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音樂的介入用於後天性腦損傷

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Referencias

Baker 2001 {published and unpublished data}

Baker F. The Effects of Live and Taped Music on the Orientation and Agitation Levels of People Experiencing Post‐Traumatic Amnesia (Masters thesis). Melbourne, Australia: University of Melbourne, 1999. CENTRAL
Baker F. The effect of live and taped music on agitation and orientation levels of people experiencing PTA. 5th European Music Therapy Congress; 2001 April 21‐24; Napoli, Italy. 2001. CENTRAL
Baker F. The effects of live, taped, and no music on people experiencing posttraumatic amnesia. Journal of Music Therapy 2001;38(3):170‐92. CENTRAL

Cha 2014a {published data only}

Cha Y, Kim Y, Chung Y. Immediate effects of rhythmic auditory stimulation with tempo changes on gait in stroke patients. Journal of Physical Therapy Science 2014;26:479‐82. CENTRAL

Cha 2014b {published data only}

Cha Y, Kim Y, Hwang S, Chung Y. Intensive gait training with rhythmic auditory stimulation in individuals with chronic hemiparetic stroke: a pilot randomized controlled study. NeuroRehabilitation 2014;35:681‐8. CENTRAL

Chouan 2012 {published data only}

Chouan S, Kumar S. Comparing the effects of rhythmic auditory cueing and visual cueing in acute hemiparetic stroke. International Journal of Therapy and Rehabilitation 2012;20:125‐31. CENTRAL

Conklyn 2012 {published data only}

Conklyn D, Novak E, Boissy A, Bethoux F, Chemali K. The effects of modified melodic intonation therapy on nonfluent aphasia: a pilot study. Journal of Speech, Language, and Hearing Research 2012;55:1463‐71. CENTRAL

Fernandes 2014 {published data only}

Fernandes Ribeiro AS, Ramos A, Bermejo E, Casero M, Corrales JM, Grantham S. Effects of different musical stimuli in vital signs and facial expressions in patients with cerebral damage: a pilot study. Journal of Neuroscience Nursing 2014;46:117‐24. CENTRAL

Hill 2011 {published data only}

Hill V, Dunn L, Dunning K, Page SJ. A pilot study of rhythm and timing training as a supplement to occupational therapy in stroke rehabilitation. Topics in Stroke Rehabilitation 2011;18(6):728‐37. CENTRAL

Jeong 2007 {published data only (unpublished sought but not used)}

Jeong S, Kim MT. Effects of a theory‐driven music and movement program for stroke survivors in a community setting. Applied Nursing Research 2007;20:125‐31. CENTRAL

Jungblut 2004 {published and unpublished data}

Jungblut M. Music therapy for people with chronic aphasia: a controlled study. Music Therapy and Neurological Rehabilitation. Performing Health. London: Jessica Kingsley Publishers, 2005:189‐211. CENTRAL
Jungblut M, Aldridge D. The music therapy intervention SIPARI with chronic aphasics ‐ research findings [Musik als brücke zur sprache – die musik‐therapeutische behandlungsmethode »SIPARI®« bei langzeitaphasikern]. Neurologie und Rehabilitation 2004;10(2):69‐78. CENTRAL

Kim 2005 {published data only}

Kim SJ, Koh I. The effects of music on pain perception of stroke patients during upper extremity joint exercises. Journal of Music Therapy 2005;42(1):81‐92. CENTRAL

Kim 2011a {published data only}

Kim J, Oh D, Kim S, Choi J. Visual and kinesthetic locomotor imagery training integrated with auditory step rhythm for walking performance of patients with chronic stroke. Clinical Rehabilitation 2011;25:134‐45. CENTRAL

Kim 2012a {published data only}

Kim JH, Park SG, Lim HJ, Park GC, Kim MH, Lee BH. Effects of the combination of rhythmic auditory stimulation and task‐oriented training on functional recovery of subacute stroke patients. Journal of Physical Therapy Science 2012;24:1307‐13. CENTRAL

Kim 2012b {published data only}

Kim JS, Oh DW. Home‐based auditory stimulation training for gait rehabilitation of chronic stroke patients. Journal of Physical Therapy Science 2012;24:775‐7. CENTRAL

Lichun 2011 {unpublished data only}

Lichun L, Gao T. Effect of music therapy rhythmic auditory stimulation on gait of stroke patients. Programme of the 13th World Congress of Music Therapy; 2011 July 5‐9; Seoul, South Korea. World Federation of Music Therapy, 2011:46. CENTRAL

Mueller 2013 {published data only}

Mueller C. Training Endogenous Task Shifting Using Neurologic Music Therapy (Masters thesis). Fort Collins, USA: Colorado State University, 2013. CENTRAL

O'Kelly 2014 {published and unpublished data}

O'Kelly J. [The development of evidence based music therapy with disorders of consciousness]. Cultural Diversity in Music Therapy Practice, Research and Education. Collection of Abstracts of the 14th World Congress of Music Therapy; 2014 July 7‐12; Vienna and Krems an der Donau, Austria. Krems/Austria: IMC University of Applied Sciences Krems, 2014:P131. CENTRAL
O'Kelly J. The Development of Evidence Based Music Therapy With Disorders of Consciousness (PhD thesis). Aalborg, Denmark: Aalborg University, 2014. CENTRAL
O'Kelly J, James L, Palannappan R, Taborin J, Fachner J, Magee W. Neurophysiological and behavioral responses to music therapy in vegetative and minimally conscious states. Frontiers in Human Neuroscience 2013;7(884):1‐15. CENTRAL

Park 2010a {published data only}

Park IM, Oh DW, Kim SY, Choi JD. Clinical feasibility of integrating fast‐tempoauditory stimulation with self‐adopted walking training for improving walking function in post‐stroke patients: a randomized, controlled pilot trial. Journal of Physical Therapy Science 2010;22:295‐300. CENTRAL

Paul 1998 {published data only}

Paul S, Ramsey D. The effects of electronic music‐making as a therapeutic activity for improving upper extremity active range of motion. Occupational Therapy International 1998;5(3):223‐37. CENTRAL

Pool 2012 {unpublished data only}

Pool J. Brief Group Music Therapy for Acquired Brain Injury: Cognition and Emotional Needs (PhD thesis). Cambridge, UK: Anglia Ruskin University, 2013. CENTRAL
Pool J. Time‐limited music therapy to address functional gains and emotional needs of people with acquired brain injury. Programme of the 13th World Congress of Music Therapy; 2011 July 5‐9; Seoul, South Korea. World Federation of Music Therapy, 2011:34. CENTRAL

Särkämö 2008 {published data only}

Särkämö T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, et al. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain 2008;131:866‐76. CENTRAL

Schneider 2007 {published data only}

Altenmüller E, Marco‐Pallares J, Münte TF, Schneider S. Neural reorganization underlies improvement in stroke‐induced motor dysfunction by music‐supported therapy. Annals of the New York Academy of Sciences 2009;1169(1):395‐405. CENTRAL
Altenmüller E, Schneider S, Marco‐Pallares J, Münte TF. Learning to play piano supports fine motor rehabilitation after stroke. Neurorehabilitation & Neural Repair 2010;26(6):19. CENTRAL
Schneider S, Münte T, Rodriguez‐Fornells A, Sailer M, Altenmüller E. Music‐supported training is more efficient than functional motor training for recovery of fine motor skills in stroke patients. Music Perception: An Interdisciplinary Journal 2010;27(4):271‐80. CENTRAL
Schneider S, Schönle PW, Altenmüller E, Münte TF. Using musical instruments to improve motor skill recovery following a stroke. Journal of Neurology 2007;254(10):1339‐46. CENTRAL

Suh 2014 {published data only}

Suh JH, Han SJ, Jeon SY, Kim HJ, Lee JE, Yoon TS, et al. Effect of rhythmic auditory stimulation on gait and balance in hemiplegic stroke patients. NeuroRehabilitation 2014;34:193‐9. CENTRAL

Thaut 1997 {published data only}

McIntosh GC, Thaut MH, Rice RR, Prassas SG. Auditory rhythmic cuing in gait rehabilitation with stroke patients. Canadian Journal of Neurological Sciences 1993;20:168. CENTRAL
Mcintosh GC, Rice RR, Prassas SG, Thaut MH. Rhythmic auditory‐motor entrainment as gait rehabilitation technique with stroke patients. International Congress on Stroke Rehabilitation; 1993 November 21‐24; Berlin. Berlin, Germany: German Society for Neurological Rehabilitation, 1993. CENTRAL
Thaut MH, McIntosh GC, Rice RR. Rhythmic facilitation of gait training in hemiparetic stroke rehabilitation. Journal of the Neurological Sciences 1997;151(2):207‐12. CENTRAL
Thaut MH, McIntosh GC, Rice RR, Miller RA. Rhythmic‐auditory motor training in gait rehabilitation with stroke patients. Journal of Stroke and Cerebrovascular Disease 1995;5:100‐1. CENTRAL

Thaut 2002 {published data only}

Thaut MH, Hoemberg B, Hurt CP, Kenyon GP. Rhythmic entrainment of paretic arm movements in stroke patients. Annual Meeting of the Society for Neuroscience; 1998 November 7‐12; Los Angeles. 1998. CENTRAL
Thaut, MH, Kenyon GP, Hurt CP, McIntosh, GC, Hoemberg V. Kinematic optimization of spatiotemporal patterns in paretic arm training with stroke patients. Neuropsychologia 2002;40(7):1073‐81. CENTRAL

Thaut 2007 {published data only}

Argstatter H, Hillecke TH, Thaut M, Bolay HV. Music therapy in motor rehabilitation. Evaluation of a musico‐medical gait training program for hemiparetic stroke patients [Musiktherapie in der neurologischen rehabilitation. Evaluation eines musikmedizinischen behandlungskonzepts für die gangrehabilitation von hemiparetischen patienten nach schlaganfall]. Neurologie und Rehabilitation 2007;13(3):159‐65. CENTRAL
Thaut MH, Leins AK, Rice RR, Argstatter H, Kenyon GP,  McIntosh GC, et al. Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near‐ambulatory patients early poststroke: a single‐blind, randomized trial. Neurorehabilitation and Neural Repair 2007;21(5):455‐9. CENTRAL

Tong 2015 {published data only}

Tong Y. Music‐supported therapy (MST) in improving post‐stroke patients’ upper‐limb motor function: a randomised controlled pilot study. Neurological Research (in press). [DOI: 10.1179/1743132815Y.0000000034]CENTRAL

Van Delden 2013 {published data only}

Van Delden AEQ, Peper CE, Nienhuys KN, Zijp NI, Beek PJ, Kwakkel G. Unilateral versus bilateral upper limb training after stroke: the upper limb training after stroke clinical trial. Stroke 2013;44:2613‐6. CENTRAL

van der Meulen 2014 {published data only}

van der Meulen I, van de Sandt‐Koenderman WME, Heijenbrok‐Kal MH, Visch‐Brink EG, Ribbers GM. The efficacy and timing of melodic intonation therapy in subacute aphasia. Neurorehabilitation and Neural Repair 2014;28(6):536‐44. CENTRAL

Whitall 2011 {published data only}

Luft AR, McCombe‐Waller S, Whitall J, Forrester LW, Macko R, Sorkin JD, et al. Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. JAMA 2004;292:1853‐61. CENTRAL
Whitall J, McCombe Waller S, Sorkin JD, Forrester LW, Macko RF, Hanley DF, et al. Bilateral and unilateral arm training improve motor function through differing neuroplastic mechanisms: a single‐blinded randomized controlled trial. Neurorehabilitation and Neural Repair 2011;25(2):118–29. CENTRAL

Al‐Mahasneh 1991 {published data only}

Al‐Mahasneh SM. Nursing Interventions to Reduce Unilateral Neglect in Right Hemisphere Stroke Patients (PhD thesis). Ann Arbor, MI: University of Michigan, 1991. CENTRAL

Amengual 2013 {published data only}

Amengual JL, Rojo N, Veciana de las Heras M, Marco‐Pallarés J, Grau‐Sánchez J, Schneider S, et al. Sensorimotor plasticity after music‐supported therapy in chronic stroke patients revealed by transcranial magnetic stimulation. PLoS One 2013;8(4):e61883. CENTRAL

Baker 2004 {published data only}

Baker F, Wigram T. The immediate and long‐term effects of singing on the mood states of people with traumatic brain injury. British Journal of Music Therapy 2004;2:55‐64. CENTRAL

Baker 2005 {published data only}

Baker F, Wigram T, Gold C. The effects of a song‐singing programme on the affective speaking intonation of people with traumatic brain injury. Brain Injury 2005;19(7):519‐28. CENTRAL

Barnes 2006 {published data only}

Barnes CL, Smith MB, Harriet E, Kunisch A, Little C, Modica J. A pilot study of bilateral arm training with repetitive auditory cueing in subjects with low functioning upper limb hemiparesis as a result of chronic stroke. Journal of Neurologic Physical Therapy 2006;30(4):221. CENTRAL

Beatty 1995 {published data only}

Beatty WF, Scott JG, Moreland VJ, Rankin EJ. Head injury effects on a new measure of remote memory: The Famous Tunes Test. Journal of Head Trauma Rehabilitation 1995;10(3):63‐6. CENTRAL

Bonakdarpour 2003 {published data only}

Bonakdarpour B, Eftekharzadeh A, Ashayeri H. Melodic intonation therapy in Persian aphasic patients. Aphasiology 2003;17(1):75‐95. CENTRAL

Bossert 2012 {unpublished data only}

Bossert S, Marz J, Pöpel A. Treatment for Patients With Psychological Disturbances After Accident in Neurological Rehabilitation. Pfäffikon, Zurich, Switzerland: Zurich University of Arts in co‐operation with derInterkantonalen College of Special Education, Service Training Music Therapy, 2012. CENTRAL
Pöpel A, Bossert S, Marz J. Music therapy in patients in neuro‐rehabilitation: a randomized control trial. Cultural Diversity in Music Therapy Practice, Research and Education. Collection of Abstracts of the 14th World Congress of Music Therapy; 2014 July 7‐12; Vienna and Krems an der Donau, Austria. Krems, Austria: IMC University of Applied Sciences Krems, 2014:366. CENTRAL

Breitenfeld 2005 {published and unpublished data}

Antić S, Galinović I, Lovrenčić‐Huzjan A, Vuković V, Jurašić MJ, Demarin V. Music as an auditory stimulus in stroke patients. Collegium Antropologicum 2008;32(1):19‐23. CENTRAL
Antić S, Morović S, Kes VB, Zavoreo I, Jurašić MJ, Demarin V. Enhancement of stroke recovery by music. Periodicum Biologorum 2012;114(3):397‐401. CENTRAL
Breitenfeld T, Jergovic K, Vargek Solter V, Demarin V. Music therapy in aphasic stroke patients: a pilot study. European Journal of Neurology 2005;12 Suppl 2:55. CENTRAL
Breitenfeld T, Vargek Solter V, Breitenfeld D, Supanc V, Jergovic K, Demarin V. Is there a benefit for aphasic stroke patients treated with music therapy?. Cerebrovascular Diseases 2005;19 Suppl 2:92‐3. CENTRAL

Carlisle 2000 {published data only}

Carlisle BJ. The Effects of Music‐Assisted Relaxation Therapy on Anxiety in Brain Injury Patients (Masters thesis). East Lansing, MI: Michigan State University, 2000. CENTRAL

Chen 2013 {published data only}

Chen MC, Tsai PL, Huang YT, Lin KD. Pleasant music improves visual attention in patients with unilateral neglect after stroke. Brain Injury 2013;27(1):75‐82. CENTRAL

Cofrancesco 1985 {published data only}

Cofrancesco EM. The effect of music therapy on hand grasp strength and functional task performance in stroke patients. Journal of Music Therapy 1985;22(3):129‐45. CENTRAL

Cohen 1992 {published and unpublished data}

Cohen NS. The effect of singing instruction on the speech production of neurologically impaired persons. Journal of Music Therapy 1992;29(2):87‐102. CENTRAL

Cohen 1995 {published data only}

Cohen NS, Ford J. The effect of musical cues on the nonpurposive speech of persons with aphasia. Journal of Music Therapy 1995;32(1):46‐57. CENTRAL

Conklyn 2010 {published data only}

Conklyn D, Stough D, Novak E, Paczak S, Chemali K, Bethoux F. A home‐based walking program using rhythmic auditory stimulation improves gait performance in patients with multiple sclerosis: a pilot study. Neurorehabilitation and Neural Repair 2010;24(9):835‐42. CENTRAL

Dellacherie 2011 {published data only}

Dellacherie D, Bigand E, Molin P, Baulac M, Samson S. Multidimensional scaling of emotional responses to music in patients with temporal lobe resection. Cortex 2011;47(9):1107‐15. CENTRAL

