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Study flow diagram for the updated review.
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Figure 1

Study flow diagram for the updated review.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

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

Funnel plot of comparison: 1 Music therapy versus control, outcome: 1.1 Gait velocity [metres/min].
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Figure 4

Funnel plot of comparison: 1 Music therapy versus control, outcome: 1.1 Gait velocity [metres/min].

Comparison 1 Music therapy versus control, Outcome 1 Gait velocity.
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Analysis 1.1

Comparison 1 Music therapy versus control, Outcome 1 Gait velocity.

Comparison 1 Music therapy versus control, Outcome 2 Gait velocity ‐ interventionist.
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Analysis 1.2

Comparison 1 Music therapy versus control, Outcome 2 Gait velocity ‐ interventionist.

Comparison 1 Music therapy versus control, Outcome 3 Gait velocity ‐ music type.
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Analysis 1.3

Comparison 1 Music therapy versus control, Outcome 3 Gait velocity ‐ music type.

Comparison 1 Music therapy versus control, Outcome 4 Stride length (affected side).
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Analysis 1.4

Comparison 1 Music therapy versus control, Outcome 4 Stride length (affected side).

Comparison 1 Music therapy versus control, Outcome 5 Stride length (affected side) ‐ music type.
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Analysis 1.5

Comparison 1 Music therapy versus control, Outcome 5 Stride length (affected side) ‐ music type.

Comparison 1 Music therapy versus control, Outcome 6 Stride length (unaffected side) [metres].
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Analysis 1.6

Comparison 1 Music therapy versus control, Outcome 6 Stride length (unaffected side) [metres].

Comparison 1 Music therapy versus control, Outcome 7 Stride length (unspecified) [metres].
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Analysis 1.7

Comparison 1 Music therapy versus control, Outcome 7 Stride length (unspecified) [metres].

Comparison 1 Music therapy versus control, Outcome 8 Gait cadence.
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Analysis 1.8

Comparison 1 Music therapy versus control, Outcome 8 Gait cadence.

Comparison 1 Music therapy versus control, Outcome 9 Gait cadence ‐ interventionist.
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Analysis 1.9

Comparison 1 Music therapy versus control, Outcome 9 Gait cadence ‐ interventionist.

Comparison 1 Music therapy versus control, Outcome 10 Gait cadence ‐ music type.
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Analysis 1.10

Comparison 1 Music therapy versus control, Outcome 10 Gait cadence ‐ music type.

Comparison 1 Music therapy versus control, Outcome 11 Stride symmetry.
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Analysis 1.11

Comparison 1 Music therapy versus control, Outcome 11 Stride symmetry.

Comparison 1 Music therapy versus control, Outcome 12 General gait.
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Analysis 1.12

Comparison 1 Music therapy versus control, Outcome 12 General gait.

Comparison 1 Music therapy versus control, Outcome 13 Balance.
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Analysis 1.13

Comparison 1 Music therapy versus control, Outcome 13 Balance.

Comparison 1 Music therapy versus control, Outcome 14 Upper extremity functioning (general).
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Analysis 1.14

Comparison 1 Music therapy versus control, Outcome 14 Upper extremity functioning (general).

Comparison 1 Music therapy versus control, Outcome 15 Upper extremity functioning ‐ time.
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Analysis 1.15

Comparison 1 Music therapy versus control, Outcome 15 Upper extremity functioning ‐ time.

Comparison 1 Music therapy versus control, Outcome 16 Range of motion ‐ shoulder flexion.
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Analysis 1.16

Comparison 1 Music therapy versus control, Outcome 16 Range of motion ‐ shoulder flexion.

Comparison 1 Music therapy versus control, Outcome 17 Hand function.
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Analysis 1.17

Comparison 1 Music therapy versus control, Outcome 17 Hand function.

Comparison 1 Music therapy versus control, Outcome 18 Upper limb strength.
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Analysis 1.18

Comparison 1 Music therapy versus control, Outcome 18 Upper limb strength.

Comparison 1 Music therapy versus control, Outcome 19 Manual dexterity.
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Analysis 1.19

Comparison 1 Music therapy versus control, Outcome 19 Manual dexterity.

Comparison 1 Music therapy versus control, Outcome 20 Overall communication.
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Analysis 1.20

Comparison 1 Music therapy versus control, Outcome 20 Overall communication.

Comparison 1 Music therapy versus control, Outcome 21 Naming.
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Analysis 1.21

Comparison 1 Music therapy versus control, Outcome 21 Naming.

