Intervention Review

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Music interventions for preoperative anxiety

  1. Joke Bradt1,*,
  2. Cheryl Dileo2,
  3. Minjung Shim1

Editorial Group: Cochrane Anaesthesia Group

Published Online: 6 JUN 2013

Assessed as up-to-date: 2 AUG 2012

DOI: 10.1002/14651858.CD006908.pub2


How to Cite

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.

Author Information

  1. 1

    College of Nursing and Health Professions, Drexel University, Department of Creative Arts Therapies, Philadelphia, PA, USA

  2. 2

    Boyer College of Music and Dance, Temple University, Department of Music Therapy and The Arts and Quality of Life Research Center, Philadelphia, USA

*Joke Bradt, Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, 1505 Race Street, rm 1041, Philadelphia, PA, 19102, USA. jbradt@drexel.edu.

Publication History

  1. Publication Status: New
  2. Published Online: 6 JUN 2013

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Characteristics of included studies [ordered by study ID]
Allen 2001

MethodsRandomized controlled trial (RCT)

2-arm parallel group design


ParticipantsAdult ambulatory surgical patients scheduled for ophthalmic surgery

Diagnosis: 2 patients with glaucoma; all others: cataract removal

Total N randomized: 40

N randomized to music group: 20

N randomized to control group: 20

N analysed in music group: 20

N analysed in control group: 20

Mean age: 75.5 years

Sex: 30 (75%) females, 10 (25%) males

Ethnicity: Not reported

Setting: outpatient

Country: USA


InterventionsTwo study groups:

1. Music group: listening to pre-recorded music through headphones

2. Control group: resting quietly, no music

Music provided: participants selected from 22 types of music including soft hits, classical guitar, chamber music, folk music or popular singers from the 1940s and 1950s

Number of sessions: 1

Length of sessions: Not reported

Categorized as music medicine


OutcomesSystolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR): post-test scores in preoperative period

Stress: not included in this review since this outcome was measured only at baseline and postoperatively

Coping: not included in this review since this outcome was measured only at baseline and postoperatively


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote: "Patients were sequentially selected from the patient rosters of two ophthalmic surgeons. Office assistants unaware of the study prepared patient rosters. On each day of data collection surgeons were randomly assigned to have their patients in the experimental or control group."

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
Low riskThis study used two subjective outcomes but these could not be included in this review because they did not pertain to preoperative anxiety. Therefore, a low risk of bias rating is given here.

Blinding of outcome assessment (detection bias)
Objective outcomes
Unclear riskSBP, DBP and HR measurement were obtained by a Propaq Monitor and digitally recorded. It is unclear if the outcome assessor collecting the physiological responses was blinded.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo subject loss

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskThis research was supported in part by a grant from the Food and Drug Administration (FD-T- 000889). No conflicts of interest identified.

Arslan 2008

MethodsControlled clinical trial (CCT)

2-arm parallel group design


ParticipantsAdult patients undergoing urogenital surgery

Diagnosis: urinary tract problems (n = 48, 75%); genital tract problems (n = 16, 25%)

Total N randomized: 64

N randomized to music group: 32

N randomized to control group: 32

N analysed in music group: 32

N analysed in control group: 32

Mean age: 43.29 years

Sex: 0 (0%) females, 64 (100%) males

Ethnicity: Turkish (no detailed ethnicity information is reported)

Setting: inpatient

Country: Turkey


InterventionsTwo study groups:

1. Music group: listening to preferred music through headphones plugged into a portable cassette player

2. Control group: standard care

Music provided: participants selected from Turkish classical music, folk music, Turkish art music, or pop music

Number of sessions: 1

Length of sessions: 30 minutes

Categorized as music medicine


OutcomesState anxiety (Spielberger State-Trait Anxiety Inventory - State Anxiety form, STAI-S): post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskQuote: "Random assignment was achieved based on the day that patients underwent surgery. Patients who underwent surgery on Monday or Wednesday were assigned to the control group while patients who had their surgery on Tuesday or Thursday were assigned to the experimental group."

Allocation concealment (selection bias)High riskAlternate assignment prohibited allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measures were used for subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
Low riskThis study did not address objective outcomes

Incomplete outcome data (attrition bias)
All outcomes
Low riskThere was no subject loss

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Augustin 1996

MethodsCCT

2-arm parallel group design


ParticipantsAdult patients scheduled for ambulatory surgery

Type of surgery: arthroscopy (n = 12, 26%), herniorrhaphy (n = 8, 17%), orthopedic procedure (n = 6, 13%), urologic procedures (n = 5, 11%), nerve repairs (n = 4, 9%), endoscopic procedure (n = 3, 6%), laparoscopic procedures (n = 2, 4%), and breast biopsies (n = 2, 4%)

Total N randomized: 42

N randomized to music group: 21

N randomized to control group: 21

N analysed in music group: 21

N analysed in control group: 21

Mean age: 47

Sex: 17 (40%) females, 25 (60%) males

Ethnicity: 100% Caucasian

Setting: inpatient

Country: USA


InterventionsTwo study groups:

1. Music group: preoperative instruction coupled with music listening

2. Control group: routine preoperative instruction

Music provided: participants selected from classical, environmental, new age, western country, or general easy-listening music

Number of sessions: 1

Length of sessions: 15-30 minutes

Categorized as music medicine


OutcomesAnxiety (STAI-S): change score

HR, respiratory rate (RR), SBP, DBP: post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskQuote: "When patients agreed to participate, we obtained their written informed consents and alternately assigned them to either the experimental or control group."

Allocation concealment (selection bias)High riskAlternate assignment prohibited allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded (personal communication with chief investigator)

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measures were used for subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
High riskThe outcome assessors were not blinded (personal communication with chief investigator)

Incomplete outcome data (attrition bias)
All outcomes
Low riskThere was no subject loss (personal communication with chief investigator)

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Bringman 2009

MethodsRCT

2-arm parallel group design


ParticipantsAdults patients scheduled for an elective day or short-stay surgery

Type of surgery: laparotomy, hip replacement, laparoscopy, ventral hernia repair, inguinal hernia repair, arthroscopy, varicose vein, scrotal or vaginal surgery (number of participants per diagnosis not reported)

Total N randomized: 372

N randomized to music group: 190

N randomized to control group: 182

N analysed in music group: 177

N analysed in control group: 150

Mean age: 50 years

Sex: 198 (53%) females, 138 (47%) males

Ethnicity: not reported

Setting: inpatient

Country: Sweden


InterventionsTwo study groups:

1. Music group: listening to pre-recorded music. Patients in the music group did not receive pre-medication midazolam solution.