Eslinger 1997 {unpublished data only}

Eslinger PJ, Stauffer JW, Rohrbacher M, Grattan LM. Music therapy and psychosocial adjustment to brain injury. Stroke Trials Registry1997. [R21RR09415]CENTRAL

Ford 2007 {published data only}

Ford M, Wagenaar R, Newell K. The effects of auditory rhythms and instruction on walking patterns in individuals post stroke. Gait and Posture 2007;26:150‐5. CENTRAL

Gerlichova 2014 {published data only}

Gerlichova M. The effects of music therapy during neurorehabilitation with persons after brain injury. Cultural Diversity in Music Therapy Practice, Research and Education. Collection of Abstracts of the 14th World Congress of Music Therapy; 2014 July 7‐12; Vienna and Krems an der Donau, Austria. Krems, Austria: IMC University of Applied Sciences Krems, 2014:398. CENTRAL

Goh 2001 {unpublished data only}

Goh M. The role of music therapy in the rehabilitation of people who have had strokes, specifically focusing on depression. National Research Register, Issue 12001. CENTRAL

Gollaher 1993 {published data only}

Gollaher KK. The Effect of Music on Task Performance in Stroke Patients. UMI Dissertation Services, University Microfilms International, 1993. CENTRAL

Grossman 1981 {published data only}

Grossman M, Shapiro BE, Gardner H. Dissociable musical processing strategies after localized brain damage. Neuropsychologia 1981;19(3):425‐33. CENTRAL

Hald 2012 {unpublished data only}

Hald S. Music Therapy, Acquired Brain Injury and Interpersonal Communication Competencies: Randomized Cross‐Over Study on Music Therapy in Neurological Rehabilitation (PhD thesis). Aalborg, Denmark: Aalborg University, 2012. CENTRAL
Hald S. Active music therapy, ABI, and interpersonal communication competencies. Programme of the 13th World Congress of Music Therapy; 2011 July 5‐9; Seoul, South Korea. World Federation of Music Therapy, 2011:194‐5. CENTRAL

Hayden 2009 {published data only}

Hayden R, Clair AA, Johnson G, Otto D. The effect of rhythmic auditory stimulation (RAS) on physical therapy outcomes for patients in gait training following stroke: a feasibility study. International Journal of Neuroscience 2009;119(12):2183‐95. CENTRAL

Hébert 2003 {published data only}

Hébert S, Racette A, Gagnon L, Peretz I. Revisiting the dissociation between singing and speaking in expressive aphasia. Brain 2003;126(8):1838‐50. CENTRAL

Hitchen 2007 {published and unpublished data}

Hitchen H, Magee WL. A comparison of the effects of verbal de‐escalation techniques with music based de‐escalation techniques on agitation levels in patients with neuro‐behavioural disorders. National Research Register2007. [N0204175715]CENTRAL

Hurt 1998 {published data only}

Hurt CP, Rice RR, McIntosh GC, Thaut MH. Rhythmic auditory stimulation in gait training for patients with traumatic brain injury. Journal of Music Therapy 1998;35:228‐91. CENTRAL

Johannsen 2010 {published data only}

Johannsen L, Wing AM, Pelton T, Kitaka K, Zietz D, Brittle N, et al. Seated bilateral leg exercise effects on hemiparetic lower extremity function in chronic stroke. Neurorehabilitation and Neural Repair 2010;24:243‐53. CENTRAL

Jun 2013 {published data only}

Jun EM, Roh YH, Kim MJ. The effect of music‐movement therapy on physical and psychological states of stroke patients. Journal of Clinical Nursing 2013;22:22‐31. CENTRAL

Kasai 2014 {published data only}

Kasai F, Wada S, Mizuma M. The effects of playing electronic musical instruments during at‐home rehabilitation on hemiplegic upper limb function. Stroke 2014;95(10):e19. CENTRAL

Kim 2008 {published data only}

Kim M, Tomaino CM. Protocol evaluation for effective music therapy for persons with nonfluent aphasia. Topics in Stroke Rehabilitation 2008;15(6):555‐69. CENTRAL

Kim 2011b {published data only}

Kim DS, Park YG, Choi JH, Im SH, Jung KJ, Cha YA, et al. Effects of music therapy on mood in stroke patients. Yonsei Medical Journal 2011;52(6):977‐81. CENTRAL

Kim 2012c {published data only}

Kim SJ, Kwak EE, Park ES, Cho SR. Differential effects of rhythmic auditory stimulation and neurodevelopmental treatment/Bobath on gait patterns in adults with cerebral palsy: a randomized controlled trial. Clinical Rehabilitation 2012;26(10):904‐14. CENTRAL

Kim 2013 {published data only}

Kim SJ, Jo U. Study of accent‐based music speech protocol development for improving voice problems in stroke patients with mixed dysarthria. NeuroRehabilitation 2012;32(1):185‐90. CENTRAL

Lee 2012 {published data only}

Lee SH, Lee KJ, Song CH. Effects of rhythmic auditory stimulation (RAS) on gait ability and symmetry after stroke. Journal of Physical Therapy Science 2012;24(4):311‐4. CENTRAL

Li 2002 {published data only}

Li YM. The effect of feeling music therapy on the rehabilitation of post‐stroke depression. Zhongguo Zuchi Goncheng Yanjiu 2002;6(19):2952. CENTRAL

Lin 2007 {published and unpublished data}

Lin SI. Effect of rhythmic auditory cues on gait of stroke patients. Cerebrovascular Diseases 2007;23 Suppl 2:128. [Stroke Trial Registry Ref 12104]CENTRAL

Magee 2002 {published data only}

Magee WL, Davidson JW. The effect of music therapy on mood states in neurological patients: a pilot study. Journal of Music Therapy 2002;39(1):20‐9. CENTRAL

Magee 2006a {unpublished data only}

Magee WL. Music therapy for adults with acquired brain injury. National Research Register2006. CENTRAL

Malcolm 2009 {published data only}

Malcolm MP, Massie C, Thaut MH. Rhythmic auditory‐motor entrainment improves hemiparetic arm kinematics during reaching movements: a pilot study. Topics in Stroke Rehabilitation 2009;16(1):69‐79. CENTRAL

Mandel 1990 {published data only}

Mandel AR, Nymark JR, Balmer SJ, Grinnell DM, O'Riain MD. Electromyographic versus rhythmic positional biofeedback in computerized gait retraining with stroke patients. Archives of Physical Medicine and Rehabilitation 1990;71:649‐54. CENTRAL

McCombe Waller 2005 {published data only}

McCombe Waller S, Whitall J. Hand dominance and side of stroke affect rehabilitation in chronic stroke. Clinical Rehabilitation 2005;19(5):544‐51. CENTRAL

Moon 2008 {published and unpublished data}

Moon SY. The effects of piano‐playing music therapy on motor coordination of stroke patients using midi‐based computer analysis. Neurorehabilitation and Neural Repair 2008;22(5):593. CENTRAL
Moon SY, Grocke DE. Piano playing focused music therapy and MIDI analysis in neurological rehabilitation. Programme of the 12th World Congress of Music Therapy; 2008 July 22‐26; Buenos Aires. Buenos Aires, Argentina: World Federation of Music Therapy, 2008:29. CENTRAL

Nayak 2000 {published and unpublished data}

Nayak S, Wheeler BL, Shiflett SC, Agostinelli S. Effect of music therapy on mood and social interaction among individuals with acute traumatic brain injury and stroke. Rehabilitation Psychology 2000;45(3):274‐83. CENTRAL
Wheeler BL, Shiflett SC, Nayak S. Effects of number of sessions and group or individual music therapy on the mood and behavior of people who have had strokes or traumatic brain injuries. Nordic Journal of Music Therapy 2003;12(2):139‐51. CENTRAL

Nie 2014 {published data only}

Nie DA, Chen JP, Xing YL, Liu LC. Effect of music rhythm stimulation on the lower limb motor function in ischemic stroke patients with hemiplegia. Chinese Journal of Cerebrovascular Diseases 2014;11:80‐3. CENTRAL

Park 2010b {published data only}

Park S. Effect of Preferred Music on Agitation After Traumatic Brain Injury (PhD thesis). Ann Arbor, MI: University of Michigan, 2010. CENTRAL

Popovici 1992 {published data only}

Popovici M, Mihailescu L. Melodic intonation in the rehabilitation of Romanian aphasics with bucco‐lingual apraxia. Revue Roumaine de Neurologie et Psychiatrie 1992;30(2):99‐113. CENTRAL

Prassas 1997 {published data only}

Prassas SG, Thaut MH, McIntosh GC, Rice RR. Effect of auditory rhythmic cuing on gait kinematic parameters in hemiparetic stroke patients. Gait and Posture 1997;6:218‐23. CENTRAL

Puggina 2011 {published data only}

Puggina ACG. Analysis of Vital, Facial and Muscular Responses Front to Music or Message in Coma, Vegetative State or Sedated Patients (PhD thesis). São Paulo, Brazil: Universidade de São Paulo, 2011. CENTRAL
Puggina ACG. Use of music and voice stimulus on patients with disorders of consciousness. Journal of Neuroscience Nursing 2011;43(1):E8‐16. CENTRAL

Purdie 1997 {published data only}

Purdie H, Hamilton S, Baldwin S. Music therapy: facilitating behavioral and psychological change in people with stroke ‐ a pilot study. International Journal of Rehabilitation Research 1997;20(3):325‐7. CENTRAL

Richards 2008 {published data only}

Richards LG, Senesac CR, Davis SB, Woodbury ML, Nadeau SE. Bilateral arm training with rhythmic auditory cueing in chronic stroke: not always efficacious. Neurorehabilitation and Neural Repair 2008;22(2):180‐4. CENTRAL

Roerdink 2009 {published data only}

Roerdink M, Lamoth CJ, van Kordelaar J, Elich P, Konijnenbelt M, Kwakkel G, et al. Rhythm perturbations in acoustically paced treadmill walking after stroke. Neurorehabilitation and Neural Repair 2009;23(7):668‐78. CENTRAL

Särkämö 2010a {published data only}

Särkämö T, Pihko E, Laitinen S, Forsblom A, Soinila S, Mikkonen M, et al. Music and speech listening enhance the recovery of early sensory processing after stroke. Journal of Cognitive Neuroscience 2010;22(12):2716‐27. CENTRAL

Särkämö 2010b {published data only}

Särkämö T, Tervaniemi M, Soinila S, HeSilvennoinen TA, Laine M, Hietanen M, et al. Auditory and cognitive deficits associated with acquired amusia after stroke: a magnetoencephalography and neuropsychological follow‐up study. PLoS One 2010;5(12):e15157. CENTRAL

Scalha 2010 {published data only}

Scalha TB, De Souaz VMG, Suzuki SS, Oberg TD, Vieira Lima NMF. Effects of the task oriented and auditory cues for chronic stroke patients. Revista Terapia Manual 2010;8(39):441‐7. CENTRAL

Schauer 1996 {published data only}

Schauer M, Steingruber W, Mauritz KH. Effect of music on gait symmetry of stroke patients on a treadmill. Biomedizinische Technik 1996;41(10):291‐6. CENTRAL

Schauer 2003 {published data only}

Schauer M, Mauritz KH. Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement. Clinical Rehabilitation 2003;17(7):713‐22. CENTRAL

Schinner 1995 {published data only}

Schinner KM, Chisholm AH, Grap MJ, Siva P, Hallinan M, LaVoice‐Hawkins A. Effects of auditory stimuli on intracranial pressure and cerebral perfusion pressure in traumatic brain injury. Journal of Neuroscience Nursing 1995;27(6):348‐54. CENTRAL

Schneider 2010 {published data only}

Schneider S, Münte T, Rodriguez‐Fornells A, Sailer M, Altenmüller E. Music‐supported training is more efficient than functional motor training for recovery of fine motor skills in stroke patients. Music Perception 2010;27(4):271‐80. CENTRAL

Shafshak 2013 {published data only}

Shafshak TS. The effect of repetitive bilateral ARM training with rhythmic auditory cueing on motor performance and central motor changes in patients with chronic stroke. 12th Congress of European Forum for Research in Rehabilitation. Journal of Physical Medicine & Rehabilitation Sciences/Fiziksel Tup ve Rehabilitasyon Bilimleri Dergisi 2013;16:8. CENTRAL

Sinclair 2013 {published data only}

Sinclair KL, Ponsford JL, Rajaratnam SMW, Anderson C. Sustained attention following traumatic brain injury: use of the Psychomotor Vigilance Task. Journal of Clinical and Experimental Neuropsychology 2013;35(2):210‐24. CENTRAL

Stahl 2011 {published data only}

Stahl B, Kotz SA, Henseler I, Turner R, Geyer S. Rhythm in disguise: why singing may not hold the key to recovery from aphasia. Brain 2011;134:3083–93. CENTRAL

Studebaker 2007 {unpublished data only}

Studebaker S. The Effect of a Music Therapy Protocol on the Attentional Abilities of Stroke Patients (Masters thesis). Lawrence, KS: University of Kansas, 2007. CENTRAL

Thaut 1992 {published data only}

Thaut MH, McIntosh GC, Prassas S, Rice R. Effects of auditory rhythmic pacing on normal gait and gait in stroke, cerebellar disorder and transverse myelitis. International Symposium on Postural and Gait Research 1992;2:437‐40. CENTRAL

Thaut 1993 {published data only}

Thaut MH, McIntosh CG, Rice R, Prassas S. Effect of rhythmic cuing on temporal stride parameters and EMG patterns in hemiparetic gait of stroke patients. Journal of Neurological Rehabilitation 1993;7:9‐16. CENTRAL

Thaut 1997b {published data only}

Thaut MH, Hurt CP, Mcintosh GC. Rhythmic entrainment of gait patterns in traumatic brain injury rehabilitation. Journal of Neurological Rehabilitation 1997;11:131. CENTRAL

Thaut 1999 {published data only}

Thaut MH, Ueno K, Hurt CP, Hoemberg V. Bilateral limb entrainment and rhythmic synchronization in paretic arm movements of stroke patients. Annual Meeting of the Society for Neuroscience; 1999 October 23‐28; Miami Beach, Florida. 1999. CENTRAL

Thaut 2009 {published data only}

Thaut MH, Gardiner JC, Holmberg D, Horwitz J, Kent L, Andrews G. Neurologic music therapy improves executive function and emotional adjustment in traumatic brain injury rehabilitation. Annals of the New York Academy of Sciences 2009;1169(1):406‐16. CENTRAL

Thompson 1986 {published data only}

Thompson CK, McReynolds LV. Wh interrogative production in agrammatic aphasia: an experimental analysis of auditory‐visual stimulation and direct‐production treatment. Journal of Speech, Language, and Hearing Research1986; Vol. 29, issue 2:193‐206. CENTRAL

Tsai 2013a {published data only}

Tsai PL, Chen MC, Huang YT, Lin KC, Chen KL, Hsu YW. Listening to classical music ameliorates unilateral neglect after stroke. American Journal of Occupational Therapy 2013;67:328‐35. CENTRAL

Tsai 2013b {published data only}

Tsai PL, Chen MC, Huang YT, Lin KC. Effects of listening to pleasant music on chronic unilateral neglect: a single‐subject study. NeuroRehabilitation 2013;32:33‐42. CENTRAL

Tseng 2014 {published data only}

Tseng CE, Lin CP, Tsai PC, Yip BS, Lin CM, Yang FP. Melodic intonation therapy in stroke patients with aphasia: a DTI study. Cerebrovascular Diseases 2014;38 (Suppl 1):40. CENTRAL

van Nes 2006 {published data only}

van Nes IJ, Latour H, Schils F, Meijer R, van Kuijk A, Geurts AC. Long‐term effects of 6‐week whole‐body vibration on balance recovery and activities of daily living in the postacute phase of stroke: a randomized, controlled trial. Stroke 2006;37(9):2331‐5. CENTRAL

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Wan 2014 {published data only}

Wan CY, Zheng X, Marchina S, Norton A, Schlaug G. Intensive therapy induces contralateral white matter changes in chronic stroke patients with Broca’s aphasia. Brain and Language 2014;136:1‐7. CENTRAL

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Bayat G, Dastgheib S, Shoeibi A. The impact of neurorehabilitation software versus Mozart's music on hemiparetic patients using SPECT imaging: a randomized control trial study. International Journal of Stroke 2014;9 Suppl 3:218. CENTRAL
Dastgheib S, Bayat G, Shoeibi A. The impact of neurorehabilitation software versus Mozart's music on hemiparetic patients using SPECT imaging: a randomized control trial study. International Journal of Stroke 2014;9:220. CENTRAL

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John S, Khanna GL, Kotwal P. Effect of music therapy and meditation along with conventional physiotherapy management in sub‐acute stroke patients. British Journal of Sports Medicine 2010;44 Suppl 1:i14. CENTRAL

