Usefulness of music therapy in clinical practice

AUGUSTOVSKI, F.; PICHON RIVIERE, A.; ALCARAZ, A.; BARDACH, A.; FERRANTE, D.; GARCIA MARTI, S.; GLUJOVSKY, D.; LOPEZ, A.; REGUEIRO, A.; COLANTONIO, L.

Documentos de Evaluación de Tecnologías Sanitarias

IECS

Año: 2006 p. 1 - 30

1668-2793

The aim of this report was to assess the usefulness of music therapy in clinical practice. Music therapy is aimed at developing potential functions and to restore the individual's functions. The use of music therapy has been proposed: - in subjects with physical, neurological, mental and sensorial disabilities - in mental health for children, adults and teenagers - in infertility, pregnancy and early attachment disorders - in special education, neurosis, addictions, coma patients, patients in intensive care unit, Down Syndrome and management of autism, among others.A bibliographic search was carried out on the main data bases (MEDLINE, Cochrane, DARE, NHS EED), on general Internet engines, in health technology evaluation agencies and health sponsors. Priority was given to including systematic reviews, randomized controlled clinical trials, health technology assessments and financial assessments, clinical practice guidelines and coverage policies from other health systems. Information from local sources on the use of sanitary resources, costs and coverage in Argentina was also searched.Music therapy in patients with neurological diseasesOne Cochrane systematic review, updated in 2004, assessed the effects of music therapy on the management of behavioral, social, cognitive and emotional disorders in demented elderly people. This review included 5 poor methodology studies whose results could not be conclusive as regards its efficacy. Only one RCT was found; it compared music therapy with physical therapy in 32 patients with Parkinson's disease. Both groups showed improvement in some of the evaluation scores while therapy was in progress, for example: bradykinesia, stiffness and tremor, but this effect could not be maintained when therapy was over.Music therapy in patients with psychiatric disordersOne Cochrane meta-analysis, updated in 2004, assessed the effects of music therapy in the management of schizophrenia. This review included 4 studies and concluded that music therapy as complementary to common assistance helps patients with schizophrenia to improve their general condition in the short and medium term. There is also certain evidence on the effects it has on mental status, performance and mainly on its negative symptoms; however, its effects do not seem to depend on the number and length of sessions and there is not enough evidence about the dose-response relationship nor the length of its long term effects. Similar results were reported in other three RCTs with fewer patients.Music therapy in inpatients or patients who undergo therapeutic or diagnostic proceduresOne meta-analysis of 19 studies published in 2002 showed that music therapy reduces anxiety during regular management of inpatients, though this effect was not observed in patients who underwent therapeutic or diagnostic procedures. These patients presented a slight reduction in respiratory frequency and better mood and tolerance.Patients who underwent colonoscopiesFindings similar to those reported in the metanalysis as regards diagnostic procedures were reported by Smolen et. al., in a study which included 32 patients who underwent colonoscopies and Lopez et. al, in a study which included 118 patients though in the first study, the group treated with music therapy required lower doses of anaesthetics. However, other studies showed decreased anxiety in patients who underwent gastrointestinal testing and who listened to music of their own choice or classical music selected by the investigators.Patients who underwent surgeryFour studies evaluating the effect of music therapy on patients who underwent surgery were found. In general, decreased anxiety in patients exposed to music therapy prior, during and post surgery and lower requirements of anesthesia was observed though no differences were found in their clinical parameters or hospital stay. One study carried out in Chinese patients did not show differences with the use of music therapy in operated patients.Female patients who underwent proceduresOne study published in 2003 randomized 110 women in labor to listen to soft music during the first hours of their labor or to common management of delivery. Women exposed to music presented less pain during the first 3 hours of labor than those in the control group. Another study which randomized 220 women who underwent colonoscopies to listen to music or to habitual management. The patients who listened to music presented less pain and less anxiety that those in the control group.Other groups of patientsBenefits were found in decreased anxiety in ventilated patients and in those patients who underwent bone marrow transplantation and decreased osteoarticular pain and better quality, length and effectiveness of sleeping in elderly patients exposed to music therapy. Coverage policies Music therapy is not included in the Argentina's Ministry of Health's Emergency Mandatory Medical Plan (PMOE). Health policies found, both in the U.S. health system, consider music therapy investigational and coverage is not provided.