Blog entry written on: Heterogeneity of Outcomes for Intraoperative Music Interventions: A Scoping Review and Evidence Map (bmjebm-2020-111382)
Authors: Melanie Ambler, Stacey Springs, Dioscaris Garcia, Christopher Born
We know that 87% of operating room staff report listening to music in the OR, but an emerging body of evidence suggests that listening to music during surgical procedures can also be beneficial for patients. A relaxing recording of Debussy’s Clair de Lune or Bach’s Solo Cello Suites can significantly decrease a patient’s need for sedation and post-operative opioid medication. Listening to music has been shown to diminish the activation of the hypothalamic pituitary axis (HPA), which is implicated in human stress responses. Surgical procedures are profound sources of stress and anxiety for patients. There is a perceived loss of control and vulnerability during surgery; this can lead to prolonged healing time, increased postoperative pain, and risk for infection. There is additional evidence to suggest that anxiety during surgery puts the patient at greater anaesthetic and surgical risk.
Music elicits emotional and physical responses; medical music interventions can be tailored to the individual patient or surgical environment (e.g., Gorecki’s Symphony of Sorrows delivered via headphones to patients or Metallica playing over speakers for everyone in the surgical suite to hear). Music applied in the healthcare context is a complex intervention, in that there is not standardization across applications. Complexity derives from the ways in which music is administered to patients (i.e., intervention complexity) such as delivering music via headphones or through speakers in the operating room. Additionally, music has unique neurobiological and psychological impacts and these outcomes can interact with other clinically important outcomes in surgical care (i.e., pathway complexity).
To better understand the ways in which music has been studied as an intervention in the surgical setting, we undertook a scoping review and used evidence mapping to document the breadth and distribution of experimental designs and outcome measures reported in studies of music interventions during surgical procedures. Our review, entitled “Heterogeneity of outcomes for intraoperative music interventions: a scoping review and evidence map,” included 21 studies, with a total of 2283 patients. Overall, studies measured 42 different outcomes. Two-thirds used at least one outcome measure unique to that study, barring opportunities for comparison to other studies of similar design.
Our review demonstrated the need for more complete reporting of study details and standardization of outcome measures. The heterogeneity of outcome measures limits our ability to synthesize data across studies to understand the effectiveness of intraoperative music interventions on surgical patients. In 2017, the National Institutes of Health co-hosted a workshop on music and the brain entitled Sound Health, where the expert panel reported recommendations to support the study of music interventions. Among their recommendations was to promote more rigorous reporting of interventions, methodologies, and results and to establish standardized and/or personalized outcome measures. In their scoping review of >3000 studies of arts interventions in health, Fancourt et al 2019 identified that increasingly, studies of arts and health interventions include rigorous study designs to improve opportunities to conduct comparative effectiveness research in the field.
Based on an accumulating body of evidence, music appears to be a promising complement to medical care and should be explored with necessary rigor and enthusiasm in future studies. To move the field forward, the adoption of thorough study designs that account for the complexity of music interventions and the standardization of outcome measures, such as the development of core outcome sets for music interventions, may improve our understanding of music as an intervention. The development and uptake of reporting guidelines to ensure full reporting of key study features—specifically the component parts of music interventions that are non-standardized across applications—may support improved understanding of the role of music in clinical care.
AUTHORS:
Melanie Ambler, MS
Brown University, Providence, RI, USA
Fulbright Scholar, Caen, France
No conflict of interest to declare
Stacey Springs, PhD
Research Associate at Brown University School of Public Health, Providence, RI, USA
Twitter: @SpringsStacey
No conflict of interest to declare
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