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Oiga L. The effect of music and rhythmic auditory stimulation on upper motor strength rehabilitation of hemiparetic stroke patients in a tertiary hospital: a randomized controlled study. International Journal of Stroke 2014;9 Suppl 3:237. CENTRAL

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Poćwierz‐Marciniak I. Music Therapy Impact on the Quality of Life and Other Aspects of Psychological Functionality in Patients after Stroke (PhD thesis). Gdansk, Poland: University of Gdansk, 2014. CENTRAL
Poćwierz‐Marciniak I. Music therapy with patients with strokes as a way of coping with the illness ‐ a pilot study [Zastosowanie muzykoterapii u pacjentów po udarze mózguw celu emocjonalnego poradzenia sobie z chorobą – badania pilotażowe]. Conference programme: Music, therapy, education. Practice, education, art2014. CENTRAL

Renna 2012 {published data only}

Renna L, Frkovic N, Spear M, Ruddell K. Stroke sounds: music listening in stroke rehabilitation. International Journal of Stroke 2012;7 Suppl 1:58. CENTRAL

Ala‐Ruona 2010 {unpublished data only}

Ala‐Ruona E, Bamberg H,  Suhonen J,  Fachner J, Erkkilä J, Parantainen H, et al. Examining the effects of active music therapy on post‐stroke recovery: a randomised controlled cross‐over trial. The Third Arts and Quality of Life Research Center Conference, February 2010, Temple University, Philadelphia (USA). CENTRAL

NCT00903266 {unpublished data only}

NCT00903266. Melodic‐intonation‐therapy and speech‐repetition‐therapy for patients with non‐fluent aphasia. clinicaltrials.gov/ct2/results?term=NCT00903266 (first received 15 May 2009). CENTRAL

NCT01372059 {published data only}

Bunketorp Kall L, Blomstrand C, Lundgren‐Nilsson A. Is it possible to improve the life situation among community‐dwelling individuals in the late phase of stroke through a rhythm and music method and therapeutic riding? Study protocol for a three‐armed randomized controlled trial. Neurorehabilitation and Neural Repair 2012;26(6):734. CENTRAL
Bunketorp Käll L, Lundgren‐Nilsson Å, Blomstrand C, Pekna M, Pekny M, Nilsson M. The effects of a rhythm and music‐based therapy program and therapeutic riding in late recovery phase following stroke: a study protocol for a three‐armed randomized controlled trial. BMC Neurology 2012;12:141. CENTRAL
NCT01372059. The effects of a rhythm and music‐based therapy program and therapeutic riding in late recovery phase following stroke. clinicaltrials.gov/ct2/show/NCT01372059 (first received 26 May 2011). CENTRAL

NCT01455155 {unpublished data only}

NCT01455155. Creative therapy to affect stroke outcomes. clinicaltrials.gov/ct2/results?term=NCT01455155 (first received 15 October 2011). CENTRAL

NCT01721668 {unpublished data only}

NCT01721668. Improving arm and hand functions in chronic stroke. clinicaltrials.gov/ct2/show/NCT01721668 (first received 1 November 2012). CENTRAL

NCT01749709 {unpublished data only}

NCT01749709. Music listening and stroke recovery. clinicaltrials.gov/ct2/results?term=NCT01749709 (first received 12 December 2012). CENTRAL

NCT01769326 {unpublished data only}

NCT01769326. Influence of timing on motor learning. clinicaltrials.gov/ct2/results?term=NCT01769326 (first received 16 November 2012). CENTRAL

NCT01956136 {unpublished data only}

NCT01956136. Efficacy and neural basis of music‐based neurological rehabilitation for traumatic brain injury (MUBI). clinicaltrials.gov/ct2/show/NCT01956136 (first received 12 September 2013). CENTRAL

NCT02208219 {unpublished data only}

NCT02208219. Music therapy to restore motor deficits after stroke (NEUROMUSIC). clinicaltrials.gov/ct2/results?term=NCT02208219 (first received 18 July 2014). CENTRAL

NCT02259062 {unpublished data only}

NCT02259062. Listening for leisure after stroke (MELLO). clinicaltrials.gov/ct2/results?term=NCT02259062 (first received 3 October 2014). CENTRAL

NCT02310438 {unpublished data only}

NCT02310438. Music therapy for the rehabilitation of upper limb with stroke patients. clinicaltrials.gov/ct2/results?term=NCT02310438 (first received 4 December 2014). CENTRAL

NCT02328573 {unpublished data only}

NCT02328573. The impact of group singing on patients with stroke and their personal caregivers. clinicaltrials.gov/ct2/results?term=NCT02328573 (first received 23 June 2014). CENTRAL

NCT02410629 {unpublished data only}

NCT02410629. To determine the therapeutic effect of the music glove and conventional hand exercises to subacute stroke patients. clinicaltrials.gov/ct2/show/NCT02410629 (first received 2 April 2015). CENTRAL

NTR1961 {unpublished data only}

NTR1961. The efficacy of Melodic Intonation Therapy (MIT) in aphasia rehabilitation. www.trialregister.nl/trialreg/admin/rctview.asp?TC=1961 (first received 19 Aug 2009). CENTRAL

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Baker 2001

Methods

RCT
Cross‐over trial with 3 groups

Participants

Participants with a severe head injury

Diagnosis: post‐traumatic amnesia scoring less than or equal to 8 on the Westmead Post‐traumatic Amnesia Scale on the day prior to commencement of the experiment

Time since onset: not stated

N randomised: 22

N analysed in treatment group (live music): 22
N analysed in treatment group (recorded music): 22
N analysed in control group: 22
Mean age: 34 years (SD 15.34)
Sex: 5 (23%) female, 17 (77%) male
Ethnicity: 72.7% Australian, 9% Croatian, 4.5% Taiwanese, 4.5% Bangladeshi, 9% Italian
Setting: rehabilitation hospital
Country: Australia

Interventions

3 study groups:

1: Music intervention (live): Participants listened to live music. The music selection was individualised for each participant and comprised 3 music pieces that were chosen from selections suggested by family members. All styles of music were permitted. The researcher was present in the room sitting opposite and facing the participant

2. Music intervention (recorded): Participants listened to recorded music. The same 3 pieces were played during the recorded music condition as were used in the live music condition, and played in the same order. The music was played free‐field on an audio cassette player. To avoid agitating the participant no headphones were used. The researcher was present in the room sitting opposite and facing the participant
3. Control condition: The music therapist was present in the room, but no music was played. Participants were free to do whatever they wanted. As in the music conditions, the verbal interactions were kept to a minimum
Number of sessions: 6 in total (2 of each condition) over 6 days
Length of sessions: 10 to 12 minutes each

Outcomes

Agitation (Agitated Behavior Scale): effect size reported
Level of orientation (Westmead Post‐traumatic Amnesia Scale): effect size reported

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated list of random numbers

Allocation concealment (selection bias)

High risk

No allocation concealment used

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Blinding of participants was not possible. It was not possible to blind the personnel delivering the interventions.

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

High risk

Outcome assessors were not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

1 dropout because of early resolution of PTA

Selective reporting (reporting bias)

Low risk

There were no indications of selective reporting in this study

Free from financial conflict of interest

Low risk

No funding support reported

Cha 2014a

Methods

RCT

Cross‐over trial

Participants

Participants with first ischaemic CVA

Time since onset: at least 6 months post‐CVA

N randomised: 41

N analysed at baseline condition: 20

N analysed in RAS condition: 21

Mean age: 60.8 years (SD 19.8)

Sex: 17 females (41.5%), 24 males (58.5%)

Ethnicity: not reported

Setting: rehabilitation centres

Country: South Korea

Interventions

All participants were studied under 5 conditions. Study compared walking with no intervention (baseline) with RAS at 4 different speeds (baseline‐matched RAS, ‐10%, +10%, and +20%). In this review we used baseline‐matched RAS and +20%

Number of sessions: not clear

Length of sessions: not stated

Outcomes

Gait parameters: gait velocity (cm/second), gait cadence (steps per minute), stride length‐affected (cm), stride length‐unaffected (cm), stride symmetry. Post‐test scores used

Notes

This study used rhythm delivered by a metronome without music

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "Conditions were applied in random order" (p480)

All participants received all conditions. We assessed randomisation bias to be low for this reason

Allocation concealment (selection bias)

Low risk

Allocation of treatment order not reported. However, all participants received all treatments

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It is not possible to blind participants receiving RAS or to blind the personnel involved in delivering RAS

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

Quote: "The GAITRite system recorded the gait velocity, cadence, stride length, double limb support (% of cycle), and double single limb support (% of cycle)” (p480). As personnel were not involved in entering the data, we rated detection bias as low risk

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Attrition was not reported. However, 41 participants were recruited, and the authors report 41 data sets included in the analysis

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support reported

Cha 2014b

Methods

RCT

2‐arm parallel‐group design

Participants

Participants with chronic hemiparetic stroke

Diagnosis: ischaemic or haemorrhagic stroke

Time since onset: at least 6 months

N randomised to RAS and intense gait‐training treatment: 10

N randomised to intensive gait training alone (control): 10

N analysed in treatment group: 10

N analysed in control group: 10

Mean age: 61.4 years

Sex: 8 females (40%), 12 males (60%)

Ethnicity: not reported

Setting: inpatient hospital

Country: South Korea

Interventions

2 study groups:

1. Music intervention group: RAS with intensive gait training

2. Control group: intensive gait training alone

Number of sessions: 30 sessions in total over 6 weeks

Length of sessions: 30 minutes

Outcomes

Gait velocity (cm/second), gait cadence (steps/minute), stride length‐affected side (cm), stride length‐unaffected side (cm), balance (Berg Balance Scale), quality of life (Stroke Specific Quality of Life Scale). Pre‐ and post‐test scores

Notes

This study used rhythm delivered by a metronome in combination with recorded music

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Quote: "randomly assigned to either and [sic] RAS training or control group using sealed envelopes”. Method of randomisation was not reported (p682)

Allocation concealment (selection bias)

Low risk

Allocation using sealed envelopes. Quote: "randomly assigned to either and [sic] RAS training or control group using sealed envelopes" (p682)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It is not possible to blind participants receiving RAS or to blind the personnel involved in delivering RAS

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Unclear risk

Blinding of the personnel involved in assessing outcomes was not reported

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Attrition was not reported, although 20 were randomised and 20 completed

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support reported. Quote: "The authors declared no potential conflicts of interest with respect to the authorship and/or publication of this article" (p687)

Chouan 2012

Methods

RCT

3‐arm parallel‐group design

Participants

Participants with middle cerebral artery hemiparetic stroke

Time since onset: discharged from hospital at least 3 months earlier

N randomised to RAS and standard care: 15

N randomised to standard care: 15

N randomised to visual cueing and standard care: 15 (not included in this review)

N analysed in RAS and standard care group: 15

N analysed in standard care (control) group: 15

N analysed in visual cueing and standard care group: 15 (not included in this review)

Mean age: 57.40 years (SD 5.18)

Sex: 9 females (20%), 36 males (80%)

Ethnicity: not reported

Setting: multispecialty hospital and research centre

Country: India

Interventions

3 study groups:

1. Music intervention group: RAS plus conventional treatment

2. Other therapy intervention (not used in this review): visual cueing plus conventional treatment

3. Control group: conventional treatment

Number of sessions: RAS given for 9 sessions in total over 3 weeks

Length of sessions: 2 hours

Outcomes

Upper extremity function (Fugl‐Meyer Assessment), general gait (Dynamic Gait Index). Post‐test scores used

Notes

This study used rhythm delivered by a metronome without music

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Quote: "The subjects selected for the study were randomly allocated using sealed envelopes into 3 groups." (p344). Method of randomisation was not stated

Allocation concealment (selection bias)

Low risk

Quote: "The subjects selected for the study were randomly allocated using sealed envelopes into 3 groups." (p396)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It is not possible to blind participants receiving RAS or to blind the personnel involved in delivering RAS

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Unclear risk

Blinding of the personnel involved in assessing outcomes was not reported

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Reported 0 withdrawals

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support reported

Conklyn 2012

Methods

RCT

2‐arm parallel‐group design

Participants

Participants with acute stroke with mild to severe nonfluent aphasia

Time since onset: most within 13 days, 2 control and 1 treatment participant were > 60 days

N randomised to treatment group at baseline: 16

N randomised to control group at baseline: 14

N analysed in treatment group at visit 1: 14

N analysed in control group at visit 1: 10

N analysed in treatment group at visit 2: 9

N analysed in control group at visit 2: 8

Mean age: 61.51 years (SD 15.49)

Sex: 14 females (47%), 16 males (53%)

Ethnicity: not reported

Setting: inpatient

Country: USA

Interventions

2 study groups:

1. Music intervention group: received modified melodic intonation therapy (MMIT). This involved a 10‐ to 15‐minute session with the music therapist "consisting of the music therapist teaching the participant a melodic phrase." (p1466)

2. Control group: received a 10‐ to 15‐minute session with the music therapist "who discussed the participant’s impairment, different forms of treatment, different outcomes, and various issues that can result from aphasia, such as depression and withdrawal." (p1466)

Number of sessions: 2 in total

Length of sessions: 10 to 15 minutes

Outcomes

2 tasks similar to Western Aphasia Battery: adjusted total score. Change scores used

Notes

Quote: "The Western Aphasia Battery has two subtests that were deemed appropriate, one for repetition and one for responsiveness; however, both sections are designed to elicit short answers. Because of the length of the phrases utilized in MMIT it was decided not to use the exact subtests from the Western Aphasia Battery, but instead to design two similar tasks that would elicit longer responses." (p465)

Outcomes were measured for all 3 visits. However, due to high attrition for visit 3, we only reported change scores between visit 1 and visit 2

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "The randomization table was generated by a biostatistician prior to the start of the study. Random assignment was performed by the music therapist after enrolment by the nursing manager, who had no prior knowledge of the ordering of participants." (p1466)

Allocation concealment (selection bias)

Unclear risk

Allocation concealment not reported

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Blinding of participants was not possible. It was not possible to blind the personnel delivering the interventions

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

Quote: "The evaluators were not present in the room when the treatment or control session was given, and the music therapist, being blinded to the test scores until after the post‐test was completed for each session, was not in the room when the test was administered." (pp1465‐6)

Incomplete outcome data (attrition bias)
All outcomes

High risk

Attrition from baseline to visits 1 and 2 higher than 20% for control group. Attrition from baseline to visit 2 higher than 20% for treatment group. Quote: "Out of the 14 controls, 10 had both pre and post scores at Visit 1, and eight had pre and post scores at Visit 2. For the treatment group, 14 out of the 16 had both pre and post scores at Visit 1, and nine had pre and post scores at Visit 2. Only patients who completed both components (responsive and repetitive) in both pre and post assessments were considered in the following analysis. Data are not given for Visit 3 due to the small number of participants (one control, three treatments)." (pp1466‐7)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support reported

Fernandes 2014

Methods

Quasi‐RCT

2‐arm parallel‐group design

Participants

Participants with severe cerebral damage in vegetative state

Diagnosis: traumatic brain injury (38%), non‐traumatic origin hypoxic‐ischaemic encephalopathy (35%), acute cerebrovascular accident (20%), central nervous system infections (4%), and central nervous system tumours (4%).

Time since onset: > 3 years, (mean 45.9 months; SD 20.5 months)

N randomised to treatment group: 13

N randomised to control group: 13

N analysed in treatment group: 13

N analysed in control group: 13

Mean age: 54.05 years (SD 14.37)

Sex: 13 females (50%), 13 males (50%)

Ethnicity: not reported

Setting: inpatient, "Irreversible cerebral damage unit" (p120)

Country: Spain

Interventions

2 study groups:

1. Music intervention group: Participants were exposed to 3 types of musical/auditory stimuli: classical relaxing music (CRM), relaxing music with nature sounds (RMNS), and radio (various musical genres and commercial messages). CRM and RMNS were played individually using an MP3 player via headphones for a period of 20 minutes. The radio was played as environmental music via a stereo system for 1 hour
2. Control group: The control group was exposed to silence on an MP3 player via headphones

Number of sessions: 18 sessions in total. The frequency of sessions is unclear: "18 sessions (six sessions for each musical stimulus), being performed once a day, twice weekly at the same hour" (p119)

Length of sessions: CRM and RMNS were played for 20 minutes. "Radio ... was played as environmental music ... for one hour via a stereo system" (p119)

Outcomes

Vital signs: systolic BP, diastolic BP, heart rate, respiratory rate, oxygen saturation (not included in this review).

