Publications by authors named "Cheryl Dileo"

17 Publications

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Music interventions for improving psychological and physical outcomes in people with cancer.

Cochrane Database Syst Rev 2021 Oct 12;10:CD006911. Epub 2021 Oct 12.

Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA.

Background: This is an update of the review published on the Cochrane Library in 2016, Issue 8. Having cancer may result in extensive emotional, physical and social suffering. Music interventions have been used to alleviate symptoms and treatment side effects in people with cancer. This review includes music interventions defined as music therapy offered by trained music therapists, as well as music medicine, which was defined as listening to pre-recorded music offered by medical staff.

Objectives: To assess and compare the effects of music therapy and music medicine interventions for psychological and physical outcomes in people with cancer.

Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 3) in the Cochrane Library, MEDLINE via Ovid, Embase via Ovid, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, CAIRSS, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the RILM Abstracts of Music Literature, http://www.wfmt.info/Musictherapyworld/ and the National Research Register. We searched all databases, except for the last two, from their inception to April 2020; the other two are no longer functional, so we searched them until their termination date. We handsearched music therapy journals, reviewed reference lists and contacted experts. There was no language restriction.

Selection Criteria: We included all randomized and quasi-randomized controlled trials of music interventions for improving psychological and physical outcomes in adults and pediatric patients with cancer. We excluded patients undergoing biopsy and aspiration for diagnostic purposes.

Data Collection And Analysis: Two review authors independently extracted the data and assessed the risk of bias. Where possible, we presented results in meta-analyses using mean differences and standardized mean differences. We used post-test scores. In cases of significant baseline difference, we used change scores. We conducted separate meta-analyses for studies with adult participants and those with pediatric participants. Primary outcomes of interest included psychological outcomes and physical symptoms and secondary outcomes included physiological responses, physical functioning, anesthetic and analgesic intake, length of hospitalization, social and spiritual support, communication, and quality of life (QoL) . We used GRADE to assess the certainty of the evidence.

Main Results: We identified 29 new trials for inclusion in this update. In total, the evidence of this review rests on 81 trials with a total of 5576 participants. Of the 81 trials, 74 trials included adult (N = 5306) and seven trials included pediatric (N = 270) oncology patients. We categorized 38 trials as music therapy trials and 43 as music medicine trials. The interventions were compared to standard care. Psychological outcomes The results suggest that music interventions may have a large anxiety-reducing effect in adults with cancer, with a reported average anxiety reduction of 7.73 units (17 studies, 1381 participants; 95% confidence interval (CI) -10.02 to -5.44; very low-certainty evidence) on the Spielberger State Anxiety Inventory scale (range 20 to 80; lower values reflect lower anxiety). Results also suggested a moderately strong, positive impact of music interventions on depression in adults (12 studies, 1021 participants; standardized mean difference (SMD): -0.41, 95% CI -0.67 to -0.15; very low-certainty evidence). We found no support for an effect of music interventions on mood (SMD 0.47, 95% CI -0.02 to 0.97; 5 studies, 236 participants; very low-certainty evidence). Music interventions may increase hope in adults with cancer, with a reported average increase of 3.19 units (95% CI 0.12 to 6.25) on the Herth Hope Index (range 12 to 48; higher scores reflect greater hope), but this finding was based on only two studies (N = 53 participants; very low-certainty evidence). Physical outcomes We found a moderate pain-reducing effect of music interventions (SMD -0.67, 95% CI -1.07 to -0.26; 12 studies, 632 adult participants; very low-certainty evidence). In addition, music interventions had a small treatment effect on fatigue (SMD -0.28, 95% CI -0.46 to -0.10; 10 studies, 498 adult participants; low-certainty evidence). The results suggest a large effect of music interventions on adult participants' QoL, but the results were highly inconsistent across studies, and the pooled effect size was accompanied by a large confidence interval (SMD 0.88, 95% CI -0.31 to 2.08; 7 studies, 573 participants; evidence is very uncertain). Removal of studies that used improper randomization methods resulted in a moderate effect size that was less heterogeneous (SMD 0.47, 95% CI 0.06 to 0.88, P = 0.02, I = 56%). A small number of trials included pediatric oncology participants. The findings suggest that music interventions may reduce anxiety but this finding was based on only two studies (SMD -0.94, 95% CI -1.9 to 0.03; very low-certainty evidence). Due to the small number of studies, we could not draw conclusions regarding the effects of music interventions on mood, depression, QoL, fatigue or pain in pediatric participants with cancer. The majority of studies included in this review update presented a high risk of bias, and therefore the overall certainty of the evidence is low. For several outcomes (i.e. anxiety, depression, pain, fatigue, and QoL) the beneficial treatment effects were consistent across studies for music therapy interventions delivered by music therapists. In contrast, music medicine interventions resulted in inconsistent treatment effects across studies for these outcomes.

