COCHRANE REVIEWS AND MUSIC THERAPY RESEARCH

Cheryl Dileo, PhD, MT-BCCarnell Professor of Music Therapy

Director: Arts and Quality of Life Research Ctr.Coordinator: PhD Program in Music Therapy

Basic issues to be addressed How to understand Cochrane

Reviews Including important concepts such

as bias How to make use of this

information in designing future research

Evidence-Based PracticeStrides being taken to accumulate high

quality evidence in field of music therapy

Attempting to assure that procedures used in music therapy are: Safe Effective Cost-Effective

Cochrane Collaboration The Cochrane Collaboration

international network of individuals and institutions

review and analyze the best clinical trials synthesize them into regularly updated

systematic reviews and meta-analyses. considered by many to be the Gold Standard,

or the final word in the medical conversation on a topic.

Current Cochrane Reviews at TempleMusic for stress and anxiety reduction in coronary heart

disease patients (Bradt, Dileo & Potvin) (2013)

Music therapy for end-of-life care (Bradt & Dileo) (2009)

Music therapy for acquired brain injury (2010) (Bradt, Magee, Dileo, Wheeler, McGilloway)

Music interventions for mechanically ventilated patients (Bradt & Dileo., 2010 update in press)

Music interventions for improving psychological and physical outcomes in cancer patients (Bradt, Dileo, Grocke & Magill) (2011) (being updated)

Music for pre-operative anxiety (Bradt, Dileo & Shim) (2013)

Other Published Cochrane Reviews Music during caesarean section under regional anaesthesia for

improving maternal and infant outcomes (Laopaiboon, Lumbiganon, Martis, Vatanasapt, Somjaivong) (2009)

Music for pain relief (Cepeda,Carr, Lau, Alvare, 2013) Music therapy for people with autism spectrum disorder Geretsegger ,

Elefant, Mössler Gold (2014) Music therapy for Depression (Maratos, Gold, Wang, Crawford) (2008) Music Therapy for People with Dementia (Vink,Bruinsma,Scholten)

(2003) Music therapy for people with schizophrenia and schizophrenia-like

disorders (Mössler, Chen, Heldal, Gold, 2011)

Cochrane Reviews

Listening to music for improving sleep in adults with insomnia (Jespersen Koenig, Jennum and PetVuust, 2013

Music therapy for attention deficit hyperactivity disorder (ADHD) in children and adolescents (Zhang, Liu, An, You,Teng, Liu 2012)

Other Arts therapies

Art therapy for people with dementia Deshmukh, Holmes, Cardno, 2014)

Art therapy for schizophrenia or schizophrenia-like illnesses Ruddy, Milnes, 2005

Dance/movement therapy for improving psychological and physical outcomes in cancer patients (Bradt, Goodill, Dileo, 2011)

Dance therapy for schizophrenia (Ren, Xia, 2013)

SOME BASICSUnderstanding Cochrane Reviews

Systematic Reviews Systematic reviews seek to collate all evidence that

fits pre-specified eligibility criteria in order to address a specific research question.

Systematic reviews aim to minimize bias by using explicit, systematic methods.

The Cochrane Collaboration prepares, maintains and promotes systematic reviews to inform healthcare decisions

Types of studies Cochrane reviews typically include

Randomized Controlled Trials

Controlled Clinical Trials

Library of Medicine definition Randomized Controlled Trial

involves at least one test treatment and one control treatment,

concurrent enrolment and follow-up of the test- and control-treated groups,

in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table.

Library of Medicine DefinitionControlled Clinical Trial

Involves one or more test treatments at least one control treatment, specified outcome measures for evaluating

the studied intervention, and a bias-free method for assigning patients

to the test treatment.

Reporting Results- Risk of Bias In clinical trials, biases can be broadly

categorized selection bias, performance bias, detection bias, attrition bias, reporting bias and other biases that do not fit into these categories.

A Common Classification Scheme for Bias

Type of bias Description Relevant domains in the Collaboration’s ‘Risk of bias’ tool

Selection bias. Systematic differences between baseline characteristics of the groups that are compared.

