. An anxiety visual analogues scale (A-VAS) was used to evaluate the level of anxiety. The bispectral index (BIS) monitor was used to measure the depth of sedation just before and 10 min after both music intervention and midazolam administration. Stress response was assessed 5 min before and 20 min after surgery via the control of plasma prolactin (PRL), growth hormone (GH), and cortisol levels. The patient global impression of satisfaction (PGIS) was tested 1 h after surgery. Participants in the MTG were asked to answer 3 questions concerning their experience with MT.
Results:
No statistical differences among the PRL, GH and cortisol levels between the two groups were registered before and after the treatment, as well as for PAS, PAD and HR. Significant differences in the A-VAS scores between the MTG and CG (p < 0.01) was observed. Compared to the CG, MTG patients had a statistically significantly lower BIS score (p = 0.02) before induction. A PGIS score of 86.7% revealed that patients in the MTG were very satisfied, versus 80% in the CG (p < 0.05).
Conclusion:
Preoperative music therapy could be an alternative to intravenous midazolam when aiming to promote a preoperative and post-operative state of anxiolysis and sedation in stomatology surgery, even if no differences were found in terms of the surgery-related stress response according to physiological and hormonal determinations.
... MT can be considered an excellent support for anesthesia as a complementary/non-pharmacological approach to reduce pre-operative anxiety in children undergoing invasive procedure [6,17]. ...
Unlabelled:
Music therapy (MT) is a complementary therapy offered to children, young adults, and their families in pediatric oncology and palliative care. We performed a survey to collect information about MT in pediatric oncology in Italy. The outbreak of COVID-19 unavoidably changed the scenario of MT, suggesting some considerations presented in this survey. 27/32 (84.4%) centers belonging to the Infections and Supportive Therapy Working Group of Association of Pediatric Hematology and Oncology (AEIOP) completed in 2 different time points (T1 and T2) an online survey on MT, before and after COVID-19 pandemia. Different kinds of music approach were used taking care of patients in 21/27 centers, while in 14/21 (66%), a specific project of MT conducted by a music therapist was present. In 6/14 centers, MT activities were delivered for < 3 h/week, in 3 centers for > 3 and < 10 h/week, and in the remaining 5 for > 3 h/week. MT sessions were in different areas, day hospital, or ward (patient rooms, operating rooms, waiting rooms), on an individual basis or by groups. Patients were invited to MT by psychologists, caring physician, or nurse, or on equipé decision. MT was evaluated with tools self-made by music therapist in 11/14 centers. After COVID-19, MT has been withdrawn in 3 centers, sessions in the waiting rooms were reduced, individual sessions were preferred, and enrollment by multidisciplinary teams increased.
Conclusion:
This survey represents the starting platform to compare and discuss different experience of MT in AIEOP centers, to implement MT in pediatric oncology for a more qualified assistance to patients, and to improve quality of care.
What is known:
• Music therapy in pediatric oncology and palliative care can be used for the management and prevention of various somatic and psychological symptoms of patients and often is provided to children together with their families. • In Italy the application of Music therapy in the AIEOP pediatric oncology centers is constantly increasing, but due to the outbreak of Covid-19 Pandemic, Italian pediatric oncology departments were obliged to adopt restrictive measures.
What is new:
• Although the majority of Centres did not abrogate MT interventions, judgment about limitation should be carefully taken since MT helps children and even more adolescents in their fight against cancer. • The best practice of Music therapy in pediatric oncology requires communication and collaboration among qualified music therapists and multidisciplinary care team, using a model of family-centered care that actively involves parents/ caregivers in assessment, treatment planning, and care delivery.
... Another study examined patientlevel associations of pandemic-related changes in music therapy on preoperative anxiety and reported that anxiety was higher in the absence of music therapy. (Giordano et al., 2021) At least one AAA program has reported on its adoption of virtual visits. (Kong & Soon, 2022) However, to our knowledge, ours is the first study to survey hospitals on changes to their AAA programs during the pandemic. ...
Introduction
The goal of this study was to document current hospital-based animal-assessed activities (AAA) practices.
Methods
We contacted 20 hospitals and asked about their AAA programs, including COVID-19 precautions.
Results
18 of 20 hospitals responded. Before 2020, all offered either in-person only (N=17) or both in-person and virtual AAA visits (N=1). In early 2022, 13 provided in-person visits; the 5 hospitals that had not resumed in-person visits planned to restart. Most hospitals stopped group visits. Additional training requirements and restrictions varied. Most required that patients and handlers be free of COVID-19 symptoms and that handlers be vaccinated and wear masks and eye protection. Most did not require COVID-19 for patients. None required handlers to test negative for COVID-19.
Discussion
The COVID-19 pandemic had large impacts on hospital-based pediatric AAA. Future studies should assess the effectiveness of virtual AAA and of precautions to prevent COVID-19 transmission between patients and AAA volunteers.