2. Control group: standard pre-medication midazolam solution orally

Music provided: participants selected from classical, soft pop/film, soft jazz, nature sound, or instrumental music. CDs were compiled by a professional music therapist.

Number of sessions: 1

Length of sessions: 17-42 minutes

Categorized as music medicine


OutcomesAnxiety (STAI-S): post-test score

HR, SBP, DBP, arterial pressure (AP): post-test scores


NotesEven though a professional music therapist helped with the selection of the music for this study, this study is categorized as a music medicine study because the patients listened to pre-recorded music without the presence of a therapeutic process with the music therapist.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote: "The music therapist randomized the patients through sealed envelopes immediately before the intervention"

Allocation concealment (selection bias)Low riskQuote: "[the music therapist] drew the first envelope in a row of previously randomly mixed envelopes consisting of an equal number of both allocations."

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measures were used for subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
High riskThe music therapist recorded the blood pressure and heart rate using a Riester fully automatic digital blood pressure monitor before and after the intervention. The music therapist was not blinded.

Incomplete outcome data (attrition bias)
All outcomes
Low riskAttrition 12%: 13 patients were excluded from experimental group due to logistic reasons (n = 12) and other reason (n = 1), and 23 patients were excluded from the control group due to logistic reasons (n = 19), and not receiving midazolam (n = 4).

Quote: "The reasons for exclusion were logistic in the majority of cases, mainly due to a too early call to the operating room, which had the effect that the time between the intervention and the evaluation was too short. Hence, 177 patients in the music group and 159 in the midazolam group went through the study protocol; however, nine patients in the midazolam group were too sedated to be able to complete the second STAI X-1."

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Cassidy 2003

MethodsRCT

2-arm parallel group design


ParticipantsAdult patients scheduled for elective surgery

Type of surgery: no details reported

Total N randomized: 32

N randomized to music group: 16

N randomized to control group: 16

N analysed in music group: 16

N analysed in control group: 16

Mean age: 41.5

Sex: 21 (65.6%) females, 11 (34.4%) males

Ethnicity: Not reported

Setting: Outpatient

Country: USA


InterventionsTwo study groups:

1. Music group: listening to pre-recorded music

2. Control group: standard care

Music provided: Participants were asked to bring the music of their choice from home

Number of sessions: 1

Length of sessions: 15 minutes

Categorized as music medicine


OutcomesAnxiety (STAI-S): post-test scores

RR, pulse, SBP, DBP: post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskQuote: "The first patients was assigned to control group or intervention group by a coin toss. Each subsequent subject was assigned alternately to the control group or intervention group"

Allocation concealment (selection bias)High riskAlternate assignment prohibited allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measures were used for subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
High riskThe researcher measured the pulse, respiration and blood pressure and was not blinded.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo subject loss

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Chang 1996

MethodsRCT

2-arm parallel group design


ParticipantsAdult patients scheduled for surgery

Type of surgery: open heart surgery including coronary artery bypass graft surgery (CABG) (n = 17, 27%) , valvular surgery (n = 33, 53%), and other (n = 12, 19%)

Total N randomized: 62

N randomized to music group: 32

N randomized to control group: 30

N analysed in music group: 32

N analysed in control group: 30

Mean age: 51.8

Sex: 29 (47%) females, 33 (53%) males

Ethnicity: not reported; most participants likely Taiwanese

Setting: Inpatient

Country: Taiwan


InterventionsTwo study groups:

1. Music group: listening to pre-recorded music

2. Control group: resting

Music provided: music with 60-72 beats per minute with bass tone and soft melody or religious music in a variety of languages including Chinese, Taiwanese, English and Japanese

Number of sessions: 1

Length of sessions: 20 minutes

Categorized as music medicine


OutcomesAnxiety (VAS): post-test scores

HR, RR, SBP, DBP, pain, skin temperature: change scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskNot reported

Allocation concealment (selection bias)Unclear riskNot reported

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measure was used for this study

Blinding of outcome assessment (detection bias)
Objective outcomes
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes
Low riskThere was no subject loss

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Cooke 2005

MethodsRCT

3-arm parallel group design


ParticipantsAdult patients scheduled for day surgery

Type of surgery: orthopaedic (n = 57, 32%), skin (n = 58,32%), breast (n = 15, 8%), urology (n = 24, 13%), general (n = 15, 8%), other (n = 11, 6%)

Total N randomized: 180 (120 included in this review)

N randomized to music group: 60

N randomized to control group: 60

N randomized to placebo group: 60 (not included in this review)

N analysed in music group: 60

N analysed in control group: 60

N analysed in placebo group: 60 (not included in this review)

Mean age: 55.7 years

Sex: 90 (50%) females, 90 (50%) males

Ethnicity: Not reported

Setting: Outpatient

Country: USA


InterventionsThree study groups:

1. Music group: listening to pre-recorded music

2. Control group: standard nursing care

3. Placebo group: Wore headphones for 30 minutes with no sound.

Music provided: patient-selected pre-recorded CD from one of the following genres, classical, jazz, country and western, new age, or easy-listening

Number of sessions: 1

Length of sessions: 30 minutes

Categorized as music medicine


OutcomesAnxiety (STAI-S): post-test scores


NotesStandard deviations (SDs) are not reported in the research report but we were able to obtain the values from the investigator


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote: "A computer-generated list was used for permuted block random assignment to intervention, placebo or control groups by gender. That is, males and females were randomized separately so that equal numbers of each were assured in each group"

Allocation concealment (selection bias)Low riskQuote: "A biostatistician and research assistant who did not participate in data collection conducted the randomization procedures and prepared sequentially numbered sealed envelopes containing the random assignment for each consenting patient."