Facial expressions: muscular facial relaxation, eye opening, mouth movements, head movements, yawning, smiling, eyebrow movements, and sound emission (results not provided for control group)

Notes

The outcomes of this study were not included in a meta‐analysis

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation was achieved using a computer‐generated list of random numbers (personal communication with principal investigator)

Allocation concealment (selection bias)

Unclear risk

Allocation was not reported.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding is not reported, however it may be assumed that personnel delivering the interventions were not blinded, as the part of the experimental intervention involved radio played as "environmental music ... via a stereo system" (p119)

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Unclear risk

Blinding is not reported, however it may be assumed that raters were not blind, as behavioural ratings were taken immediately after live music was played on headphones to heavily dependent participants

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Attrition was not reported

Selective reporting (reporting bias)

Unclear risk

Insufficient data were reported to assess the effects of music listening on facial expressions. Objectives at the outset of the research were (quote): "to verify the influence of music listening on patients’ facial expressions" (p117). Although the authors state (quote): "Alterations in facial expression were displayed in each patient" (p117), inadequate information is presented to evaluate whether this outcome has been reported selectively

Free from financial conflict of interest

Low risk

Quote: "The authors declare no conflicts of interest." (p117)

Hill 2011

Methods

Quasi‐RCT with alternate group allocation

2‐arm parallel‐group design

Participants

Participants with chronic stroke and right hemiparesis

Time since onset: mean 3.3 years (SD 2.1)

N assigned to treatment group: 6

N assigned to control group: 4

N analysed in treatment group: 5

N analysed in control group: 3

Mean age: 60 years (8.74)

Sex: 6 females (60%), 4 males (40%)

Ethnicity: 70% Caucasian (understood to be white). Otherwise not reported

Setting: Not reported. However, the setting seems to be a community outpatient setting. Quote: "Subjects were recruited by local rehabilitation therapists and by subject inquiry regarding current studies" (p729)

Country: USA

Interventions

2 study groups:

1. Music intervention group: interactive metronome (IM) intervention. Consisted of occupational therapy treatment with 30 minutes of IM session embedded. Interactive metronome consisted of a computer‐based rhythmic and auditory training program. As the computer‐generated reference was heard through headphones, the participants attempted to match the rhythmic auditory beat with repeated limb movements, such as clapping their hands together with a switch in their hand. One IM session consisted of repetitive limb movement lasting 1 to 3 minutes. Sessions took place 3 times per week for 10 weeks.
2. Control group: occupational therapy conventional treatment in 1‐hour sessions, 3 times per week for 10 weeks

Outcomes

Upper extremity function (FMA, Arm Motor Ability Test, Box and Block Test, Canadian Occupational Performance Measure).

Quality of life (Stroke Impact Scale 2.0)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Quote: "Subjects were enrolled in the study groups by alternating group assignment (i.e. Subject 1 was in the OT group, Subject 2 was in the IM+OT group)" (p729)

Allocation concealment (selection bias)

Unclear risk

Allocation is not reported

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Blinding of participants was not possible. It was not possible to blind the personnel delivering the interventions.

Blinding of outcome assessment (detection bias)
Subjective outcomes

Unclear risk

It is unclear whether the SIS for quality of life involved self reports

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

Quote: "All outcomes except the COPM were measured by the same blinded rater 1 week before intervention and within 1 week after intervention" (p729)

Incomplete outcome data (attrition bias)
All outcomes

High risk

Attrition reported at 20%. 1 participant was lost to follow‐up, and 1 withdrew from the study

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

Equipment support reported. Quote: "We thank Interactive Metronome for providing the equipment and software for the study" (p737)

Jeong 2007

Methods

RCT

2‐arm parallel‐group design

Participants

Participants following infarct (60.6%) and haemorrhagic stroke (39.4%)

Diagnosis: 17 with left stroke lesion (51.1%), 15 with right stroke lesion (45.5%), 1 with bilateral stroke lesion (3%)

Time since onset: mean 6.39 years (SD 4.96)

N randomised to treatment group: 18

N randomised to control group: 18

N received intended treatment in treatment group: 18

N received intended treatment in control group: 18

N analysed in treatment group: 16

N analysed in control group: 17

Mean age: 60.1 years (SD 7.88)

Sex: 10 females (30.3%), 23 males (69.7%)

Ethnicity: not reported

Setting: outpatient. Follow‐up data collected at a "community setting" for experimental group and from individual households for the control group (p127)

Country: South Korea

Interventions

2 study groups:

1. Music intervention group: RAS music‐movement exercise intervention, which consisted of 4 sections: (a) preparatory activities, (b) main activities, (c) wrap‐up activities, and (d) follow‐up. Quote: "The routines are composed of a series of dynamic rhythmic motions involving the whole body". Other types of dynamic rhythmic movements and rhythm tools that were used in the programme included shaking an egg shaker and playing percussion instruments, such as a small Korean drum or tambourine, to a rhythm after listening to it." (p127)

2. Control group: The intervention involved receiving referral information about available usual care services.

Number of sessions: 8 weeks in total. Number of sessions per week unclear

Length of sessions: 2 hours per week

Outcomes

Physiological parameters: upper extremity function, shoulder flexion ROM (goniometer); lower extremity function, ankle flexion ROM (goniometer); lower extremity function, ankle extension ROM (goniometer); shoulder flexibility, upward in affected arm (back‐scratch test); shoulder flexibility, downward in affected arm (back‐scratch test): change scores

Psychological outcomes: mood (POMS ‐ Korean version); interpersonal relationships (The Relationship Change Scale); Quality of life (Stroke Specific Quality of Life Scale): pre‐ and post‐scores

Notes

Intervention described appears to be more similar to therapeutic instrumental performance or patterned sensory enhancement than RAS

Total POMS scores reported only; subscale results not reported. Authors used the Korean version of the POMS. However, the total scores were very low (range 1.56 to 2.81 out of a possible 136). We repeatedly attempted to contact the authors to check the POMS data, but were unable to obtain more information. As these data seemed unreliable, we excluded them from the meta‐analysis
This RAS study used music in combination with rhythmic stimulation. Participants were encouraged to practice the RAS music‐movement exercises at home each week. "Each week, participants were given a rhythmic music tape that was specifically developed for this study, together with simple instructions for home exercise" (p127)

Change scores were computed by 1 review author (JB)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated number list. Quote: "Using computer‐generated number cards, the participants were then randomly assigned to one of two groups" (p125)

Allocation concealment (selection bias)

Unclear risk

Allocation concealment was not reported

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It was not possible to blind the participants or professionals delivering the intervention

Blinding of outcome assessment (detection bias)
Subjective outcomes

High risk

Self report measures were used for subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes

Unclear risk

Blinding of the outcome assessors for the objective outcomes was not reported

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Although the numbers of withdrawals are reported as less than 20%, the reasons for withdrawal are not given. Quote: "Of the total 36 who were originally recruited, 33 completed the follow‐up data collection. Attrition is less than 20%" (p129)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

Quote: "This study was supported by the BK21 project (Grant No. 0522‐20010002), the Korea Science and Engineering Foundation (Grant No. R04‐2001‐000‐00197‐0), and the Research Institute of Nursing Science at Seoul National University." (p131)

Jungblut 2004

Methods

Quasi‐RCT with alternate group allocation
2‐arm parallel‐group design

Participants

People with stroke with chronic aphasia (Broca's aphasia and global aphasia) who were no longer receiving speech therapy
Time since onset: mean 11.5 years (since onset of aphasia)
N randomised: 17

N allocated to treatment group: 9
N allocated to control group: 7

N analysed in treatment group: 8

N analysed in control group: 5
Mean age: 63.8 years (experimental group); 67.8 years (control group)
Sex: 6 female (46%), 7 male (54%)
Ethnicity: not reported
Setting: outpatient services
Country: Germany

Interventions

2 study groups:

1. Music intervention group: rhythmic‐melodic voice training (SIPARI) sessions. SIPARI is a music therapy technique based on specific use of the voice. It actively works with the remaining speech capabilities in the right hemisphere of people with aphasia, namely singing, intonation, prosody embedded in physiologically appropriate breathing. The SIPARI method also employs instrumental and vocal rhythmic exercises and music improvisations to practice communication scenarios.
2. Control group: no treatment
Number of sessions: 20 group sessions and 10 individual sessions in total over a period of 7 months

Length of sessions: group sessions 60 minutes, individual sessions 45 minutes

Outcomes

Articulation and prosody, repetition, labelling, speech comprehension, total speech profile (Aachener Aphasie Test/Aachen Aphasia Test): effect size reported

Notes

1 review author (JB) computed change scores and SD from raw scores received from the principal investigator.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Alternate group allocation

Allocation concealment (selection bias)

High risk

No allocation concealment was reported

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It was not possible to blind the participants or professionals delivering the intervention

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

Independent outcome assessors were used

Incomplete outcome data (attrition bias)
All outcomes

High risk

23% attrition reported: 1 control and 1 experimental excluded as diagnosis of global or Broca's aphasia was unclear. 2 further participants excluded due to serious illness

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support reported

Kim 2005

Methods

RCT
Cross‐over trial with 3 groups

Participants

Participants with stroke: 8 with severe hemiplegia, 2 with mild hemiplegia
Time since onset: approximately 3 years
N randomised: 10
N analysed: 10

Mean age: not reported, age range: 61 to 73 years
Sex: 9 female (90%), 1 male (10%)
Ethnicity: 100% South Korean
Setting: Daycare centre for seniors
Country: South Korea

Interventions

3 study groups:

1. Music intervention group: listening to recorded songs with lyrics

2. Music intervention group: listening to karaoke accompaniment without lyrics during upper extremities exercises
3. Control group: no music during upper extremities exercises

Number of sessions: 8 sessions in total on a weekly basis

Length of sessions: not reported

Outcomes

Pain (Likert scale). No post‐test means or change scores were reported; only F statistic and significance level.

Notes

The author informed us that she no longer had access to the raw data, therefore we could obtain no means or SD. We did not include extracted data from this study in our review as no other included studies examined pain as an outcome.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated list of random numbers

Allocation concealment (selection bias)

Low risk

All participants underwent the 3 conditions in random order

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It was not possible to blind the participants or professionals delivering the intervention

Blinding of outcome assessment (detection bias)
Subjective outcomes

High risk

Self report measures were used for subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

No objective outcomes were used in this study

Incomplete outcome data (attrition bias)
All outcomes

High risk

4 participants (28.5%) withdrew due to health condition or frequent absences (personal communication with author)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

Quote: "The authors wish to thank the Kwanak Senior Center in Seoul, Korea for its generous support of this research." (p81)

Kim 2011a

Methods

RCT

Cross‐over trial with 4 groups

Participants

Participants with poststroke hemiparesis. No other diagnostic information provided

Time since onset: mean 19.40 months (SD 19.49)

N recruited: 18

N analysed: 15

Mean age: 60.07 years (SD 11.93)

Sex: 7 females (47%), 8 males (53%)

Ethnicity: not reported

Setting: rehabilitation unit

Country: Korea

Interventions

4 study groups:

1. Control group: visual locomotor imagery training (used as the control in this review)

2. Music intervention group: visual locomotor imagery training with auditory step rhythm (used as the experimental condition in this review)

3. Other therapy intervention (not used in this review): kinesthetic locomotor imagery training

4. Other therapy intervention (not used in this review): kinesthetic locomotor imagery training with auditory step rhythm

Number of sessions: 4 sessions in total over 4 days, with 1 intervention presented in each session

Length of sessions: 10 to 12 minutes

Outcomes

Walking performance (Timed Up‐and‐Go Test, EMG data recorded from the quadriceps, hamstring, tibialis anterior, and gastrocnemius of the affected leg). Change scores were used

Notes

We did not include EMG recording outcomes in this review

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Drawing of lots. Quote: "For randomization, we drew lots with four cards marked with 1, 2, 3 or 4 to determine the order of treatments" (p137)

Allocation concealment (selection bias)

Low risk

Drawing of lots. Quote: "Each subject had an envelope containing the four cards; without looking, each drew one card on each occasion" (p137)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It is not possible to blind participants receiving RAS or to blind the personnel involved in delivering RAS

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Unclear risk

Blinding of the outcome assessors for the objective outcomes was not reported

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Attrition reported at 16.6%. Quote: "Although initially 18 subjects were recruited, 3 subjects were excluded in data analysis owing to spontaneous refusal and irregular participation in intervention sessions" (p137)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support reported

Kim 2012a

Methods

RCT

2‐arm parallel‐group design

Participants

Participants with subacute stroke

Diagnosis: 8 infarction (40%), 12 haemorrhage (60%)

Time since onset: mean 5.22 months (SD 2.02)

N randomised to treatment group: 10

N randomised to control group: 10

N analysed in treatment group: 9

N analysed in control group: 9

Mean age: 55.05 years (SD 12.88)

Sex: 7 females (35%), 13 males (65%)

Ethnicity: not reported

Setting: inpatient rehabilitation

Country: South Korea

Interventions

2 study groups:

1. Music intervention group: RAS

2. Control group: conventional therapy consisting of "one‐on‐one neurodevelopmental therapy between a patient and a therapist. Was composed of sitting up from lying down, sit to stand, and trunk and limb training aimed at learning normal gait patterns" (p1308)

Number of sessions: 15 sessions in total with 3 sessions per week

Length of sessions: 30 minutes

Outcomes

Gait velocity (m/minute); gait cadence (steps/minute); stride length (affected side ‐ m); stride length (unaffected side ‐ m); functional gait ability (Dynamic Gait Index); dynamic balance (Four Square Step Test); gait ability (functional ambulation category), sit to stand, walking, stand to sit (Timed Up‐and‐Go Test); spatio‐temporal parameters of gait (up stair time ‐ step/second); spatio‐temporal parameters of gait (down stair time ‐ step/second). Change scores used for all of these outcomes

Risk of falls (activities‐specific balance confidence scale). Change scores used

Dynamic balance (Timed Up‐and‐Go Test). Post scores used

Notes

This study used metronome pulse without music, delivered via a smart phone metronome application

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Drawing of lots used (personal correspondence with principal investigator)

Allocation concealment (selection bias)

Low risk

Participants drew lots (personal correspondence with principal investigator)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It is not possible to blind participants receiving RAS or to blind the personnel involved in delivering RAS

Blinding of outcome assessment (detection bias)
Subjective outcomes

High risk

Self report measures were used for subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes

Unclear risk

Blinding of the outcome assessors for the objective outcomes was not reported

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Attrition reported at 10% due to 1 participant from each group (N = 2) leaving the hospital halfway through the study

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support reported

Kim 2012b

Methods

RCT

2‐arm parallel‐group design

Participants

Participants with hemiplegic stroke

Diagnosis: 14 infarction (70%), 6 haemorrhage (30%)

Time since onset: mean 15.5 months

N randomised to treatment group: 10

N randomised to control group: 10

N analysed in treatment group: 10

N analysed in control group: 10

Mean age: 64.85 years

Sex: not reported

Ethnicity: not reported

Setting: outpatient

Country: South Korea

Interventions

2 study groups:

1. Music intervention group: Auditory stimulation with metronome beat. Quote: "over the ground gait training with a metronome beat" (p775)

2. Control group: Quote: "over the ground gait training" (p775)

Number of sessions: 18 in total, 3 sessions per week for 6 weeks

Length of sessions: 10 minutes

Outcomes

Gait velocity (km/h); stride length (affected side) (cm); stride length (unaffected side) (cm); stride length asymmetry ratio; single‐support‐time asymmetry; ratio; affected side single support time; non‐affected side single support time m/s. Pre‐ and post‐scores were used

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Contradictory reporting of randomisation procedures. Quote: "At the time of enrolment, the subjects were randomly assigned to the experimental or control groups by a computerized random‐number generator supervised by an independent researcher" (p776)

Quote: "The limitations of this study were the lack of randomization" (p777)

Allocation concealment (selection bias)

Unclear risk

Quote: "the subjects were randomly assigned to the experimental or control groups by a computerized random‐number generator supervised by an independent researcher" (p776)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It is not possible to blind participants receiving RAS or to blind the personnel involved in delivering RAS

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Unclear risk

Blinding of the outcome assessors for the objective outcomes was not reported

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Attrition not reported. Attempts to contact authors were unsuccessful

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support reported

Lichun 2011

Methods

RCT

2‐arm parallel‐group design

Participants

Participants with stroke

Diagnosis: 15 thrombosis (50%), 15 haemorrhage (50%)

Time since onset: mean 8.13 months (SD 2.16)

N randomised to treatment group: 15

N randomised to control group: 15

N analysed in treatment group: 15

N analysed in control group: 15

Mean age: 67.4 years (range 40 to 80)

Sex: 21 females (70%), 9 males (30%)

Ethnicity: not reported

Setting: nursing home

Country: China

Interventions

2 study groups:

1. Music intervention group: RAS with conventional gait training

2. Control group: conventional gait training

Number of sessions: 10 in total with 2 sessions per week over 5 weeks

Length of sessions: 30 minutes

Outcomes

Stride length (affected side ‐ cm), affected and unaffected stride difference (cm), stride frequency (steps per minute), max walking speed (m/min). Post scores used