Children and adolescents diagnosed with cancer and their caregivers are routinely exposed to challenges most families will likely never face, especially during health emergencies where health system resources are put under pressure. The goal of this review was to systematically collect and synthesize the existing literature that examined the impact of the COVID-19 pandemic on psychological, financial, and educational outcomes among children and adolescents diagnosed with cancer and their caregivers, which usually are parents but may also include other family members such as siblings or grandparents. MEDLINE, Embase, and PsycINFO were searched on May 3, 2022. We included both qualitative and quantitative original research and brief reports from which we extracted population demographics, COVID-19 intervention, data collection, and outcome-related items. We then conducted a thematic analysis on the results sections of records. 50 studies of children (0–12 years) or adolescents (13–19 years) with cancer or their families were included. We identified five themes: Positive Impacts of COVID-19, Negative Psychological Experiences, Lack of Support, Mass Job Loss, and Disrupted Education. Our results demonstrated that the COVID-19 pandemic has been associated with some positive and multiple negative psychosocial outcomes among children and adolescents diagnosed with cancer and their families.
Background:
Children with cancer (ages 3-8 years) and their parents experience significant, interrelated distress associated with cancer treatment. Active music engagement (AME) uses music-based play and shared music-making to mitigate this distress. To advance our understanding about how AME works and its essential features, we interviewed parents who received the AME intervention as part of a multi-site mechanistic trial. The purpose of this qualitative analysis was to describe parents' experiences of AME for themselves and their child and to better understand how the intervention worked to lower parent-child distress.
Procedure:
We conducted a total of 43 interviews with parents/caregivers, and purposively analyzed all interviews from underrepresented groups based on race/ethnicity and parent role. We used thematic analysis and achieved thematic redundancy after analyzing 28 interviews.
Results:
The following statement summarizes resulting themes: Music therapists skillfully use AME to create a safe and healthy space (Theme 1), where parents/children have transformative experiences (Theme 2) that lead to learning and enactment (Theme 3) of new skills that counteract suffering (Theme 4) through empowerment, connectedness, and sustained relief.
Conclusions:
This work elucidates how AME works to counteract stressful qualities of cancer treatment. As parents witnessed positive and transformative changes in their child, they experienced relief and reported shifts in their perspective about cancer treatment. This led to learning and use of music as a coping strategy that extended beyond therapist-led sessions. Accessible, music-based interventions, like AME, offer a developmentally appropriate and effective way to support parents and young children during treatment.
Background
Percutaneous renal biopsy (PRB) may subject patients to emotional distress and pain, before and during the biopsy. The aim of this study was to evaluate the effects of a complementary/non-pharmacological interventions as music therapy (MT) on anxiety, pain and satisfaction in renal patients undergoing PRB.
Methods
A prospective, single-center, single-blind, randomized controlled two-arm trial was conducted. Patients (age ≥ 18 years) hospitalized at Nephrology, Dialysis and Transplantation Unit (Bari), and scheduled for PRB were screened in the study. Participants were assigned to standard treatment (CG) or to music therapy intervention group (MG). Participants in MG received standard care and MT intervention by a certified music therapist qualified in guided imagery and music. CG received standard of care. MG and CG were subjected to identical measurements (pre/post) of the parameters State Trait Anxiety Inventory Y-1(STAI-Y1), Visual Analogue Scale for Pain (VAS-P) and Satisfaction (VAS-S), Heart Rate Variability (HRV).
Results
A statistically significant difference in the anxiety scores after PRB between MG and CG (STAI-Y 35.4 ± 6.2 vs 42.9 ± 9.0) was observed. MT had also strong and significant effects on VAS -P compared to CG (5.0 ± 1.4 vs 6.3 ± 1.3, respectively; P < 0.001) and VAS—S (7.8 ± 1.0 vs 6.0 ± 0.9, respectively. P < 0.001). A decreased activity of Sympathetic Nervous System (SNS) and an increased activity of Parasympathetic Nervous System (PNS) was observed after PRB in MG.
Conclusion
Our study supports the use of MT to mitigate the psychological anxiety, pain and sympathetic activation associated with PRB.
Clinical Trial number: clinicaltrial.gov. with n°NCT05119816
Background:
The effect of perioperative music listening has been proven to relieve preoperative anxiety and depression, while improving patient satisfaction. However, music listening has not been extensively studied in Singapore. Therefore, the primary aim of our study is to investigate the patient satisfaction towards perioperative music listening in the local setting. The secondary aim is to investigate the effect of perioperative music listening in reducing patient surgery-related anxiety and depression.
