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Study flow diagram (all searches)
Figures and Tables -
Figure 1

Study flow diagram (all searches)

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 1 Global state: No clinically important overall improvement (as rated by trialists).
Figures and Tables -
Analysis 1.1

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 1 Global state: No clinically important overall improvement (as rated by trialists).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 2 Mental state: General ‐ 1a. Average endpoint score (PANSS, high score = poor).
Figures and Tables -
Analysis 1.2

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 2 Mental state: General ‐ 1a. Average endpoint score (PANSS, high score = poor).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 3 Mental state: General ‐ 1b. Average endpoint score (BPRS, high score = poor).
Figures and Tables -
Analysis 1.3

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 3 Mental state: General ‐ 1b. Average endpoint score (BPRS, high score = poor).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 4 Mental state: Specific ‐ 2. Negative symptoms ‐ average endpoint score (SANS, high score = poor).
Figures and Tables -
Analysis 1.4

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 4 Mental state: Specific ‐ 2. Negative symptoms ‐ average endpoint score (SANS, high score = poor).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 5 Mental state: Specific ‐ 3a. Depression ‐ average endpoint score (SDS, high score = poor).
Figures and Tables -
Analysis 1.5

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 5 Mental state: Specific ‐ 3a. Depression ‐ average endpoint score (SDS, high score = poor).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 6 Mental state: Specific ‐ 3b. Depression ‐ average endpoint score (Ham‐D, high score = poor).
Figures and Tables -
Analysis 1.6

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 6 Mental state: Specific ‐ 3b. Depression ‐ average endpoint score (Ham‐D, high score = poor).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 7 Mental state: Specific ‐ 4. Anxiety ‐ average endpoint score (SAS, high score = poor).
Figures and Tables -
Analysis 1.7

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 7 Mental state: Specific ‐ 4. Anxiety ‐ average endpoint score (SAS, high score = poor).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 8 Leaving the study early.
Figures and Tables -
Analysis 1.8

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 8 Leaving the study early.

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 9 General functioning: Average endpoint score (GAF, high score = good).
Figures and Tables -
Analysis 1.9

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 9 General functioning: Average endpoint score (GAF, high score = good).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 10 Social functioning: Average endpoint score (SDSI, high score = poor).
Figures and Tables -
Analysis 1.10

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 10 Social functioning: Average endpoint score (SDSI, high score = poor).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 11 Behaviour: 1. Positive behaviour ‐ average endpoint score (NOSIE, high score = poor).
Figures and Tables -
Analysis 1.11

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 11 Behaviour: 1. Positive behaviour ‐ average endpoint score (NOSIE, high score = poor).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 12 Behaviour: 2. Negative behaviour ‐ average endpoint score (NOSIE, high score = poor).
Figures and Tables -
Analysis 1.12

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 12 Behaviour: 2. Negative behaviour ‐ average endpoint score (NOSIE, high score = poor).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 13 Cognitive functioning: 1. Attention ‐ average endpoint score (PASAT, high score = good).
Figures and Tables -
Analysis 1.13

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 13 Cognitive functioning: 1. Attention ‐ average endpoint score (PASAT, high score = good).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 14 Cognitive functioning: 2. Vigilance and attention ‐ average endpoint score (CCPT, high score = good).
Figures and Tables -
Analysis 1.14

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 14 Cognitive functioning: 2. Vigilance and attention ‐ average endpoint score (CCPT, high score = good).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 15 Cognitive functioning: 3. Memory ‐ average endpoint score (WMS, high score = good).
Figures and Tables -
Analysis 1.15

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 15 Cognitive functioning: 3. Memory ‐ average endpoint score (WMS, high score = good).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 16 Cognitive functioning: 4. Abstract thinking ‐ average endpoint score (BCST, high score = good) ).
Figures and Tables -
Analysis 1.16

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 16 Cognitive functioning: 4. Abstract thinking ‐ average endpoint score (BCST, high score = good) ).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 17 Patient satisfaction: Average endpoint score (CSQ, high score = good).
Figures and Tables -
Analysis 1.17

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 17 Patient satisfaction: Average endpoint score (CSQ, high score = good).

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 18 Quality of life: Average endpoint score (SPG, high score = good).
Figures and Tables -
Analysis 1.18

Comparison 1 Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months), Outcome 18 Quality of life: Average endpoint score (SPG, high score = good).

