| Study ID | Methods | Participants | Interventions | Outcomes | Notes |
| Allen 2001 | RCT; 2 parallel groups. | DESCRIPTION: 40 day‐patients undergoing ophthalmic surgery in New York, USA.
NUMBERS: 20 patients in each group.
AGE, mean (range): Music group = 74 (51‐87), Control group = 77 (64‐88) years old.
GENDER (male/female): Music group = 5/15, Control group = 5/15.
ETHNICITY: not described.
INCLUSION CRITERIA: Ambulatory surgical patients scheduled on the rosters of two ophthalmic surgeons.
EXCLUSION CRITERIA: none described. | MUSIC GROUP: Patient choice of 22 types of music (e.g. soft hits, classical guitar, chamber music, folk music, popular singers from 1940's and 1950's), played via headphones throughout pre‐operative, surgical, and post‐operative periods.
CONTROL GROUP: Standard care. | PHYSIOLOGICAL: HR and BP measured via Propaq Monitor (Protocol Systems, Inc., Beaverton, OR) every 5 minutes during pre‐operative, surgical, and post‐operative period. Averages for the last three recorded measures within each time period were used for analysis in the paper. For purposes of review, data is extracted for the mean post‐operative scores only.
COGNITIVE APPRAISAL: Two Likert scales used to measure questions on coping and stress, validity unclear. Not extracted for review. | |
| Andrada 2004 | RCT; 2 parallel groups. | DESCRIPTION: 118 out‐patients undergoing colonoscopy in a Digestive Endoscopy Unit in Spain.
NUMBERS: Music group = 63 patients, Control group = 55 patients.
AGE, mean (SD): Music group = 46 (14.22), Control = 49 (13.88).
GENDER (Male/Female): Music group = 31/32, Control group = 28/27.
ETHNICITY: not specified.
INCLUSION CRITERIA: 18‐75 years old, scheduled for ambulatory examination.
EXCLUSION CRITERIA: anacusis or significant bilateral hearing loss, senile dementia, cognitive disorders, acute or chronic confusional syndromes, treatment with anxiolytic medication in 72 hours prior to examination. | MUSIC GROUP: Series of classical tracks (e.g. Bach, Grieg, Mozart, Delibe, Faure, and Mendelssohn) played via headphones during procedure.
CONTROL GROUP: Wore headphones but did not receive music throughout the procedure. | ANXIETY: State anxiety measure pre and post procedure using the STAI; Reported as post ‐ pre difference with 95% CI.
ABNORMAL EVENTS: BP, capillary oxygen saturation, and HR were monitored using a Datex‐Ohmeda 3800 pulse oximeter and Nissei KTJ‐20 sphygmomanometer. Abnormal events arising from these parameters e.g. hypoxaemia, hypotension, hypertension, bradycardia, and tachycardia were recorded. | There were no significant differences between groups regarding abnormal events. This data has not been extracted for the review. |
| Argstatter 2006 | RCT; 3 parallel groups. | DESCRIPTION: 83 in‐patients undergoing cardiac catheterization in Germany.
NUMBERS: Music group = 28, Control group = 27, Coaching group excluded from review. There are some discrepancies as to reported numbers in the paper, which also states there were 28 people in the control group.
AGE, mean (SD) [range]: Music group = 65.8 (8.4) [49‐83], Control group = 67.5 (14.0) [28‐83].
GENDER (male/female): Music group = 16/12, Control group = 15/12.
ETHNICITY: not described.
INCLUSION CRITERIA: Patients were undergoing cardiac catheterization for the first or second time.
EXCLUSION CRITERIA: none described. | MUSIC GROUP: Music was played via headphones, which were worn half on so patients could still hear the medical personnel, during the cardiac catheterization. A music therapist was present only to control the volume. Music played was "Entspannung" [relaxation] by Markus Rummel, composed specially for relaxation.
CONTROL GROUP: Standard care. This group did not have the addition of a music therapist present during the cardiac catheterization.
COACHING GROUP: Excluded from review. | ANXIETY: Measured via the STAI before and after cardiac catheterization. Unclear whether post measurements were taken on the following day after cardiac catheterization.
PHYSIOLOGICAL: BP and Pulse are reported as pre‐ and post‐measurements. Unclear how measurements were obtained.
SUBJECTIVE MUSIC QUESTIONNAIRE: excluded from review. | |
| Ayoub 2005 | RCT; 3 parallel groups. | DESCRIPTION: 90 patients undergoing urological surgery with spinal anaesthesia and PCS in Connecticut (USA) and Beirut (Lebonon).
NUMBERS: Music group = 31, White noise = 31, Operating room noise = 28.
AGE, mean (SD): Music group = 55 (12), White noise = 54 (12), OR noise = 57 (10) years old.
GENDER (male/female): Music group = 28/3, White noise = 29/2, OR noise = 24/4.
ETHNICITY: Unclear, although 36 recruited in USA, and 54 recruited in Lebonon.
INCLUSION CRITERIA: 18‐60 years old; ASA status I‐III (although Table1 states music group had a classification of V).
EXCLUSION CRITERIA: On psychiatric medications; a history of affective disorders. | MUSIC GROUP: Patients brought own music from home.
WHITE NOISE: Delivered by SoundSpa Acoustic Relaxation Machine.
OR NOISE: Delivered by mini‐amplifier speaker via occlusive headphones. This Radio Shack (R) has mini‐microphone for voice acquisition.
All groups wore occlusive headphones. | PROPOFOL REQUIREMENTS: Recorded as mg/kg/min and % of patients not using any propofol. Unclear if data presented are the SDs, and if the data presented as mg/kg/min is based on the total N or % of patients who used propofol.
Observers Assessment of Alertness/Sedation Scale (OAA/S): Data not presented.
PACU LENGTH OF STAY. (not primary outcome)‐ unclear whether the numbers presented are mean and SD. | Data not extracted for meta‐analysis. |
| Bally 2003 | RCT; 2 parallel groups. | DESCRIPTION: 107 patients undergoing diagnostic coronary angiography or a percutaneous intervention procedure, in Ontario, Canada.
NUMBERS: Music group = 56 patients, Control group = 51 patients.
AGE, mean (SD): Music group = 59 (11), Control group = 58 (11).
GENDER (Male/Female): at enrolment: Music group = 34/24, Control group = 30/25.
ETHNICITY: not specified.
INCLUSION CRITERIA: 1st time diagnostic coronary angiography or a percutaneous intervention procedure, speak and read English, cognitively orientated.
EXCLUSION CRITERIA: major auditory deficits. | MUSIC GROUP: patient selected music (classical, soft rock, relaxation, country, own/other) played via headphones before, during, and after procedure, continued as the patient desired.
CONTROL GROUP: standard care (no music). | ANXIETY: State Anxiety via STAI pre and post procedure;
PAIN INTENSITY: measured via 100mm VAS pre and post procedure (data extracted);
PAIN RATING: measured via VRS pre and post procedure;
APICAL HR (bpm): measured via cardiac monitor;
BP (mm Hg): measured via pressure dynamometer and arterial pressure monitoring;
HR and BP were taken at 4 points: (1) baseline; (2) after sheath insertion; (3) end of procedure; (4) after procedure, before sheath removal. Not enough information provided for data extraction of HR and BP. | See Cepeda 2006 for details on music for pain relief. |
| Barnason 1995/1996 | RCT; 3 parallel groups. | DESCRIPTION: 96 in‐patients in the cardiovascular ICU and progressive care units having undergone elective coronary artery bypass grafting, in USA.
NUMBERS: Music group = 33, Music+video group = 29, Scheduled rest group = 34.
AGE, mean (SD): 67 (9.9) years old.
GENDER (male/female): 65/31.
ETHNICITY: White = 96 (100%)
INCLUSION CRITERIA: Orientated to person, time and place; speak and read English; 19 years or older; extubated within 12 hours of surgery; removal of intra‐aortic balloon pump within 12 hours of surgery.
EXCLUSION CRITERIA: Currently using one of the intervention techniques; major hearing deficit. | MUSIC GROUP: Choice of 5 tapes: 'Country Western Instrumental' or 'Fresh Aire' by Mannheim Steamroller, 'Winter into Spring' by George Winston, or 'Prelude' or 'Comfort Zone' by Steven Halpern. Played via headphones for 30 minutes.
MUSIC + VIDEO GROUP:
Barnason 1995 states:
Choice of 2 Steven Halpern tapes: 'Summer Wind' or 'Crystal Suite'. Each is 30 minutes of soft instrumental with visual imaging.
Zimmerman 1996 states:
Choice of three 30 minute videocassettes by Pioneer Artist ('Water's Path', 'Western Light', or 'Winter').
SCHEDULED REST: 30 minutes of rest in bed or chair, visitors and staff requested not to disturb.
2 x 30 min intervention periods during afternoons of post‐operative days 2 and 3. Lights dimmed. | Barnason 1995 reports:
STATE ANXIETY: measured using STAI at three time‐points: pre‐operatively, before intervention on 2nd post‐operative day, and after intervention on 3rd post‐operative day.
ANXIETY: taken using NRS before and after each intervention session.
PHYSIOLOGICAL: HR (bpm) and BP (mm Hg) taken using the Kendall BP Monitor (Model 8200)‐ not enough data presented for extraction.
MOOD: Measured using a NRS‐ not a validated outcome.
Zimmerman 1996 reports:
PAIN: Pain was measured with a 10‐point VRS before and after each session, and with the McGill Pain Questionnaire (scores are given for the subscales and the present pain index rating scale) administered once prior to the first session, and once after the second session.
SLEEP: Measured with the Richards‐Campbell Sleep Questionnaire (RSQ), administered between 7am and 9am on the third post‐operative day. | Data extracted for state anxiety (STAI measure).
Patients in the music group showed a significant improvement in mood after the 2nd intervention when controlling for pre‐intervention mood rating. No differences between groups were found for anxiety on either data collection tool. Physiological measures did not differ between groups, however there were significant differences over time (regardless of group), indicating a generalised relaxation response.
Authors conclude that although no intervention was overwhelmingly superior, all groups demonstrated a relaxation response. See Cepeda 2006 for details on music for pain relief. |
| Binnings 1987 | RCT; 2 parallel groups. | DESCRIPTION: 20 patients undergoing regional anaesthesia in North Carolina, USA.
NUMBERS: 10 patients in each group.
AGE: Not stated.
GENDER: Not stated.
ETHNICITY: Not stated.
INCLUSION CRITERIA: Patients scheduled for regional anaesthesia, 18‐65 years old.
EXCLUSION CRITERIA: Taking tranquilizers or psychoactive medication. | NATURE TAPES: choice of sounds of birds, the ocean, a lagoon, or deeply resonant chimes, played for the duration of the surgery.
CONTROL: standard care. | STATE ANXIETY: STAI administered pre‐operatively and one hour post‐operatively to calculate the change score.
SEDATION MEDICATION: amount of Methohexital (mg) and Fentanyl (cc) administered by the anaesthetist was recorded. The anaesthetist was instructed to administer as much sedation as needed for a safe and comfortable experience with regional anaesthesia. Data extracted for Fentanyl for analysis ( P < 0.025 for differences between groups for both medications in favour of nature sounds). | Scores given for state anxiety are outside of the normal range for this questionnaire (20‐80). Method of calculating scores is not described.
SDs calculated from t‐values presented for the difference in means between groups. |
| Blankfield 1995 | RCT; 3 parallel groups. | DESCRIPTION: 95 in‐patients undergoing coronary artery bypass (n = 92) or valvular heart surgery (n = 3) in Ohio, USA.
NUMBERS: Music group = 32, Control group = 29, therapeutic suggestions = 34.
AGE, mean (SD): Music group = 60 (10.4), Control group = 65 (7.8) years old.
GENDER (male/female): Music group = 23/9, Control group = 21/8.
ETHNICITY (White/other): Music group = 30/2, Control group = 27/2.
INCLUSION CRITERIA: All coronary artery bypass patients.
EXCLUSION CRITERIA: Impaired hearing, poor comprehension of English. | TAPED THERAPEUTIC SUGGESTIONS: excluded from review.
MUSIC GROUP: Listened to "Dreamflight II" by Herb Ernst intraoperatively and for 30 minutes twice daily during post‐operative period.
CONTROL GROUP: Listened to a blank tape intraoperatively (to blinded surgeon), and received no tape during the post‐operative period. | POST‐OPERATIVE STAY (days); Data extracted for analyses.
SURGICAL INTENSIVE CARE UNIT STAY (days); Data not entered into analyses as accounted for by postoperative stay score (no significant differences).
MORPHINE USAGE (mg);
MEPERIDINE USAGE (mg);
MORPHINE EQUIVELENTS (mg): combined morphine/meperidine usage, where the use of 10 mg of meperidine was considered equivalent to 1 mg morphine.
ORAL NARCOTICS (total number of pills);
DEPRESSION: 7‐item depression scale, unclear validity/reliability. Questionnaire given approximately one month after discharge.
ACTIVITIES OF DAILY LIVING (10‐item scale), Questionnaire given approximately one month after discharge;
CARDIAC SYMPTOM SCALE (7‐item scale), unclear validity/reliability. Questionnaire given approximately one month after discharge. | See Cepeda 2006 for details on music for pain relief. |
| Broscious 1999 | RCT: 3 parallel groups. | DESCRIPTION: 156 in‐patients undergoing chest tube removal after open heart surgery in Virginia, USA.
NUMBERS: Music group = 70 patients, White noise = 36 patients, Control group = 50 patients.
AGE, mean (SD): 66.35 (9.7) year old.
GENDER (male/female): Music group = 53/17, White noise = 22/14, Control group = 32/18.
ETHNICITY (White/Asian/Hispanic/Other): 152/1/1/2.
INCLUSION CRITERIA: Ability to read and understand English, haemodynamic stability, no prior untoward response to music.
EXCLUSION CRITERIA: Psychiatric history. | MUSIC GROUP: Patients preselected music they would prefer to hear from a library of 10 pre‐recorded music cassettes with no lyrics. Cassettes were produced by students in a music therapy programme under the supervision of a music therapist. Patients listened to the music via headphones for 10 minutes prior to and then during chest tube removal.
WHITE NOISE: Pre‐recorded tape selected by the investigator. Patients listened to the tape via headphones for 10 minutes prior to and then during chest tube removal.
CONTROL: Not explicit, presumably standard care with no headphones. | PAIN INTENSITY: Measured using a 10 cm NRS at 3 time points: (1) 10 minutes prior to chest tube removal, (2) immediately after chest tube removal, (3) 15 minutes after chest tube removal.
HR and BP: measured every 5 minutes from 10 minutes prior to chest tube removal to 15 minutes afterwards. Physiological measurements were taken with a Hewlett‐Packard Component Monitoring System or a DINAMAP. | Report states that 18 participants had missing physiological data. Unclear from which groups these belonged, so for purposes of data extraction, it has been assumed that 6 participants were missing from each group. See Cepeda 2006 for details on music for pain relief. |
| Buffum 2006 | RCT; 2 parallel groups. | DESCRIPTION: 170 pre‐operative patients to undergo vascular angiography in California, USA.
NUMBERS: Music group = 89, Control group = 81.
AGE, mean (SD): 66.8 (9.95) years old.
GENDER (male/female): 166/4.
ETHNICITY: not described.
INCLUSION CRITERIA: undergoing vascular angiography of the abdomen or lower extremities; 18 years or older; English speaking; read and write a 5th grade level; able to sign consent; interested in participating.
EXCLUSION CRITERIA: Documented diagnosis of active psychosis or dementia; unable to consent; could not listen to music for 15 minutes prior to procedure. | MUSIC GROUP: Selection of 5 categories (classical, jazz, rock, country western, easy listening), played via headphones for 15 minutes prior to angiography. Patients could continue to listen to music during the angiography after collection of outcomes.
CONTROL GROUP: 15 minute wait period. These participants were allowed to listen to music during the angiography after the study outcome measures had been taken. | ANXIETY: Measured via STAI before and after 15 minute study period.
