Music Therapy - Update on the Evidence about its Indications

PICHON RIVIERE, A.; AUGUSTOVSKI, F.; GARCIA MARTI, S.; ALCARAZ, A.; GLUJOVSKY, D.; LOPEZ, A.; REY-ARES, L.; BARDACH, A.; CIAPPONI, A; MORAES MORELLI, D

Documento de Evaluación de tecnologías Sanitarias

IECS

Año: 2013 p. 1 - 30

1668-2793

Music therapy uses music as a therapeutic intervention for emotional, mental and cognitive problems. Since 1966, it is a University Career in Argentina and is supported by professional practice laws in several provinces.TechnologyThe World Federation of Music Therapy defines it as ?the professional use of music and its elements during an intervention in medical, educational and everyday environments with individuals, groups, families or communities in order to optimize their quality of life, and improve their physical, social, emotional and intellectual health as well as their wellbeing.?The two main music therapy approaches are: active, when the patient actively participates in the creation of sounds; and passive. Therapy sessions may vary in number and form (individual or group) as well as in the great diversity of possible techniques. There are many potential indications, among them diseases accompanied by socialization difficulties and low self-esteem, chronic and/or degenerative and terminal diseases, acute or chronic pain conditions or physical disability.PurposeTo assess the available evidence on the efficacy, safety and coverage related aspects regarding the use of music therapy in clinical practice.MethodsA bibliographic search was carried out on the main literature databases: DARE, NHS EED, on Internet general search engines, in health technology evaluation agencies and health sponsors. Priority was given to the inclusion of systematic reviews (SR); controlled, randomized clinical trials (RCTs); health technology assessments (HTA) and economic evaluations; clinical practice guidelines and coverage policies of institutions and health systems.ResultsTen systematic reviews, five of them with result meta-analysis, two RCTs, one AST and three coverage policies were selected. The studies compared the standard of care, combining it with music therapy, for the different indications and have a short-term follow up, ranging between 1 and 10 weeks.Patients with Neurologic DiseasesTwo SRs of randomized quasi-experimental studies showed positive results for music therapy in relation to psychological and behavioral symptoms in patients with dementia. One 2013 SR including 20 studies (n=651) reported a small reduction in the anxiety scale score, mainly at three months [Standardized Mean Difference (SMD) -0.93; CI95% -1.72 to -0.13]. The other, from 2011, included 10 studies (n=336) and showed similar results.Patients with Mental DisordersOne Cochrane SR, updated in 2011, which included five small scale RCTs showed minimal benefits for music therapy in the general mental status of patients with schizophrenia or severe mental disorders (SMD -0.97 vs. -0.60 of a scale from 30 to 210 points). No significant differences were observed in the quality-of- life score or cognitive function.The results of another Cochrane SR from 2009 showed no consistent evidence to assert that music therapy is an effective treatment for depression.Other UsesOne SR of eight RCT (n=712) published in 2009 did not report a significant effect of music therapy in patients who underwent colonoscopy as regards procedure time and pain score.The evidence based on Cochrane SRs, published in 2010 and 2011, showed benefits for music therapy in anxiety reduction of oncology patients (SMD -11.20 of 60 points; CI95% -19.59 to ? 2.82, p<0.001) and connected to mechanical ventilation (SMD -1.06; CI95% -2.09 to -0.04; p=0.04).One SR from 2011 (n=175) did not show enough evidence about the effect of music therapy on quality of life, pain, anxiety or physical results of terminal patients.In Argentina, music therapy is mandatorily covered for patients who have a disability certificate, whereas for the other indications it varies depending of the health sponsors. Two U.S. health sponsors consider that music therapy is at experimental stage and do not cover it.The cost of one music therapy session is approximately $100 (Argentine pesos, April/2013).ConclusionsThe evidence on music therapy effects varies for the different indications, but in general it is of high methodological quality and comes from systematic reviews and RCTs. Small beneficial effects of music therapy are pointed out, mainly a slight decrease in anxiety in patients with dementia, schizophrenia and oncology patients. For other indications such as depression or during surgical and diagnostic procedures there is not enough evidence to support its benefits and larger scale, standardized studies would be required.