title: Patient-directed music therapy reduces anxiety and sedation exposure in mechanically-ventilated patients: a research critique.
abstract: This research appraisal, guided by the CASP Randomised Controlled Trial Checklist, critiques a randomised, controlled trial of patient-directed music therapy compared to either noise-cancelling headphones or usual care. This study recruited 373 alert, mechanically-ventilated patients across five intensive care units in the United States. The Music Assessment Tool, administered by a music therapist, facilitated music selection by participants in the intervention group. Anxiety was measured using the VAS-A scale. Sedation exposure was measured by both sedation frequency and by sedation intensity using a daily sedation intensity score. Context for the data was supported by an environmental scan form recording unit activity and by written comments from nurses about the patient's responses to the protocol. Patient-directed music therapy allowed a significant reduction in sedation frequency compared to noise-cancelling headphones and usual care participants. Patient-directed music therapy led to significantly lower anxiety and sedation intensity compared to usual care, but not compared to noise-cancelling headphones. This is a robust study with clear aims and a detailed description of research methods and follow-up. While no participants were lost to follow-up, not all were included in the analysis: 37% did not have the minimum of two anxiety assessments for comparison and 23% were not included in sedation analysis. While some participants utilised the intervention or active control for many hours-per-day, half the music therapy participants listened for 12min or less per day and half of the noise-cancelling headphone participants did not appear to use them. While the results suggest that patient-directed music therapy and noise-cancelling headphones may be useful and cost-effective interventions that lead to an overall improvement in anxiety and sedation exposure, these may appeal to a subset of ICU patients. The self-directed use of music therapy and noise-cancelling headphones means these findings may not transfer to sedated or cognitively-impaired patients.
authors.affiliation: Master of Emergency and Intensive Care Nursing Programs, Sydney Nursing School, University of Sydney, Australia. Electronic address: janice.gullick@sydney.edu.au.
authors.forename: Janice G
authors.initials: JG
authors.lastname: Gullick
authors.affiliation: Sydney Nursing School, University of Sydney, Australia; Intensive Care Unit, Alexandra Hospital, Jurong Health Services, Singapore.
authors.forename: Xiu Xian
authors.initials: XX
authors.lastname: Kwan
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000628:therapy*; D016638:Critical Illness; D004430:Ear Protective Devices; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009147:Music Therapy; D009622:Noise; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial; D014481:United States
chemical_list: D006993:Hypnotics and Sedatives
keywords: Anxiety; Critical care; Music therapy; Noise-cancelling headphones; Research critique; Sedation