Music for stress and anxiety reduction in coronary heart disease patients

Joke Bradt; Cheryl Dileo; Noah Potvin

doi:10.1002/14651858.CD006577.pub3

Cochrane Database of Systematic Reviews

Música para la reducción de la ansiedad y del estrés en pacientes con cardiopatía coronaria

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DOI:

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

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

28 diciembre 2013see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Corazón

Copyright:

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

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

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.

Figure 1

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

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Figure 2

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

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Figure 3

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

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Figure 4

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

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Figure 5

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

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Analysis 1.1

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

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Analysis 1.2

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

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Analysis 1.3

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

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Analysis 1.4

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

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Analysis 1.5

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

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Analysis 1.6

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

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Analysis 1.7

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

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Analysis 1.8

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

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Analysis 1.9

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

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Analysis 1.10

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

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Analysis 1.11

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

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Analysis 1.12

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

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Analysis 1.13

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

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Analysis 1.14

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

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Analysis 1.15

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

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Analysis 1.16

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

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Analysis 1.17

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

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Analysis 1.18

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

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Analysis 1.19

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

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Analysis 1.20

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

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Analysis 1.21

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

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Analysis 1.22

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

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

Outcomes	*Illustrative comparative risks (95% CI)**		No of Participants (studies)	Quality of the evidence (GRADE)
Music versus standard care for coronary heart disease
Patient or population: people with coronary heart disease Settings: Intervention: music versus standard care
	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 low^1,2,3
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 low^1,2,3
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 low^1,4
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 low^1,3,5
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%.

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

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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]

Comparison 1. Music versus standard care

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Música para la reducción de la ansiedad y del estrés en pacientes con cardiopatía coronaria

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