Blinding of participants and personnel (performance bias)
All outcomes
Low riskBlinding of participants was not possible. The nurses who provided care were blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measure was used for the subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
Low riskThe study did not address objective outcomes

Incomplete outcome data (attrition bias)
All outcomes
Low riskThere was no subject loss

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases. This research was supported by funding received from the Griffith University New Researcher Grant Scheme

DeMarco 2012

MethodsCCT

2-arm parallel group design


ParticipantsAdult patients undergoing elective cosmetic surgery

Type of surgery: cosmetic surgery (no further details reported)

Total N randomized: 38

N randomized to music group: 19

N randomized to control group: 19

N analysed in music group: 14

N analysed in control group:12

Mean age: 46.35

Sex: 24 (96%) females, 2 (4%) males

Ethnicity: Not reported

Setting: Outpatient

Country: USA


InterventionsTwo study groups:

1. Music group: listening to prerecorded music via headphones

2. Control group: standard care

Music provided: CD selected by a music therapist: "Music for Unwinding". Music was composed by J Nagler, music therapist. The music style was identified as New Age

Number of sessions: 1

Length of sessions: 20 minutes

Categorized as music medicine


OutcomesSTAI: change scores

HR, SBP: change scores


NotesEven though a music therapist was involved with the music selection, the authors specifically state that this study did not use a music therapy intervention


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High risk"Patients were randomized based on the day of their surgery using alternating placement in the control and experimental groups"

Allocation concealment (selection bias)High riskAlternate assignment prohibited allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measure was used for the subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
High riskOutcome assessor was not blinded

Incomplete outcome data (attrition bias)
All outcomes
High riskLarge subject loss: 32% (n = 12). Subject withdrawals are reported as follows: 38 participants consented and 26 completed all study requirements. Reasons for withdrawal included "patients cancelled the procedures, were taken into surgery early with no adequate time to complete all study requirements"

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo conflict of interest statement was reported

Evans 1994

MethodsRCT

2-arm parallel group design


ParticipantsPatients undergoing surgery under general anaesthesia

Type of surgery: endoscopic cholecystectomy (n = 16, 67% ), endoscopic henorrhapsy (n = 7, 29% ), endoscopic appendectomy (n = 1, 4%)

Total N randomized: 24

N randomized to music group: 18

N randomized to control group: 6

N analysed in music group: 18

N analysed in control group: 6

Mean age: 48.1

Sex: 14 (58%) females, 10 (42%) males

Ethnicity: Not reported

Setting: Inpatient

Country: USA


InterventionsTwo study groups:

1. Music group: listening to pre-recorded music

2. Control group: receiving verbal reassurance

Music provided: Participants selected from a variety of "easy listening" music that the medical staff had recorded.

Number of sessions:1

Length of sessions: 20 minutes

Categorized as music medicine


OutcomesAnxiety (STAI, Visual Analogue Anxiety Scale (VAAS)): could not be included in this review (see notes)

SBP, DBP, HR: post-test scores


NotesState anxiety was measured before the music intervention, but not immediately after the music intervention. The post-test was administered after the surgery. Therefore, this data could not be included.

VAAS was administered before and immediately after the music intervention. However, because of insufficient data reporting, this outcome could not be included in this review


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskQuotes: "The first 2 patients were assigned to the experimental group, and the third patient to the control group. This pattern was continued until 24 patients were enrolled."

Allocation concealment (selection bias)High riskAlternate assignment prohibited allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measures were used for the subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskNot reported

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Gaberson 1995

MethodsRCT

3-arm parallel group design


ParticipantsAdult patients scheduled for surgical procedures

Type of surgery: general, orthopedic, gynaecologic, ophthalmic, otolaryngologic, and dental surgery (number of participants per type of surgery not specified)

Total N randomized:46 (31 included in this review)

N randomized to music group: 16

N randomized to humorous distraction group: 15 (not included in this review)

N randomized to control group: 15

N analysed in music group: 16

N analysed in humorous distraction group:15 (not included in this review)

N analysed in control group: 15

Mean age: 47.07

Sex: 27 (59%) females, 19 (41%) males

Ethnicity: Not reported

Setting: Inpatient

Country: USA


InterventionsThree study groups:

1. Music group: listening to pre-recorded music

2. Humorous distraction group: listening to a humorous tape

3. Control group: received no auditory distraction during the waiting period

Music provided: An audiotape of slow, quiet, instrumental music (e.g., Omni Suite by Steven Bergman)

Number of sessions: 1

Length of sessions: 20 minutes

Categorized as music medicine


OutcomesAnxiety (VAS): post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote: "Each research assistant randomly assigned subjects by lottery to one of three groups"

Allocation concealment (selection bias)Low riskDraw by lots ensured allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measure was used for this study

Blinding of outcome assessment (detection bias)
Objective outcomes
Low riskThis study did not address objective outcomes

Incomplete outcome data (attrition bias)
All outcomes
Low riskThere was no subject loss

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases. This study was supported by an AORN Nurse Scientist Grant and a Duquesne University, Pittsburgh, Supplemental Faculty Development Grant.

Ganidagli 2005

MethodsRCT

2-arm parallel group design


ParticipantsAdult patients scheduled for surgical procedures

Type of surgery: septorhinoplastic surgery

Total N randomized:54

N randomized to music group: 28

N randomized to control group: 26

N analysed in music group: 25

N analysed in control group: 25

Mean age: 30

Sex: 21 (42%) females, 29 (58%) males

Ethnicity: Not reported

Setting: Inpatient

Country: Turkey


InterventionsTwo study groups:

1. Music group: listening to pre-recorded music through headphone

2. Control group: listening to a blank cassette or CD through headphone

Music provided: Patients brought their own music

Number of sessions: 1

Length of sessions: 50 minutes

Categorized as music medicine


OutcomesAnxiety (Observer’s Assessment of Alertness/Sedation Scales, Bispectral Index): post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote: “they were assigned using a table of random numbers, to receive either music (music group) or no music (control group)"

Allocation concealment (selection bias)Unclear riskNot reported

Blinding of participants and personnel (performance bias)
All outcomes
Low riskBlinding of participants was not possible. Personnel were blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
Low riskThis study did not address any subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
Low riskThe outcome assessors were blinded

Incomplete outcome data (attrition bias)
All outcomes
Low riskAttrition rate: 7 %(n = 4). Three patients from the music group and one patient from the control group were excluded from the study because of technical problems related to the music player.

