Music interventions for acquired brain injury

Wendy L Magee; Imogen Clark; Jeanette Tamplin; Joke Bradt

doi:10.1002/14651858.CD006787.pub3

Cochrane Database of Systematic Reviews

Musicoterapia para la lesión cerebral adquirida

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DOI:

https://doi.org/10.1002/14651858.CD006787.pub3 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

20 enero 2017see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Accidentes cerebrovasculares

Copyright:

Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

Wendy L Magee

Correspondencia a: Boyer College of Music and Dance, Temple University, Philadelphia, USA

[email protected]
Imogen Clark

Music Therapy, Faculty of VCA and MCM, University of Melbourne, Melbourne, Australia
Jeanette Tamplin

Music Therapy, Faculty of VCA and MCM, University of Melbourne, Melbourne, Australia
Joke Bradt

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

Contributions of authors

Wendy Magee (WM), Imogen Clark (IC), Jeanette Tamplin (JT), Joke Bradt (JB)

Co‐ordinating the review: WM
Revision of the background, objectives, criteria for considering studies for this update: WM, IC, JT, JB
Search strategies, methods: JB
Undertaking manual searches: WM, IC, JT, and graduate assistants
Searches: WM
Screening search results: WM and graduate assistant
Retrieval of papers: WM
Screening retrieved papers against inclusion criteria: IC, JT
Appraising the quality of the papers: IC, JT (in cases of disagreement, WM, JB)
Abstracting data from papers: WM, JB
Writing to authors of all trials (published and unpublished) for additional information: WM
Providing and screening additional data on all studies (published and unpublished): WM
Data management for the review: WM
Entering data into Review Manager 5: JB
Review Manager 5 statistical data and all other statistical data: JB
Double entry of data: JB, WM
Interpretation of data: JB, WM
Statistical inferences: JB
Writing the review: WM, IC, JT, JB
Obtaining funding for the review: WM for the update
Person responsible for reading and checking the review before submission: WM

Sources of support

Internal sources

Temple University, USA.

Partial support for this update provided by a Boyer College Vice Provost for the Arts Grant

External sources

State of Pennsylvania Formula Fund, USA.

Partial support for the original review (Bradt 2010)

Declarations of interest

All four of the review authors (WM, IC, JT, JB) are music therapists. WM was involved in the design, conduct, and publication of two of the studies included in this review (O'Kelly 2014; Pool 2012).

Acknowledgements

We acknowledge the Cochrane Stroke Group Editorial Team for advice and support, and Brenda Thomas for her assistance in the design of the search strategy for the original review and updated search strategies for this update. We also acknowledge the following individuals for their help in screening the titles and abstracts and the retrieval of articles as graduate assistants: Patricia Gonzalez and Mike Viega in the original review, and Vern Miller for this update. Lastly, we acknowledge the authors of the original review who were not involved with this update: Cheryl Dileo, Emer McGilloway and Barbara Wheeler.

Version history

Published

Title

Stage

Authors

Version

2017 Jan 20

Music interventions for acquired brain injury

Review

Wendy L Magee, Imogen Clark, Jeanette Tamplin, Joke Bradt

https://doi.org/10.1002/14651858.CD006787.pub3

2010 Jul 07

Music therapy for acquired brain injury

Review

Joke Bradt, Wendy L Magee, Cheryl Dileo, Barbara L Wheeler, Emer McGilloway

https://doi.org/10.1002/14651858.CD006787.pub2

2007 Oct 17

Music therapy for acquired brain injury

Protocol

Joke Bradt, Wendy L Magee, Cheryl Dileo, Barbara L Wheeler, Emer McGilloway

https://doi.org/10.1002/14651858.CD006787

Differences between protocol and review

We planned to update our search of the Science Citation Index electronic database. However, this database was omitted in the initial search by our search specialist. Although we attempted to correct this omission when we updated our searches in January 2016, a change in search specialist personnel resulted in no specialist who was available to undertake this search at that time. Although Science Citation Index is a major database, we believe that research relating to the topic under investigation (health and music) is most likely to have been published on primarily healthcare databases, for which searches were performed.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adult; Female; Humans; Male;

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

Study flow diagram for the updated review.

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Figure 2

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

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Figure 3

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

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Figure 4

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

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Analysis 1.1

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

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Analysis 1.2

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

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Analysis 1.3

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

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Analysis 1.4

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

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Analysis 1.5

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

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Analysis 1.6

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

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Analysis 1.7

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

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Analysis 1.8

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

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Analysis 1.9

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

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Analysis 1.10

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

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Analysis 1.11

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

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Analysis 1.12

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

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Analysis 1.13

Comparison 1 Music therapy versus control, Outcome 13 Balance.

