Music Reduces Patient Anxiety During Interfacility Ground Critical Care Transport

doi:10.1016/j.amj.2008.10.008

Air Medical Journal

Volume 28, Issue 2, March–April 2009, Pages 88-91

https://doi.org/10.1016/j.amj.2008.10.008 Get rights and content

Abstract

Introduction

Interfacility ground critical care transport (CCT) of patients by ambulance may be stressful. This study evaluated whether playing music during CCT reduces patient anxiety and whether objective evidence is manifested by a change in vital signs.

Setting

Urban teaching hospital.

Methods

In this prospective cohort study, music was played for eligible adult patients during CCT while recording vital signs. A questionnaire was subsequently mailed to patients to rate whether the ambulance transport was stressful, the impact music had on transport, whether music changed their anxiety, whether music made them comfortable and relaxed, and whether they would prefer music to be played on future transports. Vital signs were compared between respondents who perceived transport as stressful and those who did not.

Results

One hundred two patients were enrolled; 23 respondents (22.5%) constituted the study group. Four patients (17.4%) reported CCT as stressful (average response, 4.75). Nineteen (82.6%) rated CCT as not stressful (average response, 1.63). Subjectively, patients reported a positive impact of music on transport, with improved comfort and relaxation but only a minimal decrease in anxiety. No statistically significant change in vital signs was observed between cohorts; too few patients were enrolled to generate power to detect any difference.

Conclusions

Music therapy is a simple adjunct for use during CCT that may increase patient comfort and alleviate anxiety. The small number of patients in this preliminary report limits the strength of any conclusions. Larger studies are needed.

Introduction

Patients requiring interfacility transport are often critically ill with underlying disease stressors. Ambulance transport between medical facilities may add stress. Stress may manifest as anxiety, an emotional state comprising psycho-physiologic responses in anticipation of a perceived threat. The physiologic response is arousal of the autonomic nervous system for the “fight or flight” phenomenon; the psychological impact is feelings of powerlessness, apprehension, and impending doom.1, 2

Music therapy is the use of music to aid the physiologic, psychological, and emotional integration of the individual during an illness.³ Evidence exists for the anxiolytic effect of music on patients undergoing dental procedures,⁴ cardiac catheterization,⁵ surgery,6, 7, 8 endoscopy,9, 10 and postoperative care,¹¹ in intensive care units,12, 13, 14, 15 emergency departments,¹⁶ and outpatient settings.⁴ Music has positive effects in geriatric,¹⁷ neonatal,¹⁸ and adolescent¹⁹ patient populations.

Interfacility ground critical care transport (CCT) is common, yet little is known about transport-related anxiety and the effect of anti-anxiety interventions in this setting. In this study, we determined the effect of music on CCT-related subjective anxiety and assessed for objective evidence manifested by a change in vital signs.

Section snippets

Design

This is a prospective cohort study to evaluate music therapy intervention on the dependent variables of vital signs and self-reported intratransport effect of music with the independent variable of self-reported stress.

Setting

This study was conducted at an urban teaching hospital; the CCT transported 965 patients in 2006. The underlying condition was cardiac in 240 (25%), trauma/surgical in 178 (18%), and neurologic/neurosurgical in 128 (13%).

Experimental Protocol and Patient Population

Instrumental music was played during CCT at crew

Results

One-hundred-two eligible patients were transported with music. The average age was 58.3 years, males constituted 67.6%, and patients were transported for a variety of conditions (Table 1). Twenty-three patients responded (22.5%) and constituted the study group. The average age was 62.8 years, males constituted 52.1%, and 19 (82.6%) were transported for cardiac reasons. There were no differences between respondents and nonrespondents regarding age, sex, diagnosis, or initial vital signs.

Four

Discussion

Music is a complex web of organized sounds composed of pitch, tone, rhythm, harmony, and tempo.²⁰ The use of music to alleviate pain or anxiety is referred as “audio-analgesia,” “audio-anxiolysis,” or “music-assisted relaxation.”

Numerous mechanisms are postulated for the effects of music therapy. Music evokes a response through vibration influences on the limbic system center of emotions.²¹ Entrainment, when two objects vibrating at similar frequencies synchronize, may explain alteration of

Conclusion

Music therapy is a simple adjunct that may decrease patient anxiety during ground CCT; too few patients were enrolled in this preliminary study to draw conclusions. Subjectively, patients report a positive effect of music on transport and improved comfort and relaxation with music therapy during ground CCT. Larger studies that assess anxiety at the time of transport are needed to better define the effect of music therapy on anxiety during CCT.