Authors' Conclusions: This systematic review indicates that music interventions compared to standard care may have beneficial effects on anxiety, depression, hope, pain, and fatigue in adults with cancer. The results of two trials suggest that music interventions may have a beneficial effect on anxiety in children with cancer. Too few trials with pediatric participants were included to draw conclusions about the treatment benefits of music for other outcomes. For several outcomes, music therapy interventions delivered by a trained music therapist led to consistent results across studies and this was not the case for music medicine interventions. Moreover, evidence of effect was found for music therapy interventions for QoL and fatigue but not for music medicine interventions. Most trials were at high risk of bias and low or very low certainty of evidence; therefore, these results need to be interpreted with caution.
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http://dx.doi.org/10.1002/14651858.CD006911.pub4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8510511PMC
October 2021

Neuronal Effects of Listening to Entrainment Music Versus Preferred Music in Patients With Chronic Cancer Pain as Measured via EEG and LORETA Imaging.

Front Psychol 2021 25;12:588788. Epub 2021 Feb 25.

Department of Music Education and Therapy, Boyer College of Music and Dance, Temple University, Philadelphia, PA, United States.

Previous studies examining EEG and LORETA in patients with chronic pain discovered an overactivation of high theta (6-9 Hz) and low beta (12-16 Hz) power in central regions. MEG studies with healthy subjects correlating evoked nociception ratings and source localization described delta and gamma changes according to two music interventions. Using similar music conditions with chronic pain patients, we examined EEG in response to two different music interventions for pain. To study this process in-depth we conducted a mixed-methods case study approach, based on three clinical cases. Effectiveness of personalized music therapy improvisations (entrainment music - EM) versus preferred music on chronic pain was examined with 16 participants. Three patients were randomly selected for follow-up EEG sessions three months post-intervention, where they listened to recordings of the music from the interventions provided during the research. To test the difference of EM versus preferred music, recordings were presented in a block design: silence, their own composed EM (depicting both "pain" and "healing"), preferred (commercially available) music, and a non-participant's EM as a control. Participants rated their pain before and after the EEG on a 1-10 scale. We conducted a detailed single case analysis to compare all conditions, as well as a group comparison of entrainment-healing condition versus preferred music condition. Power spectrum and according LORETA distributions focused on expected changes in delta, theta, beta, and gamma frequencies, particularly in sensory-motor and central regions. Intentional moment-by-moment attention on the sounds/music rather than on pain and decreased awareness of pain was experienced from one participant. Corresponding EEG analysis showed accompanying power changes in sensory-motor regions and LORETA projection pointed to insula-related changes during entrainment-pain music. LORETA also indicated involvement of visual-spatial, motor, and language/music improvisation processing in response to his personalized EM which may reflect active recollection of creating the EM. Group-wide analysis showed common brain responses to personalized entrainment-healing music in theta and low beta range in right pre- and post-central gyrus. We observed somatosensory changes consistent with processing pain during entrainment-healing music that were not seen during preferred music. These results may depict top-down neural processes associated with active coping for pain.
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http://dx.doi.org/10.3389/fpsyg.2021.588788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947245PMC
February 2021

Music interventions for improving psychological and physical outcomes in cancer patients.

Cochrane Database Syst Rev 2016 Aug 15(8):CD006911. Epub 2016 Aug 15.

Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, 1601 Cherry Street, room 7112, Philadelphia, PA, USA, 19102.

Background: Having cancer may result in extensive emotional, physical and social suffering. Music interventions have been used to alleviate symptoms and treatment side effects in cancer patients.

Objectives: To assess and compare the effects of music therapy and music medicine interventions for psychological and physical outcomes in people with cancer.

Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 1), MEDLINE, Embase, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, CAIRSS, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the RILM Abstracts of Music Literature, http://www.wfmt.info/Musictherapyworld/ and the National Research Register. We searched all databases, except for the last two, from their inception to January 2016; the other two are no longer functional, so we searched them until their termination date. We handsearched music therapy journals, reviewed reference lists and contacted experts. There was no language restriction.

Selection Criteria: We included all randomized and quasi-randomized controlled trials of music interventions for improving psychological and physical outcomes in adult and pediatric patients with cancer. We excluded participants undergoing biopsy and aspiration for diagnostic purposes.

Data Collection And Analysis: Two review authors independently extracted the data and assessed the risk of bias. Where possible, we presented results in meta-analyses using mean differences and standardized mean differences. We used post-test scores. In cases of significant baseline difference, we used change scores.