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Guo 2005

MethodsRCT

2-arm parallel group design


ParticipantsAdults patients scheduled for laparoscopic surgery

Type of surgery: laparoscopic surgery

Total N randomized: 93

N randomized to music group: 48

N randomized to control group: 45

N analysed in music group: 48

N analysed in control group: 45

Mean age: 40.80

Sex: 54 (58%) females, 39 (42%) males

Ethnicity: Not reported

Setting: Not reported

Country: China


InterventionsTwo study groups:

1. Music group: listening to preferred music through headphone

2. Control group: wearing headphone without music

Music provided: participants selected from six types of pre-recorded music (classical music, light music, pop music, folk music, folk songs, and opera).

Number of sessions: 1

Length of sessions: 30 minutes

Categorized as music medicine


OutcomesAnxiety (STAI): post-test score

HR, SBP, DBP, skin conductivity response, salivary cortisol: post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskComputer-generated list of numbers

Allocation concealment (selection bias)Unclear riskNot reported

Blinding of participants and personnel (performance bias)
All outcomes
Low riskParticipants could not be blinded. Personnel were blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measures were used for the subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
Low riskOutcome assessors were blinded by use of headphones in the control group

Incomplete outcome data (attrition bias)
All outcomes
Low riskAttrition rate: 7% (n = 7). Seven patients were excluded due to changing surgery, refusing to continue the study and environmental interference. Exact number of subject loss from each group is not reported

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Hook 2008

MethodsRCT

2-arm parallel group design


ParticipantsAdult patients undergoing surgery

Type of surgery: Not specified

Total N randomized: 108

N randomized to music group: 54

N randomized to control group: 54

N analysed in music group: 51

N analysed in control group: 51

Mean age: 40.3

Sex: 108 (100%) females, 0 males

Ethnicity: 100% Malaysian

Setting: Inpatient

Country: Malaysia


InterventionsTwo study groups:

1. Music group: listening to pre-recorded music

2. Control group: standard care

Music provided: Participants selected from Western, Malay or Chinese music that the medical staff had recorded. All music has a tempo of 60-80 bpm

Number of sessions: 8

Length of sessions: 30 minutes

Categorized as music medicine


OutcomesAnxiety (STAI, Visual Analogue Scale for Anxiety (VASA)): Only VASA post-test scores are included in this review (see notes)


NotesBoth VASA and STAI were used to measure anxiety. But STAI post-test scores were obtained after the surgery. VASA data were obtained at the start and the end of the music intervention prior to surgery. Therefore, only VASA data are used in this review.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote: “Subjects were randomly assigned, using the “envelope method,” to either the music therapy group or the control group”

Allocation concealment (selection bias)Low riskUse of sealed envelopes

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measures were used for the subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
Low riskThis study did not address objective outcomes

Incomplete outcome data (attrition bias)
All outcomes
Low riskAttrition rate: 6% (n = 6) The reasons for the subject loss were not reported.

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases. This study was supported by Prince of Songkla University, Thailand.

Kushnir 2012

MethodsRCT

2-arm parallel group design


ParticipantsAdult women undergoing elective cesarean section because of medical reasons

Type of surgery: caesarean section

Total N randomized: 62

N randomized to music group: 30

N randomized to control group: 32

N analysed in music group: 28

N analysed in control group: 30

Mean age: 32.1

Sex: 60 (100%) females, 0 males

Ethnicity: not reported

Setting: Inpatient

Country: Israel


InterventionsTwo study groups:

1. Music group: listening to pre-recorded music

2. Control group: bedrest with no music

Music provided: Participants selected from three options: light popular music, light classical music, Israeli songs

Number of sessions: 1

Length of sessions: 40 minutes

Categorized as music medicine


OutcomesPositive mood, negative mood, perceived threat of surgery: not used in this study

HR, SBP, DBP: post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"The researchers preprepared sealed envelopes, each containing a card with either "yes" or "no" in equal numbers. Each woman chose a sealed envelope. the women who had the yes card were included in the experimental group, those who had no were included in the control group".

Allocation concealment (selection bias)Low riskParticipants were asked to draw and open a sealed envelope

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measure was used

Blinding of outcome assessment (detection bias)
Objective outcomes
High riskThe outcome assessor was not blinded

Incomplete outcome data (attrition bias)
All outcomes
Low riskTwo participants were excluded because of their music selection. Because these two participants were the only ones who selected popular music, the researchers decided to exclude them because analysis per music selection would not be possible with such a small subgroup.

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Lee 2004

MethodsCCT

2-arm parallel group design


ParticipantsAdults undergoing surgery

Type of surgery: cystoscopy, cauterisation or endoscopy

Total N randomized: 113

N randomized to music group: 58

N randomized to control group: 55

N analysed in music group: 58

N analysed in control group: 55

Mean age: 51

Sex: 55 (49%) females, 58 (51%) males

Ethnicity: 100% Hong Kong Chinese

Setting: inpatient

Country: China


InterventionsTwo study groups:

1. Music group: listening to pre-recorded music

2. Control group: participating in the usual pre-procedural relaxing activities (e.g., reading or watching television) in the waiting rooms

Music provided: participants selected from eastern and western style easy listening music or Chinese pop music

Number of sessions: 1

Length of sessions: 20-40 minutes

Categorized as music medicine


OutcomesAnxiety (STAI): post-test scores

RR, pulse, SBP, DBP: post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskQuote: "Patients who had their procedure on Wednesday were assigned to the control group and patients who had their procedure on Thursday were assigned to the music group"

Allocation concealment (selection bias)High riskAlternate assignment prohibited allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measures were used for the subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskNot reported

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases. The study was supported by the Lee Hysan Foundation and grant from Chinese University of Hong Kong

Lee 2011

MethodsRCT

3-arm parallel group design


ParticipantsAdults undergoing surgery

Type of surgery: orthopaedics (n = 23, 14%), general (n = 29, 17%), gynaecology (n = 44, 26%), urology (n = 16, 10%), neurosurgery (n = 20, 12%), other (n = 35, 21%)