Notes

This study used rhythm delivered by a metronome in combination with live music

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Drawing of lots (personal correspondence with principal investigator)

Allocation concealment (selection bias)

Low risk

Drawing of lots (personal correspondence with principal investigator)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It is not possible to blind participants receiving RAS or to blind the personnel involved in delivering RAS

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

High risk

Blinding of the outcome assessors for the objective outcomes was not reported

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Attrition was not reported

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support reported

Mueller 2013

Methods

RCT

3‐arm parallel‐group design

Participants

Participants with CVA (N = 1; 6.67%) and traumatic brain injury (N = 14; 93.33%)

Time since onset: mean 21.56 years (SD 21.93)

N randomised to experimental group: 5

N randomised to placebo singing group: 5

N randomised to control group: 4

N analysed in experimental group: 5

N analysed in placebo singing group: 5

N analysed in control group: 4

Mean age: 43.93 years (SD 10.41)

Sex: 5 females (36%), 9 males (64%)

Ethnicity: not reported

Setting: rehabilitation

Country: USA

Interventions

3 study groups:

1. Music intervention group (used in this review): endogenous shifting training within the context of neurologic music therapy tasks led by a board‐certified music therapist

2. Placebo singing group (not used in this review): group sing‐a‐long sessions, led by the same music therapist

3. Control group: standard care

Number of sessions: 5 in total once per day over 5 days

Length of sessions: 60 minutes

Outcomes

Mental flexibility (Trail Making Test parts A and B); executive functioning (Dysexecutive Questionnaire (DEX) of the Behavioural Assessment of the Dysexecutive Syndrome and the Paced Auditory Serial Addition Test)

Pre and post scores used

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Used computer‐generated number list with stratified random sampling. Quote: "Random assignment was accomplished by assigning numbers to each participant using the online programme RANDOM.org. The numbers were then randomly sorted into three groups using the online randomisation programme, Research Randomizer" (p32)

Allocation concealment (selection bias)

Unclear risk

Allocation concealment was not reported

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It was not possible to blind the participants or professionals delivering the intervention

Blinding of outcome assessment (detection bias)
Subjective outcomes

High risk

Participants were provided with information in the consent form that could influence subjective outcomes. Quote: "We hope to show that music therapy makes a positive difference. We hope this research will help insurance companies decide to pay for future music therapy services" (p76)

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

Blinding of outcome assessment was adequate for the outcomes recommended for inclusion in this review (from the Trail Making Test Part B). Quote: "The psychometrist ... who remained blind to group membership, performed data collection on the Trail Making Test parts A & B scores (time and errors), and scores on the Paced Auditory Serial Addition Test (3 second and 2 second delivery rate). The researcher (neurologic music therapist) collected the data for the AMMA and also distributed and collected the DEX questionnaires" (pp39‐40). Outcomes from the Trail Making Test Part A, the Paced Auditory Serial Addition Test, and the Dysexecutive Questionnaire of the Behavioural Assessment of the Dysexecutive Syndrome were not used in this review

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Attrition was 6.67%. Quote: "One participant dropped out due to scheduling conflicts" (p33 and p41)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support was reported

O'Kelly 2014

Methods

RCT

Cross‐over trial

Quote: "A multiple baseline within subjects protocol was chosen to provide data on a range of contrasting music therapy, and non‐music therapy auditory stimuli." (p38)

Participants

Participants with disorders of consciousness, grouped into 2 cohorts:

1. Minimally consciousness state (N = 9; 43%)

2. Vegetative state (N = 12; 57%)

Healthy normal participants were also included in another cohort not included in this review

Cause of brain injury: hypoxic (N = 8; 38%); traumatic brain injury (N = 11; 52%); intracerebral haemorrhage (N = 2; 10%)

Time since onset: mean 7.3 months (SD 2.8)

N randomised: 21

N analysed: 21

Mean age: 45 years (SD 17.5)

Sex: 10 females (48%), 11 males (52%)

Ethnicity: not reported

Setting: inpatient rehabilitation

Country: UK

Interventions

All participants were studied under 5 conditions on 1 occasion. Treatment order was randomised. 5 minutes of baseline silence was followed by the presentation of 4 contrasting conditions, each condition administered for 3 minutes with a 2‐minute period of silence between each. The 5 conditions were as follows.

1. Baseline (silence)

2. Liked music: live performance by a music therapist of a participant‐preferred song

3. Entrained improvisation: live performance of an improvised vocal melody singing "Hello" and the participant's name, entrained to the participant's respiration

4. Disliked music: recordings of music disliked by the participant

5. White noise

Number of sessions: 1

Length of session: 22 minutes

Outcomes

Behavioural outcomes were rated from video recordings in 10‐second segments: eye blinks per minute, eyes closed with body movements present, eyes closed with no body movements, eyes open with body movements present (not used in this review)

Physiological outcomes: respiration rate per minute, respiration amplitude variance, respiration variance, heart rate, heart rate variability (not used in this review)

Neurophysiological outcomes: electroencephalogram data across delta, theta, alpha, and beta bandwidths (not used in this review)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation through drawing of lots

Allocation concealment (selection bias)

Low risk

Quote: "To control for order effects, the order of stimuli was randomised, with order series placed in opaque sealed envelopes with envelopes selected by an independent observer for each participant." (p40). All participants underwent the 5 conditions in random order

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It was not possible to blind the participants or professionals delivering the intervention

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

Quote: "Behavioural data using video recordings of patient sessions were analysed by a trained volunteer, who was blinded by removing audio from recordings." (p41)

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Attrition was not reported

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

Quote: "The research detailed in this thesis was funded primarily through a three year full time PhD Mobility Fellowship from the Doctoral School of the Humanities within the Department of Psychology and Communication at Aalborg University. Additional funding was provided by the Royal Hospital for Neuro‐disability and the Music Therapy Charity." (piii)

Park 2010a

Methods

RCT

2‐arm parallel‐group design

Participants

Participants with unilateral poststroke hemiparesis

Diagnosis: haemorrhagic stroke (32%), infarction (68%)

Time since onset: mean 15.5 months (SD 5)

N randomised to experimental condition (fast‐tempo auditory stimulation (FTAS)): 13

N randomised to wait‐list control: 13

N analysed in FTAS: 13

N analysed in control: 12

Mean age: 59.55 years

Sex: 16 females (64%), 9 males (36%)

Ethnicity: not reported

Setting: rehabilitation unit

Country: South Korea

Interventions

2 study groups:

1. Music intervention group: FTAS

2. Control group: walking training with no specific auditory stimulation

Number of sessions: 20 sessions in total, with sessions twice a day 5 days a week over 2 weeks

Length of sessions: 30 minutes

Outcomes

Gait parameters: gait velocity, gait cadence, stride length, Wisconsin Gait Scale: post‐test scores used.

Notes

This study used rhythm delivered by a metronome in combination with recorded music.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation through drawing of lots (correspondence with principal investigator)

Allocation concealment (selection bias)

Low risk

Allocation concealment through drawing of sealed envelopes (correspondence with principal investigator)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It is not possible to blind participants receiving FTAS or the personnel involved in delivering FTAS

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

High risk

Blinding of the outcome assessors for the objective outcomes was not reported

Incomplete outcome data (attrition bias)
All outcomes

Low risk

1 participant was eliminated from the data analysis due to a history of irregular participation in repeated trials. Attrition reported at 3.85%. Quote: "During the study, one CG subject was eliminated from data analysis due to a history of irregular participation in repeated trials" (p296)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support was reported

Paul 1998

Methods

Quasi‐RCT
2‐arm parallel‐group design

Participants

Adults with stroke with unilateral cerebral hemiplegia determined to have reached their maximum capacity of physical function and subsequently discharged from occupational and physical therapies. All participants had at least 10 degrees of limitation in active shoulder flexion and elbow extension.

Time since onset: mean 93.4 days (SD 49.5)

N randomised to experimental group: 10

N randomised to control group: 10
N analysed in experimental group: 10
N analysed in control group: 10
Mean age: 61.75 years (SD 5.1)
Sex: 9 females, 11 males
Ethnicity: not reported
Setting: nursing/rehabilitation facility
Country: USA

Interventions

2 study groups:

1. Music intervention group: participants engaged in active music improvisation sessions with the music therapist using electronic music devices that allowed for easy sound manipulation. Improvisations emphasised steady rhythmic pulses.
2. Control group: physical exercise session conducted by recreational therapist for the same duration as the music therapy session
Number of sessions: 20 sessions in total with 2 sessions per week over 10 weeks
Length of sessions: 30 minutes

Outcomes

Active shoulder flexion (Jamar goniometer); elbow extension (Jamar goniometer). Post‐test scores were used

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Alternate group allocation

Allocation concealment (selection bias)

High risk

No allocation concealment used

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It is not possible to blind the participants or professionals delivering this intervention

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

2 occupational therapists who did the goniometric measurements were blinded. Quote: "The therapists were blind to the conditions of each participant” (p229)

Incomplete outcome data (attrition bias)
All outcomes

Low risk

There were no withdrawals

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

Quote: "This project was funded by a research grant from the Institute for Music and Neurologic Function, New York, New York" (p236)

Pool 2012

Methods

RCT

Cross‐over trial with 2 groups

Participants

TBI participants in subacute rehabilitation

Diagnosis: haemorrhage (N = 5) 50%, stroke (N = 2) 20%, traumatic brain injury (N = 3) 30%

Time since onset: mean 11.55 years (138.6 months)

N randomised to experimental condition: 5

N randomised to control condition: 5

N analysed in experimental group: 3

N analysed in control group: 5

Mean age: 53.8 years

Sex: 6 females (60%), 4 males (40%)

Ethnicity: not reported

Setting: community day centres

Country: UK

Interventions

2 study groups:

1. Music intervention group: 8 sessions of music therapy followed by another 8 sessions of music therapy followed by 8 weeks of standard care/follow‐up

2. Control group: 8 weeks of standard care followed by 8 sessions of music therapy followed by another 8 sessions of music therapy followed by 8 weeks of follow‐up

Music therapy intervention was musical attention‐training exercises and songwriting

In this review we only used the first phase of this study (8 sessions), before the cross‐over

Number of sessions: 8 sessions on a weekly basis

Length of sessions: 60 minutes

Outcomes

Cognitive function: Test of Everyday Attention, Immediate Recall subtest from the Rivermead Behavioural Memory Test‐Third Edition

Mood: POMS‐Bipolar version, satisfaction of emotional needs (developed for this study)

Change scores were used

Notes

For mood outcomes, this study used the following POMS‐Bipolar form subscales: agreeable‐hostile, composed‐anxious, energetic‐tired, and elated‐depressed only. As total scores were not available, we could not include these outcomes in our meta‐analyses

1 review author (JB) computed change scores

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation through flipping of coin

Allocation concealment (selection bias)

Low risk

Allocation concealment through flipping of coin

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It was not possible to blind the participants or professionals delivering the intervention

Blinding of outcome assessment (detection bias)
Subjective outcomes

High risk

Self report measures were used for subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

Outcome assessors for the objective outcomes were blinded. Quote: "The test administrators were not informed about which time‐point each participant was at in the treatment schedule. Therefore, the administrators were blinded to the treatment conditions for each participant" (p117)

Incomplete outcome data (attrition bias)
All outcomes

High risk

Attrition reported as 2 (20%). Reasons for attrition not given. Quote: "Two subjects dropped out from the total number of ten subjects recruited" (p337)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support was reported

Schneider 2007

Methods

Quasi‐RCT

2‐arm parallel‐group design

Participants

People with stroke with moderate impairment of upper limb motor function. 20 (50%) with left extremity affected (10 in each group) and 20 (50%) with right extremity affected (10 in each group)

Diagnosis: 34 (85%) ischaemic stroke, 6 (15%) haemorrhagic stroke

Time since onset: mean 2 months

N randomised to experimental group: 20

N randomised to control group: 20

N analysed in experimental group: 20

N analysed in control group: 20

Mean age: 56.3 years

Sex: 13 females (33%), 27 males (67%)

Ethnicity: all native German speakers

Setting: inpatient

Country: Germany

Interventions

2 study groups:

1. Music intervention group: Music‐supported training (MST). This involved playing either a MIDI keyboard (fine motor skills) or an electronic drum set consisting of 8 pads (gross motor skills), or both. The music exercises were adaptable to the needs of the participants and systematically increased in difficulty according to 10 set levels. All exercises were demonstrated by the instructor first and then repeated by the participant

2. Control group: Conventional therapy

Number of sessions (experimental group only): 15 in total over 3 weeks

Length of sessions: 30 minutes

Outcomes

Upper extremity motor functions (Action Research Arm Test; Arm Paresis Score; Box and Block Test; Nine‐Hole Pegboard Test). Analysis of quality and velocity of finger‐tapping and hand‐tapping movements assessed using a computerised movement analysis system (frequency of full cycles per second; number of inversions of velocity profiles per movement segment; average maximum angular velocity)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Quote: "Patients were assigned pseudo‐randomly" (p1340). We determined through correspondence with author that participants were assigned to groups in blocks using alternate assignment (20 to MST, followed by 20 to control, followed by 12 to MST, followed by 10 to control)

Allocation concealment (selection bias)

High risk

Quote: "Patients were assigned pseudo‐randomly by the occupational therapists not involved in the study to two groups" (p1340). However, we determined that there was a high risk of selection bias due to serial block allocation

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It was not possible to blind the participants or professionals delivering the intervention

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

Subjective outcomes were not used in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Unclear risk

Not reported

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Quote: "There were no drop outs" (p1340)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

Quote: "Supported by grants from the DFG (AL 269/7‐1) and the BMBF" (p1345)

Suh 2014

Methods

RCT

2‐arm parallel‐group design

Participants

Participants with hemiplegic stroke

Diagnosis: 5 (31.25%) haemorrhagic stroke, 11 (68.75%) ischaemic stroke

Time since onset: mean 305.32 days

N randomised to experimental group: 8

N randomised to control group: 8

N analysed in experimental group: 8

N analysed in control group: 8

Mean age: 65.82 years

Sex: 10 females (62.5%), 6 males (37.5%)

Ethnicity: not reported

Setting: rehabilitation unit

Country: South Korea

Interventions

2 study groups:

1. Music intervention group: neurodevelopmental therapy (NDT) gait training with RAS

2. Control group: NDT gait training without RAS

Number of sessions: 15 in total, once per day for 3 weeks

Length of sessions: 15 minutes

Outcomes

Gait parameters: gait velocity (m/minute), gait cadence (steps per minute), stride length (m), standing balance (overall stability index). Change scores used

Notes

The RAS employed in this study did not use accompanying music. Quote: "The rhythm stimulation was composed of single tone series in 4/4 time signature" (p195)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated number list. Quote: "Patients were randomly assigned to either experimental (N = 8) or control (N = 8) group by a computerized random number generator" (p194)

Allocation concealment (selection bias)

Low risk

Allocation concealment reported. Quote: "Random numbers for the allocation‐to‐treatment sequence were concealed from the recruiter and the therapists. Patients were informed of the two possible treatment allocations, but not whether they are in the experimental or control arm." (p194)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Participants were blind to treatment allocations. Quote: "Random numbers for the allocation‐to‐treatment sequence were concealed from the recruiter and the therapists. Patients were informed of the two possible treatment allocations, but not whether they are in the experimental or control arm" (p194). It is not possible to blind the personnel involved in delivering RAS

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

Subjective outcomes were not used in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Unclear risk

Not reported

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Attrition was not reported

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

Quote: "The work was supported by the Ewha Global Top 5 Grant 2012 of Ewha Womans University." (p198)

Särkämö 2008

Methods

RCT

3‐arm parallel‐group design

Participants

Participants with ischaemic stroke

Time since onset: mean 6.2 days

N randomised to music listening: 20

N randomised to audio book listening: 20

N randomised to standard care control: 20

N analysed in music listening: 19

N analysed in audio book listening: 19

N analysed in standard care control: 17

Mean age: 58.87 years

Sex: 16 females (44%), 20 males (56%)

Ethnicity: not reported

Setting: neurology unit

Country: Finland

Interventions

3 study groups:

1. Music intervention group: Music therapists provided participants with portable CD players and CDs of their own favourite music in any musical genre.