Main Results: We identified 22 new trials for inclusion in this update. In total, the evidence of this review rests on 52 trials with a total of 3731 participants. We included music therapy interventions offered by trained music therapists, as well as music medicine interventions, which are defined as listening to pre-recorded music, offered by medical staff. We categorized 23 trials as music therapy trials and 29 as music medicine trials.The results suggest that music interventions may have a beneficial effect on anxiety in people with cancer, with a reported average anxiety reduction of 8.54 units (95% confidence interval (CI) -12.04 to -5.05, P < 0.0001) on the Spielberger State Anxiety Inventory - State Anxiety (STAI-S) scale (range 20 to 80) and -0.71 standardized units (13 studies, 1028 participants; 95% CI -0.98 to -0.43, P < 0.00001; low quality evidence) on other anxiety scales, a moderate to strong effect. Results also suggested a moderately strong, positive impact on depression (7 studies, 723 participants; standardized mean difference (SMD): -0.40, 95% CI -0.74 to -0.06, P = 0.02; very low quality evidence), but because of the very low quality of the evidence for this outcome, this result needs to be interpreted with caution. We found no support for an effect of music interventions on mood or distress.Music interventions may lead to small reductions in heart rate, respiratory rate and blood pressure but do not appear to impact oxygen saturation level. We found a large pain-reducing effect (7 studies, 528 participants; SMD: -0.91, 95% CI -1.46 to -0.36, P = 0.001, low quality evidence). In addition, music interventions had a small to moderate treatment effect on fatigue (6 studies, 253 participants; SMD: -0.38, 95% CI -0.72 to -0.04, P = 0.03; low quality evidence), but we did not find strong evidence for improvement in physical functioning.The results suggest a large effect of music interventions on patients' quality of life (QoL), but the results were highly inconsistent across studies, and the pooled effect size for the music medicine and music therapy studies was accompanied by a large confidence interval (SMD: 0.98, 95% CI -0.36 to 2.33, P = 0.15, low quality evidence). A comparison between music therapy and music medicine interventions suggests a moderate effect of music therapy interventions for patients' quality of life (QoL) (3 studies, 132 participants; SMD: 0.42, 95% CI 0.06 to 0.78, P = 0.02; very low quality evidence), but we found no evidence of an effect for music medicine interventions. A comparison between music therapy and music medicine studies was also possible for anxiety, depression and mood, but we found no difference between the two types of interventions for these outcomes.The results of single studies suggest that music listening may reduce the need for anesthetics and analgesics as well as decrease recovery time and duration of hospitalization, but more research is needed for these outcomes.We could not draw any conclusions regarding the effect of music interventions on immunologic functioning, coping, resilience or communication outcomes because either we could not pool the results of the studies that included these outcomes or we could only identify one trial. For spiritual well-being, we found no evidence of an effect in adolescents or young adults, and we could not draw any conclusions in adults.The majority of studies included in this review update presented a high risk of bias, and therefore the quality of evidence is low.

Authors' Conclusions: This systematic review indicates that music interventions may have beneficial effects on anxiety, pain, fatigue and QoL in people with cancer. Furthermore, music may have a small effect on heart rate, respiratory rate and blood pressure. Most trials were at high risk of bias and, therefore, these results need to be interpreted with caution.
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http://dx.doi.org/10.1002/14651858.CD006911.pub3DOI Listing
August 2016

Music interventions for mechanically ventilated patients.

Cochrane Database Syst Rev 2014 9(12):CD006902. Epub 2014 Dec 9.

Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, 1601 Cherry Street, room 7112, Philadelphia, PA, 19102, USA.

Background: Mechanical ventilation often causes major distress and anxiety in patients. The sensation of breathlessness, frequent suctioning, inability to talk, uncertainty regarding surroundings or condition, discomfort, isolation from others, and fear contribute to high levels of anxiety. Side effects of analgesia and sedation may lead to the prolongation of mechanical ventilation and, subsequently, to a longer length of hospitalization and increased cost. Therefore, non-pharmacological interventions should be considered for anxiety and stress management. Music interventions have been used to reduce anxiety and distress and improve physiological functioning in medical patients; however, their efficacy for mechanically ventilated patients needs to be evaluated. This review was originally published in 2010 and was updated in 2014.

Objectives: To update the previously published review that examined the effects of music therapy or music medicine interventions (as defined by the authors) on anxiety and other outcomes in mechanically ventilated patients. Specifically, the following objectives are addressed in this review.1. To conduct a meta-analysis to compare the effects of participation in standard care combined with music therapy or music medicine interventions with standard care alone.2. To compare the effects of patient-selected music with researcher-selected music.3. To compare the effects of different types of music interventions (e.g., music therapy versus music medicine).

Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 2), MEDLINE (1950 to March 2014), CINAHL (1980 to March 2014), EMBASE (1980 to March 2014), PsycINFO (1967 to March 2014), LILACS (1982 to March 2014), Science Citation Index (1980 to March 2014), www.musictherapyworld.net (1 March 2008) (database is no longer functional), CAIRSS for Music (to March 2014), Proquest Digital Dissertations (1980 to March 2014), ClinicalTrials.gov (2000 to March 2014), Current Controlled Trials (1998 to March 2014), the National Research Register (2000 to September 2007), and NIH CRISP (all to March 2014). We handsearched music therapy journals and reference lists, and contacted relevant experts to identify unpublished manuscripts. There was no language restriction. The original search was performed in January 2010.

Selection Criteria: We included all randomized and quasi-randomized controlled trials that compared music interventions and standard care with standard care alone for mechanically ventilated patients.

Data Collection And Analysis: Two review authors independently extracted the data and assessed the methodological quality of included studies. We contacted authors to obtain missing data where needed. Where possible, results for continuous outcomes were presented in meta-analyses using mean differences and standardized mean differences. Post-test scores were used. In cases of significant baseline difference, we used change scores. For dichotomous outcomes, we presented the results as risk ratios.

