Research

Some selected Abstracts from research on the use of music in medical settings are listed below.

1. Hospice/Palliative care:

Restoring the spirit at the end of life: music as an intervention for oncology nurses. Halstead MT, Roscoe ST. mhalstead@towson.edu

Clin J Oncol Nurs. 2002 Nov-Dec;6(6):332-6. Music is a useful therapeutic intervention that can improve quality of life for dying patients. Physiologic mechanisms in response to carefully chosen musical selections help to alleviate pain, anxiety, and nausea and induce sleep. Expression of feelings enhances mood. Palliative care nurses increase the effectiveness of this intervention through careful assessment of patient needs, preferences, goals of intervention, and available resources. Music, a universal language, is an important clinical adjunct that addresses individual and family needs, thereby assisting patients to achieve a peaceful death. This article explores musical categories of preferences to assist nurses, patients, and families in choosing music that meets specific therapeutic objectives. PMID: 12434464 [PubMed – indexed for MEDLINE]

Music therapy with persons who are indigent and terminally ill. Mramor KM. Malachi House, Cleveland, Ohio, USA.

J Palliat Care. 2001 Autumn;17(3):182-7. This paper addresses the music therapy process specific to one subgroup of the general population identified as having terminal illness. This subgroup includes individuals who are impoverished, homeless, and do not have someone to provide them with care at the end of life. Based upon her clinical work at Malachi House, the author identified three distinct phases of the music therapy process with these individuals: engagement, relationship building, and actively dying. The progress of 50 residents through the therapy process was documented over a three-year period, as was the musical and nonmusical content of music therapy sessions. This paper reviews the results of the documentation recorded and offers case examples to represent each phase. PMID: 1116760 [PubMed – indexed for MEDLINE]

The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer.

Hilliard RE. Florida State University, Big Bend Hospice, USA. J Music Ther. 2003 Summer;40(2):113-37.

The purpose of this study was to evaluate the effects of music therapy on quality of life, length of life in care, physical status, and relationship of death occurrence to the final music therapy interventions of hospice patients diagnosed with terminal cancer. Subjects were adults who were living in their homes, receiving hospice care, and were diagnosed with terminal cancer. A total of 80 subjects participated in the study and were randomly assigned to one of two groups: experimental (routine hospice services and clinical music therapy) and control (routine hospice services only). Groups were matched on the basis of gender and age. Quality of life was measured by the Hospice Quality of Life Index-Revised (HQOLI-R), a self-report measure given every visit. Functional status of the subjects was assessed by the hospice nurse during every visit using the Palliative Performance Scale. All subjects received at least two visits and quality of life and physical status assessments. A repeated measures ANOVA revealed a significant difference between groups on self-report quality of life scores for visits one and two. Quality of life was higher for those subjects receiving music therapy, and their quality of life increased over time as they received more music therapy sessions. Subjects in the control group, however, experienced a lower quality of life than those in the experimental group, and without music, their quality of life decreased over time. There were no significant differences in results by age or gender of subjects in either condition. Furthermore, there were no significant differences between groups on physical functioning, length of life, or time of death in relation to the last scheduled visit by the music therapist or counselor. This study provides an overview of hospice/palliative care, explains the role of music therapy in providing care, and establishes clinical guidelines grounded in research for the use of music therapy in improving the quality of life among the terminally ill. PMID: 14505443 [PubMed – indexed for MEDLINE]

1On a personal note: a music therapist’s reflections on working with those who are living with a terminal illness. Hartley NA. J Palliat Care. 2001 Autumn;17(3):135-41. Music therapists are constantly called upon to justify their work through research projects and evaluation processes. Rarely do we get the opportunity to talk personally about our work, the effects it has on us as music therapists, indeed, as human beings. This paper traces my own journey as a music therapist working with the terminally ill. Using audio extracts of music improvised with patients at the end of their lives, the concept of “attention” in music is addressed and explored. The paper will investigate: a) What is the difference between the quality of attention that is available to ourselves and our patients “in” music, as opposed to other ways of being together?; b) What does musical experience, particularly when achieved through improvisation, enable us and our patients to be that we cannot achieve in other ways?; c) Can “being in music” with another person fulfill a sense of longing that is evident in people at the end of their lives? In her book Waiting For God, Simone Weil suggests, “Those who are unhappy have no need for anything else in this world other than people capable of giving them their attention…” (1). Can the improvisation of music offer a unique and uncomplicated medium for being close?