Total N randomized: 180

N randomized to music (headphone) group: 56

N randomized to music (broadcast) group: 66

N randomized to control group: 58

N analysed in music (headphone) group: 48

N analysed in music (broadcast) group: 66 (not used in this study)

N analysed in control group: 53

Mean age: 49.36

Sex: 28 (55%) females, 23 (45%) males

Ethnicity: not reported; it is likely that the majority of the participants were Taiwanese

Setting: inpatient

Country: Taiwan


InterventionsThree study groups:

1. Headphone group: Listening to music through headphone for 10 minutes

2. Broadcast group: Listening to music from an open speaker for 10 minutes

3. Control group: participants were told to rest and relax

Music provided: Folk songs or pop music, played at a tempo of 60–80 beats per minute and a volume of 50–55 db

Number of sessions: 1

Length of sessions: 10 minutes

Categorized as music medicine


OutcomesAnxiety (Numeric rating scale (NRS): post-test scores

HR and heart rate variability (HRV) (CheckMyHeart handheld HRV device): post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskRandom block sampling. Quote: "We applied random table to divide numbers 1–30 to three groups to determine each day of a month to be ‘headphone day,’ ‘broadcast day’ or ‘control day’"

Allocation concealment (selection bias)Unclear riskNot reported

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measure was used to assess the subjective outcome

Blinding of outcome assessment (detection bias)
Objective outcomes
High riskOutcome assessors were not blinded

Incomplete outcome data (attrition bias)
All outcomes
Low riskAttrition rate 7% (n = 13). Eight patients from the experimental group were excluded due to HRV data incomplete or too much noise (n = 2), being sent to surgery before the end of measurement (n = 3), or refusing to take the measure (n = 3). Five patients from the control group were excluded due to HRV data were incomplete (n = 2) or being sent to surgery before the end of measurement (n = 3).

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Lee 2012

MethodsRCT

2-arm parallel group design


ParticipantsAdults undergoing surgery

Type of surgery: Gynaecology (n = 41, 25%), orthopaedics (n = 29, 18%), general (n = 14, 8%), urology (n = 12, 7%), neurosurgery (n = 16, 10%), other (n = 25, 16%)

Total N randomized: 161

N randomized to music group: 82

N randomized to control group: 79

N analysed in music group: 76

N analysed in control group: 64

Mean age: 49.63

Sex: 70 (50%) females, 70 (50%) males

Ethnicity: Not reported

Setting: inpatient

Country: Taiwan


InterventionsTwo study groups:

1. Music group: listening to10-min session of music through headphones

2. Control group: receiving the VAS and HR measurements by the researcher at a 10-min interval without a music intervention.

Music provided: Patients selected from five kinds of music (folk songs or pop music), played at a tempo of 60–80 beats per minute and a volume of 50–55 db

Number of sessions: 1

Length of sessions: 10 minutes

Categorized as music medicine


OutcomesAnxiety (NRS): post-test scores

HR, HRV (CheckMyHeart): post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskQuote: “We assigned participants to groups using birthdays, placing those with even birth dates in the experimental group and those with odd birth dates in the control group.”

Allocation concealment (selection bias)High riskSystematic form of group allocation based on date of birth prevented allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measure was used to assess the subjective outcome

Blinding of outcome assessment (detection bias)
Objective outcomes
Unclear riskHR measurement were obtained by CheckMyHeart HRV device. Unclear if outcome assessor was blinded

Incomplete outcome data (attrition bias)
All outcomes
Low riskAttrition rate: 12% (n = 19). Six patients from the experimental group were excluded due to HRV data incomplete or too much noise (n = 4), or being sent to surgery before the end of measurement (n = 2). Thirteen patients from the control group were excluded due to HRV data incomplete or too much noise (n = 7), being sent to surgery before the end of measurement (n = 4), or refusing to take the measure (n = 2).

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases. There was no external financial support for this research

Li 2004

MethodsRCT

2-arm parallel group design


ParticipantsAdult patients undergoing surgery

Diagnosis: gastric cancer

Total N randomized: 60

N randomized to music group: 30

N randomized to control group: 30

N analysed in music group: 30

N analysed in control group: 30

Mean age: Not reported

Sex: 23(38%) females, 37 (62%) males

Ethnicity: Not reported

Setting: Inpatient

Country: China


InterventionsTwo study groups:

1. Music group: listening to pre-recorded music

2. Control group: receiving verbal support (explanation, guidance, encouragement and comfort)

Music provided: Researcher-selected Chinese classical music

Number of sessions: 8

Length of sessions: 20-30 minutes

Categorized as music medicine


OutcomesAnxiety (Zung Self-Rating Anxiety Scale (SAS)): post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskNot reported

Allocation concealment (selection bias)Unclear riskNot reported

Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskBlinding of participants was not possible. Blinding of personnel was not reported

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measure was used to assess the subjective outcome

Blinding of outcome assessment (detection bias)
Objective outcomes
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes
Low riskThere was no subject loss

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Lin 2011

MethodsRCT

2-arm parallel group design


ParticipantsAdults undergoing surgery

Type of surgery: Spinal surgery

Total N randomized: 60

N randomized to music group: 30

N randomized to control group: 30

N analysed in music group: 30

N analysed in control group: 30

Mean age: 62.18

Sex: 29 (49.3%) females, 31 (51.7%) males

Ethnicity: Not reported

Setting: Inpatient

Country: Taiwan


InterventionsTwo study groups:

1. Music group: listening to preferred music through headphones

2. Control group: resting in bed undisturbed while the environment was kept quiet

Music provided: Patients selected preferred music from Chinese pop music, classical music, nature sounds and sacred music that researchers provided. All music has a tempo between 6- and 72 beats per minute.

Number of sessions: 4 sessions with measurements before and after each music session (evening before surgery, one hour before surgery, afternoon of first post-operative day, and second post-operative days). We used the one hour pre-op time point for this review.

