Background
Methods
Search strategy
Inclusion and exclusion criteria
Data extraction
Risk of bias assessment
Statistical analysis
Results
Study selection
Sample
(treatment / control)
| Age | Gender
(male/female)
| TBSA(A) %
(range)
| Procedure | Interventions | Duration of music | Measurement tools(D)
| ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Technique(B)
| Music | Selection | Intervention description(C)
| Control | Other | ||||||||
Miller et al. (1992) [43] | 17 (9/8) | 40.9/27.8 (mean treatment/control)
| 16 M, 1 F | 1–39% | Dressing change | Muralvision | Recorded music | Investigator-selected music | ①③ | Placebo effect | Medication | During procedure | MGPQ, STAI |
Robb et al. (1995) [28] | 20 (10/10) | 8–20 | N/A | N/A | During preoperative period | MAR | Recorded music | Self-selected music | ①②③④ | Usual care | Medication | Before and during procedure | STAIC |
Fratianne et al. (2001) [26] | 25 | 7–83 | 16 M, 9 F | 1–43% | Debridement | MBI & MAE | Live music | Patient’s preferred music | ①②③④⑤ | Usual care | Medication | Before, during and after procedure | WBFRS, VAS, TOMRI |
Haythronthwaite et al. (2001) [44] | 42 | 43.6 (mean)
| 32 M, 10 F | 3–65% | Dressing change | Music distraction | Recorded music | Self-selected music | ①③⑤ | Sensory focusing, usual care | Medication | 20 min before and during procedure | 11-LS, BDI, Burn-CSQ |
Ferguson et al. (2004) [4] | 11 (5/6) | 18–75 | 8 M, 3 F | 7–50% | Range of motion | Music relaxation | Recorded music | Self-selected music | ①⑤ | Usual care | Exercise | During procedure | VAS, STAIC, H-PCMS |
Chen Shujuan et al. (2005) [39] | 40 (20/20) | 23–54 | 40 M | 12–49% | Debridement process | Music medicine | Recorded music | Investigator-selected music | ①③ | Usual care | No | Twice a day for 30 min each time; 30 days for a course of treatment | HAMA, HRSD |
Whitehead-Pleaux et al. (2006) [29] | 14 (8/6) | 6–16 | 5 M, 9 F | N/A | Dressing change | Music therapy | Live music | Self-selected music | ①②③④ | Verbal interaction | No | During procedure | NAPI, WBFRS, FT |
Lin Huiting et al. (2007) [36] | 40 (20/20) | 20–55 | 40 M | 13–50% | Debridement process | Music medicine | Recorded music | Patient’s preferred music | ①⑤ | Usual care | No | During procedure | VAS |
Tan et al. (2010) [24] | 29 | 8–71 | 24 M, 5 F | 3–40% | Debridement process | MBI & MAE | Live music and recorded music | Patients’ music preferences | ①②③④⑤ | Usual care | Medication | Before, during and after procedure | VAS, MTIS |
Liu Chenyuan et al. (2010) [22] | 120 (60/60) | 8–86 | 69 M, 51 F | N/A | Dressing change | Music medicine | Recorded music | Patient’s preferred music | ①④ | Usual care | No | 20 min before and during procedure | VAS, STAI |
Liang Wanling et al. (2010) [42] | 62 (31/31) | 17–50 | 45 M, 17 F | N/A | Isolation area | Music medicine | Recorded music | Self-selected music by patient/ family | ①③ | Usual care | No | Patient-selected music played for 1 h at 7:00 and 17:00 | SAS, SDS |
Yang Yong (2011) [38] | 46 (23/23) | 36 (mean)
| 26 M, 20 F | N/A | During hospitalization | Music medicine | Recorded music | Self-selected music from list | ①③④ | Usual care | No | Twice a day for 20–30 min each time | VAS, SDS |
Zhang Qian et al. (2012) [23] | 60 (30/30) | 19–50 | 29 M, 31 F | 4–5% | Cold therapy | Music medicine | Recorded music | Investigator-selected music | ①⑤ | Usual care | Cryotherapy | During procedure | VAS, STAI |
Jiang Mingzhu (2013) [41] | 64 (32/32) | 19–63 | 43 M, 21 F | Ocular | During hospitalization | Music medicine | Recorded music | Investigator-selected music | ①③ | Usual care | No | At 9:00 and 15:00 each day for 30–60 min each time | SAS |
Ren Yue et al. (2014) [37] | 72 (36/36) | N/A | N/A | 20–60% | Dressing change | Music medicine | Recorded music | Nurse-selected music | ①⑤ | Usual care | Medication | 15 min before and during procedure | SAS |
Zhou Tao (2014) [40] | 42 (21/21) | 47.2/45.1 (mean treatment/control)
| 23 M, 19 F | N/A | Daily nursing care | Music medicine | Recorded music | Investigator-selected music | ①③④ | Usual care | No | Before and during procedure | SAS, SDS |
Najafi et al. (2015) [25] | 100 (50/50) | 31.08/31.18 (mean treatment/control)
| 62 M, 38 F | 6–48% | During hospitalization | Music intervention | Recorded music | Patient’s preferred music | ①③⑤ | Usual care | Medication | Music intervention was offered once a day (20 min) for 3 consecutive days | VAS |
Study characteristics
Outcome measurements
Risk of bias
Outcomes of meta-analysis