VITAL SIGNS: Unclear how data collected. | |
| Cadigan 2001 | RCT; 2 parallel groups. | DESCRIPTION: 140 in‐patients in the cardiac units with intravascular sheaths or an intra‐aortic balloon pump (IABP) in place, in USA.
NUMBERS: Music group = 75 patients, Control group = 65 patients.
AGE, mean (SD): Music group = 62 (11.4), Control group = 62.5 (14).
GENDER (Male/Female): Music group = 56/19, Control group = 44/21.
ETHNICITY: not specified.
INCLUSION CRITERIA: read and speak English, haemodynamic stability, received an intravascular sheath or IABP.
EXCLUSION CRITERIA: psychiatric illness, hearing deficits (not enhanced with an assistive device), documented confusional state. | MUSIC GROUP: 30 minutes of music through headphones. Mixture of symphonic music and nature sounds selected by the researchers. Same music played to all those in the music group.
CONTROL GROUP: standard care. | PAIN PERCEPTION: measured via 10 mm VAS pre‐ and post‐intervention.
HR (bpm): determined from a 1 minute readout of electrocardiogram;
BP: measured via noninvasive automatic oscillometric BP cuff or transduced arterial wave form;
RR (breaths per minute): measured via auscultation with stethoscope over chest for 1 minute;
PERIPHERAL SKIN TEMPERATURE: taken from index finger with 'Dermatemp' hand‐held infrared thermographic scanner;
MOOD: measure by the Profile of Mood States (POMS) short form questionnaire. | See Cepeda 2006 for details on music for pain relief. |
| Cepeda 1998 | RCT; 2 parallel groups. | DESCRIPTION: 193 day‐patients undergoing lithotripsy for renal stones (America).
NUMBERS: Music group = 97, Control group = 96 patients.
AGE, mean (SD): Music group = 40.7 (12.1), Control group = 41.0 (11.4).
GENDER (male/female): Music group = 48/49, Control group = 47/49.
ETHNICITY: not described.
INCLUSION CRITERIA: 15‐65 years old, undergoing first lithotripsy for renal stones.
EXCLUSION CRITERIA: Serum creatinine exceeded 1.5 mg/dl. | MUSIC GROUP: Music of type preferred by patient played via headphones, starting 10 minutes prior to procedure and continuing until 10 minutes after lithotripsy is complete. Patients wore additional ear protectors to protect patients from the noise of the lithotriptor.
CONTROL GROUP: Wore headphones with ear protectors however the music (of patient preference) did not begin until the lithotripsy and study primary outcomes data collection had completed. Music was played for 10 minutes at the conclusion of the procedure. | PAIN INTENSITY: rated verbally every 5 minutes throughout the lithotripsy on a NRS (0‐10).
ALFENTANIL REQUIREMENT: "registered" (mg).
QUALITY OF ANALGESIA: rated by anaesthesiologist on a 4‐point scale (excellent to bad), 10 minutes after procedure conclusion.
SIDE EFFECTS: evaluated throughout procedure and in the PACU: respiratory depression, bradycardia, level of consciousness, nausea, pruritis.
PATIENT SATISFACTION WITH ANALGESIA: patient rated before leaving the PACU on a VRS, and indicated if they would accept same technique for future treatments. | See Cepeda 2006 for details on music for pain relief. |
| Chan 2003 | RCT; 2 parallel groups. | DESCRIPTION: 220 female out‐patients undergoing colposcopy in China.
NUMBERS: Music group = 112 patients, Control group = 108.
AGE, median (range): Music group = 40 (20‐61), Control group = 38.5 (19‐65).
GENDER: All patients were female.
ETHNICITY: All patients were Chinese.
INCLUSION CRITERIA: 18‐65 years old, presenting for initial colposcopy, read and understand Chinese.
EXCLUSION CRITERIA: previous experience of colposcopy, mental impairment, pregnant. | MUSIC GROUP: CD compilation of slow‐rhythm music (instrumental ballad). Patients could choose to listen to any song(s) within the compilation. Music played through speakers during the examination. Prior to onset of study women attending the clinic were surveyed on musical preferences to inform compilation disc.
CONTROL GROUP: standard care, no music. | ANXIETY: State anxiety via Chinese version of STAI measured pre and post colposcopy;
PAIN INTENSITY: measured via 10 cm VAS. | See Cepeda 2006 for details on music for pain relief. |
| Chan 2006 | RCT; 2 parallel groups. | DESCRIPTION: 43 in‐patients undergoing application of a C‐clamp (which applies pressure to stop bleeding when sheaths are removed after percutaneous coronary interventions), in an ICU, Hong Kong, China.
NUMBERS: Music group = 20, Control group = 23.
AGE: 32.6% of participants were 75+, age ranged from 35 upwards.
GENDER (male/female): Music group = 16/4, Control group = 15/8.
ETHNICITY: not described.
INCLUSION CRITERIA: Diagnosis of MI, acute coronary syndrome, or coronary artery disease; conscious and alert; able to communicate, read, and write; able to speak Cantonese.
EXCLUSION CRITERIA: hearing deficit; history of psychiatric illness; neurological disorders; dying; unable to give informed consent. | MUSIC GROUP: 3 choices of soft, slow music without lyrics (slow rhythmic songs, Chinese slow rhythmic music, Western slow rhythmic music). Music played via headphones during the application of the C‐clamp (approximately 45 minutes).
CONTROL GROUP: No music, standard care. | VITAL SIGNS: BP, HR, RR, and oxygen saturation, recorded at baseline, 15, 30, and 45 minutes via a bedside monitor.
PAIN: Measured via the Universal Pain Assessment Tool (a NRS). | Outcomes extracted for end time‐point only.
This paper states that missing values (unclear how many) were replaced with the group mean. It is unclear from the data presented if these are the raw values, or those that have been adjusted (which may potentially bias the results by lowering the variance and exaggerating group differences). For this reason we have removed this study in sensitivity analyses. See Cepeda 2006 for details on music for pain relief. |
| Chang 2005 | RCT; 2 parallel groups. | DESCRIPTION: 64 patients undergoing cesarean section in Taiwan.
NUMBERS: 32 patients per group.
AGE, mean (SD): Music group = 30.31 (4.16), Control group = 32.31 (4.48) years old.
GENDER: Female = 64 (100%) .
ETHNICITY: Taiwanese.
INCLUSION CRITERIA: Women scheduled to receive cesarean section; married, between 20 and 40 years old; pregnancies gone to term with planned cesarean births; underwent spinal or epidural anaesthesia; newborns normal singletons with an Apgar score >/= 7 at 5 minutes.
EXCLUSION CRITERIA: not stated. | MUSIC GROUP: Choice of western classical, new age, or Chinese religious music, played via headphones. Participants listened to music for at least 30 minutes from start of anaesthesia to end of surgery. Volume low enough to allow mutual conversation with the researcher.
CONTROL GROUP: Unaware they had not had the opportunity to listen to music. They received the researchers' attendance and casual conversation. | ANXIETY: measured via a 10 cm VAS, researcher filled it in after asking participant to indicate how they were feeling.
PHYSIOLOGICAL MEASURES: Oxygen saturation (measured via NONIN MODEL 9500 pulse oximeter), temperature of finger (measured via biofeedback system DT‐002), RR, pulse, and BP measured via Hewllett Packard 78352A.
BIRTH SATISFACTION: measured via the satisfaction of cesarean delivery scale (SCDS) designed for the present study. Data not extracted.
Anxiety & physiological measures taken pre‐surgery, post neonatal contact, and after completion of skin suture. Data extracted for end time‐points only. | |
| Chlan 1995 | RCT; 2 parallel groups. | DESCRIPTION: 20 in‐patients receiving mechanical ventilation in private patient room areas in critical care units in Midwest USA.
NUMBERS: Music group = 11, Control group = 9.
AGE, mean: Music group = 64.2, Control group = 55.7 years old.
GENDER (male/female): 13/7.
ETHNICITY: not described.
INCLUSION CRITERIA: mechanically ventilated patients; alert; mentally competent; haemodynamically stable; able to sign consent form; adequate hearing.
EXCLUSION CRITERIA: Documented mental incompetence; haemodynamically unstable; comatose; uncorrected impaired hearing. | MUSIC GROUP: Selection of classical music played for 30 minutes via headphones. Patients instructed to close eyes and concentrate on the music.
CONTROL GROUP: Wore headphones with no music. Instructed to close eyes and rest for 30 minutes.
For both groups lights were dimmed and/or doors closed. Experiment took place during late afternoon or early evening. | MOOD: Short‐form POMS.
PHYSIOLOGICAL: HR (bedside ECG monitor), RR (observation for 1 minute), Oxygen saturation (pulse oximetry with finger probe), airway pressure (dial on ventilator), and BP (indwelling arterial lines, automatic BP monitor, or mercury sphygmomanometer and stethoscope), were measured before, and at 5 minute intervals during and 5 minutes after the intervention for both groups. | No SDs are presented for the post‐intervention physiological outcomes. Significant differences were found for HR and RR in favour of music. Other variables did not differ significantly. |
| Chlan 1998 | RCT; 2 parallel groups. | DESCRIPTION: 54 in‐patients receiving mechanical ventilation in one of 4 Intensive Care Units, USA.
NUMBERS: 27 patients in each group.
AGE, mean (SD): Music group = 57.3 (14.5); Control = 56.8 (18.6).
GENDER (Male/Female): 22/32.
ETHNICITY (White/Black/Native American): 50/3/1.
INCLUSION CRITERIA: ventilator dependent, alert, mentally competent, adequate hearing, English as primary language.
EXCLUSION CRITERIA: receiving continuous intravenous sedation. | MUSIC GROUP: choice of non‐lyric tapes 60‐80 bpm, classical, new age, country western, religious, and easy listening (30 mins).
CONTROL GROUP: rest period (30 mins).
Both groups received an enhanced environment by closing the blinds, placing a "do not disturb" sign on door, dimming the lights, and instructed to lie quietly and close eyes. | ANXIETY: State anxiety via short form STAI (6 items);
RR (observation);
HR (bedside cardiac monitor).
Insufficient data for RR and HR data extraction. | Due to the lack of clarity over withdrawals and drop‐outs, it is unclear how many people were analysed in each group for the outcome anxiety. The degrees of freedom stated (49) suggests 51 observations were made, and we have assumed that N = 25 in the music group and N = 26 in the control group, based on the descriptions given for 3 of the withdrawals in the paper. |
| Chlan 2000 | RCT; 2 parallel groups. | DESCRIPTION: 64 out‐patients undergoing flexible sigmoidoscopy (FS) in Midwest USA.
NUMBERS: Music group = 30 patients; Control group = 34 patients.
AGE, mean (SD): Overall = 54.6 (11.5) years old.
GENDER (Male/Female):20/44
ETHNICITY (White/African‐American/Hispanic): 62/1/1.
INCLUSION CRITERIA: any adult out‐patient scheduled to undergo a nurse‐endoscopist performed screening FS, English as primary language, adequate or corrected hearing, mental competence.
EXCLUSION CRITERIA: mentally incompetent (i.e. Alzheimers), uncorrected hearing impairment, English not primary language. | MUSIC GROUP: choice of music (classical, country‐western, new‐age, easy listening, pop, rock, religious, jazz, era‐specific, motion picture soundtracks), played via headphones during FS procedure. Patients instructed to concentrate on music and that the investigator would meet with them afterwards to discuss their experiences.
CONTROL GROUP: routine care consisting of nurse‐endoscopist speaking to the patient at various times throughout the procedure. Patients were informed that the investigator will meet with them afterwards to discuss their experiences. | ANXIETY: State anxiety measured via STAI
DISCOMFORT: Intensity of discomfort measured via NRS (entered into review as pain scores).
SATISFACTION: Satisfaction measured via VRS
FUTURE COMPLIANCE: Perceived future compliance measured via VRS | |
| Chui 2003 | RCT; 2 parallel groups. | DESCRIPTION: 68 pre‐operative patients undergoing extracorporeal shock wave lithotripsy (ESWL) in Taiwan.
NUMBERS: Music group = 34 patients, Control group = 34 patients.
AGE (range): 23‐72 years old.
GENDER (male/female): 57/11.
ETHNICITY: not described.
INCLUSION CRITERIA: not described.
EXCLUSION CRITERIA: not described. | MUSIC GROUP: listened to natural music via headphones for 5 minutes prior to ESWL.
CONTROL GROUP: Headphones without music for 5 minutes.
All participants lay on the operating table and rested in the dark alone. Then experimental conditions were implemented and the outcome measures were taken, all prior to ESWL procedure. | BLOOD PRESSURE: Method of data collection unclear.
HEART RATE VARIABILITY: Measured via an electrocardiogram (ECG). A number of measures derived, including RR intervals, low frequency (LF) and high frequency (HF) bands, converted into total power (LF nu; HF nu) and the LF/HF ratio.
Heart rate variability data showed positive changes in favour of the music group. | |
| Colt 1999 | RCT; 2 parallel groups. | DESCRIPTION: 60 in‐patients and out‐patients undergoing flexible fibreoptic bronchoscopy (FB) in California, USA.
NUMBERS: Music group = 30 patients; Control group = 30 patients.
AGE, mean (SD): Music group = 49 (18); Control group = 56 (13) years.
GENDER (Male/Female): Music group = 20/10; Control group = 19/11.
ETHNICITY (Caucasian/Hispanic/Black/Asian): 37/11/10/2.
INCLUSION CRITERIA: All in‐patients and out‐patients referred for diagnostic FB.
EXCLUSION CRITERIA: under 18 years old, unable to speak and understand English, unable to give consent, in need of ICU hospitalisation, significantly hearing impaired, impaired mental status, receiving known anxiolytic or sedative medication. | MUSIC GROUP: "Relax" (Expansion Records, Manchester, UK) consisting of piano improvisations (60bpm), played via headphones during FB procedure.
CONTROL GROUP: silence whilst wearing headphones during FB procedure. | ANXIETY: State and Trait anxiety measure via STAI. | |
| Cooke 2005 | RCT; 3 parallel groups. | DESCRIPTION: 180 pre‐operative day patients scheduled for day surgery in Australia.
NUMBERS: 60 participants in each group.
AGE, median (range): Music group = 53 (19‐99), Placebo group = 58 (18‐83), Control group = 56 (18‐87) years old.
GENDER (male/female): 30/30 in each group.
ETHNICITY: not described.
INCLUSION CRITERIA: Day surgery patients.
EXCLUSION CRITERIA: < 18 years old; undergoing eye surgery requiring eye drops which could affect vision; had pre‐operative sedatives; did not like music; hearing‐impaired; difficulty wearing headphones; could not read and write English; had a pre‐operative waiting time anticipated as < 45 minutes. | MUSIC GROUP: Choice of classical, jazz, country & western, new age, easy‐listening, and "other" mostly by contemporary artists. Music played for 30 minutes via headphones.
PLACEBO GROUP: Patients wore headphones without any music for 30 minutes.
CONTROL GROUP: Routine care. | ANXIETY: State anxiety measured via STAI. | 95% Confidence Intervals are presented in the paper based on logarithmically transformed scores. Standard deviations were calculated by first back‐translating data to a log scale before utilising the CIs to estimate the SDs. Data entered into the review analysis are expressed as the natural log. |
| Cruise 1997 | RCT; 4 parallel groups. | DESCRIPTION: 121 patients undergoing elective cataract extraction in Canada.
NUMBERS: Music = 32, OR noise = 30, White noise = 29 (Relaxing Suggestions, N = 30, excluded from review).
AGE, mean: Music = 70.8, OR noise = 68.3, White noise = 73.6 years old.
GENDER (male/female): Music = 8/24, OR noise = 12/18, White noise = 12/17.
ETHNICITY: not described.
INCLUSION CRITERIA: none described.
EXCLUSION CRITERIA: On sedative or psychotropic drugs; hearing impairment. | MUSIC GROUP: Classical music accompanied by soothing sounds of nature, played via headphones intra‐operatively.
OR NOISE: Playback of a previously recorded cataract operation, played via headphones intra‐operatively.