PMID: 11816752 [PubMed – indexed for MEDLINE]

Music therapy as psychospiritual process in palliative care. Salmon D.McGill University Health Centre, Palliative Care Service, Royal Victoria Hospital, Montreal, Quebec, Canada. J Palliat Care. 2001 Autumn;17(3):142-6. This paper proposes a theoretical framework for understanding how music therapy elicits and supports depth experiences in palliative care. The author explores music therapy as a containing or sacred space in which ventures into the realm of psychospiritual awareness may safely occur. The ultimate goal is to facilitate the process of connecting to that which is psychologically and spiritually significant for the patient, thereby transforming experiences of suffering into those of meaning. PMID: 11816753 [PubMed – indexed for MEDLINE]

Music therapy in palliative medicine. Gallagher LM, Huston MJ, Nelson KA, Walsh D, Steele AL. Support Care Cancer. 2001 May;9(3):156-61. The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Taussig Cancer Center, Ohio 44195, USA. A partnership between The Cleveland Clinic Foundation and The Cleveland Music School Settlement has resulted in music therapy becoming a standard part of the care in our palliative medicine inpatient unit. This paper describes a music therapy program and its impact on patients, their families, and staff. A service delivery model is suggested for implementation and integration of music therapy within palliative medicine. Specific music therapy interventions, evaluation and documentation techniques are also mentioned. A description of patient and family responses to music therapy, staff satisfaction, and effectiveness of interventions is presented. PMID: 11401099 [PubMed – indexed for MEDLINE]

Restoring the spirit at the end of life: music as an intervention for oncology nurses.

Clin J Oncol Nurs 2002 Nov-Dec;6(6):332-6 (ISSN: 1092-1095) Halstead MT; Roscoe ST mhalstead@towson.edu. Music is a useful therapeutic intervention that can improve quality of life for dying patients. Physiologic mechanisms in response to carefully chosen musical selections help to alleviate pain, anxiety, and nausea and induce sleep. Expression of feelings enhances mood. Palliative care nurses increase the effectiveness of this intervention through careful assessment of patient needs, preferences, goals of intervention, and available resources. Music, a universal language, is an important clinical adjunct that addresses individual and family needs, thereby assisting patients to achieve a peaceful death. This article explores musical categories of preferences to assist nurses, patients, and families in choosing music that meets specific therapeutic objectives.

Music therapy in palliative care: current perspectives.

Int J Palliat Nurs 2002 Mar;8(3):130-6 (ISSN: 1357-6321) O’Kelly J Rowcroft, The Torbay and South Devon Hospice, Torquay, UK. As the music therapy profession has developed internationally over the last 25 years, so has its role in palliative care. Music is a highly versatile and dynamic therapeutic modality, lending itself to a variety of music therapy techniques used to benefit both those living with life-threatening illnesses and their family members and caregivers. This article will give a

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broad overview of the historical roots of music therapy and introduce the techniques that are employed in current practice. By combining a review of mainstream music therapy practice involving musical improvisation, song-writing and receptive/recreational techniques with case material from my own experience, this article aims to highlight the potential music therapy holds as an effective holistic practice for palliative care, whatever the care setting.