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Primary OutcomePain. The meta-analysis of six trials and 260 burn patients for measures of pain intensity demonstrated significant heterogeneity (I 2 = 81.6%, P < 0.001). The pooled result from the random effects model demonstrated significant differences in pain scores between the music intervention group and the non-music intervention group (SMD = −1.26, 95% CI [−1.83, −0.68]) [23‐25, 29, 36, 43] (Fig. 3). Music intervention was found to reduce the pain experienced by burn patients during treatment procedures.×Four studies were included in descriptive reviews. In Fratinanne et al. [26] study, self-reported pain was improved in the music therapy group by over four intervals during treatment procedures. The self-reporting of pain was significantly decreased for those who received music therapy compared to those who did not. Liu Chenyuan et al. [22] study reported that 98.33% of patients had level 0 or level 1 pain during dressing changes in the experimental group, while only 80% of patients in the control group had similar low pain levels. The majority of patients in the control group had significantly higher pain levels than those in the experimental group during dressing changes. However, contrary evidence was reported in other studies. Haythronthwaite et al. found that patients in a sensory focusing group experienced greater pain relief than those in a music distraction group based on serial pain ratings [44]. In Ferguson’s study, although there was a difference between pretest and post-test pain across groups, no difference in pain was found between the groups [4].
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Secondary OutcomesAnxiety Level. The included anxiety scores demonstrated statistically significant heterogeneity (I 2 = 87.0%, P < 0.001). The results showed a statistically significant reduction in the anxiety levels of the burn patients (SMD = −1.22, 95% CI [−1.75, −0.69]) in the intervention group compared to those in the control group [23‐26, 29, 36‐39, 41‐43] (Fig. 4).×Although the study reported by Robb et al. [28] did not include sufficient data to be included in the meta-analysis, a significant decrease in anxiety scores was found for the experimental group compared to the control group. Zhoutao reported that music intervention had a significant positive effect on anxiety alleviation; the effective ratio of the control group was 9.52%, whereas the effective ratio of the experimental group was 52.38% (P < 0.05) [40]. Although two studies that were conducted in China were not included in the meta-analysis due to a lack of pretest raw data, the results of these studies also indicated that music interventions significantly reduced anxiety for severe burn patients [38] during hospitalization or during dressing change when combined with anesthetics [37]. Fratinanne et al. [26] indicated that self-reported anxiety during medical procedures was reduced by four intervals in the music therapy group, but no statistical significance was observed. Moreover, Ferguson and Voll also reported that no significant reduction in anxiety was found during therapy including music relaxation [4].Heart Rate. The effects of music intervention on heart rate during burn treatment procedures were extracted from four studies in the meta-analysis [22, 25, 29, 41], and the statistical heterogeneity for this variable was significant (I 2 = 88.8%, P < 0.001). Compared with the usual care group, heart rate was significantly decreased in the music intervention group (SMD = −0.60, 95% CI [−0.84, −0.36]) (Fig. 5).×Three studies that had reported the effects of music interventions on heart rate were not included in the meta-analysis due to ineligibility. Robb et al. [28] indicated that music interventions showed no significant effect on heart rate between pre- and post-test periods for either group. Frantianne et al. [26] reported that music therapy had a slight effect on heart rate, although the difference was not significant. However, in Renyue et al. [37] study, the post-test results revealed that music interventions decreased heart rate significantly during dressing changes compared to the control group.Blood Pressure. Four studies reported on the effects of music interventions on blood pressure [22, 25, 28, 41]; of these, three were included in the meta-analysis. The random effects pooled result did not demonstrate differences between the intervention group and the control group with regard to blood pressure during treatment procedures (SBP: SMD = −0.37, 95% CI [−1.18, 0.45]; DBP: SMD = −0.24, 95% CI [−0.68, 0.20]) [22, 25, 41] (Figs. 6 and 7). Similarly, Robb et al. [28] study found no significant differences in heart rate between the pre- and post-test period for either group.××Respiration Rate. Two of the four studies that included information regarding the effect of music therapy on respiration rate showed statistically significant differences between pre- and post-treatment measurements of respiratory rate across the groups [4, 25]. The other two studies showed no significant difference in respiration between groups during the preoperative period or during dressing changes [28, 29].