WHITE NOISE: Played via headphones intra‐operatively.
RELAXING SUGGESTIONS: Excluded from review. | ANXIETY: Measured via STAI before and after surgery.
VITAL SIGNS: BP, HR, and RR recorded before and after the retrobulbar block, and at 15 minute intervals thereafter until procedure completion.
SATISFACTION: Unclear validity, not included in review. | Data reporting unclear. Cannot extract SDs.
No differences between groups are reported for anxiety, DBP, HR and RR.
SBP did differ between groups over time, where music and white noise groups increased more after the retrobulbar block than the OR noise group, and then the OR noise group decreased more over the course of the operation than both the music and white noise group. Exact differences between groups are unclear. |
| Daub 1988 | RCT; 3 parallel groups. | DESCIPTION: 90 pre‐operative in‐patients waiting for dental restoration surgery under general anaesthesia, or orthopedic surgery, in Germany.
NUMBERS: 30 patients in each group.
AGE: 15‐65 years old.
GENDER: not described.
ETHNICITY: not described.
INCLUSION CRITERIA: 15‐65 years old; German speaking (1st language).
EXCLUSION CRITERIA: Malignant diseases; expecting operations of uncertain outcome. | MUSIC GROUP: listened to 45 minutes of music pre‐operatively. Choice of music arranged the evening before surgery. 11 patients chose classical, 19 chose pop music.
NO MEDICATION: Patients received no premedication and no music.
MEDICATION: Received 1‐2 ml Thalamonal. Excluded from review. | ANXIETY: Measure via STAI and a tick‐box anxiety scale tailored for the clinic. There was a significant decrease in state anxiety from pre‐treatment to post‐treatment in the music group (change score = 2.2). There was no significant change in anxiety for the 'no medication' control group (change score = 0.633).
Other outcomes not included. | Not enough information for data extraction. |
| Davis‐Rollans 1987 | RCT; Cross‐over study. | DESCRIPTION: 24 in‐patients with MI (N = 12) and other cardiac conditions (N=12) in a Critical Care Unit, Ontario, Canada.
NUMBERS: Cross‐over study of 24 patients.
AGE, mean (range): 62 (45‐75) years old.
GENDER (male/female): 19/5.
ETHNICITY: not described.
INCLUSION CRITERIA: Willingness to listen to music; Asymptomatic for 6 hours prior to data collection; Stable vital signs; Physician's approval to participate.
EXCLUSION CRITERIA: Pace‐maker; Hearing deficit; Use of a ventilator; Asian or Middle Eastern cultural background [rationale: "tonal systems differ from that of Western (European) music"]. | MUSIC: 3 pieces each lasting approximately 12 minutes played in randomised Latin square design via headphones. a) Symphony no.6 by Beethoven; b) Eine Kleine Nachtmusik by Mozart; and c) The Moldau by Smetana.
CONTROL: ICU noise as heard through silent headphones.
Order of receiving conditions was randomised, each condition lasted 42 minutes. | PSYCHOLOGIC: Questionnaire not fully validated (content validity only). Not extracted for review.
PHYSIOLOGICAL: HR (median values used) and heart rhythm (clinical categorisation) measured via electrocardiography. RR measured via Brush‐Gould bellows pneumograph and Hewlett‐Packard 4 channel FM tape recorder.
Each session began with a 5 minute baseline data collection period. | Significant order effects for HR variability (P = 0.03) and heart rhythm (ectopy).
HR varied when different music pieces were played (P = 0.04) regardless of order.
Individual patient data presented for HR during music and control periods. Data extracted for review and paired t‐test reveals no significant difference between groups (MD = 0.847, 95% CI = ‐1.42, 3.11, P = 0.447), music and control significantly correlated (r = 0.942). Data entered with adjusted standard deviations.
No significant differences are reported for RR between music and control periods. |
| Domar 2005 | RCT; 3 parallel groups. | DESCRIPTION: 143 out‐patients (93 included in present review) undergoing screening mammography in a clinic of a tertiary care hospital in Massachusetts, USA.
NUMBERS: Music group = 47, Control group = 46 patients.
AGE, mean (SD): Music group = 51.7 (10.9), Control group = 53.1 (11.6).
GENDER: all patients were female.
ETHNICITY (white/black/other): Music group = 91/7/2, Control group = 80/13/7.
INCLUSION CRITERIA: Scheduled for screening mammography.
EXCLUSION CRITERIA: unable to read and speak English, current psychiatric diagnosis, brought own tape player and planned to listen to an audiotape during mammography, pain or anxiety medication taken before procedure. Additionally stated "women who have a history of breast cancer do not undergo screening, so they were not eligible for the study". | RELAXATION GROUP: excluded from review, as taped instructions constitute a psychological therapy.
MUSIC GROUP: choice of classical, jazz, or soft rock, played via headphones whilst in the waiting room and during the examination.
CONTROL GROUP: blank tape played via headphones, whilst in the waiting room and during the examination. | ANXIETY: recorded before and after study period using the STAI, and at the end of the study with a Likert scale (1‐10) asking to rate level of anxiety felt during the procedure.
PAIN: recorded after procedure using the McGil Pain Questionnaire, and a Likert scale (1‐10) asking to rate pain felt during the procedure. | Investigator identified a possible floor effect. See Cepeda 2006 for details on music for pain relief (this study is not yet included in Cepeda 2006). |
| Elliot 1994 | RCT; 3 parallel groups. | DESCRIPTION: 56 in‐patients with unstable angina pectoris or acute MI at coronary care unit in Australia.
NUMBERS: Music group = 19, Control group = 19, muscle relaxation not included in review.
AGE, average = 60.6 years old.
GENDER (male/female): 40/16.
ETHNICITY (Australian/Other): 47/9.
INCLUSION CRITERIA: Patients admitted to the coronary care unit with provisional medical diagnoses of unstable angina pectoris or acute MI.
EXCLUSION CRITERIA: none further described. | MUSIC GROUP: Received two or three 30‐minute sessions of light classical music (Bonny,Music Rx) played via headphones.
CONTROL GROUP: two or three sessions of 30 minutes uninterrupted rest.
MUSCLE RELAXATION: Excluded from review. | ANXIETY: Measured at pre and post test with three psychologic scales, 1) STAI, 2) Hospital Anxiety and Depression Scale, and 3) Linear Analogue Anxiety Scale (VAS). STAI scores extracted for review.
PHYSIOLOGICAL: HR (measured digitally by bedside cardiac monitors) and BP (measured via sphygmomanometer) were observed 7 times at the routine observation times in the coronary care unit (not directly before and after intervention period). | |
| Ezzone 1998 | RCT; 2 parallel groups. | DESCRIPTION: 33 in‐patients undergoing bone marrow transplant chemotherapy, in Columbus, USA.
NUMBERS: Music group = 16, Control group = 17.
AGE, median (range): Music group = 36.9 (21‐49), Control group = 40.3 (14‐61).
GENDER (male/female): Music group = 11/5, Control group = 8/9.
ETHNICITY: not described.
INCLUSION CRITERIA: Patients receiving treatment with autologous or allogeneic transplant; a preparative regimen consisting of busulfan and cyclophosphamide or busulfan, etoposide, and cyclophosphamide with all dosages calculated on body weight; the pharmacologic protocol for control of nausea and vomiting consisting of IV ondansetron 0.15 mg/kg every six hours around the clock starting 30 minutes before and continuing for 24 hours after the preparative regimen. Additional antiemetics were limited to IV lorazepam 1‐2 mg or promethazine 12.5‐25 mg every four to six hours as needed for breakthrough nausea and vomiting.
EXCLUSION CRITERA: none described. | MUSIC GROUP: Listened to 45 minute recording of self‐selected music via headphones at 6, 9, and 12 hours after the start of each infusion as an adjunct to antiemetic therapy. A variety of music selections was available and patients were encouraged to bring their favourite music.
CONTROL GROUP: Standard care. | NAUSEA: Measured on a VAS in the pictorial form of a thermometer (questionable validity).
Mean (range) at 8‐hour follow‐up, 1st dose of Cytoxan:
Music group = 50 (0‐90), Control group = 54.4 (0‐100)
Mean (range) at 8‐hour follow‐up, 2nd dose of Cytoxan:
Music group = 29.6 (0‐95), Control group = 59.3 (0‐100).
VOMITING: Instances of vomiting were defined as the oral expulsion of gastric contents or as retching, the act of vomiting without expulsion of gastric contents. For data analysis, the authors considered the occurrence of 5 instances of retching within one minute as a vomiting episode.
Mean (range) episodes at 8‐hour follow‐up, 1st dose:
Music group = 0.69 (0‐4), Control group = 1.73 (0‐6)
Mean (range) episodes at 8‐hour follow‐up, 2nd dose:
Music group = 0.31 (0‐2), Control group = 0.94 (0‐2). | Data not in sufficient detail for extraction.
The music group had significantly less nausea and vomiting than the control group (Mann‐Whitney U test, P < 0.017 for both comparisons). |
| Ferguson 2004 | RCT; 2 parallel groups. | DESCRIPTION: 11 patients undergoing range‐of‐motion exercises as part of acute care rehabilitation for burns, Virginia, USA.
NUMBERS: Music group = 5, Control group = 6.
AGE, mean (range, SD): Music group = 45.4 (22‐75, 19.3), Control group = 38.3 (18‐57, 16.3).
GENDER (male/female) %: Music group = 92/8, Control group = 46/54. (Note: Can not sensibly convert % to number of patients ‐data unclear)
ETHNICITY (African American/White) %: Music group = 58/42, Control group = 0/100
INCLUSION CRITERIA: English‐speaking; partial‐thickness or deeper burns crossing at least one major joint; scored 100% on a cognitive screening tool.
EXCLUSION CRITERIA: No further criteria described. | MUSIC GROUP: Choice of 6 cassette tapes (Lifescapes series) that met the guidelines for music in medical settings. Music was played during the range‐of‐motion exercises.
CONTROL GROUP: No music played during the range‐of‐motion exercises.
The number of repetitions and type of exercise (active, active‐assistive, or passive) were based on the needs of each patient. Both groups were treated in the patient's room with the door closed and "do not disturb" sign posted. Lights were turned on and the television was turned off. | PAIN: Measured via VAS before and after rehabilitation exercises. There was a statistically significant increase in pain from pre‐treatment to post‐treatment in both groups (P = 0.04). There was no significant difference between groups (P = 0.38).
ANXIETY: Measured via STAI before and after rehabilitation exercises. The mean pre‐treatment and post‐treatment state anxiety scores were greater for the control group (P = 0.04).
VITAL SIGNS: BP, HR, and RR measured before and after rehabilitation exercises using either the Hewlett‐Packard Component Monitoring System or the Dinamap 8100 Portable Vital Signs Monitor. There were no significant differences between groups (systolic BP: P = 0.30, diastolic BP: P = 0.84, HR: P = 0.29, RR: P = 0.54). RR did increase in both groups from baseline (P <0.01). | Data not in sufficient detail for extraction. See Cepeda 2006 for details on music for pain relief. |
| Gaberson 1991 | RCT (post‐test only); 3 parallel groups. | DESCRIPTION: 15 pre‐operative patients in the waiting room for elective same‐day surgery in Pittsburgh, USA.
NUMBERS: Music group = 5, Control group = 5, Humour group = 5 (excluded from review).
AGE (range): 23‐76 years old.
GENDER (male/female): 6/9.
ETHNICITY: not described.
INCLUSION CRITERIA: 21 years old and over; admitted for same‐day elective surgical procedures;
EXCLUSION CRITERIA: Can not speak, understand, and read English; Hearing loss; Surgery for diagnostic procedures; Taken anti‐anxiety medication with 24 hours of operation. | HUMOUR GROUP: excluded from review.
MUSIC GROUP: Listened to 'Omni Suite' by Steven Bergman (tranquil music) via headphones for 20 minutes in the waiting room.
CONTROL GROUP: Standard care. | ANXIETY: Measured via a VAS after the intervention period. | |
| Gaberson 1995 | RCT (post‐test only); 3 parallel groups. | DESCRIPTION: 46 pre‐operative patients scheduled for same‐day surgery in Pittsburgh, USA.
NUMBERS: Music group = 16 patients, Control group = 15 patients, Humour group = 15 patients (excluded from review);
AGE, mean (SD): Music group = 51.75 (17.18), Control group = 47.07 (19.07) years old.
GENDER (male/female): 19/27
ETHNICITY: not described.
INCLUSION CRITERIA: 21 years and older; scheduled for elective surgical procedures.
EXCLUSION CRITERIA: Can not speak, read, and understand English; Hearing loss; Undergoing diagnostic procedure; Taken medications with anti‐anxiety effects within past 24 hours; presenting with ear pathology. | HUMOUR GROUP: excluded from review.
MUSIC GROUP: listened to tranquil music via earphones for 20 minutes after admission to surgery unit and before scheduled procedure.
CONTROL GROUP: 20 minute waiting period (standard care). | ANXIETY: Measure post‐intervention via VAS. | |
| Ganidagli 2005 | RCT; 2 parallel groups. | DESCRIPTION: 50 pre‐operative patients to undergo septorhinoplastic surgery in Turkey.
NUMBERS: Music group = 25, Control group = 25 patients.
AGE, mean (SD): Music group = 31 (9), Control group = 29 (9) years old.
GENDER (male/female): Music group = 14/11, Control group = 15/10.
ETHNICITY: not described.
INCLUSION CRITERIA: ASA I‐II; 18‐60 years old; scheduled to undergo septorhinoplastic surgery.
EXCLUSION CRITERIA: 4 patients excluded as observer blinding unsuccessful due to technical problems with tape player. | MUSIC GROUP: Patients brought own CD or tape from home, those who forgot were provided with a 'suitable replacement', played via headphones during pre‐operative period, as patients were being sedated.
CONTROL GROUP: Blank tape/CD played via headphones during pre‐operative sedation period.
All patients asked to bring music from home in case they were allocated to the music group. | "modified" OAA/S: not included in review.
BI‐SPECTRAL INDEX (BIS): Time (seconds) to reach BIS value of 60 (hypnotic end point of anaesthesia). BIS values were monitored (A‐2000, Aspect Medical Systems Inc) and the average scores calculated at 10 minute intervals from baseline to 50 minutes. Data extracted for time to reach BIS 60 value (end‐point).
PROPOFOL: induction dose of propofol (mg) recorded.
Time to eyelash reflex: not included in review. | |
| Guo 2005 | RCT; 2 parallel groups. | DESCRIPTION: 93 in‐patients scheduled for laparoscope surgery, in Beijing, China.
NUMBERS: Music group = 48 patients; Control group = 45.
AGE, mean (SD) years: Music group = 40.90 (10.94); Control group = 40.69 (9.94).
GENDER (male/female): Music group = 20/28; Control group = 19/26.
ETHNICITY: Not stated.
INCLUSION CRITERIA: Consenting patients.
EXCLUSION CRITERIA: Hearing problems; cancer patients; no clear outcome from laparoscopy. | MUSIC GROUP: Choice of 6 types of music (Western classical; light; pop; folk; folksong; opera) with 30 minutes listening time. Patients listened to music via headphones 1‐2 hours before their operation, whilst lying in bed.
CONTROL GROUP: Had headphones with no music for 30 minutes 1‐2 hours prior to operation. | ANXIETY: Measured via STAI before and after intervention period.
BP, HR, GALVANIC SKIN RESPONSE: Measured before intervention, at 10 and 20 minutes after, and at 4 hours after. Unclear what time point the data in the table reflects.
SALIVA CORTISOL: Measured before and 2‐3 minutes after intervention. | |
| Harikumar 2006 | RCT; 2 parallel groups. | DESCRIPTION: 78 patients undergoing colonoscopy in Kerala, India.
NUMBERS: Music group = 38, Control group = 40
AGE: not described.
GENDER: not described.
ETHNICITY: not described.
INCLUSION CRITERIA: Scheduled for elective colonoscopy; 15‐60 years old.