Main Results: We identified six new trials for this update. In total, the evidence for this review rests on 14 trials (805 participants). Music listening was the main intervention used, and 13 of the studies did not include a trained music therapist. Results indicated that music listening may be beneficial for anxiety reduction in mechanically ventilated patients. Specifically, music listening resulted, on average, in an anxiety reduction that was 1.11 standard deviation units greater (95% CI -1.75 to -0.47, P = 0.0006) than in the standard care group. This is considered a large and clinically significant effect. Findings indicated that listening to music consistently reduced respiratory rate and systolic blood pressure, suggesting a relaxation response. Furthermore, one large-scale study reported greater reductions in sedative and analgesic intake in the music listening group compared to the control group, and two other studies reported trends for reduction in sedative and analgesic intake for the music group. One study found significantly higher sedation scores in the music listening group compared to the control group.No strong evidence was found for reduction in diastolic blood pressure and mean arterial pressure. Furthermore, inconsistent results were found for reduction in heart rate with seven studies reporting greater heart rate reductions in the music listening group and one study a slightly greater reduction in the control group. Music listening did not improve oxygen saturation levels.Four studies examined the effects of music listening on hormone levels but the results were mixed and no conclusions could be drawn.No strong evidence was found for an effect of music listening on mortality rate but this evidence rested on only two trials.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 the music intervention is compared to another treatment intervention. Because of the high risk of bias, these results need to be interpreted with caution.No studies could be found that examined the effects of music interventions on quality of life, patient satisfaction, post-discharge outcomes, or cost-effectiveness. No adverse events were identified.

Authors' Conclusions: This updated systematic review indicates that music listening may have a beneficial effect on anxiety in mechanically ventilated patients. 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. The review furthermore suggests that music listening consistently reduces respiratory rate and systolic blood pressure. Finally, results indicate a possible beneficial impact on the consumption of sedatives and analgesics. Therefore, we conclude that music interventions may provide a viable anxiety management option to mechanically ventilated patients.
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http://dx.doi.org/10.1002/14651858.CD006902.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517146PMC
January 2015

WITHDRAWN: Music therapy for end-of-life care.

Cochrane Database Syst Rev 2014 Mar 17(3):CD007169. Epub 2014 Mar 17.

Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, 1505 Race Street, rm 1041, Philadelphia, PA, USA, 19102.

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http://dx.doi.org/10.1002/14651858.CD007169.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6564090PMC
March 2014

Music for stress and anxiety reduction in coronary heart disease patients.

Cochrane Database Syst Rev 2013 Dec 28(12):CD006577. Epub 2013 Dec 28.

Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, 1505 Race Street, rm 1041, Philadelphia, PA, USA, 19102.

Background: Individuals with coronary heart disease (CHD) often suffer from severe distress due to diagnosis, hospitalization, surgical procedures, uncertainty of outcome, fear of dying, doubts about progress in recovery, helplessness and loss of control. Such adverse effects put the cardiac patient at greater risk for complications, including sudden cardiac death. It is therefore of crucial importance that the care of people with CHD focuses on psychological as well as physiological needs.Music interventions have been used to reduce anxiety and distress and improve physiological functioning in medical patients; however its efficacy for people with CHD needs to be evaluated.

Objectives: To update the previously published review that examined the effects of music interventions with standard care versus standard care alone on psychological and physiological responses in persons with CHD.

Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (2012, Issue 10), MEDLINE (OvidSP, 1950 to October week 4 2012), EMBASE (OvidSP, 1974 to October week 5 2012), CINAHL (EBSCOhost, 1982 to 9 November 2012), PsycINFO (OvidSP, 1806 to October week 5 2012), LILACS (Virtual Health Library, 1982 to 15 November 2012), Social Science Citation Index (ISI, 1974 to 9 November 2012), a number of other databases, and clinical trial registers. We also conducted handsearching of journals and reference lists. We applied no language restrictions.

Selection Criteria: We included all randomized controlled trials and quasi-randomized trials that compared music interventions and standard care with standard care alone for persons with confirmed CHD.

Data Collection And Analysis: Two review authors independently extracted data and assessed methodological quality, seeking additional information from the trial researchers when necessary. We present results using weighted mean differences for outcomes measured by the same scale, and standardized mean differences for outcomes measured by different scales. We used post-intervention scores. In cases of significant baseline difference, we used change scores (changes from baseline).

Main Results: We identified four new trials for this update. In total, the evidence for this review rests on 26 trials (1369 participants). Listening to music was the main intervention used, and 23 of the studies did not include a trained music therapist.Results indicate that music interventions have a small beneficial effect on psychological distress in people with CHD and this effect is consistent across studies (MD = -1.26, 95% CI -2.30 to -0.22, P = 0.02, I² = 0%). Listening to music has a moderate effect on anxiety in people with CHD; however results were inconsistent across studies (SMD = -0.70, 95% CI -1.17 to -0.22, P = 0.004, I² = 77%). Studies that used music interventions in people with myocardial infarction found more consistent anxiety-reducing effects of music, with an average anxiety reduction of 5.87 units on a 20 to 80 point score range (95% CI -7.99 to -3.75, P < 0.00001, I² = 53%). Furthermore, studies that used patient-selected music resulted in greater anxiety-reducing effects that were consistent across studies (SMD = -0.89, 95% CI -1.42 to -0.36, P = 0.001, I² = 48%). Findings indicate that listening to music reduces heart rate (MD = -3.40, 95% CI -6.12 to -0.69, P = 0.01), respiratory rate (MD = -2.50, 95% CI -3.61 to -1.39, P < 0.00001) and systolic blood pressure (MD = -5.52 mmHg, 95% CI - 7.43 to -3.60, P < 0.00001). Studies that included two or more music sessions led to a small and consistent pain-reducing effect (SMD = -0.27, 95% CI -0.55 to -0.00, P = 0.05). The results also suggest that listening to music may improve patients' quality of sleep following a cardiac procedure or surgery (SMD = 0.91, 95% CI 0.03 to 1.79, P = 0.04).We found no strong evidence for heart rate variability and depression. Only one study considered hormone levels and quality of life as an outcome variable. A small number of studies pointed to a possible beneficial effect of music on opioid intake after cardiac procedures or surgery, but more research is needed to strengthen this evidence.