Methods:
After obtaining ethics board approval, we conducted a quasiexperimental study on a cohort of female patients who were undergoing elective minor gynaecological surgeries. Apple iPod Touch™ devices containing playlists of selected music genres and noise-cancelling earphones were given to patients to listen during the preoperative and postoperative periods. Hospital Anxiety and Depression Scale (HADS), EQ-5D-3L questionnaire, music listening preferences, and patient satisfaction surveys were administered. Wilcoxon signed-rank and McNemar's tests for paired data were used for analysis.
Results:
83 patients were analysed with 97.6% of patients in the preoperative period and 98.8% of patients in the postoperative period were satisfied with music listening. The median (IQR [range]) score for preintervention HADS anxiety was 7.0 (6.0 [0-17]), significantly higher than that in postintervention at 2.0 (4.0 [0-12]) (P < 0.001). Similarly, there was a significant reduction in preintervention HADS depression as compared to postintervention (P < 0.001). Similarly, there was a significant reduction in preintervention HADS depression as compared to postintervention (.
Conclusion:
Perioperative music listening improved patient satisfaction and can reduce patient anxiety and depression. We hope to further investigate on how wider implementation of perioperative music listening could improve patient care.
Background: Hematopoietic stem cell transplantation (HSCT) is an established treatment for severe disorders of the pediatric hematopoietic system. However, there is a need for supportive interventions due to physiological and psychological strain. Music therapy is used in health care to help patients through difficult experiences and enable well-being. Our previous randomized studies showed significantly reduced heart rates four to eight hours after intervention as well as increased health-related quality of life. Methods: The aim of this qualitative study was to explore the participants’ and parents’ own experiences of the interactive processes during the music therapy intervention. Six families were included. The data collection used collaborative research interviews. An independent psychologist facilitated the interviews with the children, the parents, and the music therapist and also performed the analysis. Results: Three main themes emerged: experiences of competency and recognition of self, interactive affect regulation as change potential, and importance of the therapeutic relationship. Conclusions: For the participants, music therapy developed into a significant and helpful experience, an important ingredient in coping with and managing the treatment period at the hospital.
Background: In pediatric health care, non-pharmacological interventions such as music therapy have promising potential to complement traditional medical treatment options in order to facilitate recovery and well-being. Music therapy and other music-based interventions are increasingly applied in the clinical treatment of children and adolescents in many countries world-wide. The purpose of this overview is to examine the evidence regarding the effectiveness of music therapy and other music-based interventions as applied in pediatric health care. Methods: Surveying recent literature and summarizing findings from systematic reviews, this overview covers selected fields of application in pediatric health care (autism spectrum disorder; disability; epilepsy; mental health; neonatal care; neurorehabilitation; pain, anxiety and stress in medical procedures; pediatric oncology and palliative care) and discusses the effectiveness of music interventions in these areas. Results: Findings show that there is a growing body of evidence regarding the beneficial effects of music therapy, music medicine, and other music-based interventions for children and adolescents, although more rigorous research is still needed. The highest quality of evidence for the positive effects of music therapy is available in the fields of autism spectrum disorder and neonatal care. Conclusions: Music therapy can be considered a safe and generally well-accepted intervention in pediatric health care to alleviate symptoms and improve quality of life. As an individualized intervention that is typically provided in a person-centered way, music therapy is usually easy to implement into clinical practices. However, it is important to note that to exploit the potential of music therapy in an optimal way, specialized academic and clinical training and careful selection of intervention techniques to fit the needs of the client are essential.
Aim:
Paediatric recipients of haematopoietic stem cell transplants (HSCT) are at increased risk of developing post-traumatic stress disorder (PTSD) and there is a need to identify interventions that can alleviate stress in this group. The aim of this study was to examine the previously unexplored effect of music therapy on children undergoing HSCT, by analysing physiological parameters and comparing them with a control group.
Methods:
We performed a randomised clinical pilot study of 24 patients up to the age of 16 undergoing HSCT at Karolinska University Hospital, Huddinge, Sweden. Music therapy, including expressive and receptive elements, was performed twice a week in the treatment group and compared to standard care in the control group. Physiological parameters were evaluated according to the hospital's protocols.
Results:
The music therapy group had significantly reduced evening heart rates compared to the control group (p<0.001) and the effect was sustainable for four to eight hours after the intervention. There were no significant differences in saturation or blood pressure observed between the groups.
Conclusion:
Music therapy significantly lowered the heart rate of children undergoing HSCT for at least four to eight hours, indicating reduced stress levels and potentially lowering the risk of developing PTSD. This article is protected by copyright. All rights reserved.
Ketamine is an anesthetic drug that is importantly analgesic without respiratory depression. Ketamine increases blood pressure and heart rate. Propofol is an anesthetic drug with good sedation, rapid recovery, but it causes respiratory depression, low heart rate and low blood pressure. Combination of Ketamine and Propofol provides sedation, analgesia and rapid recovery with hemodynamic stability and minimal respiratory depression. The aim of this study was to compare two different combinations of these two drugs to reach necessary sedation scale for the Lp or BMA in pediatric with ALL.