Comparison 1 Music therapy versus control, Outcome 22 Repetition.
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Analysis 1.22

Comparison 1 Music therapy versus control, Outcome 22 Repetition.

Comparison 1 Music therapy versus control, Outcome 23 Memory.
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Analysis 1.23

Comparison 1 Music therapy versus control, Outcome 23 Memory.

Comparison 1 Music therapy versus control, Outcome 24 Attention.
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Analysis 1.24

Comparison 1 Music therapy versus control, Outcome 24 Attention.

Comparison 1 Music therapy versus control, Outcome 25 Quality of life.
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Analysis 1.25

Comparison 1 Music therapy versus control, Outcome 25 Quality of life.

Summary of findings for the main comparison. Music compared with standard care for acquired brain injury

Music compared with standard care for acquired brain injury

Patient or population: acquired brain injury
Setting: outpatient
Intervention: music interventions
Comparison: control

Outcomes

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Gait velocity
assessed with: metres/minute

The mean gait velocity in the intervention group was 11.34 metres more (8.4 more to 14.28 more).

268
(9 RCTs)

⊕⊕⊕⊝
MODERATE 1, 2, 3, 4

Stride length (affected side)
assessed with: metres

The mean stride length (affected side) in the intervention group was 0.12 metres more (0.04 more to 0.2 more).

129
(5 RCTs)

⊕⊕⊕⊝
MODERATE 1, 2, 5, 6

Gait cadence
assessed with: steps/minute

The mean gait cadence in the intervention group was 10.77 steps/minute more (4.36 more to 17.18 more).

223
(7 RCTs)

⊕⊕⊝⊝
LOW 1, 2, 4, 7

Stride symmetry

The mean stride symmetry in the intervention group was 0.94 standard deviations more (0.32 fewer to 2.2 more).

139
(3 RCTs)

⊕⊕⊝⊝
LOW 2, 6, 8, 9

General upper extremity functioning assessed with: Fugl‐Meyer Assessment

The mean general upper extremity functioning in the intervention group was 3.56 units higher (0.88 lower to 8 higher).

194
(5 RCTs)

⊕⊝⊝⊝
VERY LOW 1, 2, 4, 6, 10

Overall communication

The mean overall communication in the intervention group was 0.75 standard deviations more (0.11 more to 1.39 more).

67
(3 RCTs)

⊕⊝⊝⊝
VERY LOW 4, 11

Quality of life

assessed with: Stroke Specific Quality of Life Scale

The mean quality of life in the intervention group was 0.89 standard deviations more (0.32 more to 1.46 more).

53
(2 RCTs)

⊕⊕⊝⊝
LOW 2, 4, 11

CI: confidence interval; RCT: randomised controlled trial

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1Most studies were rated as at unclear or high risk of bias
2All point estimates favour the music interventions, although the magnitude of the effect differs across studies
3Results were inconsistent across studies, as evidenced by I2 = 61%
4Wide confidence interval; however, this is due to the fact that some studies reported very large beneficial effects
5Results were inconsistent across studies, as evidenced by I2 = 80%
6Wide confidence interval
7Results were inconsistent across studies, as evidenced by I2 = 83%
8One study was rated as at low, one as at unclear, and one as at high risk of bias
9Results were inconsistent across studies, as evidenced by I2 = 90%
10Results were inconsistent across studies, as evidenced by I2 = 85%
11All studies were at high risk of bias

Figures and Tables -
Summary of findings for the main comparison. Music compared with standard care for acquired brain injury
Comparison 1. Music therapy versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Gait velocity Show forest plot

9

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 All studies

9

268

Mean Difference (IV, Random, 95% CI)

11.34 [8.40, 14.28]

1.2 Adequate randomisation

7

228

Mean Difference (IV, Random, 95% CI)

10.79 [7.23, 14.35]

2 Gait velocity ‐ interventionist Show forest plot

9

268

Mean Difference (IV, Random, 95% CI)

11.34 [8.40, 14.28]

2.1 Music therapist

3

128

Mean Difference (IV, Random, 95% CI)

14.76 [13.84, 15.69]

2.2 Non‐music therapist

6

140

Mean Difference (IV, Random, 95% CI)

8.48 [5.16, 11.80]

3 Gait velocity ‐ music type Show forest plot

9

268

Mean Difference (IV, Random, 95% CI)

11.34 [8.40, 14.28]

3.1 Music

5

173

Mean Difference (IV, Random, 95% CI)

14.69 [13.77, 15.61]

3.2 Auditory stimulation (no music)

4

95

Mean Difference (IV, Random, 95% CI)

7.70 [3.03, 12.38]