Authors' Conclusions: This systematic review indicates that listening to music may have a beneficial effect on anxiety in persons with CHD, especially those with a myocardial infarction. Anxiety-reducing effects appear to be greatest when people are given a choice of which music to listen to.Furthermore, listening to music may have a beneficial effect on systolic blood pressure, heart rate, respiratory rate, quality of sleep and pain in persons with CHD. However, the clinical significance of these findings is unclear. Since many of the studies are at high risk of bias, these findings need to be interpreted with caution. More research is needed into the effects of music interventions offered by a trained music therapist.
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http://dx.doi.org/10.1002/14651858.CD006577.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8454043PMC
December 2013

Music interventions for preoperative anxiety.

Cochrane Database Syst Rev 2013 Jun 6(6):CD006908. Epub 2013 Jun 6.

Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA.

Background: 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.

Objectives: To examine the effects of music interventions with standard care versus standard care alone on preoperative anxiety in surgical patients.

Search Methods: 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.

Selection Criteria: 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.

Data Collection And Analysis: 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.

Main Results: 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.

Authors' Conclusions: 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.
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June 2013

Dance/movement therapy for improving psychological and physical outcomes in cancer patients.

Cochrane Database Syst Rev 2011 Oct 5(10):CD007103. Epub 2011 Oct 5.

Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, 1505 Race Street, rm 1041, Philadelphia, PA, USA, 19102.

Background: Current cancer care increasingly incorporates psychosocial interventions. Cancer patients use dance/movement therapy to learn to accept and reconnect with their bodies, build new self-confidence, enhance self-expression, address feelings of isolation, depression, anger and fear and to strengthen personal resources.

Objectives: To compare the effects of dance/movement therapy and standard care with standard care alone or standard care and other interventions in patients with cancer.

Search Strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, International Bibliography of Theatre and Dance, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials and the National Research Register (all to March 2011). We handsearched dance/movement therapy and related topics journals, reviewed reference lists and contacted experts. There was no language restriction.

Selection Criteria: We included all randomized and quasi-randomized controlled trials of dance/movement therapy interventions for improving psychological and physical outcomes in patients with cancer.

Data Collection And Analysis: Two review authors independently extracted the data and assessed the methodological quality. Results were presented using standardized mean differences.

Main Results: We included two studies with a total of 68 participants. No evidence was found for an effect of dance/movement therapy on body image in women with breast cancer. The data of one study with moderate risk of bias suggested that dance/movement therapy had a large beneficial effect on participants' quality of life (QoL). The second trial reported a large beneficial effect on fatigue. However, this trial was at high risk of bias. The individual studies did not find support for an effect of dance/movement therapy on mood, distress,and mental health. It is unclear whether this was due to ineffectiveness of the treatment or limited power of the trials. Finally, the results of one study did not find evidence for an effect of dance/movement therapy on shoulder range of motion (ROM) or arm circumference in women who underwent a lumpectomy or breast surgery. However, this was likely due to large within-group variability for shoulder ROM and a limited number of participants with lymphedema.

Authors' Conclusions: We did not find support for an effect of dance/movement therapy on body image. The findings of one study suggest that dance/movement therapy may have a beneficial effect on QoL. However, the limited number of studies prevents us from drawing conclusions concerning the effects of dance/movement therapy on psychological and physical outcomes in cancer patients.
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October 2011

Music interventions for improving psychological and physical outcomes in cancer patients.

Cochrane Database Syst Rev 2011 Aug 10(8):CD006911. Epub 2011 Aug 10.

Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, 1505 Race Street, rm 1041, Philadelphia, PA, USA, 19102.

Background: Having cancer may result in extensive emotional, physical and social suffering. Music interventions have been used to alleviate symptoms and treatment side effects in cancer patients.

Objectives: To compare the effects of music therapy or music medicine interventions and standard care with standard care alone, or standard care and other interventions in patients with cancer.

Search Strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 10), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, www.musictherapyworld.net, CAIRSS, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, and the National Research Register. All databases were searched from their start date to September 2010. We handsearched music therapy journals and reference lists and contacted experts. There was no language restriction.

Selection Criteria: We included all randomized controlled trials (RCTs) and quasi-randomized trials of music interventions for improving psychological and physical outcomes in patients with cancer. Participants undergoing biopsy and aspiration for diagnostic purposes were excluded.