2. Language intervention group (not used in this review): Participants were provided with portable cassette players and narrated audio books on cassettes selected by the participants from a collection of the Finnish Celia library for the visually impaired (celia.fi)

3. Control group: No listening material.

Number of sessions (experimental group): daily for 2 months

Length of sessions: minimum of 60 minutes per day

Outcomes

Communication function repetition and reading (subtests of the Finnish version of the Boston Diagnostic Aphasia Examination); verbal fluency and naming subtests (Consortium to Establish a Registry for Alzheimer’s Disease battery and a shortened version of the Token Test). Cognitive function (story recall subtest from the Rivermead Behavioural Memory Test, digit span subtest from the Wechsler Memory Scale‐Revised), and a memory interference task (Frontal Assessment Battery). Attention (CogniSpeed reaction time software). Mood (POMS). Change scores used

Notes

The POMS used in this study was "the shortened Finnish version (Hänninen 1989) of the Profile of Mood States (POMS; McNair et al 1981). It contains 38 items that form following eight subscales: tension, depression, irritability, vigour, fatigue, inertia, confusion and forgetfulness." (p868). Scores for the subscales were available from published data, and total scores were made available by the principal investigator in unpublished data

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation using computer‐generated number list. Quote: "Randomization was performed with a random number generator" (p867)

Allocation concealment (selection bias)

Low risk

Quote: "Randomization was performed with a random number generator by a researcher not involved in the patient enrollment" (p867)Quote: "The researchers involved in these studies (authors TS and MM) were blinded to the group allocation of the patients" (p868)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It was not possible to blind the participants or professionals delivering the intervention

Blinding of outcome assessment (detection bias)
Subjective outcomes

High risk

Self report measures were used for subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

Quote: "Clinical neuropsychological assessment was performed on all patients at the baseline (1 week from stroke onset), and repeated again 3 months and 6 months post‐stroke. The researchers involved in these studies (authors TS and MM) were blinded to the group allocation of the patients" (p868)

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Attrition reported with reasons for withdrawal. Quote: "Of the 60 subjects originally recruited in to the study, 55 completed the study up to the 3‐month follow‐up (music group N = 19, language group N = 19 and control group N = 17). Of the five drop‐outs, one was due to false diagnosis (transient Ischaemic attack), one due to a new stroke, one due to dementia and two due to refusal. One further subject died from myocardial infarction before the 6‐month follow‐up (music group N = 18, language group N = 19, and control group N = 17 at the 6‐month stage)" (p867)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

Quote: "This work was supported by Academy of Finland (project no 77322), Jenny and Antti Wihuri Foundation (Helsinki, Finland), National Graduate School of Psychology and Neurology Foundation (Helsinki, Finland). Funding to pay the Open Access publication charges for this article was provided by Cognitive Brain Research Unit, Department of Psychology, University of Helsinki, Finland." (p874)

Thaut 1997

Methods

RCT
2‐arm parallel‐group design

Participants

Participants with hemiparesis following stroke
Time since onset: mean 16.1 days (SD 4) for experimental group, 15.7 days (SD 4) for control group

N randomised to experimental group: 10

N randomised to control group: 10

N analysed in experimental group: 10

N analysed in control group: 10

Mean age: 73 years (SD 7) experimental group, 72 years (SD 8) control group
Sex: 10 (50%) female, 10 (50%) male
Ethnicity: not reported
Setting: inpatient
Country: USA

Interventions

2 study groups:

1. Music intervention group: RAS
2. Control group: standard neurodevelopmental treatment/Bobath
Number of sessions: 60 sessions in total, twice daily for 6 weeks
Length of sessions: 30 minutes

Outcomes

Gait parameters: velocity, stride length, cadence, symmetry: pre‐test and post‐test values
EMG variability: change score

Notes

The RAS employed in this study used metronome beat in combination with recorded music. Quote: "The rhythmic stimulus in the training sessions consisted of music tapes played over headsets that were prerecorded on a synthesizer/sequencer module. Instrumental music in 4 different styles was prepared (classic, folk, country, jazz). The music was recorded in 2/4 meter to match the rhythm of the step patterns in gait. A metronome beat was overlaid on the strong beat of the music to enhance the rhythmic perception for the patient." (p209)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated list of random numbers (personal communication with principal investigator)

Allocation concealment (selection bias)

Low risk

Recruiters did not know group conditions (personal communication with principal investigator)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It is not possible to blind participants receiving RAS or the personnel involved in delivering RAS

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

Subjective outcomes were not used in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

Participants were assessed by "a physical therapist blind to the experiment" (p208)

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No participant loss (personal communication with principal investigator)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

Quote: "This research was funded in part by a grant from the Poudre Valley Hospital Foundation and grants RR 07127‐20 and RR 07127‐23 from the National Institutes of Health (NIH)" (p211)

Thaut 2002

Methods

RCT
Cross‐over trial with 2 groups

Participants

Participants with left hemispheric stroke

Time since onset: mean 11.4 months (SD 5.2)

Diagnosis: 19 (90%) ischaemic stroke (15 in the middle cerebral artery distribution and 4 in the anterior cerebral artery distribution); 2 (10%) intracerebral haemorrhage related to a cerebral aneurysm

N randomised: 21

N analysed: 21

Mean age: 52.7 years (SD 13.7)
Sex: 8 (38%) female, 13 (62%) male
Setting: outpatient services
Country: USA

Interventions

2 study groups:

1. Music intervention group: RAS
2. Control group: non‐cued repetitive training
Number of sessions: 2 in total: 1 session with RAS and 1 session without external time cueing
Length of sessions: 30 minutes each

Outcomes

Arm timing, variability of movement timing, wrist trajectories, wrist trajectory variability, elbow range of motion. Pre‐test and post‐test scores used

Notes

The RAS employed in this study did not use accompanying music. Quote: "The auditory rhythm consisted of a metronome‐like 1000 Hz square wave tone with a 50 ms plateau time produced by a computerized MIDI‐sequencing sound software" (p1075)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated list of random numbers (personal communication with principal investigator)

Allocation concealment (selection bias)

Low risk

Serially numbered, opaque, sealed envelopes (personal communication with principal investigator)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It is not possible to blind participants receiving RAS or the personnel involved in delivering RAS

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

Subjective outcomes were not used in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

High risk

Outcome assessors were not blinded

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Participant withdrawals were not reported

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

Quote: "This research was supported in part by a grant from the Deutsche Forschungsgesellschaft, Sonderforschungsbereich 194 to Thaut and Hoemberg (DFG: German Research Council, Special Research Section 194)" (p1079)

Thaut 2007

Methods

RCT
2‐arm parallel‐group design

Participants

Participants with subacute hemiparetic stroke

Diagnosis: 65 (83%) middle cerebral artery stroke; 8 (11%) internal capsule stroke; 4 (5%) basal ganglia/thalamus stroke; 1 (1%) subdural haematoma

Time since onset: approximately 21 days

N randomised to experimental group: 43

N randomised to control group: 35

N analysed in experimental group: 43

N analysed in control group: 35

Mean age: 69.2 years (SD 11.5) experimental group; 69.7 years (SD 11.2) control group
Sex: 37 (47%) female, 41 (53%) male
Ethnicity: not reported
Setting: 2 research centres
Country: USA and Germany

Interventions

2 study groups:

1. Music intervention group: RAS
2. Control group: standard neurodevelopmental therapy/Bobath
Number of sessions: 15 sessions in total, once daily for 5 days over 3 weeks
Length of sessions: 30 minutes

Outcomes

Gait parameters: velocity, stride length, cadence, symmetry: post‐test scores were used
Participant satisfaction with treatment: F statistic and P values used

Notes

The RAS employed in this study used metronome beat in combination with recorded music. Quote: "RAS training followed established protocols using a metronome and specifically prepared music tapes in digital MIDI format to ensure temporal precision and tempo stability as well as full capacity for frequency modulation of the stimulus based on patient needs" (p456)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated list of random numbers

Allocation concealment (selection bias)

Low risk

Serially numbered, opaque, sealed envelopes

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It is not possible to blind participants receiving RAS or the personnel involved in delivering RAS. Quote: "Therapists were not blinded to the treatment conditions of the study. However, because both conditions are considered full treatment conditions, no performance bias was expected." (p456)

Blinding of outcome assessment (detection bias)
Subjective outcomes

Unclear risk

Subjective outcomes included participant satisfaction, however the measures used and the methods of data collection were not reported

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

Quote: “Both groups were assessed by blinded physical therapists” (p456)

Incomplete outcome data (attrition bias)
All outcomes

High risk

23% dropouts in German centre, 10% in US centre (absolute numbers are not reported)
Reasons: hospital transfer, early discharge, medical complications, unspecified personal reasons

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

No funding support was reported

Tong 2015

Methods

RCT

2‐arm parallel‐group design

Participants

Participants with light to moderate motor impairment in the upper extremity following stroke

Diagnosis: 15 (50%) haemorrhagic stroke, 15 (50%), ischaemic stroke

Time since onset: mean 5.35 months

N randomised to experimental group: 15

N randomised to control group: 15

N analysed in experimental group: 15

N analysed in control group: 15

Mean age: 49.35 years

Sex: 4 females (62.5%), 26 males (37.5%)

Ethnicity: Chinese

Setting: rehabilitation unit

Country: China

Interventions

2 study groups:

Music‐supported therapy involving 2 conditions:

1. Music intervention group: audible music group involving the playing of musical instruments that were audible/not muted

2. Control group: mute music group involving the playing of musical instruments that resembled the audible musical instruments used in the music intervention group but that were made of sponge

Number of sessions: 20 in total over 4 weeks
Length of sessions: 30 minutes

Outcomes

Upper extremity function (Wolf Motor Function Test, FMA): change scores used

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation using random number table. Quote: "Randomisation was performed by assigning random numbers from random number tables" (p2)

Allocation concealment (selection bias)

Unclear risk

Allocation concealment was not reported

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It was not possible to blind the participants or professionals delivering the intervention

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

Subjective outcomes were not used in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Unclear risk

Blinding of outcome assessors for the objective outcomes was not reported

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Attrition was reported as 9%. Quote: "Three patients in the CG dropped out because of training boredom" (p4)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

The authors declare no conflict of interest. Quote: "This work was partially supported by China Rehabilitation Research Center (CRRC) fund (no. 2008‐19)." (p6)

Van Delden 2013

Methods

RCT

3‐arm parallel‐group design

Participants

Participants with stroke with light to moderate motor impairment in the upper extremity

Diagnosis: stroke

Time since onset: mean 9.37 weeks

N randomised to modified bilateral arm training with rhythmic auditory cueing (mBATRAC) group: 19

N randomised to DMCT control group: 19

N randomised to modified constraint‐induced movement therapy (mCIMT) control group: 22

N analysed in mBATRAC group: 18

N analysed in DMCT control group: 16

N analysed in mCIMT control group: 21

Mean age: 59.75 years

Sex: not reported

Ethnicity: not reported

Setting: rehabilitation unit

Country: Netherlands

Interventions

3 study groups:

1. Music intervention group: mBATRAC, which involved a modification of the original bilateral arm training with rhythmic auditory cueing protocol that targeted rhythmic flexion and extension movements about the wrist rather than movements of proximal parts of the upper limb

2. Control group: Conventional treatment (DMCT) was an exercise therapy based on existing guidelines for upper limb rehabilitation after stroke, discarding specific elements of the 2 experimental conditions

3. 2nd intervention group (not used in this review): mCIMT, which involved repetitive task practices and shaping of the desired movements, with an emphasis on increased control of wrist and finger extensors

Number of sessions: 18 sessions in total with 3 sessions per week over 6 weeks
Length of sessions: 60 minutes

Outcomes

Upper extremity function (Action Research Arm Test, Motricity Index, Nine‐Hole Peg Test, Fugl‐Meyer Motor Assessment, Erasmus modifications of the Nottingham Sensory Assessment)

Communication function, cognitive function, mood (all using the Stroke Impact Scale)

Change scores used

Notes

RAC in this study followed the protocol for mBATRAC, which was not defined in this article. However, the BATRAC protocol has been defined elsewhere as moving "in time to a metronome" (McCombe Waller 2005, p546)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "Patients were randomized in permuted blocks and allocated to 1 of the 3 intervention groups" (p2164)

Allocation concealment (selection bias)

Low risk

Quote: "Concealed allocation was effectuated online using the minimization method" (p2164)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It was not possible to blind the participants or professionals delivering the intervention

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

Althoughsubjective outcomes were examined in this study, these outcomes were not included in this systematic review, as they had not been specified as outcomes of interest at the outset of the study

Blinding of outcome assessment (detection bias)
Objective outcomes

Unclear risk

The study is reported as a single‐blind trial, so presumably the data collector was blind. However, blinding is not described and is therefore unclear

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Attrition reported as 15.8%. 19 enrolled in mBATRAC; 19 enrolled in DMCT; follow‐up 17 in mBATRAC and 15 in DMCT groups. Descriptions of withdrawals: 1 refused after allocation; 3 moved away; 2 did not appear for follow‐up

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

Quote: "This study was funded by the Dutch Scientific College of Physiotherapy of the Royal Dutch Society for Physical Therapy." (p2615)

van der Meulen 2014

Methods

RCT with a wait‐list control group

Participants

Participants with stroke with aphasia

Diagnosis: 1 (7%) haemorrhagic stroke, 14 (86%) ischaemic stroke, 1 (7%) stroke type unknown

Time since onset: mean 10.6 months

N randomised to melodic intonation therapy (MIT): 16

N randomised to wait‐list control: 11

N analysed in MIT: 11

N analysed in wait‐list control: 11

Mean age: 52.55 years

Sex: 16 females (60%), 11 males (40%)

Ethnicity: not reported

Setting: hospitals, rehabilitation centres, and nursing homes

Country: Netherlands

Interventions

2 study groups:

1. Music intervention group: intensive melodic intonation therapy (MIT) for the first 6‐week period (between T1 and T2), and then received "regular therapy" for the second 6‐week period (between T2 and T3)

2. Control group: received "intensive control treatment" between T1 and T2, and then received delayed MIT between T2 and T3

Number of sessions: unclear. 5 hours a week over 6 weeks
Length of sessions: unclear. 3 hours minimum face‐to‐face intervention and 2 hours of "homework" using recorded videos

Outcomes

Communication function (Aachen Aphasia Test, Amsterdam‐Nijmegen Everyday Language Test, Semantic Association Task, Sabadell story retelling task (connected speech), MIT repetition task). Change scores used

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated number list. Quote: "A computer‐generated random allocation sequence was used” (p537)

Allocation concealment (selection bias)

Low risk

Used opaque, sealed envelopes. Quote: "a computer‐generated random allocation sequence was used and the results placed in consecutively numbered sealed envelopes” (pp537‐8)

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It was not possible to blind the participants or professionals delivering the intervention. Quote: "participants and speech‐language therapists (SLTs) could not be blinded for treatment condition" (p538)

Blinding of outcome assessment (detection bias)
Subjective outcomes

Low risk

No subjective outcomes were included in this study

Blinding of outcome assessment (detection bias)
Objective outcomes

Unclear risk

Blinding of the outcome assessors for the objective outcomes was not achieved in all cases. Quote: "The researchers administering and scoring the assessments at each test moment were blinded for group allocation. In a few cases, blinding could not be maintained because the patients spontaneously informed the researcher about their therapy allocation" (p538)

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Exact attrition rate is unclear as there is a lack of congruence between the text and the CONSORT diagram. Text suggests that there was a 14.8% attrition rate, due to early discharge and refusal to participate. Quote: "A total number of 27 patients were included in the study: 16 were allocated to the experimental group and 11 to the control group. Four patients withdrew from MIT after 1 or 2 weeks, because they felt uncomfortable with the therapy or were disappointed by their progress." (p539)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

Low risk

Quote: "The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Stichting Rotterdams Kinderrevalidatie Fonds Adriaanstichting (Grant No. 2007/0168 JKF/07.08.31KFA)" (p543)

Whitall 2011

Methods

RCT

2‐arm parallel‐group design

Participants

Participants with unilateral stroke

Diagnosis: Locations of strokes reported as follows.

