Patients awaiting surgical procedures often experience significant anxiety. Such anxiety
may result in negative physiological manifestations, slower wound healing, increased
risk of infection, and may complicate the induction of anaesthesia and impede postoperative
recovery. To reduce patient anxiety, sedatives and anti-anxiety drugs are regularly
administered before surgery. However, these often have negative side effects and may
prolong patient recovery. Therefore, increasing attention is being paid to a variety
of non-pharmacological interventions for reduction of preoperative anxiety such as
music therapy and music medicine interventions. Interventions are categorized as 'music
medicine' when passive listening to pre-recorded music is offered by medical personnel.
In contrast, music therapy requires the implementation of a music intervention by
a trained music therapist, the presence of a therapeutic process, and the use of personally
tailored music experiences. A systematic review was needed to gauge the efficacy of
both music therapy and music medicine interventions for reduction of preoperative
anxiety.
To examine the effects of music interventions with standard care versus standard care
alone on preoperative anxiety in surgical patients.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane
Library 2012, Issue 7), MEDLINE (1950 to August 2012), CINAHL (1980 to August 2012),
AMED (1985 to April 2011; we no longer had access to AMED after this date), EMBASE
(1980 to August 2012), PsycINFO (1967 to August 2012), LILACS (1982 to August 2012),
Science Citation Index (1980 to August 2012), the specialist music therapy research
database (March 1 2008; database is no longer functional), CAIRSS for Music (to August
2012), Proquest Digital Dissertations (1980 to August 2012), ClinicalTrials.gov (2000
to August 2012), Current Controlled Trials (1998 to August 2012), and the National
Research Register (2000 to September 2007). We handsearched music therapy journals
and reference lists, and contacted relevant experts to identify unpublished manuscripts.
There was no language restriction.
We included all randomized and quasi-randomized trials that compared music interventions
and standard care with standard care alone for reducing preoperative anxiety in surgical
patients.
Two review authors independently extracted the data and assessed the risk of bias.
We contacted authors to obtain missing data where needed. Where possible, results
were presented in meta analyses using mean differences and standardized mean differences.
Post-test scores were used. In cases of significant baseline differences, we used
change scores.
We included 26 trials (2051 participants). All studies used listening to pre-recorded
music. The results suggested that music listening may have a beneficial effect on
preoperative anxiety. Specifically, music listening resulted, on average, in an anxiety
reduction that was 5.72 units greater (95% CI -7.27 to -4.17, P < 0.00001) than that
in the standard care group as measured by the Stait-Trait Anxiety Inventory (STAI-S),
and -0.60 standardized units (95% CI -0.90 to -0.31, P < 0.0001) on other anxiety
scales. The results also suggested a small effect on heart rate and diastolic blood
pressure, but no support was found for reductions in systolic blood pressure, respiratory
rate, and skin temperature. Most trials were assessed to be at high risk of bias because
of lack of blinding. Blinding of outcome assessors is often impossible in music therapy
and music medicine studies that use subjective outcomes, unless in studies in which
the music intervention is compared to another treatment intervention. Because of the
high risk of bias, these results need to be interpreted with caution.None of the studies
included wound healing, infection rate, time to discharge, or patient satisfaction
as outcome variables. One large study found that music listening was more effective
than the sedative midazolam in reducing preoperative anxiety and equally effective
in reducing physiological responses. No adverse effects were identified.
This systematic review indicates that music listening may have a beneficial effect
on preoperative anxiety. These findings are consistent with the findings of three
other Cochrane systematic reviews on the use of music interventions for anxiety reduction
in medical patients. Therefore, we conclude that music interventions may provide a
viable alternative to sedatives and anti-anxiety drugs for reducing preoperative anxiety.