EXCLUSION CRITERIA: Hard of hearing; overt or borderline psychiatric illness; cardiopulmonary morbidity. | MUSIC GROUP: Choice of 6 tapes played via headphones during colonoscopy. Selection of: popular film songs (based on carnatic classical ragas), classical music, devotional songs, folk songs, soft instrumental music, bioacoustics (soft instrumental music with nature sounds).
CONTROL GROUP: Wore headphones but were not played music. | SEDATION: Dose of midazolam (2 mg given on demand).
DURATION OF PROCEDURE;
RECOVERY TIME: Defined as when patient orientated in time, place, and person, and can serially subtract 6 from 100, as assessed by recovery room nurse;
PAIN SCORE: 0‐10 visual analogue scale (UNCLEAR if patient or nurse rated);
DISCOMFORT SCORE: 0‐10 visual analogue scale (UNCLEAR if patient or nurse rated);
WILLINGNESS TO REPEAT PROCEDURE: Method of data collection not described.
Data insufficient for extraction. | Data reported as median and range.
Controls received significantly more midazolam:
Music group = 4 (0‐6) mg
Control group = 5 (0‐8) mg
Duration of procedure did not differ between groups:
Music group = 28 (14‐50) minutes
Control group = 33 (17‐58) minutes
Recovery time was significantly longer in controls:
Music group = 10 (0‐28) minutes
Control group = 20 (0‐20) minutes. See Cepeda 2006 for details on music for pain relief (this study is not yet included in Cepeda 2006). |
| Hayes 2003 | RCT; 2 parallel groups. | DESCRIPTION: 198 out‐patients awaiting gastrointestinal procedures (colonoscopy or esophagogastroduodenoscopy [EGD]) in California, USA.
NUMBERS: Music group = 100, Control group = 98.
AGE, mean (SD): 61 (10.5) years old.
GENDER (male/female): 193/5.
ETHNICITY: not described.
INCLUSION CRITERIA: Undergoing colonoscopy or EGD for the 1st time; 18 years or older; English speaking; Able to read at 5th grade level; able to sign the study consent.
EXCLUSION CRITERIA: Actively psychotic or has dementia; could not listen to music for 15 minutes prior to procedure. | MUSIC GROUP: Patient selected music (classical, rock, jazz, country western, easy listening) for 15 minutes prior to medical procedure. Were allowed to continue listening to music after outcome measures were taken.
CONTROL GROUP: No music for a 15 minute wait, were given the opportunity to listen to music during their procedure. | ANXIETY: state anxiety measured via STAI.
PHYSIOLOGICAL MEASURES: BP and pulse were recorded before and after the 15‐minute intervention period, however details of methods unclear. | This study has questionable clinical relevance: "To avoid introducing more anxiety with the explanation of the [gastrointestinal] procedure, the consent process for the [gastrointestinal] procedure was delayed until after the patients completed the music study". |
| Heitz 1992 | RCT; 3 parallel groups. | DESCRIPTION: 60 in‐patients who have undergone surgery with general anaesthesia, in a PACU in Iowa, USA.
NUMBERS: 20 participants per group.
AGE, mean (SE): Music group = 46 (3), Control group = 52 (3), Headphones only group = 54 (4) years old.
GENDER (male/female): Music group = 2/18, Control group = 1/19, Headphones only group = 1/19.
ETHNICITY: not described.
INCLUSION CRITERIA: >19 years old; Undergoing a thyroidectomy, parathyroidectomy, or unilateral modified radical mastectomy; Intact hearing; No drug abuse; No psychiatric history; class I‐III ASA status.
EXCLUSION CRITERIA: none further described. | MUSIC GROUP: Choice of three instrumental tapes: Calm classical (e.g. Bach, Debussy, Pachelbel), Stimulative classical (e.g. Strauss, Tschaikovsky), and calm popular music (e.g. piano solos by George Winston, guitar solos by William Ackerman and Steve Halpern). Patients decided which music they would like to listen to in the PACU in the pre‐operative visit. Played via headphones until discharge from PACU.
CONTROL GROUP: No headphone, no music (standard care).
HEADPHONES ONLY GROUP: Wore headphones but heard no music. Patients wore headphones until discharge from the PACU. | PAIN: Measured via 10cm VAS every 15 minutes while in the PACU.
MORPHINE REQUIREMENT: Patients received 0.025 mm/kg IV morphine every 5 minutes as necessary for pain control. Total requirement and time until initial analgesic was needed after leaving the PACU were recorded.
PHYSIOLOGICAL MEASURES: BP and HR were monitored with an ECG and Noninvasive BP machine (Spacelabs, Redmond, WA). RR was monitored by counting the rate for 1 minute. BP, HR, and RR were recorded every 15 minutes whilst in the PACU.
LENGTH OF STAY: Length of stay in the PACU was recorded.
FOLLOW‐UP QUESTIONNAIRE: not included in review (not validated). | Data insufficient for extraction.
There was no significant differences between groups in:
Pain scores; Morphine requirement; BP; HR; RR; Length of stay.
After leaving the PACU patients in the music group (mean = 6.5 hours) waited significantly longer than the headphones only group (mean = 3.5 hours) before initially requiring analgesic. Patients in the control group waited for 4.5 hours (not significant). See Cepeda 2006 for details on music for pain relief. |
| Ikonomidou 2004 | RCT; 2 parallel groups. | DESCRIPTION: 55 day‐patients undergoing laparoscopic sterilization or laparoscopic tubal dyeing as part of a fertility programme in Sweden.
NUMBERS: Music group = 29, Control group = 26.
AGE, median (range): Music group = 34 (25‐45), Control group = 34 (22‐42) years old.
GENDER: Female = 55 (100%).
ETHNICITY: not described.
INCLUSION CRITERIA: ASA rating 1‐2; 25‐45 years old (does not tally with baseline characteristics); scheduled to undergo gynaecologic laparoscopy under general anaesthesia.
EXCLUSION CRITERIA: ASA rating > 2; psychiatric disorder; history of drug/alcohol abuse; neurological disease; 1st language not Swedish; chronic pain problems; analgesic medication taken within the last week; allergy to any of the planned perioperative medications; past complications during anaesthesia or surgery; additionally 5 patients were excluded from analysis due to "extended surgery or various technical problems on the ward" | MUSIC GROUP: Panpipe music played via headphones for 30 minutes pre‐operatively and 30 minutes post operatively.
CONTROL GROUP: Blank disc and headphones for 30 minutes pre‐ and post‐operatively. | PHYSIOLOGICAL MEASURES: RR, BP, and HR, were measured by an attending nurse blinded to group allocation, before and after each 30 minute session (pre‐ and post‐surgery).
PAIN: Pain was measured post‐operatively using a VAS. Pain medication ("cumulative opioid consumption") was also recorded, units unclear.
WELLBEING: Measured pre‐ and post‐ each 30 minute session using a VAS with end‐points marked "calm" and "very anxious". For purposes of review this data is considered as the outcome ANXIETY. | Sensitivity analyses conducted using data extracted for pre‐operative and post‐operative scores for anxiety, RR, BP, and HR.
Findings reported in the paper cannot be replicated using the data provided in the table, leading to concerns over either the validity of information provided or selective outcome reporting (due to the multiple ways data could have been analysed). For this reason the study has been removed in sensitivity analyses. See Cepeda 2006 for details on music for pain relief. |
| Jacobson 1999 | RCT; 3 parallel groups. | DESCRIPTION: 110 in‐patients and out‐patients undergoing IV catheter insertion in Southwestern public and private hospitals, USA.
NUMBERS: (Saline group = 38 patients), Music group = 36 patients, Control group = 36 patients.
AGE, mean (SD): overall = 53 (14) years old.
GENDER (male/female): 58/52
ETHNICITY (Caucasian/Black/Hispanic): 74/25/11.
INCLUSION CRITERIA: 18 years and older, English speaking, vision and hearing in tact, medical orders for peripheral IV therapy.
EXCLUSION CRITERIA: cognitive, neurological, or motor impairment. | SALINE GROUP: excluded from review as confounding non‐environmental intervention.
MUSIC GROUP: choice of 11 compact discs representing different music styles (e.g. jazz, country).
CONTROL GROUP: standard care. | PAIN INTENSITY: measured via 100mm VAS.
PAIN DISTRESS: measured via 100mm VAS.
INSERTION DIFFICULTY: Difficulty of IV catheter insertion via 100mm VAS.
IV catheter insertion difficulty checklist (12 items to identify factors contributing to difficulty).
Patients filled out the pain scores and the investigator rated the insertion difficulty immediately after IV insertion or failed IV insertion attempt. | See Cepeda 2006 for details on music for pain relief. Insertion difficulty is not included in the present review as a health‐related outcome. |
| Kliempt 1999 | RCT; 3 parallel groups. | DESCRIPTION: 76 in‐patients undergoing surgery with general anaesthetic, in Sidcup, UK.
NUMBERS: Music group = 25, Control group = 26, Binaural beats group = 25.
AGE, mean: Music group = 48.7, Control group = 46.9, Binaural Beats group = 41.8
GENDER (male/female): Music group = 9/16, Control group = 9/17, Binaural beats group = 15/10.
ETHNICITY: not described.
INCLUSION CRITERIA: ASA 1‐2; Aged 18‐76 years old; Scheduled for general surgical operations under general anaesthesia.
EXCLUSION CRITERIA: Disliked classical music; knew the Monroe Institute or knew about Hemi‐Sync (Binaural Beats) music; suffered from known malignancy; hearing impairment; mentally impaired; used regular pain killers, tranquillisers, or antihypertensive medicines; known alcoholic or drug user; history of epilepsy or mental illness; were pregnancy; scheduled for operation involving the head or neck area; were not suitable for the standardised anaesthetic technique. | MUSIC GROUP: Classical music ('Adagio' Karajan, Deutsche Grammophon, 445 282‐4). Played via headphones during surgery.
CONTROL GROUP: Blank tape via headphones during surgery.
BINAURAL BEATS GROUP: Hemispheric sychronisation through binaural beats, played via headphones during surgery. (Not included in review). | FENTANYL REQUIIREMENTS: This served as an indication of the adequacy of nociception control provided during the operation. Fentanyl (ųg) was given intravenously if intra‐operative BP or HR increased by 20% or more above baseline values for more than 5 minutes. | See Cepeda 2006 for details on music for pain relief. |
| Koch 1998a | RCT; 2 parallel groups. | DESCRIPTION: 34 out‐patients undergoing urologic procedures using spinal anaesthesia, USA.
NUMBERS: Music group = 19, Control group = 15.
AGE, mean (SD): Music group = 54 (15), Control group = 53 (12) years old.
GENDER (male/female): Music group = 16/3; Control group = 13/2.
ETHNICITY: Not described.
INCLUSION CRITERIA: Unpremedicated with ASA status 1‐3.
EXCLUSION CRITERIA: Not stated. | MUSIC GROUP: All patients requested to bring their favourite CD to hospital on morning of surgery. A suitable substitution was provided to those who did not have access to their favourite CD. Music played via occlusive headphones intraoperatively.
CONTROL GROUP: As with music group, patients were asked to bring their favourite CD to the hospital. Patients in the control group did not listen to music nor did they wear headphones. They were exposed to the operating room noise (standard care). | BP (mm Hg), HR (bpm), PROPOFOL REQUIREMENTS (mg/min): recorded every 10 minutes for duration of surgery;
PACU LENGTH OF STAY (min). | See Cepeda 2006 for details on music for pain relief. |
| Koch 1998b | RCT; 2 parallel groups. | DESCRIPTION: 43 patients undergoing lithotripsy, USA.
NUMBERS: Music group = 21, Control group = 22.
AGE, mean (SD): Music group = 54 (15), Control group = 53 (12) years old.
GENDER (male/female): Music group = 17/4, Control group = 10/12.
ETHNICITY: Not described.
INCLUSION CRITERIA: ASA status 1‐3; scheduled for lithotripsy treatment of renal calculi using the Dornier 3 or 4 lithotripter.
EXCLUSION CRITERIA: None described. | MUSIC GROUP: Patients brought own music from home to listen to via occlusive headphones during surgery.
CONTROL GROUP: Standard care. Also brought in own music in case of allocation to other group. | BP (mm Hg), HR (bpm), ALFENTANIL REQUIREMENTS: recorded every 15 mins.
PAIN SCORE: Self‐report VAS recorded every 15 minutes intraoperatively.
Insufficient information for extraction of: PACU length of stay, desaturation rate, level of sedation, self‐report sedation. | See Cepeda 2006 for details on music for pain relief. |
| Korunka 1992 | RCT; 3 parallel groups. | DESCRIPTION: 163 in‐patients undergoing hysterectomy in Vienna, Austria.
NUMBERS: Music group = 55, Control group = 53.
AGE, mean (SD): Music group = 44.9 (7.6), Control group = 46.8 (8.4) years old.
GENDER: Female = 163 (100%).
ETHNICITY: not described.
INCLUSION CRITERIA: All women scheduled for hysterectomy.
EXCLUSION CRITERIA: Cardiovascular disease; psychological problems; risk of cancer in uterus. | MUSIC GROUP: Patient choice of classical (Bach), Entertainment ("Musik zum Träumen" [Music for Dreaming]), or Relaxation (Oliver Shanti "Rainbow Way"). Played via headphones for 45 minutes beginning at the start of the operation (at the abdominal incision).
POSITIVE SUGGESTIONS: Excluded from review.
CONTROL: Recording of OR noise played via headphones. | PAIN: Pain intensity measured via 10 cm VAS once a day for 5 days. There were no differences between groups.
Post‐operative pain measured via a multidimensional pain scale (with 6 subscales). Significant differences were found between the music and control group (control scores consistently higher than music on all subscales). Data presented in graphs‐ UNCLEAR.
MEDICATION: Time of request and dose of pain medications was recorded. Patients could request up to 4 more doses of medication. Patients in the music group had reduced pain medication compared to controls. Outcomes missing for 23 participants (unclear which groups):
Time to first medication administration, mean (SD):
Music = 211 (240), Control = 118 (154) minutes.
Overall pain medication dose, mean (SD):
Music = 197 (138), Control = 291 (175) uG/K.
Length of stay, mean (SD):
Music = 8.52 (2.0), Control = 10.20 (3.8) days. | Where means and SDs are presented (for length of stay), there are missing data from 23 participants so it is unclear how many people are in each group. See Cepeda 2006 for details on music for pain relief. |
| Kotwal 1998 | RCT; 2 parallel groups. | DESCRIPTION: 104 patients undergoing gastrointestinal endoscopy in India.
NUMBERS: Music group = 54, Control group = 50 patients.
AGE: not described.
GENDER: not described.
ETHNICITY: not described.
INCLUSION CRITERIA: not described.
EXCLUSION CRITERIA: not described. | MUSIC GROUP: Classical Indian instrumental music played for 10 minutes prior to procedure and then throughout the procedure.
CONTROL GROUP: no music, standard care. | PHYSIOLOGICAL OUTCOMES: BP, HR, and RR measured at beginning of the consultation and at the end of the procedure. Methods unclear. Data presented as change scores.
ATTITUDE: a 3‐point VRS was used to assess willingness to undergo procedure again‐ data not extracted for review. | |
| Kwekkeboom 2003 | RCT; 3 parallel groups. | DESCRIPTION: 58 patients undergoing noxious medical procedures (e.g. tissue biopsy, vascular port placement) at an oncology clinic in Midwestern USA.
NUMBERS: Music group = 24, Control group = 20, Distraction group = 14 (excluded from review).
AGE, mean (SD): Music group = 51.96 (15.21), Control group = 53.30 (17.83) years old.
GENDER, (male/female): Music group = 9/15, Control group = 7/13.
ETHNICITY (white/other): Music group = 21/3, Control group = 20/0.
INCLUSION CRITERIA: Treated by one particular surgeon.
EXCLUSION CRITERIA: Unable to read/write English; incapable of completing questionnaires independently or with minor assistance from researcher. | MUSIC GROUP: Patient choice from selection of CDs (pop, rock, easy listening, classical, religious hymns, jazz or blues, country), listened via headphones prior to and during procedure.