The use of music therapy in meeting the multidimensional needs of hospice patients and families. J Palliat Care 2001 Autumn;17(3):161-6 (ISSN: 0825-8597) Hilliard RE

Big Bend Hospice, Tallahassee, Florida, USA. This article presents four case studies which demonstrate the use of music therapy in assisting palliative care patients and families cope with grief and loss, pain and anxiety, disorientation and dementia, lack of meaning, and hopelessness. Music therapy techniques are illustrated and patient-related goals are defined within the case studies. A review of the literature supports the use of music therapy in palliative care, and a variety of qualitative and quantitative studies are reported in the article.

Music therapy as psychospiritual process in palliative care. J Palliat Care 2001 Autumn;17(3):142-6 (ISSN: 0825-8597) Salmon D McGill University Health Centre, Palliative Care Service, Royal Victoria Hospital, Montreal, Quebec, Canada. This paper proposes a theoretical framework for understanding how music therapy elicits and supports depth experiences in palliative care. The author explores music therapy as a containing or sacred space in which ventures into the realm of psychospiritual awareness may safely occur. The ultimate goal is to facilitate the process of connecting to that which is psychologically and spiritually significant for the patient, thereby transforming experiences of suffering into those of meaning.

Bringing music to life: a study of music therapy and palliative care experiences in a cancer hospital. J Palliat Care 2001 Autumn;17(3):155-60 (ISSN: 0825-8597) O’Callaghan C Peter MacCallum Cancer Institute, University of Melbourne, Melbourne, Australia. A music therapy research study aimed at understanding patients’, visitors’ and staff members’ experiences of a music therapy program in a cancer hospital over a three-month period is described. Respondents’ answers to brief open-ended questions, as well as the music therapist researcher’s interpretations of the program’s relevance, were examined using thematic analysis based on grounded theory. ATLAS software supported data management and analysis. Themes encapsulating 128 patients’ reflections about music therapy were delineated and substantiate how music therapy can support palliative care aims throughout the cancer illness trajectory.

The effects of single-session music therapy interventions on the observed and self-reported levels of pain control, physical comfort, and relaxation of hospice patients. Am J Hosp Palliat Care 2001 Nov-Dec;18(6):383-90 (ISSN: 1049-9091) Krout RE Hospice of Palm Beach County, West Palm Beach, Florida, USA.

This article describes the process and results of a three-month music therapy clinical effectiveness study conducted with terminally ill patients. The purpose of this study was to quantify and evaluate the effectiveness of single-session music therapy interventions with hospice patients in three patient problem areas: pain control; physical comfort; and relaxation. Data from a total of 90 sessions conducted with a total of 80 subjects served by Hospice of Palm Beach County, Florida, were included in the study. Music therapy services were provided by five board-certified music therapists and one music therapist eligible for board certification. The subjects in this study were receiving regularly scheduled music therapy services from the hospice organization. The study used both behavioral observation and subject’s self-reporting as methods of data reporting and recording. Subjects were observed for, or self-reported, their levels of pain control, physical comfort, and relaxation, both before and after each music therapy session. The subjects were served in the environments where music therapy services would normally be delivered (i.e., home, hospital, nursing home, or inpatient acute-care unit of the hospice organization). Music therapy services included live active and passive music-based experiences. These were designed to build and to establish rapport with patient or family, to facilitate family interaction and patient control, to provide support and comfort, to facilitate relaxation, to enable reminiscence and life review, to provide a frame-work for spiritual exploration and validation, and to encourage the identification and expression of feelings of anticipatory mourning and grief. A total of six hypotheses stated that there would be significant pre- to postsession differences in each of the three variables: pain control, physical comfort, and relaxation, as measured during two different session and

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data collection scenarios. These scenarios included the independent observation and recording of the three subject variables and the subject’s self-report of each variable. Reliability correlation coefficients were calculated for each of the different session and data-collection scenarios to help assess the correlation between primary and reliability observers. Pearson product moment correlations indicated reliability agreement coefficients of r = .85 and r = .90. One-tailed t-tests were performed on the collected data for subject pain control, physical comfort, and relaxation. Results of the t-tests were significant at the p < or = .001 (for observed pain control, physical comfort, and relaxation) and p < or = 005 (for self-reported pain control, physical comfort, and relaxation) levels. These results suggest that single-session music therapy interventions appear to be effective in increasing subject pain control, physical comfort, and relaxation during both data collection scenarios. Based on the results of these tests of the analyzed data, the hypotheses were all accepted. Tables illustrate pre- to post-session changes in levels of all three variables from both session and data-collection scenarios. Copies of the data-collection forms are also included in the Appendix. The discussion section addresses limitations of this study and suggestions for future studies.