Length of sessions: 30 minutes

Categorized as music medicine


OutcomesAnxiety (VAS): post-test score

Pulse, DBP, SBP: post-test score


NotesBoth STAI and VAS were used to measure anxiety but only VAS data are used because the STAI post-test was administered after the surgery.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High risk Quote: "All patients scheduled for surgery on Tuesdays and Thursdays were assigned to the study group, while those scheduled for surgery on Wednesdays and Fridays were assigned to the control group."

Allocation concealment (selection bias)High riskSystematic form of group allocation prevented allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measure was used for the subjective outcome

Blinding of outcome assessment (detection bias)
Objective outcomes
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes
Low riskThere was no subject loss

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases. This study was financially sponsored by the Taipei Veterans General Hospital (Grant No.V95B2-004).

Miluk-Kolasa 1996

MethodsCCT

2-arm parallel group design


ParticipantsAdult patients awaiting non-orthopaedic surgeries

Diagnosis: Laryngological surgery (n = 79, 79%), varicectomy (n = 21, 21%)

Total N randomized: 100

N randomized to music group: 50

N randomized to control group: 50

N analysed in music group: 50

N analysed in control group: 50

Mean age: range between 20-60

Sex: 28 (28%) females, 72 (72%) males

Ethnicity: Not reported

Setting: Inpatient

Country: Poland


InterventionsTwo study groups:

1. Music group: listening to individually composed music programs from Walkman-type tape players.

2. Control group: standard care

Music provided: Not reported

Number of sessions: 1

Length of sessions: 1 hour

Categorized as music medicine


OutcomesSBP, DBP, HR, cardiac output, stroke volume, temperature, and glucose count: only percentage change scores are reported. These cannot be combined with post-test/change scores in the meta-analysis and therefore results are only presented in the narrative.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskRandomization method is not reported. Quote: "Subjects were randomly assigned to either group C or Group M"

Allocation concealment (selection bias)Unclear riskNot reported

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
Low riskThis study did not address any subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
Unclear riskOutcomes were measured with electronic equipment. It is unclear if outcome assessors were blinded

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskNot reported

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Miluk-Kolasa 2002

MethodsCCT

2-arm parallel group design


ParticipantsPatients awaiting for the crural varicectomy or laryngological surgeries

Type of surgery: crural varicectomy (n = 19, 21%) or laryngological surgery (n = 70, 79%)

Total N randomized: 89

N randomized to music group: 45

N randomized to control group: 44

N analysed in music group: 45

N analysed in control group: 44

Mean age: 40

Sex: 27 (30%) females, 62 (70%) males

Ethnicity: Not reported

Setting: Inpatient

Country: Poland


InterventionsTwo study groups:

1. Music group: listening to the music for 60 minutes

2. Control group: standard care

Music provided: Not reported

Number of sessions: 1

Length of sessions: 60 minutes

Categorized as music medicine


OutcomesAnxiety (STAI): post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskRandomization method was not reported. Quote: "Patients were allotted to groups at random"

Allocation concealment (selection bias)Unclear riskNot reported

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measures were used for the subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
Low riskThis study does not address objective outcomes

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskNot reported

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Ni 2011

MethodsRCT

2-arm parallel group design


ParticipantsAdult patients admitted to outpatient surgery

Type of surgery: neurosurgery (n = 29, 17%), obstetrics and gynaecology (n = 32, 7%), general clinic (n = 19, 11.1%), ear - nose - throat (n = 13, 7.6%), urology (n = 14, 8.2%), plastic surgery (n = 61, 35.7%), cardiovascular (n = 3, 1.8%)

Total N randomized: 174

N randomized to music group: 87

N randomized to control group: 87

N analysed in music group: 86

N analysed in control group: 86

Mean age: 40.9 (11.8)

Sex: 112 (65%) females, 60 (35%) males

Ethnicity: Not reported

Setting: Outpatient

Country: Taiwan


InterventionsTwo study groups:

1. Music group: listening to the music for 20 minutes via headphones

2. Control group: standard care

Music provided: Investigator-selected mini library of soothing popular Chinese and Taiwanese pop songs (low-tone, slow rhythm ballads only). Participants selected music from this library

Number of sessions: 1

Length of sessions: 20 minutes

Categorized as music medicine


OutcomesSTAI: change scores

HR, SBP, DBP: change scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"computer-generated permuted block randomization was used to assign participants to either experimental or control group"

Allocation concealment (selection bias)Unclear riskNot reported

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measures were used for the subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
High riskOutcome assessor was not blinded

Incomplete outcome data (attrition bias)
All outcomes
Low riskAuthors reported two withdrawals

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Szeto 1999

MethodsCCT

2-arm parallel group design


ParticipantsAdult patients awaiting elective inpatient surgery

Diagnosis: Not reported

Total N randomized:12

N randomized to music group: 6

N randomized to control group: 6

N analysed in music group: 6

N analysed in control group: 3

Mean age: 58

Sex: Not reported

Ethnicity: Not reported

Setting: Inpatient

Country: Hong Kong


InterventionsTwo study groups:

1. Music group: listening to self-selected music for 20 minutes

2. Control group: standard care

Music provided: participants selected from slow rhythmical songs: Chinese or Western music. This music was determined to have sedative qualities by a panel of experts

Number of sessions: 1

Length of sessions: 20 minutes

Categorized as music medicine


OutcomesAnxiety (Chinese version STAI): change scores

Tension (Subjective Unit of Tension Scale): change scores

SBP, DBP: change scores


NotesJB computed change scores because of large pre-test differences


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskNot reported

Allocation concealment (selection bias)Unclear riskNot reported

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measures were used for subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes
High riskAttrition rate: 33% (n = 3). Three patients from the control group could not complete the procedure, as they had to be sent to surgery

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Winter 1994

MethodsRCT

2-arm parallel group design


ParticipantsWomen undergoing elective gynaecological procedures

Types of surgery: exploratory laparoscopies, laparoscopic tubal ligation, ovarian cysts excision, and intrauterine device removal

Total N randomized: 50

N randomized to music group: 31

N randomized to control group: 19

N analysed in music group: 31

N analysed in control group: 19

Mean age: 37

Sex: 50 (100%) females, 0 (0%) males

Ethnicity: Not reported

Setting: Outpatient

Country: USA


InterventionsTwo study groups:

