Impact of an Active Music Therapy Intervention on Intensive Care Patients

Amanda J. Golino, MSN, RN, RN-BC, CCRN, CCNS; Raymond Leone, MMT, MT-BC; Audra Gollenberg, PhD; Catherine Christopher, MEd, CCC-SLP; Debra Stanger, MSN, RN, NEA-BC; Theresa M. Davis, PhD, RN, NE-BC, CHTP; Anthony Meadows, PhD, MT-BC, LPC; Zhiwei Zhang, PhD; Mary Ann Friesen, PhD, RN, CPHQ

Disclosures

Am J Crit Care. 2019;28(1):48-55. 

In This Article

Abstract and Introduction

Abstract

Background: Nonpharmacological interventions appear to benefit many patients and do not have the side effects commonly associated with medications. Music-based experiences may benefit critical care patients.

Objective: To examine the effect of an active music therapy intervention on physiological parameters and self-reported pain and anxiety levels of patients in the intensive care unit.

Methods: A study was conducted using a pretest-posttest, within-subject, single-group design. The study population consisted of a convenience sample of 52 patients. Study participants received a 30-minute music therapy session consisting of either a relaxation intervention or a "song choice" intervention. The music therapist recorded the patients' vital signs before and after the intervention, and patients completed self-assessments of their pain and anxiety levels before and after the intervention.

Results: After the intervention, significant decreases (all P < .001) were found in respiratory rate (mean difference, 3.7 [95% CI, 2.6–4.7] breaths per minute), heart rate (5.9 [4.0–7.8] beats per minute), and self-reported pain (1.2 [0.8–1.6] points) and anxiety levels (2.7 [2.2–3.3] points). No significant change in oxygen saturation level was observed. Outcomes differed between the 2 intervention groups: patients receiving the relaxation intervention often fell asleep.

Conclusions: The results of this study support active music therapy as a nonpharmacological intervention in intensive care units. This study may lay the groundwork for future research on music therapy in critical care units using larger, more diverse samples.

Introduction

The critical care unit is one of the most anxiety-producing medical environments for patients and their caregivers.[1] Critically ill patients often experience anxiety, depression, posttraumatic stress disorder, cognitive impairment, and a general decline in their overall well-being.[2] Physiological distress can lead to increased respiratory and heart rates, elevated blood glucose levels, hyperlactatemia, and lowered blood pressure, all of which can affect treatment outcomes.[3]

The psychological stress of critical illness also may have lasting effects after discharge. An estimated 15% of intensive care unit (ICU) patients experience posttraumatic stress disorder.[4] Chahraoui and colleagues[5] reported that approximately 25% of ICU patients experience at least 1 psychiatric comorbidity within the first year after hospitalization, and that anxiety affects roughly 70% to 80% of all critical care patients, especially those receiving mechanical ventilation.

Although treatment teams recognize the physiological and psychological impact of an ICU stay, they have limited interventions available to address patients' experiences, as the patients are often unconscious or otherwise unable to engage in self-care.[6] Medications have thus become the primary intervention with which to address patients' clinical needs.[7] Medications can be beneficial in mitigating or masking primary psychological distress, but they can have marked adverse effects that may impede recovery.

In response to these psychophysiological concerns, nonpharmacological interventions have become more widely accepted and implemented, as they appear to benefit many patients without the risks of adverse effects associated with medications.[8] Some nonpharmacological interventions currently being used in critical care are massage, mindfulness-based stress reduction, Reiki therapy, integrative energetic medicine, healing touch, music listening, and music therapy, all of which offer low-risk, low-cost alternatives to standard care.[8,9]

Music listening interventions are among the most widely used nonpharmacological interventions and have been shown to reduce stress and anxiety, pain, depression, and feelings of isolation in critical care patients.[7,10] For example, Bradt and Dileo[11] found that music listening in patients receiving mechanical ventilation reduced anxiety, respiratory rate, and systolic blood pressure, and Chlan and colleagues[12] found that music listening reduced the frequency of sedative administration. However, the impact of music listening experiences is equivocal. Chlan et al[13] concluded that while music listening decreased stress responses in patients undergoing mechanical ventilation, the findings were not significant. Hetland and colleagues[14] found that music listening did not have an impact on duration of weaning trials in patients receiving mechanical ventilation. Cooke and colleagues[15] found that music listening did not significantly affect discomfort or anxiety among postoperative ICU patients during turning procedures.

"Nonpharmacological interventions are becoming more widely accepted and are low-risk, low-cost alternatives."

Incorporating active music therapy involving live music into the ICU may clarify the effectiveness of these music-based interventions. Hunter and colleagues[16] reported that active music therapy was effective in managing anxiety associated with weaning from mechanical ventilation. In their study, a music therapist provided multiple live music therapy sessions while participants were undergoing weaning trials from mechanical ventilation. After assessing the patient's ability to actively participate, the music therapist extemporaneously modified the volume and tempo of the music according to the patient's respiration and/or heart rate. The authors found significant differences in heart and respiratory rates after music therapy sessions, along with lower reported anxiety.[16]

When examined as a whole, the literature suggests that music-based experiences may be beneficial for patients in the ICU, with the potential to address both physiological and psychological concerns. Variations in reported benefits, however, warrant further examination. In particular, differential effectiveness of music listening experiences, specifically those that use recorded music, may be accounted for by their lack of adaptability to the patient's immediate needs, as well as the absence of an interventionist who can respond "in the moment" to the patient.[1,17] Thus, music-based experiences in which a board-certified therapist uses live music in an attempt to alter the physiological and/or psychological state of the patient, adjusting the activity in response to changes in the patient, may provide additional benefits over music listening experiences alone. Music therapy is a clinical approach in which a licensed music therapist implements music-based interventions to reach a clinical goal (Table 1).[18]

"The music therapy intervention was either a relaxation/guided imagery experience or a song choice experience."

Music therapy also encompasses the dynamic relationship between the therapist and the patient and includes verbal processing of the music experience. Little research has been published on active music therapy individualized for critical care patients. Therefore, this study was designed to explore the value of active music therapy in the ICU.

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