Music therapy in palliative medicine. Support Care Cancer 2001 May;9(3):156-61 (ISSN: 0941-4355) Gallagher LM; Huston MJ; Nelson KA; Walsh D; Steele AL The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Taussig Cancer Center, Ohio 44195, USA. A partnership between The Cleveland Clinic Foundation and The Cleveland Music School Settlement has resulted in music therapy becoming a standard part of the care in our palliative medicine inpatient unit. This paper describes a music therapy program and its impact on patients, their families, and staff. A service delivery model is suggested for implementation and integration of music therapy within palliative medicine. Specific music therapy interventions, evaluation and documentation techniques are also mentioned. A description of patient and family responses to music therapy, staff satisfaction, and effectiveness of interventions is presented.

Music therapy with imminently dying hospice patients and their families: facilitating release near the time of death Am J Hosp Palliat Care 2003 Mar-Apr;20(2):129-34 (ISSN: 1049-9091) Krout RE

Conservatorium of Music, Massey University, Mt. Cook, Wellington, New Zealand. Hospice care seeks to address the diverse needs of terminally ill patients in a number of physical, psychosocial, and spiritual areas. Family members of the patient often are included in the care and services provided by the hospice team, and hospice clinicians face a special challenge when working with families of patients who are imminently dying. When loved ones are anticipating the patient’s impending death, they may find it difficult to express feelings, thoughts, and last wishes. Music therapy is a service modality that can help to facilitate such communication between the family and the patient who is actively dying, while also providing a comforting presence. Music therapy as a way to ease communication and sharing between dying patients and their loved ones is discussed in this article. The ways in which music therapy can facilitate a means of release for both patients and family members in an acute care unit of a large US hospice organization are specifically described. Case descriptions illustrate how music therapy functioned to allow five patients and their families to both come together and let go near the time of death. Elements to consider when providing such services to imminently dying patients and their families are discussed.

2. Medical/Surgical:

Intensive Crit Care Nurs. 2003; 19(1):21-30 (ISSN: 0964-3397) Almerud S; Petersson K Department of Anaesthesiology and Intensive Care, Central Hospital, SE-351 85 Växjö, Sweden. sofia.almerud@telia.com The aim of this study was to ascertain whether music therapy had a measurable relaxing effect on patients who were temporarily on a respirator in an intensive care unit (ICU) and after completion of respirator treatment investigate those patients’ experiences of the music therapy. In the study both quantitative and qualitative measurements were applied. Twenty patients were included using consecutive selection. It became apparent that the patients remembered very little of their time in ICU. The analysis of the quantitative data showed a significant fall in systolic and diastolic blood pressure during the music therapy

Music Therapy and patients on Respirators

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session and a corresponding rise after cessation of treatment. All changes were found to be statistically significant. The conclusion was that intensive care nursing staff can beneficially apply music therapy as a non-pharmacological intervention.