1. Music group: listening to music through headphones

2. Control group: standard care

Music provided: Participants were asked to select from Schumann: Quartet for Piano and Strings in E-Flat Major, Tchaikovsky: Symphony No. 6 in B minor (“Pathetique”), Beethoven: Symphony No. 2 in D Major (op. 36), Johnny Cash’s Greatest Hits, Willie Nelson’s Greatest Hits, The Beatles Part I, The Beatles Part II, Benny Goodman: Small Group 1941-1945, Johnny Mathis: Better Together, Madonna: True Blue. The Temptations: 26th Anniversary, or The Mamas & The Papas: If You Can Believe Your Eyes

Number of sessions: 1

Length of sessions: 50 minutes

Categorized as music medicine


OutcomesAnxiety (STAI-S): change scores

HR, SBP, DBP: change scores


NotesJB computed change scores and SD


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskComputer-generated list of random numbers

Allocation concealment (selection bias)Unclear riskNot reported

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measures were used for subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes
Low riskThere was no subject loss.

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Yung 2002

MethodsCCT

2-arm parallel group design


ParticipantsChinese male surgical patients in an acute general hospital waiting to undergo inpatient surgery for transurethral resection of the prostate (TURP)

Total N randomized: 30 (20 included in this review)

N randomized to music group: 10

N randomized to nurse present group: 10 (not included in review)

N randomized to control group: 10

N analysed in music group: 10

N analysed in nurse present group: 10 (not included in review)

N analysed in control group: 10

Mean age: 67.67

Sex: 0 (0%) females, 30 (100%) males

Ethnicity: 100% Chinese

Setting: Inpatient

Country: Hong Kong


InterventionsThree study groups:

1. Music group: listening to slow rhythm soft music via headphones

2. Nurse present group: A nurse stood with the patients while they were waiting in the holding area.  The nurse was present, but there was minimal verbal interaction

3. Control group: No music intervention or nurse present

Music provided: participants selected from slow rhythm songs, Chinese slow rhythm songs or Western slow rhythm songs

Number of sessions: 1

Length of sessions: 20 minutes

Categorized as music medicine


OutcomesAnxiety (Chinese version STAI): change scores

HR, SBP, DBP: change scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskQuote: "The subjects were randomly allocated to different conditions."

Allocation concealment (selection bias)Unclear riskNot reported

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding of participants was not possible. Personnel were not blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskSelf-report measure was used for subjective outcome.

Blinding of outcome assessment (detection bias)
Objective outcomes
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes
Low riskThere was no subject loss

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

Yung 2003

MethodsCCT

2-arm parallel group design


ParticipantsPatient awaiting urological surgery

Type of surgery: TURP; Transurethral resection of the bladder (TURB); Cystolithotripsy; Herniorrhaphy; Laparoscopic cholecystectomy

Total N randomized: 66

N randomized to music group: 33

N randomized to control group: 33

N analysed in music group: 33

N analysed in control group: 33

Mean age: 64.68

Sex: 0 (0%) females, 60 (100%) males

Ethnicity: 100% Chinese

Setting: Inpatient

Country: Hong Kong


InterventionsTwo study groups:

1. Music group: listening to music through headphones

2. Control group: standard care

Music provided: Participants were given choice of 3 tapes approved by panel of 3 music instructors at the university level. The panel agreed that the music was sedative in that it possessed minimal rhythmic characteristics. Choices included: Chinese instrumental music, Western instrumental music, or Western and Chinese slow songs

Number of sessions: 1

Length of sessions: 20 minutes

Categorized as music medicine


OutcomesAnxiety (Chinese version STAI): post-test scores

HR, RR, AP: post-test scores


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskQuote: "Patients were matched by type of operation into a music treatment group or a test control group."

Allocation concealment (selection bias)Unclear riskNot reported

Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskThe participants were not blinded. It is unknown whether the personnel were blinded

Blinding of outcome assessment (detection bias)
Subjective outcomes
High riskA self-report measure was used to measure the subjective outcome

Blinding of outcome assessment (detection bias)
Objective outcomes
Unclear riskNot reported

Incomplete outcome data (attrition bias)
All outcomes
Low riskThere was no subject loss

Selective reporting (reporting bias)Low riskNo indication of selective reporting

Other biasLow riskNo indication of other biases

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Aldrige 1993Not RCT or CCT

Aragon 2002Does not address preoperative anxiety; post-test administered after the surgery

Arvelo Correa 1985No numerical data reported

Bansal 2010Does not address preoperative anxiety; music intervention provided during surgery

Beach 1991Insufficient data reporting

Beddows 1997Insufficient data reporting

Behl 1972Not RCT or CCT

Brunges 2003Insufficient data reporting

Chetta 1981Insufficient data reporting

Chu 2004Not RCT or CCT

Cirina 1994Not RCT or CCT

Cowan 1991Not RCT or CCT

Curtis 1987Unable to obtain Master's thesis from University

Dabu-Bondoc 2010Use of binaural beat instead of music

Daub 1988Standard deviations not reported. Unable to obtain contact information for authors

Erickson 1989Insufficient data reporting

Gillen 2008Not RCT or CCT

Haun 2001Unclear if the study only included surgical biopsy patients. We contacted the authors but no response was received. As procedural patients (e.g., needle aspiration) are not included in this review, we decided to exclude this study

Jarred 2003Not population of interest. Participants were family members of surgical patients

Johnson 2012Did not address preoperative anxiety; post-test administered after the surgery

Kaempf 1989Insufficient data reporting

Kain 2006Insufficient data reporting

Kamin 1982Insufficient data reporting

Kamin 1987Insufficient data reporting

Koch 1998Does not address preoperative anxiety; music intervention provided during surgery

Leardi 2007Does not address preoperative anxiety; music intervention provided during surgery

Lee 2002Did not use standardized measures (personal communication)

Madson 2010Does not address preoperative anxiety; music intervention provided after surgery

Miluk-Kolasa 1994Insufficient data reporting

Mok 2003Does not address preoperative anxiety; music intervention provided during surgery

Moss 1987Does not address preoperative anxiety; music intervention provided during surgery

Murphree 1988Not RCT or CCT

Nilsson 2009Does not address preoperative anxiety; music intervention provided during surgery