Data Collection And Analysis: Two review authors independently extracted the data and assessed the risk of bias. 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 difference, we used change scores.

Main Results: We included 30 trials with a total of 1891 participants. We included music therapy interventions, offered by trained music therapists, as well as listening to pre-recorded music, offered by medical staff. The results suggest that music interventions may have a beneficial effect on anxiety in people with cancer, with a reported average anxiety reduction of 11.20 units (95% confidence interval (CI) -19.59 to -2.82, P = 0.009) on the STAI-S scale and -0.61 standardized units (95% CI -0.97 to -0.26, P = 0.0007) on other anxiety scales. Results also suggested a positive impact on mood (standardised mean difference (SMD) = 0.42, 95% CI 0.03 to 0.81, P = 0.03), but no support was found for depression.Music interventions may lead to small reductions in heart rate, respiratory rate, and blood pressure. A moderate pain-reducing effect was found (SMD = -0.59, 95% CI -0.92 to -0.27, P = 0.0003), but no strong evidence was found for enhancement of fatigue or physical status. The pooled estimate of two trials suggested a beneficial effect of music therapy on patients' quality of life (QoL) (SMD = 1.02, 95% CI 0.58 to 1.47, P = 0.00001).No conclusions could be drawn regarding the effect of music interventions on distress, body image, oxygen saturation level, immunologic functioning, spirituality, and communication outcomes.Seventeen trials used listening to pre-recorded music and 13 trials used music therapy interventions that actively engaged the patients. Not all studies included the same outcomes and due to the small number of studies per outcome, we could not compare the effectiveness of music medicine interventions with that of music therapy interventions.

Authors' Conclusions: This systematic review indicates that music interventions may have beneficial effects on anxiety, pain, mood, and QoL in people with cancer. Furthermore, music may have a small effect on heart rate, respiratory rate, and blood pressure. Most trials were at high risk of bias and, therefore, these results need to be interpreted with caution.
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http://dx.doi.org/10.1002/14651858.CD006911.pub2DOI Listing
August 2011

Music interventions for mechanically ventilated patients.

Cochrane Database Syst Rev 2010 Dec 8(12):CD006902. Epub 2010 Dec 8.

The Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, 2001 N 13 Street, Philadelphia, PA, USA, 19122.

Background: Mechanical ventilation often causes major distress and anxiety in patients. Music interventions have been used to reduce anxiety and distress and improve physiological functioning in medical patients; however its efficacy for mechanically ventilated patients needs to be evaluated.

Objectives: To examine the effects of music interventions with standard care versus standard care alone on anxiety and physiological responses in mechanically ventilated patients.

Search Strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1), MEDLINE, CINAHL, AMED, EMBASE, PsycINFO, LILACS, Science Citation Index, www.musictherapyworld.net, CAIRSS for Music, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the National Research Register, and NIH CRISP (all to January 2010). We handsearched music therapy journals and reference lists and contacted relevant experts to identify unpublished manuscripts. There was no language restriction.

Selection Criteria: We included all randomized and quasi-randomized controlled trials that compared music interventions and standard care with standard care alone for mechanically ventilated patients.

Data Collection And Analysis: Two authors independently extracted the data and assessed the methodological quality. Additional information was sought from the trial researchers, when necessary. Results were presented using mean differences for outcomes measured by the same scale and standardized mean differences for outcomes measured by different scales. Post-test scores were used. In cases of significant baseline difference, we used change scores.

Main Results: We included eight trials (213 participants). Music listening was the main intervention used, and seven of the studies did not include a trained music therapist. Results indicated that music listening may be beneficial for anxiety reduction in mechanically ventilated patients; however, these results need to be interpreted with caution due to the small sample size. Findings indicated that listening to music consistently reduced heart rate and respiratory rate, suggesting a relaxation response. No strong evidence was found for blood pressure reduction.Music listening did not improve oxygen saturation level.No studies could be found that examined the effects of music interventions on quality of life, patient satisfaction, post-discharge outcomes, mortality, or cost-effectiveness.

Authors' Conclusions: Music listening may have a beneficial effect on heart rate, respiratory rate, and anxiety in mechanically ventilated patients. However, the quality of the evidence is not strong. Most studies examined the effects of listening to pre-recorded music. More research is needed on the effects of music offered by a trained music therapist.
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http://dx.doi.org/10.1002/14651858.CD006902.pub2DOI Listing
December 2010

Music therapy for acquired brain injury.

Cochrane Database Syst Rev 2010 Jul 7(7):CD006787. Epub 2010 Jul 7.

The Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, Presser Hall, 2001 North 13 Street, Philadelphia, USA.

Background: Acquired brain injury (ABI) can result in impairments in motor function, language, cognition, sensory processing and emotional disturbances. This may severely reduce a survivor's quality of life. Music therapy has been used in rehabilitation to stimulate brain functions involved in movement, cognition, speech, emotions and sensory perceptions. A systematic review is needed to gauge the efficacy of music therapy as a rehabilitation intervention for people with ABI.