Acknowledgment

The authors thank Stephen Thomas, MD, MPH, for assistance with data analysis; Terrence Hoben, MICP, for assistance with the poster and oral presentations; and Dennis Boos, EMT, Thomas Huffman, EMT, and Glenn McRae, EMT, for creating, maintaining, and securing the study database.

References (33)

NL Corah et al.
Relaxation and musical programming as means of reducing psychological stress during dental procedures
J Am Dent Assoc
(1981)
VR Kshettry et al.
Complementary alternative medical therapies for heart surgery patients: Feasibility, safety, and impact
Ann Thorac Surg
(2006)
JM Dubois et al.
Music improves patient comfort level during outpatient bronchoscopy
Chest
(1995)
JJ Menegazzi et al.
A randomized, controlled trial of the use of music during laceration repair
Ann Emerg Med
(1991)
HG Colt et al.
Effect of music on state anxiety scores in patients undergoing fiberoptic bronchoscopy
Chest
(1999)
SB Hanser et al.
The effects of music therapy in cardiac healthcare
Cardiology in Review
(2005)
CD Spielberger
The nature and measurement of anxiety
S Munro et al.
Music therapy in palliative care
Can Med Assoc J
(1978)
H Argstatter et al.
Study of the effectiveness of musical stimulation during intracardiac catheterization
Clin Res Cardiol
(2006)
SE Sendelbach et al.
Effects of music therapy on physiological and psychological outcomes for patients undergoing cardiac surgery
J Cardiovasc Nurs
(2006)

SL Robb et al.

The effects of music assisted relaxation on pre-operative anxiety

J Music Therapy

(1995)

A Hayes et al.

A music intervention to reduce anxiety prior to gastrointestinal procedures

Gastroenterol Nurs

(2003)

U Nilsson et al.

Stress reduction and analgesia in patients exposed to calming music postoperatively: A randomized controlled trial

Eur J Anaesthesiol

(2005)

L Chlan

Integrating nonpharmacological, adjunctive interventions into critical care practice: A means to humanize care?

Am J Crit Care

(2002)

LL Chlan et al.

Influence of music on the stress response in patients receiving mechanical ventilatory support: A pilot study

Am J Crit Care

(2007)

D Elliott

The effects of music and muscle relaxation on patient anxiety in a coronary care unit

Heart Lung

(1994)

Cited by (8)