This randomized, double blinded study was designed to compare the quality of sedation and side effects of intravenous Ketofol on 60 patients of both gender. Patients received titrated injection of a solution containing combination of one part of Ketamine and two parts of Propofol (1:2) (group I) or one part of Ketamine and three parts of Propofol (1:3) (group II) to reach almost near 5 sedation level (using Ramsay Sedation Scale). Respiratory and hemodynamic profiles, amount of drug injected and side effects were recorded.
These drug combinations were used on 60 children with a median age of 6.2 years. In this study, recovery time and hallucination was significantly high in group I, but in both groups hemodynamic were stable, amnesia was enough, and there was no respiratory depression.
Lower doses of Ketamine in these combinations have lower psycho mimetic side effects, and shorter recovery time.
Objectives:
Recorded music risks overstimulation in NICUs. The live elements of music such as rhythm, breath, and parent-preferred lullabies may affect physiologic function (eg, heart and respiratory rates, O2 saturation levels, and activity levels) and developmental function (eg, sleep, feeding behavior, and weight gain) in premature infants.
Methods:
A randomized clinical multisite trial of 272 premature infants aged ≥32 weeks with respiratory distress syndrome, clinical sepsis, and/or SGA (small for gestational age) served as their own controls in 11 NICUs. Infants received 3 interventions per week within a 2-week period, when data of physiologic and developmental domains were collected before, during, and after the interventions or no interventions and daily during a 2-week period.
Results:
Three live music interventions showed changes in heart rate interactive with time. Lower heart rates occurred during the lullaby (P < .001) and rhythm intervention (P = .04). Sucking behavior showed differences with rhythm sound interventions (P = .03). Entrained breath sounds rendered lower heart rates after the intervention (P = .04) and differences in sleep patterns (P < .001). Caloric intake (P = .01) and sucking behavior (P = .02) were higher with parent-preferred lullabies. Music decreased parental stress perception (P < .001).
Conclusions:
The informed, intentional therapeutic use of live sound and parent-preferred lullabies applied by a certified music therapist can influence cardiac and respiratory function. Entrained with a premature infant's observed vital signs, sound and lullaby may improve feeding behaviors and sucking patterns and may increase prolonged periods of quiet-alert states. Parent-preferred lullabies, sung live, can enhance bonding, thus decreasing the stress parents associate with premature infant care.
Music-based interventions are used to address a variety of problems experienced by individuals across the developmental lifespan (infants to elderly adults). In order to improve the transparency and specificity of reporting music-based interventions, a set of specific reporting guidelines is recommended. Recommendations pertain to seven different components of music-based interventions, including theory, content, delivery schedule, interventionist, treatment fidelity, setting, and unit of delivery. Recommendations are intended to support Consolidated Standards for Reporting Trials (CONSORT) and Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statements for transparent reporting of interventions while taking into account the variety, complexity, and uniqueness of music-based interventions.
Context
Eighty-seven patients newly diagnosed with lung, breast, or gastrointestinal cancer and undergoing chemotherapy in the infusion suite of a large urban hospital in New York City.
Objective
Patients were enrolled in this study of music therapy's impact on resilience in coping with the impact of symptoms inclusive of symptom clustering.
Methods
Patients were randomly assigned to three arms: clinical instrumental improvisation or clinical vocal improvisation 43 subjects to instrumental improvisation or vocal improvisation and 44 subjects to control. All subjects received a Medical Music Psychotherapy Assessment including psychosocial information and music preferences, pre-/post-Resilience Scale, Hospital Anxiety and Depression Scale, Visual Analogue Scale/Faces Scale, and a pain—Color Analysis Scale. Interventions included 20-minute music therapy (MT) and two additional sessions.
Results
Significant increases in Resilience Scale in MT groups after treatment with instrumental and vocal MT interventions equally potent-reflect average changes of 3.4 and 4.83 (P = 0.625), respectively. Although Hospital Anxiety and Depression Scale scores showed little impact of MT on perceived anxiety/depression, a strong correlation is seen between vocal intervention and lower depression scores through Visual Analogue Scale–rendered postsessions. This yielded a significant decrease in pain levels immediately after MT, with the final session showing the most significant change in pain level. Resilience in enduring procedures is a necessary component of combating potential negative illness perception.
Conclusion
Our study shows MT's facility to propel resilience in patients newly diagnosed with cancer, particularly when promoting and pairing adaptation toward coping through the expression of perceived negative effects of emotional and physiological symptoms.