Brainstem: 6 (6%)

Cerebellar: 2 (2%)

Cortex: 39 (42%)

Multiple: 3 (3%)

Subcortical: 19 (20%)

Unknown/missing: 24 (26%)

Time since onset: > 6 months

N randomised to BATRAC group: 55

N randomised to control (dose‐matched therapeutic exercises (DMTE)): 56

N analysed in BATRAC group: 42

N analysed in control group: 50

Mean age: 59.8 years

Sex: 42 females (46%), 50 males (54%)

Ethnicity: not reported

Setting: outpatient

Country: USA

Interventions

2 study groups:

1. Music intervention group: BATRAC

2. Control group: dose‐matched therapeutic exercises (DMTE) consisting of 4 exercises based on neurodevelopmental principles including thoracic spine mobilisation with weight shifting, scapular mobilisation, weight bearing with the paretic arm (elbow fixed), and opening the hand with finger extension

Number of sessions: 18 in total with 3 sessions per week over 6 weeks

Length of sessions: 1 hour, which included 20 minutes active participation and 4 minutes rest

Outcomes

Motor impairment (Fugl‐Meyer Assessment of the Upper Extremity, Wolf Motor Function Test (time), Stroke Impact Scale, isokinetic strength of elbow flexion/extension arm movements)

Notes

Total N of participants adds up to 83, not 92 as reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "Participants were randomized after B2 to receive either BATRAC or DMTE using a stratified block allocation scheme based on initial function (NIH Stroke Scale with 2 as cutoff) and motor dominance of stroke." (pp121‐2)

Allocation concealment (selection bias)

Unclear risk

Not reported

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

It was not possible to blind the participants or professionals delivering the intervention

Blinding of outcome assessment (detection bias)
Subjective outcomes

High risk

Self report measures were used for subjective outcomes

Blinding of outcome assessment (detection bias)
Objective outcomes

Low risk

Quote: "Testing was conducted in a separate location from the training site by trained testers blinded to group assignment." (p122)

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Attrition at post‐training analysis (6‐week time point): 17%. 55 allocated to BATRAC; 56 allocated to DMTE. N analysed in BATRAC = 42; N analysed in DMTE = 50. Descriptions of withdrawals: 12 for medical reasons (BATRAC, N = 8; DMTE, N = 4); 7 for personal reasons (BATRAC, N = 5; DMTE, N = 2)

Selective reporting (reporting bias)

Low risk

There are no indications of selective reporting for this study

Free from financial conflict of interest

High risk

Quote: "The author(s) declared a potential conflict of interest (e.g. a financial relationship with the commercial organizations or products discussed in this article) as follows: As inventors of the subject technology, Jill Whitall and Sandy McCombe Waller anticipate receiving licensing income from their institution (UMB), under its Intellectual Property Policy." (p127)

BATRAC: bilateral arm training with rhythmic auditory cueing
BP: blood pressure
COPM: Canadian Occupational Performance Measure
CVA: cerebrovascular accident
EMG: electromyography
FMA: Fugl‐Meyer Assessment
POMS: Profile of Mood States
PTA: post‐traumatic amnesia
RAC: rhythmic auditory cueing
RAS: rhythmic auditory stimulation
RCT: randomised controlled trial
ROM: range of motion
SD: standard deviation
SIS: Stroke Impact Scale
TBI: traumatic brain injury

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Al‐Mahasneh 1991

Insufficient reporting on intervention and design. Attempts to obtain additional data from authors were unsuccessful.

Amengual 2013

Control group used healthy participants, and not RCT.

Baker 2004

Not RCT or CCT

Baker 2005

Not RCT or CCT

Barnes 2006

Not RCT or CCT

No control group

Beatty 1995

Control group used healthy participants.

Bonakdarpour 2003

Not RCT or CCT

Single‐subject design

Bossert 2012

Insufficient reporting of results: only means are reported, no SDs. Attempts to obtain additional data from authors were unsuccessful. The authors use a standardised measure (12‐Item Short Form Health Survey) for physical and mental health, but all other outcomes (e.g. body awareness, emotional awareness, relational quality) are measured by self developed questionnaires.

Breitenfeld 2005

The published results of this study examine outcomes not included in this review.

Carlisle 2000

Not RCT or CCT

Chen 2013

Not RCT or CCT

Within‐subject design

Cofrancesco 1985

Not RCT or CCT

Cohen 1992

Unacceptable treatment allocation method

Cohen 1995

Compared rhythmically cued speech, melodically cued speech, and verbal speech of participants who had been receiving music therapy
No standard‐treatment group
Insufficient data reporting

Conklyn 2010

Not population of interest (multiple sclerosis)

Dellacherie 2011

Control group used healthy participants.

Eslinger 1997

We could not locate any published results. Attempts to obtain additional data from authors were unsuccessful.

Ford 2007

Not RCT or CCT

Gerlichova 2014

Not RCT or CCT

Goh 2001

Planned to be conducted as RCT, however only 2 participants enrolled

Gollaher 1993

Not RCT or CCT

Within‐subject design

Grossman 1981

Not RCT or CCT

Within‐subject design

Hald 2012

Standardised outcome measures had been adapted, and adaptations had not been validated.

Hayden 2009

Not RCT or CCT

Wait‐list design with no control group

Hitchen 2007

Insufficient data collection (personal communication)

Hurt 1998

Not RCT or CCT

Hébert 2003

Not RCT or CCT

Single‐subject design with healthy controls

Johannsen 2010

An intervention using rhythmic auditory stimulation was used as a control condition, therefore control condition did not qualify as a 'no‐music' condition.

Jun 2013

Extremely large standard deviations indicate that the data was not normally distributed.

Kasai 2014

Not RCT or CCT

Kim 2008

Not RCT or CCT

Protocol description

Kim 2011b

No randomisation or quasi‐randomisation

Kim 2012c

Not population of interest (cerebral palsy)

Kim 2013

Not RCT or CCT

Within‐subject design using pre and post measures

Lee 2012

Single‐group design with no randomisation

Li 2002

The research question was not relevant to this review.

Lin 2007

Not RCT or CCT

Magee 2002

Comparative study of 2 music therapy interventions

Magee 2006a

Not RCT or CCT

Malcolm 2009

Not RCT or CCT

Mandel 1990

Further details are required about the randomisation process. Attempts to obtain additional data from authors were unsuccessful. We could not locate the authors through an internet search for the facility. Given the age of this article, we have excluded it from our review.

McCombe Waller 2005

Not RCT or CCT

Moon 2008

Not RCT or CCT (personal communication with author's project advisor)

Nayak 2000

Not RCT or CCT
Participants were assigned to music therapy group individually or in groups of varying sizes, as this was the only way they were available to the researchers, compromising the randomisation procedures (personal communication).

Nie 2014

Cannot access this publication through interlibrary searching

Park 2010b

Cross‐over design that examined 2 conditions (preferred music with classical music) and used baseline data as the "control"

No control data reported

Popovici 1992

We could not determine whether randomisation had been used in this study. Attempts to obtain additional data from authors were unsuccessful as we were unable to obtain author contact information.

Prassas 1997

Not RCT or CCT

Puggina 2011

Inconsistent reporting of research design, treatment conditions, and dosage

We contacted the authors on several occasions but received no response.

Purdie 1997

Not RCT or CCT

Richards 2008

Not RCT or CCT

No control group

Roerdink 2009

Control group used healthy participants.

Scalha 2010

Not RCT or CCT

No randomisation (personal communication with author)

Schauer 1996

Control group used healthy participants.

Schauer 2003

Inadequate methodological information

Schinner 1995

Outcomes are not of interest to this review.

Schneider 2010

Not RCT or CCT

Study was designed as a 2‐group parallel study, and the control group was added to the research at a later stage.

Shafshak 2013

Unable to retrieve publication

Sinclair 2013

Used matched healthy controls

Stahl 2011

Not RCT or CCT

Studebaker 2007

Not RCT or CCT

Särkämö 2010a

This study is part of the Särkämö 2008 study, however it only reports on brain imaging outcomes, which are not outcomes of interest to this review.

Särkämö 2010b

Not RCT or CCT

This study does not examine outcomes of interest to this review (amusia).

Thaut 1992

Control group used healthy participants.

Thaut 1993

Not RCT or CCT

Thaut 1997b

Not RCT or CCT

Thaut 1999

Not RCT or CCT

Thaut 2009

Not RCT or CCT

No randomisation or quasi‐randomisation

Results present within‐group comparisons rather than between‐group comparisons.

Thompson 1986

Not RCT or CCT

Single‐subject design with multiple baselines

Intervention does not seem to include a musical condition, and so is not an intervention of interest to this review.

Tsai 2013a

Not RCT or CCT

Within‐subject design

Tsai 2013b

Not RCT or CCT

Single‐subject design

Tseng 2014

Not RCT or CCT

Single‐subject design

van Nes 2006

Not RCT or CCT

No control intervention

Comparison of 2 interventions: somatosensory stimulation and "exercise therapy on music"

Wallace 1985

Not RCT or CCT

Walworth 2008

Unable to determine methods of randomisation

We contacted the authors on several occasions but received no response.

Wan 2014

Not RCT or CCT

No randomisation or quasi‐randomisation

Whitall 1999

Not RCT or CCT

Whitall 2000

Not RCT or CCT

Zazula 1984

Unable to retrieve publication

Zhao 2010

Unable to retrieve publication

CCT: controlled clinical trial
RCT: randomised controlled trial
SD: standard deviation

Characteristics of studies awaiting assessment [ordered by study ID]

Bayat 2014

Methods

RCT

4‐arm parallel‐group design

Participants

Participants with stroke with hemiparesis

Time since onset: unknown

N randomised: 60

Age range: unknown

Sex: unknown

Ethnicity: unknown

Setting: unknown

Country: Iran

Interventions

4 study groups:

1. Program‐based computer software use

2. Listening to Mozart Sonata K448

3. Software use plus listening to Mozart Sonata K448

4. Control: no intervention

Length of intervention: 6 months

Number of sessions: unclear

Length of sessions: 1 hour per night

Outcomes

Magnetic resonance spectroscopy

Fugl‐Meyer Assessment of Physical Performance

Mini Mental State Exam

Notes

John 2010

Methods

RCT

3‐arm parallel‐group design

Participants

Participants with subacute stroke

Time since onset: unknown

N randomised: 60

Age range: 50 to 70 years, mean unknown

Sex: 22 females (37%), 38 males (63%)

Ethnicity: unknown

Setting: unknown

Country: unknown

Interventions

3 study groups:

1: Listening to film and classical songs plus conventional management

2. Meditation plus conventional management

3. Conventional management only (control)

Length of intervention: 6 weeks

Number of sessions: total unknown

Length of sessions: unknown

Outcomes

Hamilton Rating Scale for Depression

Berg Balance Scale

Barthel Activities of Daily Living Index

Fatigue Severity Scale

Notes

Oiga 2014

Methods

RCT

3‐arm parallel‐group design

Participants

Participants with stroke

Time since onset: unknown

N randomised: 16

Mean age: unknown

Sex: unknown

Ethnicity: unknown

Setting: tertiary inpatient medical centre

Country: Philippines

Interventions

3 study groups:

1. Control: white noise background

2. Rhythm: metronome ‐ 100 beats per minute

3. Music: "Pomp and Circumstance"

Length of intervention: unknown

Number of sessions: unknown

Length of sessions: unknown

Outcomes

Functional Independence Measure

Hand dynamometer

Notes

Poćwierz‐Marciniak 2014

Methods

RCT

2‐arm parallel‐group design

Participants

Participants with stroke

Time since onset: unknown

N randomised to intervention: 8

N randomised to control: 11

Mean age: unknown

Sex: unknown

Ethnicity: unknown

Setting: unknown

Number of sessions: unknown

Length of intervention: unknown

Length of sessions: unknown

Interventions

Music therapy

Outcomes

Health‐related quality of life

Anxiety, depression, irritation, and anger

Quality of life (anxiety, acceptance of condition, sense of control)

Notes

Renna 2012

Methods

RCT

2‐arm parallel‐group design

Participants

Adults following stroke

Time since onset: first 12 weeks' poststroke

N randomised: unknown

Mean age: unknown

Sex: unknown

Ethnicity: unknown

Setting: unknown

Number of sessions: unknown

Length of intervention: unknown

Length of sessions: unknown

Interventions

70 hours of preferred music listening over 12 weeks via MP3 players and logged in diaries

Outcomes

Not specified, but describes mood and cognition as primary outcomes, and function and quality of life as secondary outcomes

Notes

Prospective abstract describing study protocol

RCT: randomised controlled trial

Characteristics of ongoing studies [ordered by study ID]

Ala‐Ruona 2010

Trial name or title

Examining the effects of active music therapy on post‐stroke recovery: a randomised controlled cross‐over trial

Methods

RCT

Cross‐over trial

Computer‐generated randomisation

Participants

45 participants with stroke

Interventions

Experimental music therapy condition: 2 (60‐minute) weekly sessions of active music therapy in individual setting over a period of  3 months
The music therapy includes a combination of structured musical exercises with different levels of difficulty, interactive clinical improvisation, rhythmic dynamic playing with changing movement sequences, music‐assisted relaxation, and therapeutic discussion
Control condition: standard care according to the Finnish Current Care guidelines for stroke

Outcomes

Functional disability and activities of daily living independency (BI), level of impairment (NIHSS), disability grade (mRS), neglect (BIT), and motor function of upper extremity (ARAT)

Starting date

Contact information

Contact: Professor Esa Ala‐Ruona, email: esa.ala‐[email protected]

Notes

NCT00903266

Trial name or title

Melodic‐intonation‐therapy and speech‐repetition‐therapy for patients with non‐fluent aphasia

Methods

RCT

Parallel assignment

Participants

Adults with aphasia following first‐time ischaemic left‐hemispheric stroke or CVA

Interventions

Music condition: melodic intonation therapy

Active comparator: speech repetition therapy

Control: no therapy

Outcomes

Primary outcomes: language outcomes (correct information units)

Secondary outcomes: language, speech, functional and structural brain changes

Starting date

February 2008

Contact information

Contact: Gottfried Schlaug, MD, PhD, email: [email protected]

Andrea Norton, email: [email protected]

Notes

This study is currently recruiting participants. Estimated study completion date: December 2016

NCT01372059

Trial name or title

The effects of a rhythm and music‐based therapy program and therapeutic riding in late recovery phase following stroke

Methods

RCT

Parallel assignment

Participants

Adults aged 50 to 75 years who are 1 to 5 years' poststroke

Estimated enrolment: 123

Interventions

Music condition: rhythm and music therapy

Active comparator: therapeutic riding

Control: receives no intervention

Outcomes

Primary: degree of participation (Stroke Impact Scale, version 2)

Secondary: self reported fatigue, perceived physical functioning, self rated perceived mental functioning, cognitive function, body function, environmental factors, personal factors

Starting date

January 2010

Contact information

Contact: Lina Bunketorp Kall, PhD, email: Lina.Bunketorp‐[email protected]

Notes

The results of this study are being prepared for publication (correspondence with principal investigator). Estimated study completion date: December 2015

NCT01455155

Trial name or title

Creative therapy to affect stroke outcomes

Methods

RCT

Parallel assignment

Participants

Adults with stroke more than 1 month prior

Interventions

Music condition: creative therapy (art and music therapy)

Control condition: conventional physical therapy

Outcomes

Primary outcome: cognition (Abbreviated Mental Test Score)

Secondary outcomes: physical function (BI), mood (Hospital Anxiety and Depression Scale), quality of life (Pictorial Thai Quality of Life)

Starting date

November 2011

Contact information

Contact: Vilai Kuptniratsaikul, MD, email: [email protected]

Notes

The recruitment status of this study is unknown because the information has not been recently verified. Estimated study completion date: May 2014

NCT01721668

Trial name or title

Improving arm and hand functions in chronic stroke

Methods

RCT

Parallel assignment

Participants

Adults who sustained first‐time unilateral middle cerebral artery stroke more than 6 months prior. Estimated enrolment: 60

Interventions

Music condition: music‐supported rehabilitation using musical exercises to improve hand and arm motor functioning

Control: conventional upper extremity therapy

Outcomes

Primary: arm and hand functions: ARAT; Chedoke Arm and Hand Activity Inventory; Stroke Impact Scale

Secondary: brain structure and brain function

Starting date

November 2012

Contact information

Contact: Deirdre R Dawson, PhD, email: [email protected]

Notes

This study is ongoing, but not recruiting participants. Estimated study completion date: December 2015

NCT01749709

Trial name or title

Music listening and stroke recovery

Methods

RCT

Factorial assignment

Participants

Adults with stroke. Estimated enrolment: 60

Interventions

Music condition 1: daily listening to instrumental music

Music condition 2: daily listening to vocal music

Control condition: standard rehabilitation

Outcomes

Primary outcomes: physiological stress indicators, neuropsychological performance, brain MRI

Starting date

December 2012

Contact information

Contact: Seppo Soinila, MD, email: [email protected]

Notes

The recruitment status of this study is unknown because the information has not been recently verified. Estimated study completion date: December 2014

NCT01769326

Trial name or title

Influence of timing on motor learning

Methods

RCT

Parallel assignment

Participants

Adults with CVA. Estimated enrolment: 40

Interventions

Music condition: MusicGlove group

Active comparator for MusicGlove: conventional hand exercise

Experimental: resonating arm exerciser

Active comparator for experimental: conventional arm exercise

Outcomes

Motor and strength: Box and Block Test; Fugl‐Meyer Assessment

Starting date

September 2012

Contact information

Principal investigator: Steven Cramer, MD, University of California, Irvine

Notes

This study is ongoing, but not recruiting participants. Estimated study completion date: June 2015

NCT01956136

Trial name or title

Efficacy and neural basis of music‐based neurological rehabilitation for traumatic brain injury (MUBI)

