Music interventions for acquired brain injury

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

doi:10.1002/14651858.CD006787.pub3

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Figure 1

Study flow diagram for the updated review.

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Figure 2

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

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Figure 3

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

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Figure 4

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

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Analysis 1.1

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

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Analysis 1.2

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

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Analysis 1.3

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

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Analysis 1.4

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

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Analysis 1.5

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

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Analysis 1.6

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

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Analysis 1.7

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

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Analysis 1.8

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

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Analysis 1.9

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

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Analysis 1.10

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

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Analysis 1.11

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

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Analysis 1.12

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

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Analysis 1.13

Comparison 1 Music therapy versus control, Outcome 13 Balance.

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Analysis 1.14

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

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Analysis 1.15

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

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Analysis 1.16

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

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Analysis 1.17

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

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Analysis 1.18

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

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Analysis 1.19

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

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Analysis 1.20

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

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Analysis 1.21

Comparison 1 Music therapy versus control, Outcome 21 Naming.

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Analysis 1.22

Comparison 1 Music therapy versus control, Outcome 22 Repetition.

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Analysis 1.23

Comparison 1 Music therapy versus control, Outcome 23 Memory.

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Analysis 1.24

Comparison 1 Music therapy versus control, Outcome 24 Attention.

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Analysis 1.25

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

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

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

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

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Comparison 1. Music therapy versus control

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comparison 1. Music therapy versus control

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