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Cochrane Database of Systematic Reviews

Music for stress and anxiety reduction in coronary heart disease patients

Información

DOI:
https://doi.org/10.1002/14651858.CD006577.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 28 diciembre 2013see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Corazón

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Joke Bradt

    Correspondencia a: Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, USA

    [email protected]

  • Cheryl Dileo

    Department of Music Therapy and The Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, Philadelphia, USA

  • Noah Potvin

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

Contributions of authors

Joke Bradt: conceived and designed the review, developed the search strategies and wrote the protocol. She is the guarantor for the review and identified potentially relevant trials, extracted eligible articles, extracted data from included studies, performed the statistical analysis and wrote the review text.

Cheryl Dileo: conceived and designed the review, and contributed to writing the protocol. For the original review, she identified potentially relevant trials, tracked eligible articles, extracted data from them, and contributed to writing the text. For the update of the review, she completed the quality assessment of the trials.

Noah Potvin: contributed to the update of this review by screening the database search outputs for eligible trials, updating the handsearches, retrieving full‐text articles, completing quality assessment of the trials, extracting data from included studies, and reviewing the text of this review.

Sources of support

Internal sources

  • Temple University, Philadelphia, PA, USA

External sources

  • State of Pennsylvania Formula Fund, USA

Declarations of interest

All three authors are trained music therapists.

Acknowledgements

The authors would like to thank the Cochrane Heart Group editorial base for their excellent advice and support. We would also like to acknowledge Charla Thomas, graduate assistant, for her help in the handsearching of journals for the original review. Finally, we would like to express our gratitude to Ana Filipa Macedo, Chen Jing, and Farhad Shokraneh for their help with the translation of manuscripts.

Version history

Published

Title

Stage

Authors

Version

2013 Dec 28

Music for stress and anxiety reduction in coronary heart disease patients

Review

Joke Bradt, Cheryl Dileo, Noah Potvin

https://doi.org/10.1002/14651858.CD006577.pub3

2009 Apr 15

Music for stress and anxiety reduction in coronary heart disease patients

Review

Joke Bradt, Cheryl Dileo

https://doi.org/10.1002/14651858.CD006577.pub2

2007 Jul 18

Music for people with coronary heart disease

Protocol

Joke Bradt, Cheryl Dileo

https://doi.org/10.1002/14651858.CD006577

Differences between protocol and review

The following subgroup analysis was not included in the protocol:

A comparison of (a) MI patients, (b) surgical or procedural patients, and (c) rehabilitation patients. Although this subanalysis was not determined a priori, the reviewers decided it was important to conduct a subanalysis comparing the effect of these three groups of studies for those outcome variables for which significant heterogeneity was found.

The original review only included randomized controlled trials. For the update of this review, we decided to also include quasi‐randomized controlled trials and conduct a sensitivity analysis to examine the impact of such trials on the effect size.

Finally, an explicit statement was added to the method section regarding the exclusion of studies with participants who did not all have a confirmed CHD.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Funnel plot of comparison: 1 music versus standard care, outcome: 1.2 Anxiety (all measures) ‐ patient type.

Figuras y tablas -
Figure 1

Funnel plot of comparison: 1 music versus standard care, outcome: 1.2 Anxiety (all measures) ‐ patient type.

Funnel plot of comparison: 1 music versus standard care, outcome: 1.11 Heart rate‐patient type.

Figuras y tablas -
Figure 2

Funnel plot of comparison: 1 music versus standard care, outcome: 1.11 Heart rate‐patient type.

Funnel plot of comparison: 1 music versus standard care, outcome: 1.15 Systolic blood pressure.

Figuras y tablas -
Figure 3

Funnel plot of comparison: 1 music versus standard care, outcome: 1.15 Systolic blood pressure.

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

Figuras y tablas -
Figure 4

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

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

Figuras y tablas -
Figure 5

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

Comparison 1: Music versus standard care, Outcome 1: Psychological distress

Figuras y tablas -
Analysis 1.1

Comparison 1: Music versus standard care, Outcome 1: Psychological distress

Comparison 1: Music versus standard care, Outcome 2: Anxiety (all measures) ‐ patient type

Figuras y tablas -
Analysis 1.2

Comparison 1: Music versus standard care, Outcome 2: Anxiety (all measures) ‐ patient type

Comparison 1: Music versus standard care, Outcome 3: Anxiety (all measures) ‐ music preference