Methods

RCT

Cross‐over trial

Participants

Adults with traumatic brain injury. Estimated enrolment: 60

Interventions

Music condition: music‐based neurological rehabilitation with standard care

Control condition: standard care

Outcomes

Primary outcomes: cognition (executive functions; focused and sustained attention; verbal working memory and learning; verbal and non‐verbal reasoning)

Secondary outcomes: upper extremity motor function; depression; quality of life; emotional well‐being; structural and functional neuroplasticity

Starting date

March 2014

Contact information

Contact: Susanna Melkas, MD, PhD, email: [email protected]

Notes

This study is currently recruiting participants. Estimated study completion date: December 2017

NCT02208219

Trial name or title

Music therapy to restore motor deficits after stroke (NEUROMUSIC)

Methods

RCT

Parallel assignment

Participants

Adults aged 30 to 75 with motor deficits following a first stroke

Interventions

Music condition 1: music‐supported therapy

Music condition 2: home‐based music‐supported therapy

Control condition: conventional treatment

Outcomes

Primary outcome: performance of movements with the paretic upper extremity (ARAT)

Secondary outcomes: motor function; cognitive function; emotional and quality of life change; changes in brain activation

Starting date

November 2013

Contact information

Contact: Antoni Rodríguez‐Fornells, PhD, email: [email protected]

Notes

Currently recruiting participants. Estimated study completion date: April 2016

NCT02259062

Trial name or title

Listening for leisure after stroke (MELLO)

Methods

RCT

Parallel assignment

Participants

Adults with ischaemic stroke, ≤ 14 days poststroke at time of recruitment. Estimated enrolment: 100

Interventions

Music condition: music listening with brief mindfulness

Active comparator: music listening

Placebo comparator: audio book intervention

Outcomes

Neuropsychological assessment of cognition and mood

Starting date

October 2014

Contact information

Contact: Jonathan Evans, PhD, email: [email protected]

Satu Baylan, PhD, email: [email protected]

Notes

Currently recruiting participants. Estimated study completion date: September 2016

NCT02310438

Trial name or title

Music therapy for the rehabilitation of upper limb with stroke patients

Methods

RCT

Cross‐over trial

Participants

Estimated enrolment: 12

Interventions

Experimental music condition: early‐intervention music therapy

Active comparator: delayed‐intervention music therapy

Outcomes

Primary outcomes: ARAT

Secondary outcomes: Nine‐Hole Peg Test

Starting date

January 2014

Contact information

Contact: Alexander J Street, email: [email protected]

Notes

This study is currently recruiting participants. Estimated study completion date: September 2016

NCT02328573

Trial name or title

The impact of group singing on patients with stroke and their personal caregivers

Methods

RCT

Parallel assignment

Participants

Adults with stroke. Estimated enrolment: 80

Interventions

Music condition: communal singing

Control: no intervention

Outcomes

Primary: change in mood and quality of life as indicated through saliva (cortisol and melatonin sampling)

Secondary: change in language aphasia

Starting date

April 2014

Contact information

Contact: Joanne Loewy, DA, email: [email protected]

Marie Grippo, email: [email protected]

Notes

Currently recruiting participants. Estimated study completion date: April 2018

NCT02410629

Trial name or title

To determine the therapeutic effect of the Music Glove and conventional hand exercises to subacute stroke patients

Methods

RCT

Cross‐over trial

Participants

Adults with CVA. Estimated enrolment: 40

Interventions

Music condition: MusicGlove

Active comparator: conventional hand exercise programme

Outcomes

Primary: Box and Block Test

Secondary: Fugl‐Meyer Assessment of the Upper Extremity; ARAT; Nine‐Hole Peg Test

Starting date

March 2015

Contact information

Contact: Vicky Chan, email: [email protected]

Renee Augburger, email: [email protected]

Notes

Currently recruiting participants. Estimated study completion date: June 2016

NTR1961

Trial name or title

The efficacy of Melodic Intonation Therapy (MIT) in aphasia rehabilitation

Methods

RCT

Participants

Adults with aphasia after left hemisphere stroke

Interventions

Music condition: melodic intonation therapy (MIT)

Control condition (postacute group): non‐MIT condition

Control condition (chronic group): no treatment

Outcomes

Primary outcome: language (Sabadell)

Secondary outcomes: language (ANELT; Aachen Aphasia Test; repetition of trained and untrained items)

Starting date

October 2009

Contact information

Contact: Dr van der Meulen, email: [email protected]

Notes

See van der Meulen 2014 for results of MIT in the postacute group. This study examined the efficacy of MIT in the chronic phase of stroke. The results of the chronic phase are being prepared for publication (correspondence with principal investigator).

ANELT: Amsterdam‐Nijmegen Everyday Language Test
ARAT: Action Research Arm Test
BI: Barthel index
BIT: Behavioral Inattention Test
CVA: cerebrovascular accident
MRI: magnetic resonance imaging
mRS: modified Rankin Scale
NIHSS: National Institutes of Health Stroke Scale
RCT: randomised controlled trial

Data and analyses

Open in table viewer
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

Analysis 1.1

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

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

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]

Analysis 1.2

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

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

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]

Analysis 1.3

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

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

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

Analysis 1.4

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

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

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]

Analysis 1.5

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

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

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

Analysis 1.6

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

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

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]

Analysis 1.7

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

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

8 Gait cadence Show forest plot

7

Mean Difference (IV, Random, 95% CI)

Subtotals only

Analysis 1.8

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

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

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]

Analysis 1.9

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

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

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]

Analysis 1.10

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

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

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]

Analysis 1.11

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

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

12 General gait Show forest plot

2

48

Mean Difference (IV, Random, 95% CI)

7.67 [5.67, 9.67]

Analysis 1.12

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

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

13 Balance Show forest plot

3

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

Subtotals only

Analysis 1.13

Comparison 1 Music therapy versus control, Outcome 13 Balance.

Comparison 1 Music therapy versus control, Outcome 13 Balance.

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

Analysis 1.14

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

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

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]

Analysis 1.15

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

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

16 Range of motion ‐ shoulder flexion Show forest plot

2

53

Mean Difference (IV, Random, 95% CI)

9.81 [‐12.71, 32.33]

Analysis 1.16

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

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

17 Hand function Show forest plot

2

113

Mean Difference (IV, Random, 95% CI)

0.32 [‐0.91, 1.54]

Analysis 1.17

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

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

18 Upper limb strength Show forest plot

2

113

Mean Difference (IV, Random, 95% CI)

6.03 [‐2.52, 14.59]

Analysis 1.18

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

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

19 Manual dexterity Show forest plot

2

74

Mean Difference (IV, Random, 95% CI)

0.47 [‐1.08, 2.01]

Analysis 1.19

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

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

20 Overall communication Show forest plot

3

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

Subtotals only

Analysis 1.20

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

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

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]

Analysis 1.21

Comparison 1 Music therapy versus control, Outcome 21 Naming.

Comparison 1 Music therapy versus control, Outcome 21 Naming.

22 Repetition Show forest plot

2

35

Mean Difference (IV, Random, 95% CI)

8.90 [3.25, 14.55]

Analysis 1.22

Comparison 1 Music therapy versus control, Outcome 22 Repetition.

Comparison 1 Music therapy versus control, Outcome 22 Repetition.

23 Memory Show forest plot

2

42

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

0.33 [‐0.29, 0.95]

Analysis 1.23

Comparison 1 Music therapy versus control, Outcome 23 Memory.

Comparison 1 Music therapy versus control, Outcome 23 Memory.

24 Attention Show forest plot

2

39

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

0.30 [‐0.34, 0.94]

Analysis 1.24

Comparison 1 Music therapy versus control, Outcome 24 Attention.

Comparison 1 Music therapy versus control, Outcome 24 Attention.

25 Quality of life Show forest plot

2

53

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

0.89 [0.32, 1.46]

Analysis 1.25

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

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

Study flow diagram for the updated review.
Figuras y tablas -
Figure 1

Study flow diagram for the updated review.

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

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

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

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

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

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

Comparison 1 Music therapy versus control, Outcome 1 Gait velocity.
Figuras y tablas -
Analysis 1.1

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

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

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

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

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

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

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

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

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

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

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

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

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

Comparison 1 Music therapy versus control, Outcome 8 Gait cadence.
Figuras y tablas -
Analysis 1.8

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

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

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

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

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

Comparison 1 Music therapy versus control, Outcome 11 Stride symmetry.
Figuras y tablas -
Analysis 1.11

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

Comparison 1 Music therapy versus control, Outcome 12 General gait.
Figuras y tablas -
Analysis 1.12

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

Comparison 1 Music therapy versus control, Outcome 13 Balance.
Figuras y tablas -
Analysis 1.13

Comparison 1 Music therapy versus control, Outcome 13 Balance.

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

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

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

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

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

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

Comparison 1 Music therapy versus control, Outcome 17 Hand function.
Figuras y tablas -
Analysis 1.17

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

Comparison 1 Music therapy versus control, Outcome 18 Upper limb strength.
Figuras y tablas -
Analysis 1.18

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

Comparison 1 Music therapy versus control, Outcome 19 Manual dexterity.
Figuras y tablas -
Analysis 1.19

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

Comparison 1 Music therapy versus control, Outcome 20 Overall communication.
Figuras y tablas -
Analysis 1.20

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

Comparison 1 Music therapy versus control, Outcome 21 Naming.
Figuras y tablas -
Analysis 1.21

Comparison 1 Music therapy versus control, Outcome 21 Naming.

Comparison 1 Music therapy versus control, Outcome 22 Repetition.
Figuras y tablas -
Analysis 1.22

Comparison 1 Music therapy versus control, Outcome 22 Repetition.

Comparison 1 Music therapy versus control, Outcome 23 Memory.
Figuras y tablas -
Analysis 1.23

Comparison 1 Music therapy versus control, Outcome 23 Memory.

Comparison 1 Music therapy versus control, Outcome 24 Attention.
Figuras y tablas -
Analysis 1.24

Comparison 1 Music therapy versus control, Outcome 24 Attention.

Comparison 1 Music therapy versus control, Outcome 25 Quality of life.
Figuras y tablas -
Analysis 1.25

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

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

Music compared with standard care for acquired brain injury

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

Outcomes

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Gait velocity
assessed with: metres/minute

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

268
(9 RCTs)

⊕⊕⊕⊝
MODERATE 1, 2, 3, 4

Stride length (affected side)
assessed with: metres

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

129
(5 RCTs)

⊕⊕⊕⊝
MODERATE 1, 2, 5, 6

Gait cadence
assessed with: steps/minute

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

223
(7 RCTs)

⊕⊕⊝⊝
LOW 1, 2, 4, 7

Stride symmetry

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

139
(3 RCTs)

⊕⊕⊝⊝
LOW 2, 6, 8, 9

General upper extremity functioning assessed with: Fugl‐Meyer Assessment

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

194
(5 RCTs)

⊕⊝⊝⊝
VERY LOW 1, 2, 4, 6, 10

Overall communication

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

67
(3 RCTs)

⊕⊝⊝⊝
VERY LOW 4, 11

Quality of life

assessed with: Stroke Specific Quality of Life Scale

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

53
(2 RCTs)

⊕⊕⊝⊝
LOW 2, 4, 11

CI: confidence interval; RCT: randomised controlled trial

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

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

Figuras y tablas -
Summary of findings for the main comparison. Music compared with standard care for acquired brain injury
Comparison 1. Music therapy versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Gait velocity Show forest plot

9

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 All studies

9

268

Mean Difference (IV, Random, 95% CI)

11.34 [8.40, 14.28]

1.2 Adequate randomisation

7

228

Mean Difference (IV, Random, 95% CI)

10.79 [7.23, 14.35]

2 Gait velocity ‐ interventionist Show forest plot

9

268

Mean Difference (IV, Random, 95% CI)

11.34 [8.40, 14.28]

2.1 Music therapist

3

128

Mean Difference (IV, Random, 95% CI)

14.76 [13.84, 15.69]

2.2 Non‐music therapist

6

140

Mean Difference (IV, Random, 95% CI)

8.48 [5.16, 11.80]

3 Gait velocity ‐ music type Show forest plot

9

268

Mean Difference (IV, Random, 95% CI)

11.34 [8.40, 14.28]

3.1 Music

5

173

Mean Difference (IV, Random, 95% CI)

14.69 [13.77, 15.61]

3.2 Auditory stimulation (no music)

4

95

Mean Difference (IV, Random, 95% CI)

7.70 [3.03, 12.38]

4 Stride length (affected side) Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 All studies

5

129

Mean Difference (IV, Random, 95% CI)

0.12 [0.04, 0.20]

4.2 Adequate randomisation

3

89

Mean Difference (IV, Random, 95% CI)

0.08 [0.05, 0.11]

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

5

129

Mean Difference (IV, Random, 95% CI)

0.12 [0.04, 0.20]

5.1 Music

2

50

Mean Difference (IV, Random, 95% CI)

0.08 [0.05, 0.12]

5.2 Auditory stimulation (no music)

3

79

Mean Difference (IV, Random, 95% CI)

0.14 [0.02, 0.25]

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

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 All studies

4

99

Mean Difference (IV, Random, 95% CI)

0.11 [0.01, 0.22]

6.2 Adequate randomisation

2

59

Mean Difference (IV, Random, 95% CI)

0.06 [0.01, 0.12]

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

3

186

Mean Difference (IV, Random, 95% CI)

0.16 [‐0.01, 0.33]

8 Gait cadence Show forest plot

7

Mean Difference (IV, Random, 95% CI)

Subtotals only

8.1 all studies

7

223

Mean Difference (IV, Random, 95% CI)

10.77 [4.36, 17.18]

8.2 Adequate randomisation

6

203

Mean Difference (IV, Random, 95% CI)

10.80 [4.05, 17.56]

9 Gait cadence ‐ interventionist Show forest plot

7

223

Mean Difference (IV, Random, 95% CI)

10.77 [4.36, 17.18]

9.1 Music therapist

3

128

Mean Difference (IV, Random, 95% CI)

11.51 [‐2.57, 25.60]

9.2 Non‐music therapist

4

95

Mean Difference (IV, Random, 95% CI)

7.65 [4.43, 10.86]

10 Gait cadence ‐ music type Show forest plot

7

223

Mean Difference (IV, Random, 95% CI)

10.77 [4.36, 17.18]

10.1 Music

4

148

Mean Difference (IV, Random, 95% CI)

11.34 [‐1.05, 23.74]

10.2 Auditory stimulus (no music)

3

75

Mean Difference (IV, Random, 95% CI)

7.58 [4.33, 10.83]

11 Stride symmetry Show forest plot

3

139

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

0.94 [‐0.32, 2.20]

12 General gait Show forest plot

2

48

Mean Difference (IV, Random, 95% CI)

7.67 [5.67, 9.67]

13 Balance Show forest plot

3

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

Subtotals only

13.1 All studies

3

54

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

0.31 [‐0.48, 1.09]

13.2 Adequate randomisation

2

34

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

0.13 [‐1.10, 1.37]

14 Upper extremity functioning (general) Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

14.1 All studies

5

194

Mean Difference (IV, Random, 95% CI)

3.56 [‐0.88, 8.00]

14.2 Adequate randomisation

3

156

Mean Difference (IV, Random, 95% CI)

0.89 [‐2.33, 4.12]

15 Upper extremity functioning ‐ time Show forest plot

2

122

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

‐1.08 [‐1.69, ‐0.47]

16 Range of motion ‐ shoulder flexion Show forest plot

2

53

Mean Difference (IV, Random, 95% CI)

9.81 [‐12.71, 32.33]

17 Hand function Show forest plot

2

113

Mean Difference (IV, Random, 95% CI)

0.32 [‐0.91, 1.54]

18 Upper limb strength Show forest plot

2

113

Mean Difference (IV, Random, 95% CI)

6.03 [‐2.52, 14.59]

19 Manual dexterity Show forest plot

2

74

Mean Difference (IV, Random, 95% CI)

0.47 [‐1.08, 2.01]

20 Overall communication Show forest plot

3

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

Subtotals only

20.1 All studies

3

67

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

0.75 [0.11, 1.39]

20.2 Adequate randomisation

2

54

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

0.52 [‐0.03, 1.07]

21 Naming Show forest plot

2

35

Mean Difference (IV, Random, 95% CI)

9.79 [1.37, 18.21]

22 Repetition Show forest plot

2

35

Mean Difference (IV, Random, 95% CI)

8.90 [3.25, 14.55]

23 Memory Show forest plot

2

42

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

0.33 [‐0.29, 0.95]

24 Attention Show forest plot

2

39

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

0.30 [‐0.34, 0.94]

25 Quality of life Show forest plot

2

53

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

0.89 [0.32, 1.46]

Figuras y tablas -
Comparison 1. Music therapy versus control