Using massage and music therapy to improve postoperative outcomes

AORN J 2003 Sep;78(3):433-42, 445-7 (ISSN: 0001-2092) McRee LD; Noble S; Pasvogel A University of Arizona College of Nursing, Tucson, USA. An experimental pilot study was conducted to investigate the effects of preoperative massage and music therapy on patients’ preoperative, intraoperative, and postoperative experiences. Participants were assigned randomly to one of four groups–a group that received massage with music therapy, a group that received massage only, a group that received music therapy only, or a control group. Hemodynamics, serum cortisol and prolactin levels, and anxiety were measured preoperatively and postoperatively. Postoperative anxiety levels were significantly lower and postoperative prolactin levels were significantly higher for all groups

Cultural Differences in Music Chosen for Pain Relief

Good M.[1]; Picot B.L.[2]; Salem S.G.[1]; Chin C-C.[3]; Picot S.F.[4]; Lane D.[5] [1] Case Western Reserve University [2] University of North Carolina-Chapel Hill [3] Kaoshiung Medical University [4] University of Maryland, Baltimore [5] University Hospitals of Cleveland Nurses use music therapeutically, but often assume that all patients will equally appreciate the same type of music. Cultural differences in music preferences are compared across five pain studies. Music preferences for pain relief are described as the most frequently chosen type of music for each culture. Findings indicate that in four studies musical choices were related to cultural background (p = .002 to .049). Although the majority in each group chose among the other types of music, Caucasians most frequently chose orchestra music, African Americans chose jazz, and Taiwanese chose harp music. For culturally congruent care, nurses should become aware of cultural differences in music preference and provide culturally specific selections amongst other music expected to have a therapeutic effect.

Music as an adjunct to antiemetic therapy. Oncol Nurs Forum 1998 Oct;25(9):1551-6, Ezzone S; Baker C; Rosselet R; Terepka E To test whether use of music as a diversional intervention during high-dose chemotherapy administration would affect perception of nausea and episodes of vomiting. SAMPLE: 39 patients undergoing bone marrow transplant. A total of 33 patients were included in the data analysis, with 17 in the control group and 16 in the music intervention group. METHODS: Patients were assigned randomly to a control group (usual antiemetic protocol) or the experimental group (usual antiemetic group plus music intervention during the 48 hours of high-dose cyclophosphamide administered as part of the preparative regimen). MAIN RESEARCH VARIABLES: Use of a music intervention, perception of nausea, and instances of vomiting. FINDINGS: Significant differences were found between group scores on a visual analog scale for nausea and number of episodes of vomiting, demonstrating that the experimental group experienced less nausea and fewer instances of vomiting. CONCLUSION: This study found that music is an effective adjunct to a pharmacologic antiemetic regimen for lessening nausea and vomiting, and this study merits further investigation through a larger multi-institutional effort. IMPLICATIONS FOR NURSING PRACTICE: Using music as a diversional adjunct intervention to antiemetic therapy is helpful in decreasing nausea and vomiting. The intervention can be initiated independently by nurses and individualized for each patient, leading to greater patient comfort and compliance with high-dose chemotherapy.

Music in hospitals

Lindsay S. Br J Hosp Med. 1993 Dec 15-1994 Jan 18;50(11):660-2. Council for Music in Hospitals, Hersham, Surrey. Live music may be enjoyed by patients in hospitals, homes, hospices, training centres, stroke clubs and so on. This article discusses the provision of high quality concerts for those who–through age, illness or the nature of their disability–are precluded from attending a performance in the community and the benefits it brings them. PMID: 8124548 [PubMed – indexed for MEDLINE]

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Music as a therapeutic intervention for anxiety in patients receiving radiation therapy.