Objectives: To examine the effects of music therapy with standard care versus standard care alone or standard care combined with other therapies on gait, upper extremity function, communication, mood and emotions, social skills, pain, behavioral outcomes, activities of daily living and adverse events.

Search Strategy: We searched the Cochrane Stroke Group Trials Register (February 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2009), MEDLINE (July 2009), EMBASE (August 2009), CINAHL (March 2010), PsycINFO (July 2009), LILACS (August 2009), AMED (August 2009) and Science Citation Index (August 2009). We handsearched music therapy journals and conference proceedings, searched dissertation and specialist music databases, trials and research registers, reference lists, and contacted experts and music therapy associations. There was no language restriction.

Selection Criteria: Randomized and quasi-randomized controlled trials that compared music therapy interventions and standard care with standard care alone or combined with other therapies for people older than 16 years of age who had acquired brain damage of a non-degenerative nature and were participating in treatment programs offered in hospital, outpatient or community settings.

Data Collection And Analysis: Two review authors independently assessed methodological quality and extracted data. We present results using mean differences (using post-test scores) as all outcomes were measured with the same scale.

Main Results: We included seven studies (184 participants). The results suggest that rhythmic auditory stimulation (RAS) may be beneficial for improving gait parameters in stroke patients, including gait velocity, cadence, stride length and gait symmetry. These results were based on two studies that received a low risk of bias score. There were insufficient data to examine the effect of music therapy on other outcomes.

Authors' Conclusions: RAS may be beneficial for gait improvement in people with stroke. These results are encouraging, but more RCTs are needed before recommendations can be made for clinical practice. More research is needed to examine the effects of music therapy on other outcomes in people with ABI.
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http://dx.doi.org/10.1002/14651858.CD006787.pub2DOI Listing
July 2010

Music therapy for end-of-life care.

Cochrane Database Syst Rev 2010 Jan 20(1):CD007169. Epub 2010 Jan 20.

The Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, Presser Hall, 2001 North 13 Street, Philadelphia, USA.

Background: Music therapy in end-of-life care aims to improve a person's quality of life by helping relieve symptoms, addressing psychological needs, offering support, facilitating communication, and meeting spiritual needs. In addition, music therapists assist family and caregivers with coping, communication, and grief/bereavement.

Objectives: To examine effects of music therapy with standard care versus standard care alone or standard care combined with other therapies on psychological, physiological, and social responses in end-of-life care.

Search Strategy: We searched CENTRAL, MEDLINE, CINAHL, EMBASE, PSYCINFO, LILACS, CancerLit, Science Citation Index, www.musictherapyworld.de, CAIRSS for Music, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, and the National Research Register to September 2009. We handsearched music therapy journals and reference lists, and contacted experts to identify unpublished manuscripts. There was no language restriction.

Selection Criteria: We included all randomized and quasi-randomized controlled trials that compared music interventions and standard care with standard care alone or combined with other therapies in any care setting with a diagnosis of advanced life-limiting illness being treated with palliative intent and with a life expectancy of less than two years.

Data Collection And Analysis: Data were extracted, and methodological quality was assessed, independently by review authors. Additional information was sought from study authors when necessary. Results are presented using weighted mean differences for outcomes measured by the same scale and standardized mean differences for outcomes measured by different scales. Posttest scores were used. In cases of statistically significant baseline difference, we used change scores.

Main Results: Five studies (175 participants) were included. There is insufficient evidence of high quality to support the effect of music therapy on quality of life of people in end-of-life care. Given the limited number of studies and small sample sizes, more research is needed.No strong evidence was found for the effect of music therapy on pain or anxiety.These results were based on two small studies. There were insufficient data to examine the effect of music therapy on other physical, psychological, or social outcomes.

Authors' Conclusions: A limited number of studies suggest there may be a benefit of music therapy on the quality of life of people in end-of-life care. However, the results stem from studies with a high risk of bias. More research is needed.
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http://dx.doi.org/10.1002/14651858.CD007169.pub2DOI Listing
January 2010

Music for stress and anxiety reduction in coronary heart disease patients.

Cochrane Database Syst Rev 2009 Apr 15(2):CD006577. Epub 2009 Apr 15.

Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, Presser Hall, 2001 North 13 Street, Philadelphia, USA.

Background: Individuals with coronary heart disease (CHD) often suffer from severe distress putting them at greater risk for complications. Music interventions have been used to reduce anxiety and distress and improve physiological functioning in medical patients, however its efficacy for CHD patients needs to be evaluated.

Objectives: To examine the effects of music interventions with standard care versus standard care alone on psychological and physiological responses in persons with CHD.

Search Strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, PSYCINFO, LILACS, Science Citation Index, www.musictherapyworld.net, CAIRSS for Music, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, and the National Research Register (all to May 2008). We handsearched music therapy journals and reference lists, and contacted relevant experts to identify unpublished manuscripts. There was no language restriction.

Selection Criteria: We included all randomized controlled trials that compared music interventions and standard care with standard care alone for persons with CHD.

Data Collection And Analysis: Data were extracted, and methodological quality was assessed, independently by the two reviewers. Additional information was sought from the trial researchers when necessary. Results are presented using weighted mean differences for outcomes measured by the same scale and standardized mean differences for outcomes measured by different scales. Posttest scores were used. In cases of significant baseline difference, we used change scores.