Figuras y tablas -
Analysis 1.3

Comparison 1: Music versus standard care, Outcome 3: Anxiety (all measures) ‐ music preference

Comparison 1: Music versus standard care, Outcome 4: State anxiety (STAI) ‐ patient type

Figuras y tablas -
Analysis 1.4

Comparison 1: Music versus standard care, Outcome 4: State anxiety (STAI) ‐ patient type

Comparison 1: Music versus standard care, Outcome 5: State Anxiety (STAI) ‐ music preference

Figuras y tablas -
Analysis 1.5

Comparison 1: Music versus standard care, Outcome 5: State Anxiety (STAI) ‐ music preference

Comparison 1: Music versus standard care, Outcome 6: State Anxiety (STAI) ‐ music preference MI only

Figuras y tablas -
Analysis 1.6

Comparison 1: Music versus standard care, Outcome 6: State Anxiety (STAI) ‐ music preference MI only

Comparison 1: Music versus standard care, Outcome 7: Anxiety (non‐STAI)‐patient type

Figuras y tablas -
Analysis 1.7

Comparison 1: Music versus standard care, Outcome 7: Anxiety (non‐STAI)‐patient type

Comparison 1: Music versus standard care, Outcome 8: Anxiety (non‐STAI) ‐ music preference

Figuras y tablas -
Analysis 1.8

Comparison 1: Music versus standard care, Outcome 8: Anxiety (non‐STAI) ‐ music preference

Comparison 1: Music versus standard care, Outcome 9: Depression

Figuras y tablas -
Analysis 1.9

Comparison 1: Music versus standard care, Outcome 9: Depression

Comparison 1: Music versus standard care, Outcome 10: Mood

Figuras y tablas -
Analysis 1.10

Comparison 1: Music versus standard care, Outcome 10: Mood

Comparison 1: Music versus standard care, Outcome 11: Heart rate‐patient type

Figuras y tablas -
Analysis 1.11

Comparison 1: Music versus standard care, Outcome 11: Heart rate‐patient type

Comparison 1: Music versus standard care, Outcome 12: Heart rate ‐ music preference

Figuras y tablas -
Analysis 1.12

Comparison 1: Music versus standard care, Outcome 12: Heart rate ‐ music preference

Comparison 1: Music versus standard care, Outcome 13: Heart rate variability

Figuras y tablas -
Analysis 1.13

Comparison 1: Music versus standard care, Outcome 13: Heart rate variability

Comparison 1: Music versus standard care, Outcome 14: Respiratory rate ‐ music preference

Figuras y tablas -
Analysis 1.14

Comparison 1: Music versus standard care, Outcome 14: Respiratory rate ‐ music preference

Comparison 1: Music versus standard care, Outcome 15: Systolic blood pressure

Figuras y tablas -
Analysis 1.15

Comparison 1: Music versus standard care, Outcome 15: Systolic blood pressure

Comparison 1: Music versus standard care, Outcome 16: Diastolic blood pressure

Figuras y tablas -
Analysis 1.16

Comparison 1: Music versus standard care, Outcome 16: Diastolic blood pressure

Comparison 1: Music versus standard care, Outcome 17: Mean A rterial Pressure

Figuras y tablas -
Analysis 1.17

Comparison 1: Music versus standard care, Outcome 17: Mean A rterial Pressure

Comparison 1: Music versus standard care, Outcome 18: Oxygen Saturation

Figuras y tablas -
Analysis 1.18

Comparison 1: Music versus standard care, Outcome 18: Oxygen Saturation

Comparison 1: Music versus standard care, Outcome 19: Pain

Figuras y tablas -
Analysis 1.19

Comparison 1: Music versus standard care, Outcome 19: Pain

Comparison 1: Music versus standard care, Outcome 20: Length of hospital stay

Figuras y tablas -
Analysis 1.20

Comparison 1: Music versus standard care, Outcome 20: Length of hospital stay

Comparison 1: Music versus standard care, Outcome 21: Opioid intake

Figuras y tablas -
Analysis 1.21

Comparison 1: Music versus standard care, Outcome 21: Opioid intake

Comparison 1: Music versus standard care, Outcome 22: Quality of sleep

Figuras y tablas -
Analysis 1.22

Comparison 1: Music versus standard care, Outcome 22: Quality of sleep

Summary of findings 1. Music versus standard care for coronary heart disease

Music versus standard care for coronary heart disease

Patient or population: people with coronary heart disease
Settings:
Intervention: music versus standard care