Smith M, Casey L, Johnson D, Gwede C, Riggin OZ. Oncol Nurs Forum. 2001 Jun;28(5):855-62. Geriatric Psychiatry Department, James A. Haley Veterans Affairs Medical Center, Tampa, USA. PURPOSE/OBJECTIVES: To determine whether music moderates the level of anxiety that patients experience during radiation therapy. DESIGN: Experimental, longitudinal, random assignment to music or no music therapy. SETTING: Urban radiation oncology center in a Department of Veterans Affairs hospital in the southeastern United States. SAMPLE: Forty-two men (19 in the experimental group, 23 in the control group) aged 39-80 years (74% white, 12% African American, 12% Hispanic, and 2% other) receiving definitive external beam radiation therapy for pelvic or abdominal malignancies. METHODS: Patients in the experimental group listened to music of their choice provided via audiotapes and headphones before and during their simulation and daily treatments for the duration of the planned course of therapy. The control group received standard care. The State-Trait Anxiety Inventory was administered initially to participants in both groups at the time of evaluation (time 1), post-simulation (time 2), at the end of the first week (time 3), at the end of the third week (time 4), and at the end of the fifth week or end of radiation therapy (time 5). MAIN RESEARCH VARIABLE: State anxiety. FINDINGS: No significant difference existed between the two groups to suggest that music moderated the level of anxiety during radiotherapy. However, post-hoc analyses identified changes and trends in state anxiety scores, suggesting a possible benefit of music therapy during radiotherapy. CONCLUSIONS: Despite a lack of group differences, early intervention with music therapy for patients with high levels of anxiety may be beneficial. IMPLICATIONS FOR NURSING PRACTICE: Nurses and other clinicians may administer state anxiety scales at the initial visit or prior to pretreatment radiation planning (simulation). Individuals who have high state anxiety scores may receive nursing interventions tailored to reduce anxiety during simulation and the early part of radiotherapy.

Effects of relaxation and music therapy on patients in a coronary care unit with presumptive acute myocardial infarction. Guzzetta CE. Holistic Nursing Consultants, Washington, D.C. Heart Lung. 1989 Nov;18(6):609-16.

The purpose of this study was to determine whether relaxation and music therapy were effective in reducing stress in patients in a coronary care unit admitted with the presumptive diagnosis of acute myocardial infarction. In this experimental study, 80 patients were randomly assigned to a relaxation, music therapy, or control group. The relaxation and music therapy groups participated in three sessions over a two-day period. Stress was evaluated by apical heart rates, peripheral temperatures, cardiac complications, and qualitative patient evaluative data. Data analysis revealed that lowering apical heart rates and raising peripheral temperatures were more successful in the relaxation and music therapy groups than in the control group. The incidence of cardiac complications was found to be lower in the intervention groups, and most intervention subjects believed that such therapy was helpful. Both relaxation and music therapy are effective modalities to reduce stress in these patients.

PMID: 2684920 [PubMed – indexed for MEDLINE]

State of the science of music interventions. Critical care and perioperative practice. White JM. School of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA. jill@uwm.edu Crit Care Nurs Clin North Am. 2000 Jun;12(2):219-25. Music therapy is an easy to administer, relatively inexpensive, noninvasive intervention that can reduce anxiety and pain in critical care and perioperative patients. Libraries of relaxing music selections need to be compiled, reflecting diverse musical tastes. Providing patients with the opportunity to partake in music therapy sessions, selecting their own music, and providing them with quiet, uninterrupted time to listen to the music provides patients with a sense of control and separation from the multiple environmental stressors they are experiencing. Although there is now an extensive empirical base for the therapeutic usefulness of music therapy, particularly with the myocardial infarction population, few hospitals have adopted music therapy programs. Patient satisfaction and outcomes clearly have improved after music therapy sessions have been implemented. Further study with more diverse samples with a wider variety of medical conditions is indicated. Most of these studies used only one or two music sessions. It is not known whether effectiveness of music therapy sessions improves with repeated exposures. Further, there are little data with respect to optimal time for implementation of music therapy, length of music therapy sessions, or types of music to use. The effects of cultural diversity have not been addressed. Music therapy can improve the quality of care that

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critical care and perioperative nurses deliver to their patients. PMID: 11249367 [PubMed – indexed for MEDLINE]

Music therapy’s relevance in a cancer hospital researched through a constructivist lens.