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Analysis 1.14

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

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Analysis 1.15

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

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Analysis 1.16

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

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Analysis 1.17

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

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Analysis 1.18

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

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Analysis 1.19

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

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Analysis 1.20

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

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Analysis 1.21

Comparison 1 Music therapy versus control, Outcome 21 Naming.

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Analysis 1.22

Comparison 1 Music therapy versus control, Outcome 22 Repetition.

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Analysis 1.23

Comparison 1 Music therapy versus control, Outcome 23 Memory.

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Analysis 1.24

Comparison 1 Music therapy versus control, Outcome 24 Attention.

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Analysis 1.25

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

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

Music compared with standard care for acquired brain injury
Patient or population: acquired brain injury Setting: outpatient Intervention: music interventions Comparison: control
Outcomes	Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)
Gait velocity assessed with: metres/minute	The mean gait velocity in the intervention group was 11.34 metres more (8.4 more to 14.28 more).	268 (9 RCTs)	⊕⊕⊕⊝ MODERATE ^{1, 2, 3, 4}
Stride length (affected side) assessed with: metres	The mean stride length (affected side) in the intervention group was 0.12 metres more (0.04 more to 0.2 more).	129 (5 RCTs)	⊕⊕⊕⊝ MODERATE ^{1, 2, 5, 6}
Gait cadence assessed with: steps/minute	The mean gait cadence in the intervention group was 10.77 steps/minute more (4.36 more to 17.18 more).	223 (7 RCTs)	⊕⊕⊝⊝ LOW ^{1, 2, 4, 7}
Stride symmetry	The mean stride symmetry in the intervention group was 0.94 standard deviations more (0.32 fewer to 2.2 more).	139 (3 RCTs)	⊕⊕⊝⊝ LOW ^{2, 6, 8, 9}
General upper extremity functioning assessed with: Fugl‐Meyer Assessment	The mean general upper extremity functioning in the intervention group was 3.56 units higher (0.88 lower to 8 higher).	194 (5 RCTs)	⊕⊝⊝⊝ VERY LOW ^{1, 2, 4, 6, 10}
Overall communication	The mean overall communication in the intervention group was 0.75 standard deviations more (0.11 more to 1.39 more).	67 (3 RCTs)	⊕⊝⊝⊝ VERY LOW ^{4, 11}
Quality of life assessed with: Stroke Specific Quality of Life Scale	The mean quality of life in the intervention group was 0.89 standard deviations more (0.32 more to 1.46 more).	53 (2 RCTs)	⊕⊕⊝⊝ LOW ^{2, 4, 11}
CI: confidence interval; RCT: randomised controlled trial
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹Most studies were rated as at unclear or high risk of bias ²All point estimates favour the music interventions, although the magnitude of the effect differs across studies ³Results were inconsistent across studies, as evidenced by I² = 61% ⁴Wide confidence interval; however, this is due to the fact that some studies reported very large beneficial effects ⁵Results were inconsistent across studies, as evidenced by I² = 80% ⁶Wide confidence interval ⁷Results were inconsistent across studies, as evidenced by I² = 83% ⁸One study was rated as at low, one as at unclear, and one as at high risk of bias ⁹Results were inconsistent across studies, as evidenced by I² = 90% ¹⁰Results were inconsistent across studies, as evidenced by I² = 85% ¹¹All studies were at high risk of bias

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

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Comparison 1. Music therapy versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Gait velocity Show forest plot	9		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 All studies	9	268	Mean Difference (IV, Random, 95% CI)	11.34 [8.40, 14.28]
1.2 Adequate randomisation	7	228	Mean Difference (IV, Random, 95% CI)	10.79 [7.23, 14.35]
2 Gait velocity ‐ interventionist Show forest plot	9	268	Mean Difference (IV, Random, 95% CI)	11.34 [8.40, 14.28]

2.1 Music therapist	3	128	Mean Difference (IV, Random, 95% CI)	14.76 [13.84, 15.69]
2.2 Non‐music therapist	6	140	Mean Difference (IV, Random, 95% CI)	8.48 [5.16, 11.80]
3 Gait velocity ‐ music type Show forest plot	9	268	Mean Difference (IV, Random, 95% CI)	11.34 [8.40, 14.28]

3.1 Music	5	173	Mean Difference (IV, Random, 95% CI)	14.69 [13.77, 15.61]
3.2 Auditory stimulation (no music)	4	95	Mean Difference (IV, Random, 95% CI)	7.70 [3.03, 12.38]
4 Stride length (affected side) Show forest plot	5		Mean Difference (IV, Random, 95% CI)	Subtotals only

4.1 All studies	5	129	Mean Difference (IV, Random, 95% CI)	0.12 [0.04, 0.20]
4.2 Adequate randomisation	3	89	Mean Difference (IV, Random, 95% CI)	0.08 [0.05, 0.11]
5 Stride length (affected side) ‐ music type Show forest plot	5	129	Mean Difference (IV, Random, 95% CI)	0.12 [0.04, 0.20]