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Music versus standard care

Psychological Distress
POMS

The mean psychological distress in the intervention groups was
1.26 lower
(2.30 to 0.22 lower)

228
(5 studies)

⊕⊕⊝⊝
low1

Anxiety (all measures)
NRS, VAS, HADS, STAI

The mean anxiety (all measures) in the intervention groups was
0.70 standard deviations lower
(1.17 to 0.22 lower)

353
(10 studies)

⊕⊝⊝⊝
very low1,2,3

State anxiety (MI patients)
STAI

The mean state anxiety (MI patients) in the intervention groups was
5.87 lower
(7.99 to 3.75 lower)

243
(6 studies)

⊕⊕⊝⊝
low1

Heart rate
bpm

The mean heart rate in the intervention groups was
3.62 lower
(6.28 to 0.95 lower)

828
(13 studies)

⊕⊝⊝⊝
very low1,2,3

Respiratory rate
breaths per minute

The mean respiratory rate in the intervention groups was
2.50 lower
(3.61 to 1.39 lower)

442
(7 studies)

⊕⊝⊝⊝
very low1,4

Systolic blood pressure

The mean systolic blood pressure in the intervention groups was
5.52 lower
(7.43 to 3.60 lower)

775
(11 studies)

⊕⊕⊝⊝
low1

Pain
VAS, NRS

The mean pain in the intervention groups was
0.43 standard deviations lower
(0.80 to 0.05 lower)

562
(8 studies)

⊕⊝⊝⊝
very low1,3,5

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

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

1The majority of the trials were assessed as being at high risk of bias
2Results were inconsistent across studies as evidenced by I² = 77%.
3Wide confidence interval
4Results were inconsistent across studies as evidenced by I² = 79%.
5Results were inconsistent across studies as evidenced by I² = 81%.

Figuras y tablas -
Summary of findings 1. Music versus standard care for coronary heart disease
Comparison 1. Music versus standard care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Psychological distress Show forest plot

5

228

Mean Difference (IV, Fixed, 95% CI)

‐1.26 [‐2.30, ‐0.22]

1.2 Anxiety (all measures) ‐ patient type Show forest plot

10

353

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

‐0.70 [‐1.17, ‐0.22]

1.2.1 anxiety (all measures) (MI)

4

143

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

‐0.94 [‐1.95, 0.06]

1.2.2 anxiety (all measures)(surgical/procedural)

4

171

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

‐0.63 [‐1.25, ‐0.01]

1.2.3 anxiety (all measures)(rehabilitation)

2

39

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

‐0.38 [‐1.60, 0.83]

1.3 Anxiety (all measures) ‐ music preference Show forest plot

9

323

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

‐0.79 [‐1.29, ‐0.29]

1.3.1 Anxiety (all measures) ‐ partcipant‐selected

4

144

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

‐0.89 [‐1.42, ‐0.36]

1.3.2 Anxiety (all measures) ‐ researcher‐selected

5

179

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

‐0.74 [‐1.55, 0.08]

1.4 State anxiety (STAI) ‐ patient type Show forest plot

7

310

Mean Difference (IV, Random, 95% CI)

‐4.58 [‐7.78, ‐1.39]

1.4.1 State anxiety (STAI) ‐ MI

6

243

Mean Difference (IV, Random, 95% CI)

‐5.87 [‐7.99, ‐3.75]

1.4.2 State anxiety (STAI) ‐ surgical/procedural

1

67

Mean Difference (IV, Random, 95% CI)

0.40 [‐1.33, 2.13]

1.5 State Anxiety (STAI) ‐ music preference Show forest plot

7

310

Mean Difference (IV, Random, 95% CI)

‐4.58 [‐7.78, ‐1.39]

1.5.1 State Anxiety (STAI) ‐ participant‐preferred

3

167

Mean Difference (IV, Random, 95% CI)

‐4.71 [‐10.76, 1.33]

1.5.2 State Anxiety (STAI) ‐ researcher‐selected

4

143

Mean Difference (IV, Random, 95% CI)

‐4.68 [‐8.27, ‐1.10]

1.6 State Anxiety (STAI) ‐ music preference MI only Show forest plot

6

243

Mean Difference (IV, Random, 95% CI)

‐5.87 [‐7.99, ‐3.75]

1.6.1 State Anxiety (STAI) ‐ participant‐preferred

2

100

Mean Difference (IV, Random, 95% CI)