CONTROL GROUP: Standard care. Asked to rest quietly prior to and during procedure.
DISTRACTION GROUP: Excluded from review. Book on tape with quiz post‐treatment. | PAIN: Pain intensity measured via a NRS prior to treatment, during treatment (retrospectively), and post treatment.
ANXIETY: State anxiety measured via STAI pre‐ and post‐procedure.
CONTROL: Perceived control over pain and anxiety was measured via a NRS post‐procedure. Data not extracted for review (compound question not validated). | Values provided are adjusted scores (from analysis of covariance), adjusted for baseline scores, medications, and gender. Numbers reported as SDs in the text although too small so assumed to be the standard errors, which reflect the non‐significant findings described. See Cepeda 2006 for details on music for pain relief |
| Lee 2002 | RCT; 3 parallel groups. | DESCRIPTION: 165 out‐patients undergoing elective colonoscopy in Hong Kong, China.
NUMBERS: 55 patients per group.
AGE, median (interquartile range): Music + PCS = 54 (46‐68); PCS alone = 47 (39‐67).
GENDER (Male/Female): Music + PCS = 33/22; PCS alone = 29/26.
ETHNICITY: not specified.
INCLUSION CRITERIA: Scheduled for elective out‐patient colonoscopy, 16‐75 years old.
EXCLUSION CRITERIA: none stated. | MUSIC ALONE: excluded from review as no appropriate control (i.e. music with no PCS).
MUSIC + PCS: music played via headphones, patients offered a choice of classical, jazz, popular (Chinese or English), and Chinese opera. Patient controlled sedation administered via pump.
PCS ALONE: patient controlled sedation via pump with no music or headphones. | PAIN SCORE: 10 mm VAS;
SATISFACTION: 10 mm VAS;
WILLINGNESS TO REPEAT SEDATION: (not included as health‐related outcome in review);
PAIN MEDICATION: Dose of propofol (mg/kg) ‐ patient‐controlled sedation.
EPISODES OF HYPERTENSION: systolic BP < 90 mm Hg, observed by blinded assessor (4 vs. 6 episodes in 'music + PCS' and 'PCS alone' groups respectively‐ unclear if numbers are independent).
EPISODES OF OXYGEN DESATURATION: Oxygen saturation < 90%, observed by blinded assessor (no events observed).
RECOVERY TIME: Assessed every 5 minutes by independent (blinded) recovery nurse until patient was orientated to person, time, and place, and able to serially subtract 7 from 100. Results presented as median and interquartile range. | See Cepeda 2006 for details on music for pain relief. |
| Lee 2005 | RCT; 2 parallel groups. | DESCRIPTION: 64 in‐patients on mechanical ventilation in an Intensive Care Unit in Hong Kong, China.
NUMBERS: 32 patients per group.
AGE, mean (SD): Music group = 70.6 (15.1); Control group = 68.3 (15.6).
GENDER (Male/Female): Music group = 25/7; Control = 21/11.
ETHNICITY: not stated.
INCLUSION CRITERIA: alert, able to obey commands, able to hear, haemodynamic stability, undergoing mechanical ventilation with self‐triggering modes.
EXCLUSION CRITERIA: psychiatric illness. | MUSIC GROUP: Choice of Chinese classical music, religious music (Buddhist and Christian), Western classical, natural sounds with slow beats. Played via headphones.
CONTROL GROUP: Headphones without music.
All patients instructed to close eyes. The lights were dimmed and the curtains were closed for all patients. Intervention and control periods lasted for 30 minutes. | ANXIETY: State anxiety using Chinese STAI ‐short version (6 items). Participants responded to questions by holding up corresponding number of fingers.
RR;
HR;
BP;
All measure taken before and after 30 minute intervention/control period. | |
| Lembo 1998 | RCT; 3 parallel groups. | DESCRIPTION: 37 patients undergoing flexible sigmoidoscopy in Calfornia, USA.
NUMBERS: Audiovisual group = 13, audio alone group = 12, control group = 12.
AGE, mean (SD): Audiovisual group = 58 (7), Audio alone group = 60 (8), Control group = 59 (7) years old.
GENDER: Male = 37 (100%).
ETHNICITY: not described.
INCLUSION CRITERIA: Undergoing routine screening flexible sigmoidoscopy.
EXCLUSION CRITERIA: none described. | AUDIOVISUAL: Virtual‐i glasses, personal display system showing an ocean shoreline with corresponding sounds (via headphones)
AUDIO ALONE: Sounds of the ocean shoreline only played via headphones.
CONTROL: No intervention, standard care. | DISCOMFORT: Measured via VAS which asked patients to rate their level of abdominal discomfort from faint to severely intense.
STRESS SYMPTOMS: Measured 6 subscales (arousal, stress, anxiety, anger, fatigue, and attention) using 12 VAS. | Data extracted for review on anxiety and anger. Arousal and attention not considered health‐related outcomes.
There was no difference between groups on the stress and fatigue subscales, data not reported for extraction. |
| Lepage 2001 | RCT; 2 parallel groups. | DESCRIPTION: 50 in‐patients and out‐patients undergoing non‐oncologic surgery under spinal anaesthesia in Canada.
NUMBERS: 25 patients per group.
AGE, mean (SD): Music group = 37.8 (12.6), Control group = 38.9 (8.6) years old.
GENDER (male/female): Music group = 15/10, Control group = 16/9.
ETHNICITY: not described.
INCLUSION CRITERIA: ASA I or II; scheduled to undergo non‐oncologic surgery under spinal anaesthesia.
EXCLUSION CRITERIA: Parturients; patients experiencing mental illness; documented hearing loss; taking drugs likely to influence mood or haemodynamic status. | MUSIC GROUP: Choice of pop, jazz, classical, and new age played via non‐occlusive headset. Patients received the music prior to, during and after surgery.
CONTROL GROUP: standard care (no music). | PCS: Amount of midazolam consumed during the perioperative period was recorded. Data extracted for total midazolam consumed (mg).
ANXIETY: Measured via STAI and VAS at four time points. Data presented in graph form and estimated readings of end scores taken from this.
PHYSIOLOGICAL DATA: BP, HR, and RR collected in study although data not presented for extraction. There were no significant differences between groups on any of these measures. | Estimated anxiety data extracted.
Physiological data not presented: n.s. |
| Lueders Bolwerk 1990 | RCT; 2 parallel groups. | DESCRIPTION: 35 in‐patients in one of 5 Intensive Care Units having had an acute myocardial infarction, Midwestern USA.
NUMBERS: Music group = 17 patients, Control group = 18 patients.
AGE, mean (range): Music group = 61 (36‐79), Control group = 56.3 (33 to 78).
GENDER (male/female): Music group = 11/6, Control group = 16/2.
ETHNICITY: not described.
INCLUSION CRITERIA: Anxious patients (STAI state anxiety score ≥ 40), medical diagnosis of MI, within 48 hours of hospitalisation, patients understood they had had a "heart attack".
EXCLUSION CRITERIA: Class 4 MI patient (physiologically unstable). | MUSIC GROUP: 3 sessions of music listening on 1st, 2nd, and 3rd day (or 2nd‐4th day) of hospitalisation. Music session consisted of listening to 3 pieces of music each session: Bach's 'Largo', Beethoven's 'Largo', and Dubussy's 'Prelude to the Afternoon Faun'. Each session lasted approximately 22 minutes.
CONTROL GROUP: standard care, received no music sessions. | STATE ANXIETY: measured with the STAI at two time points: (1) during the first 48 hours of admission, and (2) on the 3rd or 4th day of hospitalisation. For the music group, these measurements were taken prior to the first music session and at the end of the 3rd music session. | |
| Mandle 1990 | RCT; 3 parallel groups. | DESCRIPTION: 45 patients undergoing femoral angiography in Boston, USA.
NUMBERS: Music group = 14 patients, Control group = 16 patients, Relaxation tape group = 15 patients (excluded from review).
AGE: not described.
GENDER: not described.
ETHNICITY: not described.
INCLUSION CRITERIA: Peripheral vascular disease undergoing femoral angiography.
EXCLUSION CRITERIA: not described. | RELAXATION TAPE: Progressive muscle relaxation. Excluded from review.
MUSIC TAPE: Contemporary instrumental music ("Music for Airports" by Brian Eno, EG Music, New York, 1978).
CONTROL GROUP: Blank tape.
Participants instructed to listen to the tape throughout the entire procedure. | STATE ANXIETY: Measured via STAI immediately pre‐ and post‐procedure.
PAIN: Measured using the pain rating index and the pain intensity scale of the McGill Pain Questionnaire. Pain intensity data extracted for review.
NURSE RATINGS: Nurses rated the degree of pain and anxiety exhibited by each patient during the procedure on a 7‐point scale. Data not included in review.
MEDICATION REQUESTS: A record of kept of the amount of Fentanyl Citrate (ųg) and Diazepam consumed.
VITAL SIGNS: BP and HR were measured however no data presented. No significant differences reported. | See Cepeda 2006 for details on music for pain relief. |
| Masuda 2005 | RCT; 2 parallel groups. | DESCRIPTION: 44 post‐operative in‐patients in an Orthopaedic Department, Japan.
NUMBERS: 22 patients per group.
AGE, mean (SD): Music group = 67.1 (4.8), Control group = 70.8 (7.7) years old.
GENDER (male/female): Music group = 9/13, Control group = 9/13.
ETHNICITY: not described.
INCLUSION CRITERIA: Over 60 years old; undergone surgical treatment of any kind, with general or spinal anaesthesia, in the Orthopaedic Department between April 2001 and November 2002; were required to be on post‐operative bed rest for one week or less in a private room.
EXCLUSION CRITERIA: cardiovascular disease; hypertension; mental illness. | MUSIC GROUP: Choice of: Western classical music, Gagaku (Japanese traditional court music), Noh songs, or Enka. All participants choose Enka (a melodramatic and representative genre of Japanese popular songs, usually about sad aspects of life, irrecoverable destiny, and desertion by a lover, sung with a slow tempo), which is popular among elderly Japanese people. There were 10 Enka CDs to choose from. Music played via headphones for 20 minutes whilst lying in bed.
CONTROL GROUP: No headphones or music. | PAIN: Measured via 10 cm VAS and the Wong/Baker Faces Pain Rating Scale (includes 6 categories of facial expressions ranging from '0, a happy smiling face' and '5, a tearful face').
VITAL SIGNS: HR and BP measured via an automatic sphygmomanometer.
SKIN TEMPERATURE: Taken at the palmar centre point of the tip of the middle finger with a thermograph. Room temperature was adjusted with an air conditioner and monitored thermographically. Skin and room temperature had to be stable for 5 minutes before beginning the experiment. Patients kept their hands on top of the bed quilts.
SKIN BLOOD FLOW: measured using a laser type skin blood flow analysis system (FLO‐C1, Omega Wave Co., Ltd.) with a skin contact probe taped the palmar centre point of the tip of the index finger. This device measures blood flow, blood mass, and blood velocity.
Outcome measures recorded at baseline, and at 10 and 20 minutes. | See Cepeda 2006 for details on music for pain relief (study not yet included in Cepeda 2006). |
| McRee 2003 | RCT; 4 parallel groups. | DESCRIPTION: 52 in‐patients undergoing various surgical procedures in USA.
NUMBERS: 13 patients in each group.
AGE, mean (SD): 43.08 (13.1) years old.
GENDER (male/female): 19/33.
ETHNICITY: not described.
INCLUSION CRITERIA: At least 18 years old; Read English; Low‐risk surgical patients (determined by pre‐operative assessment by anaesthesia provider on the ASA scale).
EXCLUSION CRITERIA: Not described.
Demographic information detailed includes information from study groups excluded from this review. Demographic characteristics were similar between groups. | MASSAGE THERAPY: excluded from review.
MASSAGE AND MUSIC: excluded from review.
MUSIC ONLY GROUP: compilation of soft piano music selected by investigator. played for 30 minutes pre‐operatively.
CONTROL GROUP: Standard care, waited in the waiting room. | STATE ANXIETY: measured via the short‐form STAI‐6 in the PACU (after surgical procedure).
VITAL SIGNS: BP and pulse (measured pre‐operatively, intraoperatively, and post‐operatively) measured using automatic monitoring equipment. End time‐points extracted for analysis.
HORMONES: Established post‐operatively. Cortisol measured by a chemiluminescent immunoassay, and prolactin measured with a two‐site sandwich antibody assay.
Blood was sent to a regional laboratory for processing.
PAIN CONTROL: amount and frequency of analgesia administered, was measured in the recovery room. Data not presented although states no significant differences. | See Cepeda 2006 for details on music for pain relief (study not included in Cepeda 2006). |
| Mennegazzi 1991 | RCT; 2 parallel groups. | DESCRIPTION: 38 emergency department admissions undergoing laceration repair in Pittsburgh, USA.
NUMBERS: 19 patients per group.
AGE, mean (SD): Music group = 24.4 (5.1), Control group = 25.9 (7.5) years old.
GENDER (male/female): Music group = 13/6, Control group = 8/11.
ETHNICITY: not described.
INCLUSION CRITERIA: All patients presenting to the emergency department for laceration repair.
EXCLUSION CRITERIA: Laceration repair secondary to more serious medical condition; under 18 years old; received analgesics in the field; alcohol or substance intoxication. | MUSIC GROUP: Listened to music via headset. Choice of 50 styles and artists to choose from.
CONTROL GROUP: Standard care. | ANXIETY: State anxiety measured via STAI before and after laceration repair. SDs presented in graphical format. Estimated figures extracted for purposes of review.
PAIN: Measured via VAS after laceration repair. Estimated SDs extracted from graph.
PHYSIOLOGICAL: HR, BP, RR data collected before and after laceration repair by nurses although methods of data collection unclear. | SDs for pain and anxiety are estimates from graphs. See Cepeda 2006 for details on music for pain relief. |
| Migneault 2004 | RCT; 2 parallel groups. | DESCRIPTION: 30 patients undergoing surgery with general anaesthesia, Canada.
NUMBERS: 15 patients per group.
AGE, mean (SD): Music group = 46.3 (12.1), Control group = 52.2 (9.1) years old.
GENDER: All female.
ETHNICITY: Not described.
INCLUSION CRITERIA: ASA grade I‐III, 18‐70 years old, scheduled for abdominal hysterectomy, hysterosalpingo‐oophorectomy, or salpingo‐oophorectomy under general anaesthesia.
EXCLUSION CRITERIA: Auditory problems, uncontrolled hypertension, Raynaud syndrome, hormonal dysfunction (adrenal, pituitary, or thyroid), steroid use, cocaine abuse, established diagnosis of severe anxiety disorder. | MUSIC GROUP: Selected a CD preoperatively from a choice of 4: classical, jazz, new‐age, popular piano music. Selected listening volume. Anesthesiologist started CD once patients were anaesthetised. Music played via headphones.
CONTROL GROUP: Also selected music prior to surgery. Wore headphones during surgery however no music was played.
The CD player was covered in both groups to blind the investigator. At the end of wound closure and after the last intraoperative blood sample was drawn, the CD was stopped and the headphones removed. | Repeated measures observations (4 time points)‐ T1: immediately after arterial line insertion, T2: 5 min after peritoneal incision, T3: at skin closer, T4: 30 min after arrival in the recovery area.
STRESS HORMONES: Epinephrine, norepinephrine, cortisol and adrenocorticotropic hormone.
PHYSIOLOGICAL OBSERVATIONS: Arterial BP; and HR.
MORPHINE: Total administered via PCA for the first 24 post‐operative hours (mg).
ADVERSE EVENTS: Six patients in the music group versus two patients in the control group needed rescue medication for hypertensive episodes (P value = 0.13). | Data extracted for end time points only. See Cepeda 2006 for details on music for pain relief |
| Mullooly 1998 | RCT; 2 parallel groups. | DESCRIPTION: 28 post‐operative in‐patients who have undergone elective abdominal hysterectomy, USA.
NUMBERS: 14 patients in each group.
AGE, mean (range): 47 (37 to 57) years old.