Keywords: end of life, musictherapy, pediatric cancer, songwriting, supportive care
End-of-life accompaniment requires even greater care of the patient and their family by the multi-disciplinary
team, which requires a clear, wellorganized interdisciplinary and interprofessional approach. Musictherapy
(MT) is often use as a complementary approach to improve a person’s quality of life by helping to relieve
symptoms, addressing psychological needs, offering support and comfort, facilitating communication, and
meeting spiritual needs.
Through songwriting, Ettore, a teenager was able to make choices and act on his own will. Songwriting
represented a channel for effective and powerful communication and expression. The song became the
means by which the relationship with the team was maintained and deepened; it became something tangible,
a product with its own consistency, a further bond that unites Ettore to his family to this day.
As the global Coronavirus disease (COVID-19) pandemic transforms our society, music therapists must adapt service delivery models that ensure client safety. Given the prevalence of COVID-19 in our communities and lack of personal protective equipment in many settings, music therapists are faced with the need to shift delivery models in order to provide safe and relevant services. Telehealth is one solution to these current service delivery challenges. Music therapists possess a depth of practice-based knowledge and understanding of client populations, which enables them to develop virtual services, matching both the clinicians’ and clients’ technical capabilities. Developed during the initial wave of COVID-19 infections in the United States, this article describes the coauthors’ three-tiered scaffold model intended to support the program development and deployment of virtual music therapy (VMT) services. The model describes an approach to developing VMT services that directs the clinician’s goals of care in formats that are accessible, appropriate, and best meet the patient/client’s needs and abilities. The severity and lasting nature of this worldwide health crisis and its disruption of traditional service delivery models require clinicians and researchers to develop the most effective uses of VMT while considering its limits with regard to clinical populations and need areas.
The influence of music therapy (MT) as a support intervention to reduce stress and improve wellbeing in Clinical Staff (CS) working with COVID-19 patients was evaluated. Participants were enrolled as a result of spontaneous agreement (n = 34) and were given remote receptive MT intervention over a 5-week period. Their levels of tiredness, sadness, fear and worry were measured with MTC-Q1 before and after MT intervention. An immediate significant variation in the CS emotional status was observed. The results seem to confirm that in an emergency situation, it is possible to put in place a remote MT support intervention for CS exposed to highly stressful situations.
Objective
The COVID‐19 pandemic seems to be developing into a planetary‐scale mental health experiment, undermining the foundations of our being human, obliging us to keep physically apart from one another, and inducing us to see other people as a potential threat.
Methods
In the world of pediatric oncology, we have found ourselves up against new challenges. In this article, we discuss the difficulties found in conducting psychological support sessions while complying with physical distancing rules, as well as wearing protective face masks, and even gloves; or while using modern remote communication telecommunications.
Results
The classic reasons behind requests for psychological support have been compounded by other, novel problems, such as: fewer relational resources for families at home, less chance to socialize, hospital stays with only one parent, the suspension of all teaching and group activities on the ward, economic difficulties caused by the pandemic, the rising levels of family conflictuality and generalized anxiety.
Conclusions
It is essential to find new solutions that can be promptly implemented, reconfiguring the way we humanize our hospital wards.
The COVID-19 pandemic is producing a huge health care burden with millions of cases and thousands of deaths. The coronavirus’ high virulence and contagiousness and the frequent sudden onset of illness is overwhelming critical care and frontline healthcare staff. Frontline professionals are exposed to unprecedented levels of intensive existential threat requiring systematic, specialized psychological intervention and support. New psychological services need to be urgently implemented to manage the mental healthcare needs of frontline medical staff working with patients with COVID-19. The COVID-19 pandemic is a watershed moment: health care systems universally require a step-change to improve our preparedness for future pandemics.
The influence of music therapy (MT) on preoperative anxiety in children affected by leukemia undergoing invasive diagnostic procedures (IP) was evaluated. The participants were assigned to two different types of preoperative preparation for IP: MT intervention or standard care. Preoperative anxiety scores were measured with the Modified Yale Pre-operative Anxiety Scale. Interviews with medical staff were performed.
A lower preoperative anxiety score in the MT group (n = 29) compared with standard care (n = 19) was observed. Results support the potential effectiveness of integrating music therapy with a pharmacological approach to reduce preoperative anxiety in IP. More than 90% of the medical staff (n = 19) were very satisfied with the ability of MT to distract the patient and support the staff.
Objectives
Music therapy has been shown to be effective for reducing anxiety and pain in people with a serious illness. Few studies have investigated the feasibility of integrating music therapy into general inpatient care of the seriously ill, including the care of diverse, multiethnic patients. This leaves a deficit in knowledge for intervention planning. This study investigated the feasibility and effectiveness of introducing music therapy for patients on 4 inpatient units in a large urban medical center. Capacitated and incapacitated patients on palliative care, transplantation, medical intensive care, and general medicine units received a single bedside session led by a music therapist.
