COCHRANE REVIEWS AND MUSIC THERAPY RESEARCH Cheryl Dileo, PhD, MT-BC Carnell Professor of Music...
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Transcript of COCHRANE REVIEWS AND MUSIC THERAPY RESEARCH Cheryl Dileo, PhD, MT-BC Carnell Professor of Music...
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