Summary of findings for the main comparison. MUSIC THERAPY versus STANDARD CARE for people with schizophrenia and schizophrenia‐like disorders

MUSIC THERAPY versus STANDARD CARE for people with schizophrenia and schizophrenia‐like disorders

Patient or population: people with schizophrenia and schizophrenia‐like disorders
Settings:
Intervention: MUSIC THERAPY versus STANDARD CARE

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

MUSIC THERAPY versus STANDARD CARE

Mental state: Negative symptoms
SANS
Follow‐up: 1‐3 months

The mean Mental state: Negative symptoms in the intervention groups was
0.74 standard deviations lower
(1 to 0.47 lower)

240
(4 studies)

⊕⊕⊕⊕
high1,2

SMD ‐0.74 (‐1 to ‐0.47)

Social functioning
SDSI
Follow‐up: 3 months

The mean Social functioning in the intervention groups was
0.78 standard deviations lower
(1.27 to 0.28 lower)

70
(1 study)

⊕⊕⊕⊕
high2,3

SMD ‐0.78 (‐1.27 to ‐0.28)

Global state: No clinically important overall improvement
as rated by trialists
Follow‐up: 3 months

Study population

RR 0.1
(0.03 to 0.31)

72
(1 study)

⊕⊕⊕⊕
high3,4

710 per 1000

71 per 1000
(21 to 220)

Medium risk population

710 per 1000

71 per 1000
(21 to 220)

General mental state
PANSS
Follow‐up: 3 months

The mean General mental state in the intervention groups was
0.36 standard deviations lower
(0.84 lower to 0.12 higher)

69
(1 study)

⊕⊕⊕⊕
high

SMD ‐0.36 (‐0.84 to 0.12)

General mental state
BPRS
Follow‐up: 1.5‐3 months

The mean General mental state in the intervention groups was
0.73 standard deviations lower
(1.16 to 0.31 lower)

100
(2 studies)

⊕⊕⊕⊝
moderate1,2,5

SMD ‐0.73 (‐1.16 to ‐0.31)

General functioning
GAF
Follow‐up: 3 months

The mean General functioning in the intervention groups was
0.05 standard deviations lower
(0.53 lower to 0.43 higher)

69
(1 study)

⊕⊕⊕⊝
moderate3

SMD ‐0.05 (‐0.53 to 0.43)

Quality of life
SPG
Follow‐up: 1 months

The mean Quality of life in the intervention groups was
0.05 standard deviations higher
(0.66 lower to 0.75 higher)

31
(1 study)

⊕⊕⊕⊝
moderate3

SMD 0.05 (‐0.66 to 0.75)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Limitations in the designs such as poorly reported randomisation and blinding, as well as less‐well defined music therapy.
2 The effect was in the large range according to Cohen 1988.
3 Imprecision ‐ only one study reported results on this outcome.
4 Very large effect based on direct evidence with no major threats to validity.
5 Inconsistency ‐ Heterogeneity between studies was high and significant.

Figures and Tables -
Summary of findings for the main comparison. MUSIC THERAPY versus STANDARD CARE for people with schizophrenia and schizophrenia‐like disorders
Table 1. Music therapeutic approach: Further characteristics of included studies

No. of
sessions
(offered/
received)

Adequate
method

Adequate
training

Modality
(active/
receptive/
both)

Form of therapy

Therapy
process
(fixed
structure/
process‐
oriented)

Improvisation

Playing and/or singing pre‐
composed
music

Songwriting

Listening
to music

Verbal
discussion/reflection
of therapy process

Others

Ceccato 2009

Max. 16 (1/week over 4 months)

Yes

Yes

Receptive

No

No

No

Central

No

No

Fixed structure

He 2005

Max. 30
(5/week over 6 weeks)

Yes

Unclear

Receptive

No

No

No

Central

Yes

Dancing, reading poems with music background

Unclear

Li 2007

Max. 30
(5/week over 6 weeks)

Yes

Unclear

Receptive

No

No

No

Central

Yes

No

Unclear

Talwar 2006

Max. 12 sessions (1/week over 3 months)

Yes

Yes

Active

Central

Yes

No

No

Central

No

Process‐
oriented

Tang 1994

19 sessions received

Yes

Unclear

Both

Yes

Yes

No

Central

Yes

No

Fixed structure

Ulrich 2007

7.5 sessions received

Yes

Yes

Active

Yes

Yes

No

No

Yes

No

Process‐
oriented

Wen 2005

Max. 30
(5/week over 6 weeks)

Yes

Unclear

Receptive

No

No

No

Central

Yes

Dancing

Unclear

Yang 1998

Max. 78 (6/week over 3 months)

Yes

Yes

Both

Yes

Yes

No

Yes

Yes

Learning musicology

Unclear

Adequate music therapeutic method: A "yes" indicates that the method applied considered both musical experiences and relational aspects as dynamic forces of change in music therapy. A "no" indicates that relational aspects are missing.
Adequate music therapy training: A "yes" indicates that the persons conducting the music therapy have attended an appropriate music therapy training. A "no" indicates that the person conducting the music therapy had limited or even no music therapy training.