Methods
A mixed-methods, pre-post design was used to assess clinical indicators and the acceptability and feasibility of the intervention. Multiple regression modeling was used to evaluate the effect of music therapy on anxiety, pain, pulse, and respiratory rate. Process evaluation data and qualitative analysis of observational data recorded by the music therapists were used to assess the feasibility of providing music therapy on the units and patients’ interest, receptivity, and satisfaction.
Results
Music therapy was delivered to 150 patients over a 6-month period. Controlling for gender, age, and session length, regression modeling showed that patients reported reduced anxiety post-session. Music therapy was found to be an accessible and adaptable intervention, with patients expressing high interest, receptivity, and satisfaction.
Significance of Results
This study found it feasible and effective to introduce bedside music therapy for seriously ill patients in a large urban medical center. Lessons learned and recommendations for future investigation are discussed.
While recent research suggests that music therapy interventions impact pre-surgical anxiety (Palmer, Lane, Mayo, Schluchter, & Leeming, 2015), staff and patron perceptions of the modality are not well established. A total of 629 surgical patients, surgeons, nurses, and family members were surveyed to identify factors that might affect willingness to participate and to educate practitioners on preferred methods of facilitation. The majority of participants (93%) believed music to be beneficial during the surgical experience. Subjects were welcoming of live preoperative music listening (74%), recorded preoperative music listening (84%), and intraoperative music listening (77%). Eighty-eight percent of patients reported that they would be willing to accept music if it was offered to them as part of surgical care. Fifty percent of patients relayed that they would rather listen to live or recorded music than any other preoperative activity. Music may be a welcome addition to the surgical arena, with all affected parties largely in support of music practices. Employment of a music therapist in the surgical arena may provide optimum benefits, as practitioners can tailor interventions to meet the ever-changing needs of patients. This study further reinforces the importance of educating staff and patients about music therapy and raising awareness about the differential benefits music therapy may offer.
Objectives:
Music intervention has been shown to reduce anxiety and sedative exposure among mechanically ventilated patients. Whether music intervention reduces ICU costs is not known. The aim of this study was to examine ICU costs for patients receiving a patient-directed music intervention compared with patients who received usual ICU care.
Design:
A cost-effectiveness analysis from the hospital perspective was conducted to determine if patient-directed music intervention was cost-effective in improving patient-reported anxiety. Cost savings were also evaluated. One-way and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness.
Setting:
Midwestern ICUs.
Patients:
Adult ICU patients from a parent clinical trial receiving mechanical ventilatory support.
Interventions:
Patients receiving the experimental patient-directed music intervention received a MP3 player, noise-canceling headphones, and music tailored to individual preferences by a music therapist.
Measurements and main results:
The base case cost-effectiveness analysis estimated patient-directed music intervention reduced anxiety by 19 points on the Visual Analogue Scale-Anxiety with a reduction in cost of 2,155 less than usual ICU care and projected that cost saving is achieved in 70% of 1,000 iterations. Based on break-even analyses, cost saving is achieved if the per-patient cost of patient-directed music intervention remains below 329.
Conclusions:
Patient-directed music intervention is cost-effective for reducing anxiety in mechanically ventilated ICU patients.
Background
Young children who experience high levels of preoperative anxiety often exhibit distress behaviors, experience more surgical complications, and are at a higher risk for developing a variety of negative postoperative consequences. A significant factor in pediatric preoperative anxiety is the level of anxiety present in their caregivers. Active and passive music therapy interventions addressing anxiety prior to invasive procedures have been met with success.
Objective
The purpose of this study was to investigate the comparative effectiveness of two distraction-based music therapy interventions on reducing preoperative anxiety in young pediatric surgical patients and their caregivers.
Methods
A total of 40 pediatric patient and caregiver dyads undergoing ambulatory surgery were included in this study. Pediatric preoperative anxiety was measured pre- and post-intervention using the modified Yale Pediatric Anxiety Scale, while caregiver anxiety was measured through self-report using the short-form Strait-Trait Anxiety Inventory-Y6. Participants were randomized to either an active or passive intervention group for a preoperative music therapy session.
Results
Results indicated a significant reduction in preoperative anxiety for both patients and their caregivers regardless of intervention type. Neither active nor passive music therapy interventions were significantly more effective than the other.
Conclusions
For future studies, the researchers recommend an increased sample size, controlling for various factors such as sedative premedication use, and testing interventions with patients in various stages of development.
Background:
Existing systematic reviews provide evidence that music therapy is an effective intervention in the treatment of children and adolescents with psychopathology. The objective of the present review was to systematically review and quantify the effects of music-based interventions in reducing internalizing symptoms (i.e., depression and anxiety) in children and adolescents using a meta-analytical approach.
Methods:
Databases and journals were systematically screened for studies eligible for inclusion in meta-analysis on the effects of music-based interventions in reducing internalizing symptoms. A random-effect meta-analysis using standardized mean differences (SMD) was conducted.