O’Callaghan C, McDermott F. Peter MacCallum Cancer Centre, Melbourne, Australia. J Music Ther. 2004 Summer;41(2):151-85 The constructivist research paradigm informed a research investigation on the relevance of music therapy in a cancer hospital, that is, what did the music therapy do and did it help? Over 3 months, criterion sampling was used to elicit interpretations in 5 studies from 5 sources: 128 patients who participated, 27 patients who overheard or witnessed music therapy, 41 visitors, 61 staff, and the music therapist-researcher. Fifty-seven percent of the patients who participated had advanced or end stage cancer. The music therapist’s interpretations were recorded in a reflexive clinical journal and the respondents’ interpretations were written on anonymous open-ended questionnaires. Thematic and content analyses were performed on the 5 groups of data with the support of qualitative data management software. Findings from the 5 data groups were contrasted and compared. Many patients’, visitors’ and staff members’ affective, contemplative, and imagined moments in music therapy affirmed their “aliveness,” resonating with an expanded consciousness, in a context where life’s vulnerability is constantly apparent. Philosophical depictions about the relevance of music in human life, including theories by Addis and Winnicott, substantiated the therapeutic reactions. PMID: 15307812 [PubMed – indexed for MEDLINE]

Music Improves Adherence to Exercise for COPD Patients

Bauldoff GS, Hoffman LA, Zullo TG, Sciurba FC. Exercise maintenance following pulmonary rehabilitation: effect of distractive stimuli. Chest. 2002;122:948-954. Completion of a pulmonary rehabilitation program (PRP) involving exercise training increases strength, endurance, and exercise tolerance while reducing dyspnea for elderly patients with chronic obstructive pulmonary disease (COPD). However, benefits gained from the PRP often drop off quickly after completion due to a lack of continued adherence. Researchers tested a home-based exercise regimen that included the use of music as a distractive stimuli with 24 elderly COPD patients who had recently completed a PRP. The subjects, mostly white females with an average age of 68 years, completed baseline surveys on depressive symptoms, anxiety, quality of life, and perceived dyspnea. Exercise tolerance was measured by 6-minute walk (6MW) distance. Each subject received instruction in a self-directed, 8-week walking program involving 20-45 minute sessions, 2 to 5 days a week, on flat terrain or on a treadmill, and each was given an electronic pedometer along with an exercise log to record the walking sessions. Subjects in the intervention group also received a portable audiocassette player with tapes of different types of music. At the end of the 8-week program, subjects in the intervention group had an average cumulative walking distance 24% greater than the control group. In addition, they showed a significant increase their 6MW distance and decrease in their dyspnea, while those in the control group remained at baseline or worsened. Depression in both groups decreased over time. Use of music as a distractive stimulus may decrease discomfort and improve adherence to exercise programs in COPD patients.

The effect of standard care, ibuprofen, and music on pain relief and patient satisfaction in adults with musculoskeletal trauma. J Emerg Nurs 2001 Apr;27(2):124-31 (ISSN: 0099-1767) Tanabe P; Thomas R; Paice J; Spiller M; Marcantonio R Northwestern Memorial Hospital, Chicago, IL 60607, USA. ptanabe@nmh.org. OBJECTIVE: The purposes of this study were to determine the most effective nursing intervention to decrease pain for patients with minor musculoskeletal trauma and moderate pain at triage and to examine patient satisfaction. METHODS: Patients were assigned to 1 of 3 intervention groups: (1) standard care (ice, elevation, and immobilization); (2) standard care and ibuprofen; or (3) standard care and music distraction. Patients were monitored for pain ratings for 60 minutes. Patients who sustained minor musculoskeletal trauma within the past 24 hours and presented with pain ratings of 4 or greater were included. Two patient satisfaction questions were asked upon discharge from the emergency department. RESULTS: Seventy- seven patients met the inclusion criteria. No differences in pain ratings between groups were demonstrated. A statistically significant reduction in pain for all patients occurred at 30 minutes (F = 16.18, P <.01) and was maintained at 60 minutes. However, 70% of patients continued to report pain ratings of 4 or greater (on a scale of 1 to 10) at 60 minutes. The reduction in pain was not found to be clinically significant.Eighty-four percent of patients stated that they were more satisfied with their overall care in the emergency department

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