‐7.36 [‐9.45, ‐5.27]

1.6.2 State Anxiety (STAI) ‐ researcher‐selected

4

143

Mean Difference (IV, Random, 95% CI)

‐4.68 [‐8.27, ‐1.10]

1.7 Anxiety (non‐STAI)‐patient type Show forest plot

7

248

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

‐0.43 [‐0.93, 0.06]

1.7.1 Anxiety (surgical/procedural)

4

171

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

‐0.63 [‐1.25, ‐0.01]

1.7.2 Anxiety (MI and rehabilitation)

3

77

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

‐0.03 [‐0.61, 0.56]

1.8 Anxiety (non‐STAI) ‐ music preference Show forest plot

7

248

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

‐0.43 [‐0.93, 0.06]

1.8.1 Anxiety (non‐STAI) ‐ participant‐preferred

4

144

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

‐0.89 [‐1.42, ‐0.36]

1.8.2 Anxiety (non‐STAI) ‐ researcher‐selected

3

104

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

0.11 [‐0.28, 0.49]

1.9 Depression Show forest plot

6

217

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

‐0.11 [‐0.38, 0.16]

1.10 Mood Show forest plot

2

97

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

1.08 [‐0.02, 2.17]

1.11 Heart rate‐patient type Show forest plot

13

828

Mean Difference (IV, Random, 95% CI)

‐3.40 [‐6.12, ‐0.69]

1.11.1 heart rate (surg ical/procedural)

7

604

Mean Difference (IV, Random, 95% CI)

‐2.61 [‐5.62, 0.39]

1.11.2 Heart rate (MI)

5

194

Mean Difference (IV, Random, 95% CI)

‐4.75 [‐9.26, ‐0.25]

1.11.3 Heart rate (rehab)

1

30

Mean Difference (IV, Random, 95% CI)

4.50 [‐9.68, 18.68]

1.12 Heart rate ‐ music preference Show forest plot

13

828

Mean Difference (IV, Random, 95% CI)

‐3.62 [‐6.28, ‐0.95]

1.12.1 Heart rate ‐ participant‐selected music

7

430

Mean Difference (IV, Random, 95% CI)

‐4.69 [‐9.40, 0.02]

1.12.2 Heart rate ‐ researcher‐selected music

6

398

Mean Difference (IV, Random, 95% CI)

‐2.67 [‐4.27, ‐1.07]

1.13 Heart rate variability Show forest plot

2

90

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

0.07 [‐0.34, 0.48]

1.14 Respiratory rate ‐ music preference Show forest plot

7

442

Mean Difference (IV, Random, 95% CI)

‐2.50 [‐3.61, ‐1.39]

1.14.1 Respiratory Rate ‐ participant‐selected

3

186

Mean Difference (IV, Random, 95% CI)

‐4.42 [‐7.37, ‐1.46]

1.14.2 Respiratory Rate ‐ researcher‐selected

4

256

Mean Difference (IV, Random, 95% CI)

‐1.66 [‐2.20, ‐1.12]

1.15 Systolic blood pressure Show forest plot

11

775

Mean Difference (IV, Fixed, 95% CI)

‐5.52 [‐7.43, ‐3.60]

1.16 Diastolic blood pressure Show forest plot

9

685

Mean Difference (IV, Fixed, 95% CI)

‐1.12 [‐2.57, 0.34]

1.17 Mean A rterial Pressure Show forest plot

3

158

Mean Difference (IV, Fixed, 95% CI)

‐0.91 [‐4.08, 2.26]

1.18 Oxygen Saturation Show forest plot

3

184

Mean Difference (IV, Random, 95% CI)

‐0.02 [‐1.65, 1.61]

1.19 Pain Show forest plot

8

630

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

‐0.43 [‐0.80, ‐0.05]

1.19.1 One music session

5

420

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

‐0.55 [‐1.16, 0.07]

1.19.2 Two or more music sessions

3

210

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

‐0.27 [‐0.55, ‐0.00]

1.20 Length of hospital stay Show forest plot

2

82

Mean Difference (IV, Fixed, 95% CI)

‐0.06 [‐1.03, 0.92]

1.21 Opioid intake Show forest plot

2

90

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

‐0.25 [‐0.67, 0.16]

1.22 Quality of sleep Show forest plot

2

122

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

0.91 [0.03, 1.79]

Figuras y tablas -
Comparison 1. Music versus standard care