The impact of music therapy on morphine consumption in emergency room: A prospective randomized study
2018, Douleurs
La musicothérapie permet de soutenir le bien-être du patient et détourne l’attention de la douleur vers une alternative très agréable. Peu d’études prospectives randomisées sont réalisées aux urgences montrant son effet antalgique potentiel. Notre objectif était de déterminer l’effet de la musicothérapie sur la consommation morphinique aux urgences.
Étude prospective randomisée, monocentrique réalisée aux urgences durant une période de quatre mois. Nous avons inclus tout patient âgé de plus de 16 ans, consultant les urgences de traumatologie avec une échelle numérique (EN) ≥ 5. Les critères de non-inclusion étaient l’absence de consentement et les anomalies de la compréhension ou de la communication. Après consentement, les patients ont été randomisés en G. S (morphine) et G. M (morphine + musique). Nous avons recueilli les caractéristiques démographiques, l’évolution des paramètres vitaux et de l’EN en fonction du temps. Le critère de jugement principal était la diminution de la consommation morphinique. Les critères de jugement secondaires étaient le temps de résolution de la douleur, les effets indésirables et le degré de satisfaction des patients.
Nous avons inclus 144 patients. Nous avons colligé moins de consommation morphinique dans le G. M (7,1 ± 2,7 versus 9,6 ± 3 mg avec un p = 0,022). Le temps de résolution de la douleur était plus rapide dans le G. M (30 ± 13,7 versus 42 ± 16,7 min avec un p = 0,036). Nous avons observé moins d’effets indésirables et plus de satisfaction des patients dans le G. M.
La musicothérapie diminue la consommation morphinique aux urgences et par conséquent diminue ces effets indésirables. Cette thérapie anodine, peu coûteuse, accroît la satisfaction des patients consultant les urgences.
Music therapy helps to support the well-being of the patient and diverts attention from pain to a very pleasant alternative. Few prospective randomized studies are carried out in emergency departments showing its potential analgesic effect. The aim of the study was to determine the effect of music therapy on morphine consumption in emergencies.
A prospective, randomized, monocentric study conducted in emergency departments over a four-month period. We included any patient older than 16 years, consulting trauma emergencies with a numerical scale ≥ 5. Exclusion criteria were absence of consent and anomalies of understanding or communication. After consent, patients were randomized to G. S (morphine) and G. M (Morphine + music therapy). We collected the demographic characteristics, the evolution of the vital parameters and the numerical scale. The primary endpoint was decreased morphine consumption. Secondary endpoints were pain resolution time, side effects and patient satisfaction.
We included 144 patients. We recorded reduced morphine consumption in G. M (7.1 ± 2.7 versus 9.6 ± 3 mg with P = 0.022). Time to resolution was faster in G. M (30 ± 13.7 versus 42 ± 16.7 min with P = 0.036). We observed less side effects and more satisfaction in G. M.
Music therapy reduces morphine consumption in emergencies and consequently decreases these side effects. This inexpensive therapy increases the patient satisfaction of emergency patients.
The psychoneuroimmunological effects of music: A systematic review and a new model
2014, Brain, Behavior, and Immunity
Citation Excerpt :
Of these, two merely quote theories from other studies without using their results to expand the knowledge base (Kreutz et al., 2004; Lai and Li, 2011). And one contains non-specific theories, which are neither expanded nor tested (Stuhlmiller et al., 2003, which also contains a misquotation of Boso et al., 2006). Lai et al. (2013) propose a model of cytokine circuits in the body, but unfortunately cytokine levels were undetectable in the samples taken, which means they were unable to confirm or negate their theory. (
There has been a growing interest over the past decade into the health benefits of music, in particular examining its psychological and neurological effects. Yet this is the first attempt to systematically review publications on the psychoneuroimmunology of music. Of the selected sixty-three studies published over the past 22 years, a range of effects of music on neurotransmitters, hormones, cytokines, lymphocytes, vital signs and immunoglobulins as well as psychological assessments are cataloged.
Research so far points to the pivotal role of stress pathways in linking music to an immune response. However, several challenges to this research are noted: (1) there is very little discussion on the possible mechanisms by which music is achieving its neurological and immunological impact; (2) the studies tend to examine biomarkers in isolation, without taking into consideration the interaction of the biomarkers in question with other physiological or metabolic activities of the body, leading to an unclear understanding of the impact that music may be having; (3) terms are not being defined clearly enough, such as distinctions not being made between different kinds of stress and ‘music’ being used to encompass a broad spectrum of activities without determining which aspects of musical engagement are responsible for alterations in biomarkers.
In light of this, a new model is presented which provides a framework for developing a taxonomy of musical and stress-related variables in research design, and tracing the broad pathways that are involved in its influence on the body.
Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients
2013, Medicina Intensiva
El óptimo manejo de la sedación, analgesia y delirium ofrece al paciente crítico comodidad y seguridad, facilita el buen desarrollo de medidas de soporte y manejo integral y disminuye complicaciones, impactando en un mejor desenlace.
Actualizar la Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo publicada en Medicina Intensiva en el 2007 y dar recomendaciones para el manejo de la sedación, analgesia y delirium.
Se reunió un grupo de 21 intensivistas procedentes de 9 países de la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 de ellos además especialistas en epidemiología clínica y metodología para elaboración de guías. Se acogió la propuesta del Grading of Recommendations Assessment, Development and Evaluation Working Group para emitir el grado de recomendación y evaluar la calidad de la evidencia. La fuerza de las recomendaciones fue calificada como 1 = fuerte, o 2 = débil, y la calidad de la evidencia como A = alta, B = moderada, o C = baja. Expertos en búsqueda de literatura apoyaron con esta estrategia de búsqueda: MEDLINE a través de PUBMED, bases de datos de la biblioteca Cochrane a través de The Cochrane Library y la base de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud. Los miembros asignados a las 11 secciones de la guía, basándose en la revisión de la literatura, presentaron las recomendaciones, sustentadas y discutidas en sesiones plenarias, aprobando aquellas que superaron el 80% del consenso. La elaboración de las guías contó con el soporte de la Asociación Colombiana de Medicina Crítica y Cuidado Intensivo.
Para la elaboración de la guía fueron finalmente seleccionadas 467 referencias, observándose un importante aumento en el número y calidad de los estudios, permitiendo realizar 64 fuertes recomendaciones con evidencia alta y moderada, contrastando con las 28 de la edición anterior.
Esta guía contiene recomendaciones y sugerencias basadas en la mejor evidencia para el manejo de la sedación, analgesia y delirium del paciente crítico, incluyendo un paquete de medidas (bundle). Se destacan: evaluación del dolor y la agitación/sedación mediante escalas; usar inicialmente opioides para el control de la analgesia, adicionando técnicas multimodales para disminuir consumo de opioides; promover el menor nivel de sedación necesario, evitando la sobresedación; en caso de requerir medicamentos sedantes, escoger el más apropiado, evitando el uso rutinario de benzodiazepinas; por último, identificar factores de riesgo para delirium, prevenirlo, diagnosticarlo y manejarlo, con el medicamento más conveniente, ya sea haloperidol, antipsicóticos atípicos o dexmedetomidina, evitando el uso de benzodiazepinas y disminuyendo el uso de opioides.
Optimal management of sedation, analgesia and delirium offers comfort and security for the critical care patient, allows support measures to be applied more easily and enables an integral approach of medical care, at the same time that lowers the incidence of complications, wich translates in better patient outcomes.
To update the Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo published in Medicina Intensiva in 2007, and give recommendations for the management of sedation, analgesia, and delirium.
A group of 21 intensivists from 9 countries of the Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 of them also specialists in clinical epidemiology and methodology, gathered for the development of guidelines. Assessment of evidence quality and recommendations were made based on the Grading of Recommendations Assessment, Development and Evaluation system. Strength of recommendations was classified as 1 = strong, or 2 = weak, and quality of evidence as A = high, B = moderate, or C = low. Two authors searched the following databases: MEDLINE through PUBMED, The Cochrane Library and Literatura Latinoamericana y del Caribe en Ciencias de la Salud and retrieved pertinent information. Members assigned to the 11 sections of the guidelines, based on the literature review, formulated the recommendations, that were discussed in plenary sessions. Only those recommendations that achieved more than 80% of consensus were approved for the final document. The Colombian Association of Critical Medicine and Intensive Care (AMCI) supported the elaboration of this guidelines.
Four hundred sixty-seven articles were included for review. An increase in number and quality of publications was observed. This allowed to generate 64 strong recommendations with high and moderate quality of evidence in contrast to the 28 recommendations of the previous edition.
This Guidelines contains recommendations and suggestions based on the best evidence available for the management of sedation, analgesia and delirium of the critically ill patient, including a bundle of strategies that serves this purpose. We highlight the assessment of pain and agitation/sedation through validated scales, the use of opioids initially to apropiate analgesic control, associated with multimodal strategies in order to reduce opioide consumption; to promote the lowest level of sedation necessary avoiding over-sedation. Also, in case of the need of sedatives, choose the most appropiate for the patient needs, avoiding the use of benzodiazepines and identify risk factors for delirium, in order to prevent its occurrence, diagnose delirium and treat it with the most suitable pharmacological agent, whether it is haloperidol, atypical antipsychotics or dexmedetomidine, once again, avoiding the use of benzodiazepines and decreasing the use of opioids.
Caring science research in the ambulance services: an integrative systematic review
2019, Scandinavian Journal of Caring Sciences
Integrating palliative care in the out-of-hospital setting: Four things to jump-start an EMS-palliative care initiative
2013, Prehospital Emergency Care
Critical care transfer quality 2000-2009: Systematic review to inform the ICS Guidelines for Transport of the Critically Ill Adult (3rd ed) 1B04 3A13
2012, Journal of the Intensive Care Society