GENDER: Female = 28 (100%).
ETHNICITY (White/other): 25/3
INCLUSION CRITERIA: undergoing elective abdominal hysterectomy.
EXCLUSION CRITERIA: History of drug abuse; psychiatric disorder; potential malignant neoplasm; experience with use of relaxation techniques. | MUSIC GROUP: Four easy listening selections (out of an original 10) were selected by nursing graduate students to be harmonious, pleasant, and calming. Patients listened to music for 10 minutes via headphones and were requested to close eyes on the first and second post‐operative day.
CONTROL GROUP: Standard care. | PAIN: measured via VAS on first and second post‐operative day (pre and post 10 minute intervention period).
ANXIETY: measured via a NRS (with VRS) pre‐ and post‐intervention period on first and second day. | Outcomes extracted for 2nd post‐operative day as only 6 and 5 outcome measures were obtained for the intervention and control group on the 1st post‐operative day (all 28 participants completed the 2nd day of testing). See Cepeda 2006 for details on music for pain relief. |
| Nilsson 2001 | RCT; 3 parallel groups. | DESCRIPTION: 90 (58 included in present review) in‐patients undergoing elective hysterectomy in Sweden.
NUMBERS: Music group = 30, Control group = 28 patients.
AGE, mean (SD): Music group = 51 (8.1), Control group = 50 (8.2) years old.
GENDER: Female = 90 (100%), (58 included in review).
ETHNICITY: not described.
INCLUSION CRITERIA: ASA I‐III, scheduled for elective abdominal hysterectomy via lower abdominal incision, good understanding of Swedish.
EXCLUSION CRITERIA: Hearing impairment, alcohol or drug abuse, psychiatric or memory disorder. | MUSIC GROUP: relaxing music accompanied by sea waves (ref: Uneståhl L‐E. Avslappningmusik. Träningsprogram för kropp och själ. [Relaxation music. Training programme for body and soul]. Örebro, Sweden Veje International AB: 1970). Played through headphones from time of skin incision to time of wound closure.
MUSIC +THERAPEUTIC SUGGESTIONS: Excluded from review.
CONTROL: playback of previously recorded operation. Played through headphones from time of incision to time of wound closure. | PAIN INTENSITY: 10‐point VAS used every hour for the first 24 post‐operative hours, and every 3 hours after that until the patient felt no pain. Data presented as group mean score of patients' median score.
POST‐OPERATIVE ANALGESIA: This was recorded from the amount of patient controlled analgesia used.
MOBILISATION: Estimated as time from the end of surgery to the time the patient could sit, stand, and walk without assistance. Recorded by the patient in a patient diary.
POST‐OPERATIVE FATIGUE, WELLBEING, AND NAUSEA: Graded on individual VRS by the patient in a diary on the day of surgery, the day after surgery and at discharge from the hospital. | Data extracted for responses given on the day of surgery. See Cepeda 2006 for details on music for pain relief. |
| Nilsson 2003a | RCT; 3 parallel groups. | DESCRIPTION: 151 day patients undergoing surgery of varicose veins or inguinal hernia repair under general anaesthesia, in Sweden.
NUMBERS: Intra‐operative music = 51, Post‐operative music = 51, Control = 49 patients.
AGE, mean (SD): Intra‐operative music = 54 (14.5), Post‐operative music = 53 (14.7), Control = 54 (12.2) years.
GENDER (male/female): Intra‐operative music = 39/12, Post‐operative music = 35/16, Control = 33/16.
ETHNICITY: not described.
INCLUSION CRITERIA: Good understanding of Swedish, ASA I‐II, 21 to 85 years old, scheduled for day‐case surgery of varicose veins or inguinal hernia repair under general anaesthesia.
EXCLUSION CRITERIA: Hearing impairment, drug abuse, psychiatric or memory disorder. | INTRA‐OPERATIVE MUSIC GROUP: Music played via headphones from end of induction of anaesthesia until wound dressing via headphones. Music was soft instrumental comprising 7 melodies of a new‐age synthesizer. Post‐operatively, in the PACU, patients were exposed for 1 hour to a blank (silent) disc via headphones.
POST‐OPERATIVE MUSIC GROUP: Exposed to blank disc intra‐operatively via headphones, and the same music as above for 1 hour post‐operatively in the PACU, via headphones.
CONTROL GROUP: Blank disc both intra‐operatively and post‐operatively. | PAIN INTENSITY: Post‐operatively on a NRS (0 to10), every 30 minutes for 2 hours in the PACU.
MORPHINE REQUIREMENTS: Total amount of post‐operative morphine requirements in the PACU recorded from patient records (mg).
ANXIETY: Recorded pre‐operatively, after 1hour in the PACU, at discharge, at home in the evening of the day of surgery, days 1 and 2 following surgery in the morning and evening, on a NRS (0 to 10).
FATIGUE: Using a NRS (0 to10), recorded after 1 hour in the PACU, at discharge, at home in the evening of the day of surgery, days 1 and 2 after surgery in the evening.
NAUSEA: Using a NRS (0 to10), recorded after 1 hour in the PACU, at discharge, at home in the evening of the day of surgery, days 1 and 2 after surgery in the morning and evening.
NIGHT SLEEP: Recorded in the morning on the 1st and 2nd day after surgery on a NRS.
SATISFACTION: patient NRS rating (0 to10) of peri‐operative care. | Anxiety and fatigue not presented in enough detail. Findings on night sleep not reported at all. See Cepeda 2006 for details on music for pain relief. |
| Nilsson 2003b | RCT; 3 parallel groups. | DESCRIPTION: 182 (125 included in present review) day patients undergoing surgery for varicose veins or inguinal hernia repair under general anaesthesia, from two hospitals in Sweden.
NUMBERS: Music group = 62, Control group = 63 patients.
AGE, mean (SD): Music group = 53 (14.1), Control group = 52 (13.2) years old.
GENDER (male/female): Music group = 44/18, Control group = 48/15.
ETHNICITY: not described.
INCLUSION CRITERIA: Good understanding of Swedish, ASA I‐II, scheduled for day care surgery of varicose veins or open inguinal hernia repair under general anaesthesia.
EXCLUSION CRITERIA: Hearing impairment, drug abuse, known psychiatric or memory disorder. | MUSIC GROUP: Soft classical music via headphones which allow conversation to take place. Played on auto‐reverse from the time of arrival at the PACU until the patient wanted to stop listening.
CONTROL GROUP: Blank tape (silence). Played from time of arrival at the PACU until the patient wanted to stop listening.
MUSIC + THERAPEUTIC SUGGESTIONS: excluded from review due to psychological intervention. | PAIN INTENSITY: taken every 30 minutes until patient reports a pain level of ≤ 3 on a VAS (0 to 10). Data presented as the mean of median scores in 120 minutes.
MORPHINE REQUIREMENT (mg): taken from the patient records.
ANXIETY: recorded using the STAI, pre‐operatively at the hospital, and post‐operatively at home on the day of the surgery.
SYMPTOMS: well‐being, nausea, headache, fatigue, and urinary problems recorded using VRSs post‐operatively at home in the evening of the day of the surgery. | There was a significant difference in the length of time patients listened to their allocated tape.
Music group = 117.0 (50.6) minutes
Blank tape group = 80.2 (44.9) minutes. See Cepeda 2006 for details on music for pain relief. |
| Nilsson 2005 | RCT; 3 parallel groups. | DESCRIPTION: 75 day patients undergoing surgery of open Lichtenstein inguinal hernia repair, in Sweden.
NUMBERS: 25 patients in each group.
AGE, mean (SD): Intra‐operative music = 55 (14.7), Post‐operative music = 56 (16.8), Control = 57 (11.6) years.
GENDER: 24 males per group, 1 female per group.
ETHNICITY: not described.
INCLUSION CRITERIA: ASA grade I‐II, scheduled for day care surgery between 8 and 11.30am of open Lichtenstein inguinal hernia repair under general anaesthesia.
EXCLUSION CRITERIA: Hearing impairment, diabetes mellitus, treatment with corticosteroids. | INTRA‐OPERATIVE MUSIC GROUP: exposed to new‐age synthesizer music during operation, and a sham (silent) CD for 1 hour post‐operatively in the PACU.
POST‐OPERATIVE MUSIC GROUP: exposed to sham (silent) CD intra‐operatively, and new‐age synthesizer music for 1 hour post‐operatively in PACU.
CONTROL GROUP: Exposed to sham (silent) CD both intra‐operatively and for 1 hour post‐operatively.
All patients wore headphones throughout. Intra‐operative headphones were occlusive to block out other sounds; post‐operative headphones allowed conversation between patients and staff. Intra‐operative period ran from end of anaesthesia induction to after wound dressing at the end of the surgery. | PAIN: assessed by NRS (0 to 10), 30 minutes before anaesthesia and 1 hour after admission to PACU.
ANXIETY: same as pain score.
BP, HR, and OXYGEN SATURATION: assessed at same time points as pain, using a digital BP monitor and pulse oximetry.
MORPHINE REQUIREMENTS: total amount used in the PACU was recorded (mg).
SERUM CORTISOL, BLOOD GLUCOSE LEVELS, and SERUM IgA LEVELS: taken at 5 time points: 30 minutes prior to anaesthesia, at the end of surgery after wound dressing, and at the 1st, 2nd, and 3rd hour after arrival at the PACU. Not enough data presented for extraction. | Data extracted for post‐operative music group versus control group. See Cepeda 2006 for details on music for pain relief (study not yet included in Cepeda 2006). |
| Nowobilski 2005 | RCT; 2 parallel groups. | DESCRIPTION: 36 in‐patients with bronchial asthma, in Poland.
NUMBERS: 18 patients per group.
AGE, mean (SD): Music group = 44.9 (15.9), Control group = 47.4 (13.4) years old.
GENDER (male/female): 13/23.
ETHNICITY: not described.
INCLUSION CRITERIA: not described.
EXCLUSION CRITERIA: not described. | MUSIC GROUP: Underwent 10 day rehabilitation programme, including 45 minutes each day of: exercise of breath control, correction of respiratory pattern, training of diaphragm and additional respiratory muscles, plus an additional 15 minutes of music listening (C.M. Weber "Adagio"; J.S. Bach "Air on a G‐string"; V.A. Mozart "Andante z Divertimenta D‐dur").
CONTROL GROUP: Underwent 10 day rehabilitation programme, including 45 minutes each day of: exercise of breath control, correction of respiratory pattern, training of diaphragm and additional respiratory muscles. Did not receive additional music listening. | ANXIETY: Measured via the STAI at baseline and after the 10th session.
There was no significant difference between groups:
F (1,34) = 0.37, P value = 0.55
DYSPNEA: Measured via the Borg dyspnoea scale at baseline and after the 10th session.
There was no significant difference between groups:
F (1, 32) = 1.02, P value = 0.32 | Data not provided in sufficient detail for extraction. |
| Padmanabhan 2005 | RCT; 3 parallel groups. | DESCRIPTION: 104 day‐patients scheduled for elective surgical procedures (gynaecology, general surgery, urology) in a Day Surgery Unit in England.
NUMBERS: Music + binaural beat = 35 patients, Music only = 34 patients, Control = 35 patients.
AGE: not described.
GENDER (male/female): Music+binaural beat = 12/23, Music only = 12/22, Control = 15/20.
ETHNICITY: not described.
INCLUSION CRITERIA: Scheduled to undergo elective surgery with general anaesthetic.
EXCLUSION CRITERIA: History of epilepsy, < 16 years old, history of profound deafness. | MUSIC + BINAURAL BEAT: taken to a quiet environment pre‐operatively and asked to listen to music with their eyes closed; 30 minute soundtrack (Holosync Solution, 'Awakening Prologue', Centerpointe Research Institute, Beaverton, OR) which produces binaural beats (through two similar pure tones being presented separately to each other).
MUSIC ONLY: taken to a quiet environment pre‐operatively and asked to listen to music with eyes closed; Identical soundtrack to above without the added tones.
CONTROL: standard care, allowed to read or watch television for 30 minutes pre‐operatively. | STATE ANXIETY: measured via the STAI before and after intervention period. Results converted to percentages instead of presenting STAI score. | It is unclear if > 90% of participants are 18 years old or over.
Data extracted for music only group versus control group.
Confidence intervals have been used to estimate standard deviations for purposes of review. |
| Palakanis 1994 | RCT; 2 parallel groups. | DESCRIPTION: 50 out‐patients undergoing flexible sigmoidoscopy in Maryland, USA.
NUMBERS: 25 patients per group.
AGE, mean (range): Music group = 55 (22 to 76), Control group = 49 (20 to 79).
GENDER (male/female): Music group = 17/8, Control group = 20/5.
ETHNICITY: not described.
INCLUSION CRITERIA: scheduled for out‐patient flexible sigmoidoscopy. No patients were taking anxiolytic medications.
EXCLUSION CRITERIA: none described. | MUSIC GROUP: Choice of 20 tapes (classical/country‐western/popular/rhythm and blues/gospel) played via headphones throughout the procedure.
CONTROL GROUP: Standard care. | ANXIETY: Measured via STAI. An analysis of variance identified a significant difference between groups (P < 0.002):
Music group = 25.24
Control group = 31.48
PHYSIOLOGICAL: BP and HR measured via Dinamap Model 845XT before and during the procedure (at full insertion of the sigmoidoscope). Paper reports significantly less change in HR and mean arterial BP for the music group.
Mean HR:
Music group: Before = 86 bpm; During = 84 bpm
Control group: Before = 75 bpm; During = 80 bpm
Mean arterial BP:
Music group: Before = 111; During = 110 mm Hg
Control group: Before = 104; During = 115 mm Hg | No SDs reported. Insufficient data for extraction. |
| Phumdoung 2003 | RCT; 2 parallel groups. | DESCRIPTION: 110 in‐patients giving birth for the first time (to a singleton fetus), in Southern Thailand.
NUMBERS: 55 in each group.
AGE (mean, SD): 24 (3) years old.
GENDER: Female = 110 (100%).
ETHNICITY: not described.
INCLUSION CRITERIA: Married primiparas, 20 to 30 years old, with a singleton fetus, received antenatal care from the 2nd trimester, been in the latent phase of labour for no more than 10 hours, normal fetal heart rate, cephalic presentation, vertical lie, 38 to 42 weeks gestation with estimated fetal weight of 2500 to 4000 grams.
EXCLUSION CRITERIA: Received analgesic medication, difficulty hearing the spoken word, induced labour, infections, HIV, asthma, previous negative reaction to music, had a spontaneous membrane rupture for longer than 20 hours, history of psychiatric problems, major antipsychotic medications. | MUSIC: patient choice of western music without lyrics, including synthesizer, harp, piano, orchestra, and jazz (60‐80 bpm). Patients listened to their choice via headphones for the first 3 hours of the active phase of labour, starting when cervical dilation was 3 or 4 cm with uterine contraction of 30 to 60 seconds. Women could stop listening to music for 10 minutes if they wished.
CONTROL: No music or headphones, but were told that they would receive music at a later time during labour, after all the pain measurements had been taken. | PAIN SENSATION: measured using 100 mm VAS at four time points‐ once at the start of the study before the treatment period, and then every hour for 3 hours.
PAIN DISTRESS: measured in the same manner as pain sensation.
There was a small ceiling effect reported in the second hour for 4% of controls, and in the 3rd hour for 7% of controls and 5% of the music group. | See Cepeda 2006 for details on music for pain relief. |
| Schiemann 2002 | RCT; 2 parallel groups. | DESCRIPTION: 119 patients undergoing diagnostic endoscopy in Germany.
NUMBERS: Music group = 59, Control group = 60
AGE, mean (SD): Music group = 52.3 (13.9), Control group = 55.8 (13.5) years old.
GENDER (male/female): Music group = 25/34, Control group = 33/27.
ETHNICITY: not described.
INCLUSION CRITERIA: 18 to 80 years old.