Figures and Tables -
Table 1. Music therapeutic approach: Further characteristics of included studies
Comparison 1. Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Global state: No clinically important overall improvement (as rated by trialists) Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

0.10 [0.03, 0.31]

1.1 20 or more sessions

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

0.10 [0.03, 0.31]

2 Mental state: General ‐ 1a. Average endpoint score (PANSS, high score = poor) Show forest plot

1

69

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.36 [‐0.84, 0.12]

2.1 less than 20 sessions

1

69

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.36 [‐0.84, 0.12]

3 Mental state: General ‐ 1b. Average endpoint score (BPRS, high score = poor) Show forest plot

2

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 20 or more sessions

2

100

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.73 [‐1.16, ‐0.31]

4 Mental state: Specific ‐ 2. Negative symptoms ‐ average endpoint score (SANS, high score = poor) Show forest plot

4

240

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.74 [‐1.00, ‐0.47]

4.1 less than 20 sessions

2

110

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.79 [‐1.19, ‐0.40]

4.2 20 or more sessions

2

130

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.69 [‐1.05, ‐0.33]

5 Mental state: Specific ‐ 3a. Depression ‐ average endpoint score (SDS, high score = poor) Show forest plot

2

90

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.63 [‐1.06, ‐0.21]

5.1 20 or more sessions

2

90

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.63 [‐1.06, ‐0.21]

6 Mental state: Specific ‐ 3b. Depression ‐ average endpoint score (Ham‐D, high score = poor) Show forest plot

1

30

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.52 [‐1.25, 0.21]

6.1 20 or more sessions

1

30

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.52 [‐1.25, 0.21]

7 Mental state: Specific ‐ 4. Anxiety ‐ average endpoint score (SAS, high score = poor) Show forest plot

1

60

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.61 [‐1.13, ‐0.09]

7.1 20 or more sessions

1

60

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.61 [‐1.13, ‐0.09]

8 Leaving the study early Show forest plot

8

493

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.38, 2.78]

8.1 less than 20 sessions

4

261

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.36, 2.99]

8.2 20 or more sessions

4

232

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.06, 15.45]

9 General functioning: Average endpoint score (GAF, high score = good) Show forest plot

1

69

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.05 [‐0.53, 0.43]

9.1 less than 20 sessions

1

69

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.05 [‐0.53, 0.43]

10 Social functioning: Average endpoint score (SDSI, high score = poor) Show forest plot

1

70

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.78 [‐1.27, ‐0.28]

10.1 20 or more sessions

1

70

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.78 [‐1.27, ‐0.28]

11 Behaviour: 1. Positive behaviour ‐ average endpoint score (NOSIE, high score = poor) Show forest plot

1

60

Std. Mean Difference (IV, Fixed, 95% CI)

‐1.24 [‐1.79, ‐0.68]

11.1 20 or more sessions

1

60

Std. Mean Difference (IV, Fixed, 95% CI)

‐1.24 [‐1.79, ‐0.68]

12 Behaviour: 2. Negative behaviour ‐ average endpoint score (NOSIE, high score = poor) Show forest plot

1

60

Std. Mean Difference (IV, Fixed, 95% CI)

‐2.22 [‐2.87, ‐1.57]

12.1 20 or more sessions

1

60

Std. Mean Difference (IV, Fixed, 95% CI)

‐2.22 [‐2.87, ‐1.57]

13 Cognitive functioning: 1. Attention ‐ average endpoint score (PASAT, high score = good) Show forest plot

1

67

Std. Mean Difference (IV, Fixed, 95% CI)

0.72 [0.22, 1.21]

13.1 less than 20 sessions

1

67

Std. Mean Difference (IV, Fixed, 95% CI)

0.72 [0.22, 1.21]

14 Cognitive functioning: 2. Vigilance and attention ‐ average endpoint score (CCPT, high score = good) Show forest plot

1

67

Std. Mean Difference (IV, Fixed, 95% CI)

0.25 [‐0.23, 0.74]

14.1 less than 20 sessions

1

67

Std. Mean Difference (IV, Fixed, 95% CI)

0.25 [‐0.23, 0.74]

15 Cognitive functioning: 3. Memory ‐ average endpoint score (WMS, high score = good) Show forest plot

1

67

Std. Mean Difference (IV, Fixed, 95% CI)

0.43 [‐0.06, 0.92]

15.1 less than 20 sessions

1

67

Std. Mean Difference (IV, Fixed, 95% CI)

0.43 [‐0.06, 0.92]

16 Cognitive functioning: 4. Abstract thinking ‐ average endpoint score (BCST, high score = good) ) Show forest plot

1

67

Std. Mean Difference (IV, Fixed, 95% CI)

0.09 [‐0.39, 0.58]

16.1 less than 20 sessions

1

67

Std. Mean Difference (IV, Fixed, 95% CI)

0.09 [‐0.39, 0.58]

17 Patient satisfaction: Average endpoint score (CSQ, high score = good) Show forest plot

1

69

Std. Mean Difference (IV, Fixed, 95% CI)

0.32 [‐0.16, 0.80]

17.1 less than 20 sessions

1

69

Std. Mean Difference (IV, Fixed, 95% CI)

0.32 [‐0.16, 0.80]

18 Quality of life: Average endpoint score (SPG, high score = good) Show forest plot

1

31

Std. Mean Difference (IV, Fixed, 95% CI)

0.05 [‐0.66, 0.75]

18.1 less than 20 sessions

1

31

Std. Mean Difference (IV, Fixed, 95% CI)

0.05 [‐0.66, 0.75]

Figures and Tables -
Comparison 1. Music therapy versus standard care (all outcomes short‐term ‐ 1 to 3 months)