5.1 Music	2	50	Mean Difference (IV, Random, 95% CI)	0.08 [0.05, 0.12]
5.2 Auditory stimulation (no music)	3	79	Mean Difference (IV, Random, 95% CI)	0.14 [0.02, 0.25]
6 Stride length (unaffected side) [metres] Show forest plot	4		Mean Difference (IV, Random, 95% CI)	Subtotals only

6.1 All studies	4	99	Mean Difference (IV, Random, 95% CI)	0.11 [0.01, 0.22]
6.2 Adequate randomisation	2	59	Mean Difference (IV, Random, 95% CI)	0.06 [0.01, 0.12]
7 Stride length (unspecified) [metres] Show forest plot	3	186	Mean Difference (IV, Random, 95% CI)	0.16 [‐0.01, 0.33]

8 Gait cadence Show forest plot	7		Mean Difference (IV, Random, 95% CI)	Subtotals only

8.1 all studies	7	223	Mean Difference (IV, Random, 95% CI)	10.77 [4.36, 17.18]
8.2 Adequate randomisation	6	203	Mean Difference (IV, Random, 95% CI)	10.80 [4.05, 17.56]
9 Gait cadence ‐ interventionist Show forest plot	7	223	Mean Difference (IV, Random, 95% CI)	10.77 [4.36, 17.18]

9.1 Music therapist	3	128	Mean Difference (IV, Random, 95% CI)	11.51 [‐2.57, 25.60]
9.2 Non‐music therapist	4	95	Mean Difference (IV, Random, 95% CI)	7.65 [4.43, 10.86]
10 Gait cadence ‐ music type Show forest plot	7	223	Mean Difference (IV, Random, 95% CI)	10.77 [4.36, 17.18]

10.1 Music	4	148	Mean Difference (IV, Random, 95% CI)	11.34 [‐1.05, 23.74]
10.2 Auditory stimulus (no music)	3	75	Mean Difference (IV, Random, 95% CI)	7.58 [4.33, 10.83]
11 Stride symmetry Show forest plot	3	139	Std. Mean Difference (IV, Random, 95% CI)	0.94 [‐0.32, 2.20]

12 General gait Show forest plot	2	48	Mean Difference (IV, Random, 95% CI)	7.67 [5.67, 9.67]

13 Balance Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

13.1 All studies	3	54	Std. Mean Difference (IV, Random, 95% CI)	0.31 [‐0.48, 1.09]
13.2 Adequate randomisation	2	34	Std. Mean Difference (IV, Random, 95% CI)	0.13 [‐1.10, 1.37]
14 Upper extremity functioning (general) Show forest plot	5		Mean Difference (IV, Random, 95% CI)	Subtotals only

14.1 All studies	5	194	Mean Difference (IV, Random, 95% CI)	3.56 [‐0.88, 8.00]
14.2 Adequate randomisation	3	156	Mean Difference (IV, Random, 95% CI)	0.89 [‐2.33, 4.12]
15 Upper extremity functioning ‐ time Show forest plot	2	122	Std. Mean Difference (IV, Random, 95% CI)	‐1.08 [‐1.69, ‐0.47]

16 Range of motion ‐ shoulder flexion Show forest plot	2	53	Mean Difference (IV, Random, 95% CI)	9.81 [‐12.71, 32.33]

17 Hand function Show forest plot	2	113	Mean Difference (IV, Random, 95% CI)	0.32 [‐0.91, 1.54]

18 Upper limb strength Show forest plot	2	113	Mean Difference (IV, Random, 95% CI)	6.03 [‐2.52, 14.59]

19 Manual dexterity Show forest plot	2	74	Mean Difference (IV, Random, 95% CI)	0.47 [‐1.08, 2.01]

20 Overall communication Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

20.1 All studies	3	67	Std. Mean Difference (IV, Random, 95% CI)	0.75 [0.11, 1.39]
20.2 Adequate randomisation	2	54	Std. Mean Difference (IV, Random, 95% CI)	0.52 [‐0.03, 1.07]
21 Naming Show forest plot	2	35	Mean Difference (IV, Random, 95% CI)	9.79 [1.37, 18.21]

22 Repetition Show forest plot	2	35	Mean Difference (IV, Random, 95% CI)	8.90 [3.25, 14.55]

23 Memory Show forest plot	2	42	Std. Mean Difference (IV, Random, 95% CI)	0.33 [‐0.29, 0.95]

24 Attention Show forest plot	2	39	Std. Mean Difference (IV, Random, 95% CI)	0.30 [‐0.34, 0.94]

25 Quality of life Show forest plot	2	53	Std. Mean Difference (IV, Random, 95% CI)	0.89 [0.32, 1.46]

Comparison 1. Music therapy versus control

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Musicoterapia para la lesión cerebral adquirida

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