EXCLUSION CRITERIA: History of partial colectomy, gastrectomy, or hysterectomy; Impassable colonic stenosis due to a tumour, chronic inflammatory bowel disease, or diverticulitis. | MUSIC GROUP: Played Radio Arabella (105.2 MHz) throughout the procedure. This is a well‐known regional broadcasting company in Munich, and plays various trends of pop, rock, soul, and 'Deutsche Schlager' music, specialising in 'oldies'.
CONTROL GROUP: Standard care. | SEDATION & ANALGESIA: Number of patients requiring midazolam and pethidine, and amount administered. It is unclear from the report if sedation is an outcome measure or baseline characteristic.
TIME: Examination time and number of colonoscopies prematurely aborted due to pain were recorded.
OXYGEN: Number of patients requiring oxygen supplementation was recorded. | See Cepeda 2006 for details on music for pain relief. |
| Schneider 2001 | RCT; 2 parallel groups. | DESCRIPTION: 30 patients undergoing cerebral angiography in Hannover, Germany.
NUMBERS: 15 patients per group.
AGE, mean (range): Music group = 42.1 (26‐58), Control group = 44.3 (25 to 59) years old.
GENDER (male/female): 14/16.
ETHNICITY: not described.
INCLUSION CRITERIA: Undergoing cerebral angiography for the first time.
EXCLUSION CRITERIA: hypertension; cardiac dysrhythmia; anaemia; endocrine disease; psychiatric problems; infections; use of sedative, anxiolytic, or illegal drugs. | MUSIC GROUP: Choice of nine tapes (international pop, German pop, oldies, meditation, rock, techno, instrumental, classic, and traditional). Played via stereo speakers throughout the angiogram; patients could adjust the volume.
CONTROL GROUP: No music (standard care). | ANXIETY: Measured via STAI the evening before the angiography and during the angiography.
ENDOCRINE: Cortisol and catecholamines were taken through an indwelling IV catheter four times: 1) before placing patient on the angiographic table, 2) before giving local anaesthetic, 3) after the first angiographic run, and 4) before returning to bed.
PHYSIOLOGICAL: BP and HR were measured continuously every 5 minutes by a non‐invasive system. | Data not sufficient for extraction.
There were no significant differences between groups in anxiety or HR.
BP decreased significantly in music group but remained constant in the control group.
The control group had a significant increase in cortisol over the angiogram. Cortisol remained constant in the music group.
There were no differences between groups in adrenaline and noradrenaline levels. |
| Sendelbach 2006 | RCT; 2 parallel groups. | DESCRIPTION: 86 post‐operative in‐patients who have undergone cardiac surgery, in cardiovascular units, Midwest USA.
NUMBERS: Music group = 50, Control group = 36
AGE, mean (SD): Music group = 62.3 (14.8), Control group = 64.7 (11.4).
GENDER (male/female): music group = 31/19, Control group = 29/7.
ETHNICITY: not described.
INCLUSION CRITERIA: Scheduled for non‐emergent coronary artery bypass and/or valve replacement surgeries.
EXCLUSION CRITERIA: Non‐English speaking; intubated; physician‐documented psychiatric disorder. | MUSIC GROUP: Participants advised to clear minds and allow muscles to relax. They were given a choice of easy listening, classical, or jazz music, played via headphones, for 20 minutes whilst participant remained in bed. Music qualities were: no dramatic changes, consonance, instrumental, 60 to 70 bpm. The environment was made conducive to rest.
CONTROL GROUP: 20 minute rest period. Advised to rest in bed and a comfortable position was encouraged. No relaxation suggestions were given.
Interventions were for 20 minutes, two times a day, in the morning and evening, of the post‐operative days 1 to 3. | HR: Recorded on bedside monitor. No differences between groups.
BP: Recorded on bedside monitor or with BP cuff. No differences between groups.
ANXIETY: Recorded with short form state anxiety scale. Significantly lower in the music group.
PAIN: Recorded on an NRS. Significantly lower in the music group.
OPIOD REQUIREMENT: No differences between groups. | Paper only reports data for the first 3 sessions due to missing data. SDs obtained from authors (unpublished). Data extracted for morning session of the first post‐operative day. See Cepeda 2006 for details on music for pain relief (study not yet included in Cepeda 2006). |
| Smith 2001 | RCT; 2 parallel groups. | DESCRIPTION: 42 male out‐patients undergoing radiation therapy in a Veterans Affairs Hospital in Southeastern USA.
NUMBERS: Music group = 19 patients, Control group = 23 patients
AGE: mean (range): Music group = 62.2 (39‐78), Control group = 63.4 (44 to 80).
GENDER: Not described.
ETHNICITY: Caucasian/African‐American/Hispanic/Other: Music group = 11/4/4/0, Control group = 20/1/1/1.
INCLUSION CRITERIA: Expected to receive at least 5 weeks of radiation therapy; 18 years or older; Able to read and understand English.
EXCLUSION CRITERIA: Hearing impaired; overtly psychotic; previous diagnosis of anxiety or currently taking anxiolytic medications; participating in a radiation therapy setup that precludes the use of headphones. | MUSIC GROUP: Patient choice of rock and roll, big band, country and western, classical, easy listening, Spanish, religious. Four to six tapes were available in each category. Each patient could choose one category for the duration of the study. Patients listened via headphones to the music before and during the radiation simulation appointment, and during daily radiation treatments for the duration of course of therapy.
CONTROL GROUP: Standard care. | STATE ANXIETY: measured using the STAI at 5 time points: (1) time of evaluation; (2) post simulation appointment; (3) end of first week of treatment; (4) end of third week of treatment; and (5) end of the fifth week or end of radiation therapy. | Data extracted for end time point.
Standard deviations derived from P value of a t‐test. |
| Smolen 2002 | RCT; 2 parallel groups. | DESCRIPTION: 32 out‐patients undergoing colonoscopy, USA.
NUMBERS: 16 patients in each group.
AGE, mean (SD): Music group = 58.63 (13.64), Control group = 61. 06 (9.48) years old.
GENDER (male/female): Music group = 10/6, Control group = 7/9.
ETHNICITY: Not described.
INCLUSION CRITERIA: Scheduled for ambulatory colonoscopy with an admitting diagnosis of personal history of colorectal cancer, colon polyps, long‐standing ulcerative colitis, or significant family histories of colorectal neoplasia; 18 years and older; conscious, orientated; able to read, write, and speak English; evidenced haemodynamic stability by BP between 90 to 160 mm Hg systolic and 50 to 95 mm Hg diastolic.
EXCLUSION CRITERIA: Taking anti‐anxiety or anti‐depressant medication; unable to engage in verbal conversation throughout the procedure and into the recovery phase. | MUSIC GROUP: Patient choice of classical, jazz, pop rock, easy listening, played via headphones throughout pre‐sedation and procedure.
CONTROL GROUP: Standard care. | SEDATION REQUIREMENTS (mg). Amount of Versed and Demerol administered was recorded (not a primary outcome).
STATE ANXIETY: measured using STAI before and after the procedure.
HR (bpm) and BP (mm Hg): measured using Critikon Model SNK9935 at four time points: on admission, 5 minutes after medication, 5 minutes after procedure, and immediately before discharge. Data presented in graphs, not extracted as unclear what lines represent (e.g. SD or 95% CI). | State anxiety data extracted from graph in article, bars taken as standard errors and converted into SD. |
| Staricoff 2003f | RCT; 2 parallel groups. | DESCRIPTION: 17 in‐patients with HIV/AIDS staying in the HIV/AIDS ward, London, UK.
NUMBERS: Music group = 8, Control group = 9.
AGE: not described.
GENDER: not described.
ETHNICITY: not described.
INCLUSION CRITERIA: Clinicians performed clinical assessment of hospitalised patients and sent a list of nominated patients to the study personnel for randomisation. No further details given.
EXCLUSION CRITERIA: none described. | MUSIC GROUP: Attended a live music concert played in the public area on the hospital ground floor. Unclear what type of music was played.
CONTROL GROUP: Remained on the ward, where they could not hear the music. | LEVELS OF CD4 AND CD8 LYMPHOCYTES (cells/mm3): measured within one hour before and after the study period.
There was no difference in the number of CD4 cells before and after the concert in either group.
Paper reports that the number of CD8 cells increased in the music group, and remained unchanged in the control group. Table of results suggest that CD8 cells decreased in the control group and increased in the music group.
Change score (post‐pre):
Music group (n = 8) = 77
Control group (n = 9) = −78
Paper reports a t‐test to show statistical significance (P value = 0.01, 95% CI 40 to 269).
Estimated SDs (not reported) = 150 | Data insufficient detail. |
| Tang 1993 | RCT; 2 parallel groups. | DESCRIPTION: 120 in‐patients undergoing surgery with epidural anaesthesia in Taiwan.
NUMBERS: 60 patients in each group.
AGE, mean (SD) years: Music group = 42.18 (11.82); Control group = 41.92 (14.22).
GENDER (male/female): Music group = 26/34; Control group = 32/28.
ETHNICITY: not stated.
INCLUSION CRITERIA: To undergo surgery with epidural anaesthesia; ASA grade I‐II.
EXCLUSION CRITERIA: Patients who wish to switch study group. Patients who request tranquillisers. | MUSIC GROUP: Walkman music via headphones. Choice of 5 types (Manderin pop song, local Taiwanese folksong, Western, Classical, Buddhist hymn). Music played throughout operation.
CONTROL GROUP: No music, standard care. | Subjective feelings of anxiety and sedation: Method of assessment unclear (data EXCLUDED from review).
HR (bpm) and BP (mm Hg): Repeated measures (7 time points). Outcomes reported as means and SD taken at baseline and 20 minutes into operation. | |
| Taylor 1998 | RCT; 3 parallel groups. | DESCRIPTION: 61 in‐patients who have had an elective abdominal hysterectomy using general anaesthesia in Arizona, USA.
NUMBERS: Unclear how many participants assigned to each group.
AGE, mean (SD): Music group = 40.7 (7.29); Headphones only group = 43.3 (7.79); Control = 34.6 (6.13). The control group were significantly younger than the intervention groups.
GENDER: Female = 61 (100%).
ETHNICITY: not specified.
INCLUSION CRITERIA: All patients scheduled for elective abdominal hysterectomies using general anaesthesia.
EXCLUSION CRITERIA: hearing or visually impaired, unable to communicate in English. | MUSIC GROUP: patient choice brought from home or from selection provided (classical; jazz; light rock; country; rock and roll; easy listening; gospel), played via headphones.
HEADPHONES ONLY GROUP: headphones without music were used to block out unpleasant sounds in the PACU.
CONTROL GROUP: No headphones or music, standard care.
Interventions took place post‐operatively in the PACU. | PAIN INTENSITY: Two measures used: a 9‐inch VAS, and a 10‐point NRS. Measures were taken every 15 minutes for the duration of PACU stay (unspecified). Results of VAS are reported as a mean value for each group; results of NRS are reported as mean rating at 1 hour and at discharge from PACU. | See Cepeda 2006 for details on music for pain relief. |
| Taylor‐Piliae 2002 | RCT; 3 parallel groups. | DESCRIPTION: 30 pre‐operative in‐patients scheduled to undergo cardiac catheterization (CC) in Hong Kong, China.
NUMBERS: 15 patients in each group.
AGE, mean (SD): music group = 56.9 (10.3), control group = 65 (6.9).
GENDER (Male/Female): Music group = 12/3, Control group = 11/4.
ETHNICITY: Chinese = 30 (100%).
INCLUSION CRITERIA: admitted for CC, ethnic Chinese, literate in Chinese, 35 to 75 years old.
EXCLUSION CRITERIA: diagnosed mental illness, major hearing difficulties, life threatening or concomitant major illness (e.g. renal failure/cancer). | SENSORY INFORMATION: excluded from review.
MUSIC GROUP: Instrumental music without words, choice of new age, Chinese instrumental, or classical music.
CONTROL GROUP: standard care.
The study period was 1 hour before CC and lasted for 15 to 20 minutes. | STATE ANXIETY: measured via STAI before and after intervention period;
MOOD: measured via POMS questionnaire.
UNCERTAINTY: measured via Mishel's Uncertainty in Illness Scale.
HR (bpm) taken manually for 1 minute by researcher.
RR recorded manually for 1 minute by researcher.
Outcomes were collected at: (T0) baseline, (T1) after the study intervention (pre‐procedure), and (T2) approximately 1 hour after cardiac catheterization. | Outcomes extracted for T1 ‐ after the study intervention but before cardiac catheterization, as the study has been categorised in the "pre‐procedure" subgroup. |
| Triller 2006 | RCT; 2 parallel groups. | DESCRIPTION: 200 patients undergoing flexible bronchoscopy in Slovenia.
NUMBERS: Music group = 93, Control group = 107.
AGE, mean (SD): Music group = 58.6 (14.9), Control group = 59.6 (14.5) years old.
GENDER (male/female): Music group = 64/29, Control group = 77/30.
ETHNICITY: not described.
INCLUSION CRITERIA: not described.
EXCLUSION CRITERIA: not described. | MUSIC GROUP: Easy listening and relaxation ambient music selected by the investigator, started immediately after the beginning of the procedure and stopped when the procedure is over.
CONTROL GROUP: Standard care.
Bronchoscopist team asked not to communicate aloud with each other during the procedure. | PHYSIOLOGICAL: HR and BP recorded before and after the procedure, method of data collection not described.
FEELINGS: Overall feelings during the procedure were measured using a VAS. This outcome was not extracted for the review due to questionable validity. | |
| Tsuchiya 2003 | RCT; 2 parallel groups. | DESCRIPTION: 59 in‐patients undergoing elective laparoscopic cholecystectomy in an operating theatre in Japan.
NUMBERS: Nature sounds = 29, Control = 30.
AGE, mean (SD): Nature sounds = 65 (10), Control = 66 (9) years old.
GENDER: not described.
ETHNICITY: not described.
INCLUSION CRITERIA: ASA grade I‐II, scheduled for elective laparoscopic cholecystectomy.
EXCLUSION CRITERIA: angina; essential hypertension; auditory perception complications. | NATURE SOUNDS: Patients were played their choice of nature sounds via headphones throughout operation, after induction of anaesthesia until the last suture of surgery.
CONTROL: Patients wore dummy headphones so were exposed to the operating theatre noise. They were not played nature sounds during operation, after induction of anaesthesia until the last suture of surgery.
All patients choose a set of sounds they felt to be calming and comforting in the pre‐operative period. These sounds included familiar Japanese environmental sounds including: sounds of a ripple, a small stream, a soft wind, and a twitter. They all listened to their selected sounds via headphones to determine a comfortable volume. All participants listened to sounds for at least 30 minutes to familiarise themselves with them, prior to operation. | PHYSIOLOGICAL MEASURES: BP and HR was recorded through 'non‐invasive' methods using the Philips patient monitoring system for anaesthesia [unpublished]. Outcomes were measured pre‐anaesthesia, at the start of surgery, at gallbladder removal, at the end of surgery, at extubation, at the end of anaesthesia, and in the PACU.
Patients in the control group had higher BP and HR at extubation than those in the nature sounds group (P value < 0.05). All other time‐points were non‐significant.
EXPERIENCE OF ANAESTHESIA: Unclear validity, 10‐point VAS from 'acceptable' to 'not acceptable'. | Data insufficient detail for extraction. Authors unable to provide means and SDs for physiological measures. |
| Twiss 2006 | RCT; 2 parallel groups. | DESCRIPTION: 60 in‐patients undergoing coronary artery bypass graft or vascular surgery, in the OR and ICU, Florida, USA.
NUMBERS: Music group = 30, Control group = 30.
AGE, mean (SD): Music group = 72.6 (2.1), Control group = 75.1 (3.4) years old.
GENDER (male/female): Music group = 10/20, Control group = 10/20.
ETHNICITY: not described.
INCLUSION CRITERIA: Orientated to person, time, and place on admission; not currently using music therapy intervention; able to hear music played with the CD player; available the night before surgery to meet with investigator and take the baseline STAI.