Results:
Five studies were included. Analysis of data from (randomized) controlled trials, yielded a significant main effect (Hedge's g = -0.73; 95%CI [-1.42;-0.04], Z = 2.08, p = 0.04, k = 5), indicating a greater reduction of internalizing symptoms in youth receiving music-based interventions (n = 100) compared to different control group interventions (n = 95).
Limitations:
The existing evidence is limited to studies of low power and methodological quality. Included studies were highly heterogeneous with respect to the nature of the intervention, the measurements applied, the samples studied, and the study design.
Conclusions:
Findings indicate that music-based interventions may be efficient in reducing the severity of internalizing symptoms in children and adolescents. While these results are encouraging with respect to the application of music-based intervention, rigorous research is necessary to replicate existing findings and provide a broader base of evidence. More research adopting well controlled study designs of high methodological quality is needed.
Music therapy is recognised as being applicable to a wide range of healthcare and social contexts. Since the first edition of Music Therapy: An art beyond words, it has extended into areas of general medicine, mainstream education and community practice. This new edition revises the historical and theoretical perspectives and recognises the growing evidence and research base in contemporary music therapy. Leslie Bunt and Brynjulf Stige document the historical evolution of music therapy and place the practice within seven current perspectives: medical, behavioural, psychoanalytical, humanistic, transpersonal, culture-centred and music-centred. No single perspective, individual or group approach is privileged, although the focus on the use of sounds and music within therapeutic relationships remains central. Four chapters relate to areas of contemporary practice across different stages of the lifespan: child health, adolescent health, adult health and older adult health. All include case narratives and detailed examples underpinned by selected theoretical and research perspectives. The final two chapters of the book reflect on the evolution of the profession as a community resource and the emergence of music therapy as an academic discipline in its own right. A concise introduction to the current practice of music therapy around the world, Music Therapy: An art beyond words is an invaluable resource for professionals in music therapy and music education, those working in the psychological therapies, social work and other caring professions, and students at all levels.
Background:
Patients awaiting surgical procedures often experience significant anxiety. Such anxiety may result in negative physiological manifestations, slower wound healing, increased risk of infection, and may complicate the induction of anaesthesia and impede postoperative recovery. To reduce patient anxiety, sedatives and anti-anxiety drugs are regularly administered before surgery. However, these often have negative side effects and may prolong patient recovery. Therefore, increasing attention is being paid to a variety of non-pharmacological interventions for reduction of preoperative anxiety such as music therapy and music medicine interventions. Interventions are categorized as 'music medicine' when passive listening to pre-recorded music is offered by medical personnel. In contrast, music therapy requires the implementation of a music intervention by a trained music therapist, the presence of a therapeutic process, and the use of personally tailored music experiences. A systematic review was needed to gauge the efficacy of both music therapy and music medicine interventions for reduction of preoperative anxiety.
Objectives:
To examine the effects of music interventions with standard care versus standard care alone on preoperative anxiety in surgical patients.
Search methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7), MEDLINE (1950 to August 2012), CINAHL (1980 to August 2012), AMED (1985 to April 2011; we no longer had access to AMED after this date), EMBASE (1980 to August 2012), PsycINFO (1967 to August 2012), LILACS (1982 to August 2012), Science Citation Index (1980 to August 2012), the specialist music therapy research database (March 1 2008; database is no longer functional), CAIRSS for Music (to August 2012), Proquest Digital Dissertations (1980 to August 2012), ClinicalTrials.gov (2000 to August 2012), Current Controlled Trials (1998 to August 2012), and the National Research Register (2000 to September 2007). We handsearched music therapy journals and reference lists, and contacted relevant experts to identify unpublished manuscripts. There was no language restriction.
Selection criteria:
We included all randomized and quasi-randomized trials that compared music interventions and standard care with standard care alone for reducing preoperative anxiety in surgical patients.
Data collection and analysis:
Two review authors independently extracted the data and assessed the risk of bias. We contacted authors to obtain missing data where needed. Where possible, results were presented in meta analyses using mean differences and standardized mean differences. Post-test scores were used. In cases of significant baseline differences, we used change scores.
Main results:
We included 26 trials (2051 participants). All studies used listening to pre-recorded music. The results suggested that music listening may have a beneficial effect on preoperative anxiety. Specifically, music listening resulted, on average, in an anxiety reduction that was 5.72 units greater (95% CI -7.27 to -4.17, P < 0.00001) than that in the standard care group as measured by the Stait-Trait Anxiety Inventory (STAI-S), and -0.60 standardized units (95% CI -0.90 to -0.31, P < 0.0001) on other anxiety scales. The results also suggested a small effect on heart rate and diastolic blood pressure, but no support was found for reductions in systolic blood pressure, respiratory rate, and skin temperature. Most trials were assessed to be at high risk of bias because of lack of blinding. Blinding of outcome assessors is often impossible in music therapy and music medicine studies that use subjective outcomes, unless in studies in which the music intervention is compared to another treatment intervention. Because of the high risk of bias, these results need to be interpreted with caution.None of the studies included wound healing, infection rate, time to discharge, or patient satisfaction as outcome variables. One large study found that music listening was more effective than the sedative midazolam in reducing preoperative anxiety and equally effective in reducing physiological responses. No adverse effects were identified.