View all citing articles on Scopus

Poster presentation at the Critical Care Transport Medicine Conference in Las Vegas, NV, April 3, 2006.

Oral presentation at the New Jersey Office of EMS Statewide Conference on EMS in Atlantic City, NJ, November 6, 2006.

View full text

Original ResearchMusic Reduces Patient Anxiety During Interfacility Ground Critical Care Transport

Abstract

Introduction

Setting

Methods

Results

Conclusions

Introduction

Section snippets

Design

Setting

Experimental Protocol and Patient Population

Results

Discussion

Conclusion

Acknowledgment

J Am Dent Assoc

Ann Thorac Surg

Chest

Ann Emerg Med

Chest

The effects of music therapy in cardiac healthcare

Cardiology in Review

The nature and measurement of anxiety

Music therapy in palliative care

Can Med Assoc J

Study of the effectiveness of musical stimulation during intracardiac catheterization

Clin Res Cardiol

Effects of music therapy on physiological and psychological outcomes for patients undergoing cardiac surgery

J Cardiovasc Nurs

The effects of music assisted relaxation on pre-operative anxiety

J Music Therapy

A music intervention to reduce anxiety prior to gastrointestinal procedures

Gastroenterol Nurs

Stress reduction and analgesia in patients exposed to calming music postoperatively: A randomized controlled trial

Eur J Anaesthesiol

Integrating nonpharmacological, adjunctive interventions into critical care practice: A means to humanize care?

Am J Crit Care

Influence of music on the stress response in patients receiving mechanical ventilatory support: A pilot study

Am J Crit Care

The effects of music and muscle relaxation on patient anxiety in a coronary care unit

Heart Lung

Original Research
Music Reduces Patient Anxiety During Interfacility Ground Critical Care Transport