EXCLUSION CRITERIA: It is UNCLEAR if patients < 65 years old were excluded. | MUSIC GROUP: Choice of 6 discs played during surgery and post‐operatively. Family encouraged to bring in additional music choices post‐operatively. Music selection from Prescriptive Music Inc., ('Clarity'‐ melodies from classical motion pictures; 'Timeless'‐ heartfelt originals, 'Towards'‐ piano improvisation, 'Interlude'‐ piano music by Mozart, 'Universe'‐ synthesized compositions, 'Essence'‐ cello and piano).
CONTROL GROUP: Standard care. | ANXIETY: Measured via the STAI on the 3rd post‐operative day.
INTUBATION TIME: Recorded in minutes. | |
| Voss 2004 | RCT; 3 parallel groups. | DESCRIPTION: 61 post‐operative in‐patients following open heart surgery undergoing 30 minutes chair rest, in the surgical intensive care unit of a rural Midwestern hospital, USA.
NUMBERS: Music group = 19, rest group = 21, control group = 21.
AGE, mean (SD): 63 (13) years old.
GENDER (male/female): 39/22.
ETHNICITY (White/American Indian): 52/8.
INCLUSION CRITERIA: 1st post‐operative day following open heart surgery. Morning chair rest ordered. At least 18 years old. No major hearing deficit. Stable condition. Alert, orientated, able to follow commands. Read/write/understand English.
EXCLUSION CRITERIA: Femoral arterial sheath remained in place after surgery. | MUSIC GROUP: Instructed to listen and follow music and allow it to distract and relax. Played through headphones. 6 choices: synthesizer, harp, piano, orchestra ,slow jazz, flute. 30 second excerpts provided for choice. Phone unplugged, blinds closed, lights dimmed and door closed. Do not disturb sign placed on door.
REST GROUP: Phone unplugged, blinds closed, lights dimmed and door closed. Do not disturb sign placed on door.
CONTROL GROUP: Activity as normal. | ANXIETY: Anxiety about chair rest measured via 100 mm VAS.
PAIN SENSATION: measured via 100 mm VAS.
PAIN DISTRESS: measured via 100 mm VAS. | Change scores extracted for anxiety.
See Cepeda 2006 for details on music for pain relief (study not included in Cepeda 2006). |
| Wang 2002 | RCT; 2 parallel groups. | DESCRIPTION: 93 pre‐surgical out‐patients, to undergo elective surgery (ear‐nose‐throat; orthopedics; plastics; or other general minor surgery), in USA.
NUMBERS: Music group = 48, Control group = 45.
AGE, mean (SD): Music group = 44 (11), Control group = 41 (11) years old.
GENDER (male/female): Music group = 56/44, Control group = 61/39.
ETHNICITY (White/African‐American/Other): Music group = 38/8/2, Control group = 37/6/2.
INCLUSION CRITERIA: Aged 18 to 65 years old; ASA grade 1 to 3; Scheduled to undergo anaesthesia and elective out‐patient surgery.
EXCLUSION CRITERIA: none described. | MUSIC GROUP: Music played for 30 minutes via headphones prior to surgery in a hospital isolation room. Participants brought their own choice of music from home.
CONTROL GROUP: Wore headphones but did not listen to any music or white noise. In hospital isolation room. Condition lasted 30 minutes.
No hospital personnel were allowed in the room during the experiment. The experimenter waited outside the room. Persons accompanying the participant were allowed in the room, and participants were allowed to read and converse during the experiment. | ANXIETY: Measured via STAI before and after experiment.
HR: Measured via Biolog monitoring system.
BP: Method of measurement unclear.
SKIN CONDUCTANCE: Continually monitored with a Biolog ambulatory recording system (Model 3992/2).
HORMONES: Plasma catecholamines (cortisol, epinephrine, and norepinephrine) were obtained before and after experimental condition via blood sampling. Outcomes were obtained through radioimmunoassay then through high‐performance liquid chromatography and an electrochemical detector. | Outcomes are expressed as a percentage of the baseline score (mean and SD). |
| White 1992 | RCT; 2 parallel groups. | DESCRIPTION: 40 in‐patients in acute care unit for acute myocardial infarction in Midwest USA.
NUMBERS: 20 patients per group.
AGE, mean (SD): 55.7 (7.57) years old.
GENDER (male/female): 29/11.
ETHNICITY (Euro‐American/African‐American): 36/4.
INCLUSION CRITERIA: Stable condition; confirmed diagnosis of acute MI; State anxiety > 40; Alert and orientated; Able to read and write English.
EXCLUSION CRITERIA: Interrupted during the study. | MUSIC GROUP: listened to 4 adagios selected by the investigator for 25 minutes. Primarily string composition, low‐pitched, simple and direct musical rhythm, tempo approximately 60 bpm. Played via headphones.
CONTROL GROUP: received 25 minutes of uninterrupted rest. | ANXIETY: state anxiety measured via STAI.
HR and RR measured by auscultation for 30 seconds. | |
| White 1999 | RCT; 3 parallel groups. | DESCRIPTION: 45 in‐patients who had an acute MI, in private rooms in an ICU in Midwest USA.
NUMBERS: 15 patients per group.
AGE: mean = 63 years old.
GENDER (male/female): Music group = 13/2, Rest group = 10/5, Control group = 11/4.
ETHNICITY (African‐American/White/Hispanic): Music group = 2/13/0, Rest group = 4/10/1, Control group = 2/12/1.
INCLUSION CRITERIA: Confirmed acute MI within previous 72 hours; haemodynamic condition stable enough for participation (determined by nurse); alert and orientated; primary cardiac rhythm originating from the sinoatrial node.
EXCLUSION CRITERIA: Receiving mechanical ventilation. | MUSIC GROUP: Experimenter selected classical music, played via headphones. Asked to assume a comfortable position in bed, lights lowered, telephones unplugged, curtains drawn, doors closed, advised to clear mind and let muscles relax. 20 minutes.
REST GROUP: 20 minutes uninterrupted rest (experimenter outside door). Asked to assume comfortable position in bed, lights lowered, telephones unplugged, curtains drawn, doors closed, advised to clear mind and let muscles relax.
CONTROL GROUP: activities as normal (standard care). | PHYSIOLOGICAL: HR (chart extraction), RR (auscultation with a stethoscope for 30 seconds), BP (non‐invasive automatic oscillometric BP cuff), measured pre, immediately post and at 1 and 2 hours post the intervention period. Heart rate variability determined using power spectral analysis and fast Fourier transform from 3 hours of continuous electrocardiographic data (30 minutes pre to 2 hours post intervention period).
ANXIETY: Measured via state portion of STAI pre and immediately post intervention. | Data presented as mean and SE. SEs converted into SDs for purposes of review.
Data extracted for measures immediately after 20 minute intervention period.
Data extracted for HR, RR, BP, and anxiety, for purposes of review. Data not extracted for Rate pressure product or high‐frequency HR. |
| Winter 1994 | RCT; 2 parallel groups. | DESCRIPTION: 50 day patients scheduled for elective same‐day surgery of gynaecological procedures (e.g. exploratory laparoscopies, laparoscopic tubal ligation, ovarian cysts excision, and intrauterine device removal), in New Jersey, USA.
NUMBERS: Music group = 31 patients, Control group = 19 patients.
AGE, mean (SD): Music = 37 (8), Control = 37 (8).
GENDER: Female = 50 (100%).
ETHNICITY: not stated.
INCLUSION CRITERIA: Not described.
EXCLUSION CRITERIA: Not described. | MUSIC GROUP: Choice of classical, country, jazz, popular, or show music, played via headphones.
CONTROL GROUP: Standard care.
The intervention period took place in the surgical holding area prior to the patients' gynaecological procedure. Pre‐operative stay in holding area was 50 (+/‐ 20) minutes. | ANXIETY: State and trait anxiety via STAI on entry and exit of holding area. Results reported as Mean +/‐ SEM.
BP and HR: Taken on arrival in the surgical holding area and again just before going to the Operating Room (secondary outcomes). | Anxiety data presented as mean and SEs. SEs converted into SDs for purposes of review. |
| Wong 2001 | RCT; cross‐over study (2 allocation groups). | DESCRIPTION: 20 ventilator‐dependent in‐patients in an ICU in Hong Kong, China.
NUMBERS: Music group = 20 patients, Scheduled rest = 20 patients (cross‐over design).
AGE, mean (SD): 58.25 (15.53) years old.
GENDER (male/female): 15/5.
ETHNICITY: Chinese = 20 (100%).
INCLUSION CRITERIA: Chinese; understand Cantonese or English; 18 to 85 years old; alert, mentally competent; without hearing problems; able to communicate by holding up fingers in response to researchers' questions; undergoing mechanical ventilation with self‐triggering; haemodynamically stable.
EXCLUSION CRITERIA: Receiving any continuous intravenous analgesia; receiving any inotropic support; enrolled in previous similar studies. | MUSIC GROUP: Choice of 7 cassettes (Chinese folk song; Chinese instrumental music; Chinese music with western instruments; Buddhist music; Western classic; Western movie music; piano music). Participants instructed to close eyes and focus on the flow of the music.
SCHEDULED REST GROUP: Dimmed lights, drawn curtains (if in cubicle) or closed door (if in single room). Instructed to close eyes and rest.
Interventions lasted 30 minutes with an interval of at least 6 hours between the two interventions. Visitors were allowed to stay during the experimental and control interventions. | STATE ANXIETY: short‐form STAI, patients held up appropriate number of fingers in response to questions. Taken before and after each intervention.
RR: breaths per minute counted via observation.
BP (mm Hg): measured with the means of indwelling arterial lines recorded on the bedside cardiac monitor.
RR and BP recorded every 5 minutes during intervention periods (7 measurement points). | This cross‐over study has not reported patient‐specific differences between the two intervention measurements. Therefore, the data has been extracted as if it is independent groups (as there was not enough data to calculate a correlation coefficient). |
| Yang 2003 | RCT; 2 parallel groups. | DESCRIPTION: 39 patients undergoing eye operations with anaesthetics and analgesics in China.
NUMBERS: Music group = 19 patients; Control group = 20.
AGE, mean years: Music group = 39; Control group = 37.
GENDER: Male = 39 (100%).
ETHNICITY: not stated.
INCLUSION CRITERIA: 18 to 60 years old, with a baseline anxiety score of more than 40.
EXCLUSION CRITERIA: not stated. | MUSIC GROUP: Given a choice of 3 musical styles (pop, light, classical) with each type including 4 songs. Patients were asked to listen to the music 2 to 3 times the night before the operation and relax (not clear if patients were in‐patients). Patients then listened to the music throughout their operation.
CONTROL GROUP: Were given a pre‐operative visit but were not given a music tape. These patients received standard care during their operation. | ANXIETY: STAI presented as change scores.
DEPRESSION: Self‐rating Depression Scale (SDS) presented as change scores.
CONCERN / WORRY: via VAS (0 to 10) taken before, during, and after surgery.
BI: Bispectral Index measured via EEG. | |
| Yung 2003 | RCT; 2 parallel groups. | DESCRIPTION: 66 pre‐operative surgical patients in the OR holding area in Hong Kong, China.
NUMBERS: 33 patients in each group.
AGE, mean (range): 64.7 (21 to 89) years old.
GENDER: Male = 66 (100%).
ETHNICITY: Chinese = 66 (100%).
INCLUSION CRITERIA: Volunteer surgical patients; 50 to 80 years old (this does not reflect age range provided in table); comprehend written and verbal instructions; have prior surgical experience.
EXCLUSION CRITERIA: auditory impairment; received preoperative sedation; cardiac and respiratory disease; history of hypertension. | MUSIC GROUP: Slow music played via headphones for 20 minutes pre‐operatively. Participants had a choice of 3 tapes‐ Chinese instrumental, Western instrumental, or Western and Chinese slow songs.
CONTROL GROUP: Standard care. | ANXIETY: State anxiety measured via C‐STAI pre‐ and post‐intervention period.
PHYSIOLOGICAL: BP and HR measured with an automated monitor (Dinamap 1846‐SX) before and after intervention period. RR measured through observing the number of chest movements. | |
| Zhang 2005 | RCT; 2 parallel groups. | DESCRIPTION: 110 in‐patients undergoing abdominal hysterectomy in China.
NUMBERS: 55 patients in each group.
AGE, mean (SD): Music group = 41 (5) years old; Control group = 41 (3) years old.
GENDER: Female = 110 (100%).
ETHNICITY: not described.
INCLUSION CRITERIA: ASA I‐II; scheduled for elective total abdominal hysterectomy under spinal‐epidural anaesthesia.
EXCLUSION CRITERIA: Hearing impairment; drug abuse; known psychiatric disorders or memory disorders. | MUSIC GROUP: Patient choice of music they felt to be calming and comforting, played via headphones intraoperatively, from 6 minutes before skin incision and 1 minute before the loading dose of anaesthesia to wound closure
CONTROL GROUP: Wore headphones without sound or music. | PHYSIOLOGICAL: BP, HR, Bispectral Index recorded at 10‐minute intervals during surgery. Results reported as baseline and mean score during surgery (during target sedation period).
SEDATION: Level of alertness graded using the OAA/S at 10‐minute intervals. Time to sedation (OAA/S score = 3) reported (mins).
PROPOFOL: amount of intra‐operative propofol (mg) recorded.
SATISFACTION: patient's satisfaction with the peri‐operative care measured using a 10 cm VAS one day after surgery.
SERUM INTERLEUKIN‐6: measured at 3 time intervals (before, immediately after, and 1 hour after intervention). Determined using radioimmunoassay kits. | See Cepeda 2006 for details on music for pain relief (study not yet included in Cepeda 2006). |
| Zimmerman 1988 | RCT; 3 parallel groups. | DESCRIPTION: 75 in‐patients with suspected myocardial infarction in a coronary care unit in Midwest USA.
NUMBERS: 25 participants in each group.
AGE, mean: Music group = 65, Control group = 72, White noise group = 59. Overall mean (range) = 65 (34 to 92) years old.
GENDER (male/female): 49/26
ETHNICITY: White = 75 (100%).
INCLUSION CRITERIA: Orientated to person, place, and time; English speaking; > 19 years old; Stable condition.
EXCLUSION CRITERIA: Hearing deficit; Health professional background. | MUSIC GROUP: 30 minutes of self‐selected music choice of instrumental tapes: Halpern relaxation tape, classical music, country and western. Played via headphones.
WHITE NOISE GROUP: 30 minutes of white noise played via headphones.
CONTROL GROUP: Standard care. Were told the study was for gaining information about new admissions. Asked to lay quietly in bed for 30 minutes.
The music and white noise groups were told the tapes were to relax them. | ANXIETY: state anxiety measured via STAI
PHYSIOLOGICAL: BP and HR measured via an automatic monitor (Kendall Co., Model 8200). Skin temperature monitored by a digital thermometer (No. 865; Omega Engineering Inc.). | |
| Zimmerman 1989 | RCT; 2 parallel groups. | DESCRIPTION: 40 in‐patients with chronic cancer pain in acute care, Midwestern USA.
NUMBERS: 20 patients per group.
AGE, mean (range): 60 (34 to 79) years old.
GENDER (male/female): 16/24.
ETHNICITY (white/other): 39/1.
INCLUSION CRITERIA: orientation to person time and space; English speaking; 19 years or older; ability to consent verbally and in writing; experiencing pain for > 6months; receiving a scheduled (e.g. every 3 or 4 hours round‐the‐clock) pain medication; free of major hearing deficit.
EXCLUSION CRITERIA: no further criteria described. | MUSIC GROUP: Choice of 10 relaxing instrumental tapes. Participants without a preference were given a Halpern antifrantic tape. The researcher suggested to the participant that the music would help them relax and reduce their pain. Participants listened to the music for 30 minutes via headphones. Participants lay on their beds and the lights were dimmed.
CONTROL GROUP: Patients lay on their beds for 30 minutes with the lights dimmed. | PAIN: Measured before and after 30 minute test period via McGill Pain Questionnaire (Pain Rating Index, Number of Words Chosen, and Present Pain Index). Additionally, pain intensity was measured via a 10 mm [sic] VAS. | See Cepeda 2006 for details on music for pain relief. |