Main Results: Twenty-three trials (1461 participants) were included. Music listening was the main intervention used, and 21 of the studies did not include a trained music therapist.Results indicated that music listening has a moderate effect on anxiety in patients with CHD, however results were inconsistent across studies. This review did not find strong evidence for reduction of psychological distress. Findings indicated that listening to music reduces heart rate, respiratory rate and blood pressure. Studies that included two or more music sessions led to a small and consistent pain-reducing effect.No strong evidence was found for peripheral skin temperature. None of the studies considered hormone levels and only one study considered quality of life as an outcome variable.

Authors' Conclusions: Music listening may have a beneficial effect on blood pressure, heart rate, respiratory rate, anxiety, and pain in persons with CHD. However, the quality of the evidence is not strong and the clinical significance unclear.Most studies examined the effects of listening to pre-recorded music. More research is needed on the effects of music offered by a trained music therapist.
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http://dx.doi.org/10.1002/14651858.CD006577.pub2DOI Listing
April 2009

Predictive factors in the quality of life of cancer inpatients.

J Psychosoc Oncol 2008 ;26(4):75-90

Temple University, Philadelphia, PA 19122, USA.

The purpose of the study was to determine whether sense of coherence (SOC), and demographic variables (age, gender, race, education, length of illness) predict quality of life (QOL) in cancer inpatients. SOC is the extent to which one finds life comprehensible, manageable, and meaningful. Participants were 49 inpatients (66% female) with various forms of cancer, mostly African American (71%), with a mean age of 54.5 years. The mean QOLS of cancer inpatients (84.6) was lower than a healthy population (90.0), however, their mean item scores indicated that they are mostly satisfied with most areas of QOL except for active forms of past-time and health. The mean SOC score (133.8) was also lower than other groups; however without appropriate norms, it cannot be concluded that cancer inpatients have a weak SOC. Multiple regressions showed that SOC was a significant predictor of QOL, and that the demographic variables were not predictive of QOL, except when combined with SOC. All findings may be limited by demographics of the sample (race, gender, age, severity of illness), and the inability of cross-sectional investigations to determine causality.
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http://dx.doi.org/10.1080/07347330802359602DOI Listing
April 2009

Predictors of quality of life in hospitalized cardiac patients.

J Health Psychol 2008 Nov;13(8):982-7

Temple University, Philadelphia, PA 19122, USA.

This cross-sectional investigation examined relationships between Sense of Coherence (SOC), age, gender, race, education, length of illness, and Quality of Life (QOLS) in 121 hospitalized cardiac patients (mean age 61.7 years), varying in condition and treatment regimen. QOLS scores were relatively good; SOC scores were slightly lower than other groups. SOC predicted QOLS alone, and in conjunction with age, gender, race, length of illness, and education, which did not predict QOLS separately. Thus, an important interdisciplinary goal is to help cardiac patients perceive life as comprehensible, manageable, and meaningful (as measured by SOC), as this greatly influences Quality of Life.
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http://dx.doi.org/10.1177/1359105308097960DOI Listing
November 2008

The sense of coherence in hospitalized cardiac and cancer patients.

J Holist Nurs 2008 Dec 11;26(4):286-94; discussion 295-6. Epub 2008 May 11.

Temple University, Philadelphia, PA 19122, USA.

The sense of coherence (SOC) is a measure of one's global orientation toward the world; it is the extent to which one perceives life as comprehensible, manageable, and meaningful. The study assesses the SOC of cardiac and cancer inpatients, and examines whether age, gender, race, education, and length of illness predict SOC. Participants comprise 172 patients (84 women, 88 men) at an urban hospital in the Northeastern United States, 122 with cardiac conditions and 50 with cancer. The mean age is 59.8. Results show that the SOC of cardiac and cancer patients is slightly lower than the general population. There are no differences in SOC between cardiac and cancer patients. Multiple regression shows that age and length of illness predict SOC (R=.26, R2=.07, p=.002); however because of the small effect size and collinearity, their exact contributions need further study. SOC does not vary according to gender, race, or education.
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http://dx.doi.org/10.1177/0898010108317400DOI Listing
December 2008

Effects of music and music therapy on medical patients: a meta-analysis of the research and implications for the future.

Authors:
Cheryl Dileo

J Soc Integr Oncol 2006 ;4(2):67-70

Temple University, Philadelphia, PA, USA.

Although the literature examining the effects of music medicine or music therapy interventions in medical settings is both large and growing, this literature is difficult to summarize because of of its diversity. The current article reports the results of a recent meta-analysis of 183 studies across 11 medical specialty areas with 40 categories of outcome variables. Emphasized are results for patients with cancer, those who are terminally ill, and patients with human immunodeficiency virus. Meta-analysis results revealed significantly greater effect sizes for outcomes of music therapy versus music medicine interventions, and significant and homogeneous size effects for several outcome variables, including pain, well-being, mood, and nausea/vomiting. Suggestions for future research are provided.
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http://dx.doi.org/10.2310/7200.2006.002DOI Listing
June 2009
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