4 Stride length (affected side) Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 All studies

5

129

Mean Difference (IV, Random, 95% CI)

0.12 [0.04, 0.20]

4.2 Adequate randomisation

3

89

Mean Difference (IV, Random, 95% CI)

0.08 [0.05, 0.11]

5 Stride length (affected side) ‐ music type Show forest plot

5

129

Mean Difference (IV, Random, 95% CI)

0.12 [0.04, 0.20]

5.1 Music

2

50

Mean Difference (IV, Random, 95% CI)

0.08 [0.05, 0.12]

5.2 Auditory stimulation (no music)

3

79

Mean Difference (IV, Random, 95% CI)

0.14 [0.02, 0.25]

6 Stride length (unaffected side) [metres] Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 All studies

4

99

Mean Difference (IV, Random, 95% CI)

0.11 [0.01, 0.22]

6.2 Adequate randomisation

2

59

Mean Difference (IV, Random, 95% CI)

0.06 [0.01, 0.12]

7 Stride length (unspecified) [metres] Show forest plot

3

186

Mean Difference (IV, Random, 95% CI)

0.16 [‐0.01, 0.33]

8 Gait cadence Show forest plot

7

Mean Difference (IV, Random, 95% CI)

Subtotals only

8.1 all studies

7

223

Mean Difference (IV, Random, 95% CI)

10.77 [4.36, 17.18]

8.2 Adequate randomisation

6

203

Mean Difference (IV, Random, 95% CI)

10.80 [4.05, 17.56]

9 Gait cadence ‐ interventionist Show forest plot

7

223

Mean Difference (IV, Random, 95% CI)

10.77 [4.36, 17.18]

9.1 Music therapist

3

128

Mean Difference (IV, Random, 95% CI)

11.51 [‐2.57, 25.60]

9.2 Non‐music therapist

4

95

Mean Difference (IV, Random, 95% CI)

7.65 [4.43, 10.86]

10 Gait cadence ‐ music type Show forest plot

7

223

Mean Difference (IV, Random, 95% CI)

10.77 [4.36, 17.18]

10.1 Music

4

148

Mean Difference (IV, Random, 95% CI)

11.34 [‐1.05, 23.74]

10.2 Auditory stimulus (no music)

3

75

Mean Difference (IV, Random, 95% CI)

7.58 [4.33, 10.83]

11 Stride symmetry Show forest plot

3

139

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

0.94 [‐0.32, 2.20]

12 General gait Show forest plot

2

48

Mean Difference (IV, Random, 95% CI)

7.67 [5.67, 9.67]

13 Balance Show forest plot

3

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

Subtotals only

13.1 All studies

3

54

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

0.31 [‐0.48, 1.09]

13.2 Adequate randomisation

2

34

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

0.13 [‐1.10, 1.37]

14 Upper extremity functioning (general) Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

14.1 All studies

5

194

Mean Difference (IV, Random, 95% CI)

3.56 [‐0.88, 8.00]

14.2 Adequate randomisation

3

156

Mean Difference (IV, Random, 95% CI)

0.89 [‐2.33, 4.12]

15 Upper extremity functioning ‐ time Show forest plot

2

122

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

‐1.08 [‐1.69, ‐0.47]

16 Range of motion ‐ shoulder flexion Show forest plot

2

53

Mean Difference (IV, Random, 95% CI)

9.81 [‐12.71, 32.33]

17 Hand function Show forest plot

2

113

Mean Difference (IV, Random, 95% CI)

0.32 [‐0.91, 1.54]

18 Upper limb strength Show forest plot

2

113

Mean Difference (IV, Random, 95% CI)

6.03 [‐2.52, 14.59]

19 Manual dexterity Show forest plot

2

74

Mean Difference (IV, Random, 95% CI)

0.47 [‐1.08, 2.01]

20 Overall communication Show forest plot

3

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

Subtotals only

20.1 All studies

3

67

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

0.75 [0.11, 1.39]

20.2 Adequate randomisation

2

54

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

0.52 [‐0.03, 1.07]

21 Naming Show forest plot

2

35

Mean Difference (IV, Random, 95% CI)

9.79 [1.37, 18.21]

22 Repetition Show forest plot

2

35

Mean Difference (IV, Random, 95% CI)

8.90 [3.25, 14.55]

23 Memory Show forest plot

2

42

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

0.33 [‐0.29, 0.95]

24 Attention Show forest plot

2

39

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

0.30 [‐0.34, 0.94]

25 Quality of life Show forest plot

2

53

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

0.89 [0.32, 1.46]

Figures and Tables -
Comparison 1. Music therapy versus control