Nix 1963Not RCT or CCT

Oyama 1987Insufficient data reporting

Padmanabhan 2005Use of binaural beat instead of music

Paradise 2001Not RCT or CCT

Park 2000Not RCT or CCT

Peristein 1994Unable to obtain master's thesis

Phillips 1997Insufficient data reporting

Robb 1995No standard deviations reported. Chief investigator could not provide us with this information

Sanderson 1986Not RCT or CCT

Scheve 2002Did not use standardized measures (personal communication)

Spintge 1982Insufficient data reporting

Staples 1993Insufficient data reporting

Tusek 1999Unacceptable allocation method: participants were assigned to the music intervention group based on availability of a CD player

Updike 1987Not RCT or CCT

Walters 1996Insufficient data reporting

Wang 2002Unclear post-test data reporting. Post-test values are expressed as percentages of pretest values but it is unclear how the standard deviations were computed

Zhan 2008Did not address preoperative anxiety; only reported data on postoperative anxiety

 
Characteristics of studies awaiting assessment [ordered by study ID]
Berbel 2007

MethodsUnknown

ParticipantsPatients awaiting surgery

InterventionsMusic versus midazolam

OutcomesPreoperative anxiety

NotesUnable to obtain article

Dwita 2002

MethodsRCT

ParticipantsPatients awaiting surgery

InterventionsMusic

OutcomesPreoperative anxiety

NotesUnable to obtain article

 
Comparison 1. Music versus standard care

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 State anxiety STAI)13Mean Difference (IV, Random, 95% CI)Subtotals only

    1.1 All studies
13896Mean Difference (IV, Random, 95% CI)-5.72 [-7.27, -4.17]

    1.2 Adequate randomization
4435Mean Difference (IV, Random, 95% CI)-5.76 [-7.94, -3.57]

 2 Anxiety (non-STAI)7Std. Mean Difference (IV, Random, 95% CI)Subtotals only

    2.1 All studies
7504Std. Mean Difference (IV, Random, 95% CI)-0.60 [-0.90, -0.31]

    2.2 Adequate randomization
3182Std. Mean Difference (IV, Random, 95% CI)-0.41 [-0.71, -0.12]

 3 Heart rate16Mean Difference (IV, Random, 95% CI)Subtotals only

    3.1 All studies
161109Mean Difference (IV, Random, 95% CI)-2.77 [-4.76, -0.78]

    3.2 Adequate randomization
6525Mean Difference (IV, Random, 95% CI)-2.44 [-5.95, 1.07]

 4 Heart rate variability - LF/HF ratio2241Mean Difference (IV, Random, 95% CI)-0.37 [-1.16, 0.42]

 5 Systolic blood pressure14Mean Difference (IV, Random, 95% CI)Subtotals only

    5.1 All studies
14809Mean Difference (IV, Random, 95% CI)-4.82 [-12.13, 2.49]

    5.2 Adequate randomization
5424Mean Difference (IV, Random, 95% CI)-5.80 [-18.96, 7.36]

 6 Diastolic blood pressure13Mean Difference (IV, Random, 95% CI)Subtotals only

    6.1 All studies
13786Mean Difference (IV, Random, 95% CI)-2.37 [-4.03, -0.71]

    6.2 Adequate randomization
5424Mean Difference (IV, Random, 95% CI)-2.74 [-5.65, 0.17]

 7 Respiratory rate6375Mean Difference (IV, Fixed, 95% CI)0.97 [0.82, 1.11]

 
Summary of findings for the main comparison. Music interventions versus standard care for preoperative anxiety


Patient or population: patients with preoperative anxiety
Settings: In-patient
Intervention: Music
Comparison: standard care

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

Standard careMusic

Preoperative anxiety (STAI)
STAI. Scale from: 20 to 80.
The mean preoperative anxiety (stai) ranged across control groups from
37.63 to 44.43 points
The mean preoperative anxiety (stai) in the intervention groups was
5.72 lower
(7.27 to 4.17 lower)
896
(13 studies)
⊕⊕⊝⊝
low1

Preoperative anxiety (non-STAI)
VAS, NRS
The mean preoperative anxiety (non-stai) in the intervention groups was
0.60 standard deviations lower
(0.9 to 0.31 lower)
504
(7 studies)
⊕⊕⊝⊝
low1,2

Heart rateThe mean heart rate ranged across control groups from
70.06 to 86.44 beats per minute
The mean heart rate in the intervention groups was
2.77 lower
(4.76 to 0.78 lower)
1109
(16 studies)
⊕⊝⊝⊝
very low1,3,4

Heart rate variability
LF/HF ratio
The mean heart rate variability ranged across control groups from
1.77 to 2.6 LF/HF ratio
The mean heart rate variability in the intervention groups was
0.37 lower
(1.16 lower to 0.42 higher)
241
(2 studies)
⊕⊝⊝⊝
very low1,4,5

Systolic blood pressureThe mean systolic blood pressure ranged across control groups from
125.87 to 152 mm Hg
The mean systolic blood pressure in the intervention groups was
4.82 lower
(12.13 lower to 2.49 higher)
809
(14 studies)
⊕⊝⊝⊝
very low1,4,6

Diastolic blood pressureThe mean diastolic blood pressure ranged across control groups from
74.5 to 90 mm Hg
The mean diastolic blood pressure in the intervention groups was
2.37 lower
(4.03 to 0.71 lower)
786
(13 studies)
⊕⊝⊝⊝
very low1,4,7

Respiratory rateThe mean respiratory rate ranged across control groups from
16 to 23.2 breaths per minute
The mean respiratory rate in the intervention groups was
0.97 higher
(0.82 to 1.11 higher)
375
(6 studies)
⊕⊝⊝⊝
very low1,8

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1 The majority of the trials were assessed as high risk of bias studies
2 All point estimates favour music although the magnitude of the effect differs across studies.
3 Results were inconsistent across studies as evidenced by I² =79%.
4 Wide confidence interval
5 Results were inconsistent across studies as evidenced by I² =69%.
6 Results were inconsistent across studies as evidenced by I² =98%.
7 Results were inconsistent across studies as evidenced by I² =82%.
8 Results were inconsistent across studies as evidenced by I² =96%.