•Sequence generation.•Allocation concealment.

Performance bias. Systematic differences between groups in the care that is provided, or in exposure to factors other than the interventions of interest.

•Blinding of participants and personnel.•Other potential threats to validity.

Detection bias. Systematic differences between groups in how outcomes are determined.

•Blinding of outcome assessment.•Other potential threats to validity.

Attrition bias. Systematic differences between groups in withdrawals from a study.

•Incomplete outcome data

Reporting bias. Systematic differences between reported and unreported findings.

•Selective outcome reporting (see also Chapter 10).

Understanding Results Effect size

Confidence Intervals

Heterogeneity

Music for stress and anxiety reduction in coronary heart disease patients

Bradt, Dileo, Potvin, 2013

Music…CHDPurpose: to assess the effects of

music interventions with standard care

vs. standard care alone

On psychological responses physiological responses

Inpeople with heart disease.

Studies Included 26 trials- 1369 Ss

Representing US, Australia, Denmark, Hong Kong, S, Korea, Sweden, Iran

3 trials - music therapy

23 trials - music medicine

Music Medicine vs. Music Therapy Use of music by

medical professionals No therapeutic

process No relationship

established through the music

Primarily pre-recorded music listening

Trained/ Credentialed music therapist

Therapeutic process (assessment, treatment, evaluation

Relationship with pt through music

Range of music experiences

Data Analysis Were there significant differences between

patients who had music vs. no music/standard care?

What was size of difference? Small? Moderate? Large?

Did the studies differ significantly in their results? Homogenous or heterogenous?

BRADT, DILEO & GROCKE, 2010) (BRADT & DILEO, IN PRESS)

Music Interventions for Mechanically Ventilated Patients

Music…Mechanically Ventilated Patients PURPOSE

Compare the effects of standard care + music therapy or music medicine interventions

with standard care alone on anxiety in mechanically ventilated

patients.

Music…Mechanically Ventilated Patients 14 studies

USA (5) China (3) and 1 each from Taiwan, Canada, Germany, Netherlands, Turkey & France

805 participants

13 studies- music medicine

1 study-music therapy

BRADT, MAGEE, DILEO, WHEELER, MCGILLOWAY , 2010

Music Therapy for Acquired Brain Injury

MT/ABI Seven studies (184 participants, 54% male)

All Music Therapy

3 US, 1 South Korea, 1 Germany, 1 Australia, 1 US and Germany

BRADT, DILEO, GROCKE, MAGILL, 2011BRADT, DILEO, MAGILL (IN PROGRESS)

Music Interventions for Improving Psychological and Physical Outcomes in Cancer Patients

Music….Cancer Patients 29 studies (1880 participants; 33% male)

17 US, 6 China, 2 Italy, 1 Iran, 1 Spain, 1 Taiwan, 1 Vietnam

12 music therapy 17 music medicine

9 chemotherapy or radiation 8 surgery or procedure 12 general 4 pediatric

BRADT, DILEO, SHIM (2013)

Music for Preoperative Anxiety

Music….Preoperative Anxiety 26 Trials (2051 Participants) Inpatients, outpatients, emergency, non-

emergency Patients undergoing major as well as minor

surgical procedures General, endoscopic, gynecological, urogenital,

orthopedic,cosmetic, caesarean, cardiac, opthalmic, septorhinoplastic, gastric

Music….Preoperative Anxiety 54% female; 46% male participants (Average

48.7 years) Studies included

USA (9); Taiwan (5); Hong Kong (3); China (3); Turkey (2); Poland (2); Malaysia (1); Israel (1)

All studies classified as Music Medicine Most with one 20-30 minute listening session 2 with multiple listening sessions

BRADT & DILEO, 2010

Music Therapy for End-of-Life Care

Music Therapy…..EOL PURPOSE

To compare the effects of music therapy combined with standard care with

standard care alone, or

standard care and other therapies.

Music Therapy….EOL Studies Included

5 studies (175 participants, 49% male)

All Music Therapy

4 US, 1 Australia

Contact cdileo@temple.edu

www.temple.edu/musictherapy

www.temple.edu/boyer/researchcenter