Authors' conclusions:
This systematic review indicates that music listening may have a beneficial effect on preoperative anxiety. These findings are consistent with the findings of three other Cochrane systematic reviews on the use of music interventions for anxiety reduction in medical patients. Therefore, we conclude that music interventions may provide a viable alternative to sedatives and anti-anxiety drugs for reducing preoperative anxiety.
In partial response to the demand for evidence-based practice, there is an increasing interest in the use of music therapy as procedural support for both invasive and non-invasive medical procedures. Clinicians and researchers are attempting to define how music therapy functions as procedural support in order to advance clinical practice and research, but concepts remain inadequately specified in the literature. The current philosophical inquiry used qualitative document analysis to critically examine the extant literature in music therapy as procedural support during invasive medical procedures. The aims of the analysis were to identify key concepts, provide definitions of those concepts, and begin to explicate the interrelationships among concepts related to music therapy as procedural support. A total of 19 clinical practice articles, clinical practice book chapters, and research articles met the criteria for inclusion in the analysis. Data analysis and synthesis resulted in a working model of music therapy as procedural support, in which the music therapist engages in a reflexive process of continually assessing the patient's responses in order to refocus the intervention lens (e.g., altering aspects of the music, of focus of attention, and of patient/therapist interaction) to positively influence outcomes. It is hoped that the working model of music therapy as procedural support may stimulate clinical dialogue and serve as an initial systematic step toward theory construction in this area.
Unlabelled:
Evaluating the effectiveness of interventions directed toward the treatment of preoperative anxiety in children has been hindered by the absence of a statistically valid measurement tool. In a previous investigation, we developed an instrument (Yale Preoperative Anxiety Scale [YPAS]) that can be used to assess anxiety in children undergoing induction of anesthesia. The purpose of the present investigation was to modify and expand the applicability of the instrument to the preoperative holding area and to validate the modified instrument (m-YPAS) against a recognized "gold standard" (State-Trait Anxiety Inventory for Childrens [STAIC]). Videotapes of children in a preoperative holding area were analyzed by the investigators. The existing five categories of the YPAS were found to reflect most of the behaviors observed. Several items, however, were modified to describe new behaviors observed. Reliability analysis using weighted kappa statistics revealed that inter-observer agreement ranged from 0.68 to 0.86, whereas intraobserver weighted kappa ranged from 0.63 to 0.90. Concurrent validity between the YPAS and the STAIC was acceptable (P = 0.01, r = 0.79). Construct validity was high as assessed by increased m-YPAS scores from the preoperative holding area (28 +/- 8) to entering the operating room (35 +/- 12), to introduction of the anesthesia mask (43 +/- 15;F [1,36] = 0.6, P = 0.001]. Showing good to excellent observer reliability and high concurrent and construct validity, the m-YPAS proved to be an appropriate tool for assessing children's anxiety during the perioperative period.
Implications:
The absence of a statistically valid measurement tool that can be applied easily in perioperative settings hinders the evaluation of interventions directed toward treatment of preoperative anxiety in children. The authors describe the development of such a tool, the modified Yale Preoperative Anxiety Scale.
This study included a total of 60 pediatric patients ranging from 1 month through 5 years of age. The effects of chloral hydrate and music therapy were evaluated and compared as means of safe and effective ways to achieve sleep/sedation in infants and toddlers undergoing EEG testing. The results of the study indicate that music therapy may be a cost-effective, risk-free alternative to pharmacological sedation.
The Yale Preoperative Anxiety Scale: How Does It Compare with a «Gold Standard»?
- Kain
marzo 31). See Which States and Cities Have Told Residents to Stay at Home. The New York Times
- S Mervosh
- D Lu
- V Swales
Mervosh, S., Lu, D., & Swales, V. (2020, marzo 31). See Which States and Cities Have Told
Residents to Stay at Home. The New York Times.
https://www.nytimes.com/interactive/2020/us/coronavirus-stay-at-home-order.html
See which states and cities have told residents to stay at home. The New York Times
- S Mervosh
- D Lu
- V Swales
Mervosh, S., Lu, D., & Swales, V. (2020). See which states and cities have told residents to
stay at home. The New York Times. https://www.nytimes.com/interactive/2020
/us/coronavirus-stay-at-home-order.html.