Amanda, Manda
Please I would like a summary of this article not less than 200 words. Thank you.
L I T E R A T U R E R E V I E W
Effectiveness of music on anxiety and pain among cardiac
surgery patients: A quantitative systematic review an
d
meta-analysis of randomized controlled trials
Ramesh Chandrababu RN, RM, PhD, Lecturer1 |
Jyothi Ramesh RN, RM, MSN, Assistant Professor2 |
Elsa Sanatombi Devi RN, RM, PhD, Professor1 |
Baby S. Nayak RN, RM, PhD, Professor1 | Anice George RN, RM, PhD, Professor1
1Manipal College of Nursing, Manipal
Academy of Higher Education, Manipal,
Karnataka, India
2Udupi College of Nursing, Shree Krishna
Educational Trust, Manipal, Karnataka, India
Correspondence
Ramesh Chandrababu, Manipal College of
Nursing, Manipal Academy of Highe
r
Education, Manipal, Karnataka, 576104, India.
Email: ramesh.c@manipal.edu
Abstrac
t
Aim: The aim of this study is to evaluate the effectiveness of music on anxiety and
pain among patients fol
lowing car
diac
surgery.
Background: Cardiac surgery affects patients physically, psychologically and socially.
Anxiety and pain are the usual problems among patients follow
ing cardiac surgery.
Design: The study design is a systematic review and meta-analysis.
Data sources: The Medical Literature Analysis and Retrieval System Online
(MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL),
Cochrane Central Register of Controlled Trials (CENTRAL), Excerpta Medica database
(EMBASE) and Web of Science databases were searched for randomized controlled
trials from January 2000 to December 2017.
Review methods: The Cochrane collaboration guidelines were followed and
reported using the Preferred Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) statement. The Grading of Recommendations, Assessment,
Development, and Evaluations (GRADE) approach was used to summarize the qual-
ity
of evidence.
Results: Fourteen studies were included in systematic review and 13 in meta-
analysis. The meta-analysis revealed that there was a significant reduction in anxiety
and pain among patients who received musical intervention compared with those
who did no
t.
Conclusion: Music has positive benefits on anxiety and pain. However, well-designed
and high-quality trials are needed to generate higher quality evidence.
K E Y W O R D S
anxiety, cardiac surgery, meta-analysis, music, nursing, pa
in
SUMMARY STATEMENT
What is already known about this topic?
• Post-operative problems such as severe anxiety, pain and emo-
tional distress are generally related to the recovery of patients fol-
lowing cardiac surgery.
Received: 1 June 2018 Revised: 22 January 2021 Accepted: 3 February 2021
DOI: 10.1111/
ijn.12928
Int J Nurs Pract. 2021;e12928. wileyonlinelibrary.com/journal/ijn © 2021 John Wiley & Sons Australia, Ltd 1 of 12
https://doi.org/10.1111/ijn.12928
https://orcid.org/0000-0001-9481-6489
mailto:ramesh.c@manipal.edu
http://wileyonlinelibrary.com/journal/ijn
https://doi.org/10.1111/ijn.12928
http://crossmark.crossref.org/dialog/?doi=10.1111%2Fijn.12928&domain=pdf&date_stamp=2021-03-23
•
Music has been utilized since ancient times to influence hum
an
health and in hospital settings to decrease patient anxiety, pain and
stress.
• There is a need for rigorous research to demonstrate the effective-
ness of music in
patients following cardiac surgery.
What this paper adds?
• The trials included in the meta-analysis produced positive findings
on the effectiveness of musical interventions among cardiac sur-
gery patients on anxiety and pain among patients undergoing car-
diac surgery during the post-operative period.
• This meta-analysis revealed a low to moderate quality of evidence
in decreasing anxiety and pain among cardiac surgery patients who
received a musical intervention.
The implications of this paper:
• The use of music after cardiac surgery can be a favourable inter-
vention that decreases anxiety and pain.
• Although musical intervention alone may be inadequate to increase
recovery, these findings are significant support to the scope of
investigation on music in patients following cardiac surgery.
• There is a need for high-quality and well-designed randomized
controlled trials to generate a strong evidence base for
implementing musical intervention among patients undergoing car-
diac surgery.
1 | INTRODUCTION
Cardiac surgery affects patients physically, psychologically and
socially. The patient is vulnerable to infections, pain and risk of death
as it is an invasive procedure. Cardiac surgery is a life-threatening pro-
cedure resulting in increased anxiety for many patients (Maria
et al., 2015). Anxiety is a common psychological disturbance among
patients undergoing heart surgeries. Patients with higher anxiety dur-
ing the preoperative and post-operative periods have a higher mortal-
ity rate after cardiac surgery (Cserep et al., 2012). Moderate to severe
levels of depression and anxiety are present during the first month
after the cardiac surgery affecting behaviour and performance of self-
management (Fredericks et al., 2012).
The concerns of patients related to cardiac surgery are the
chances of a successful surgery, fear of death, recovery process, pain,
discomfort, loss of appetite, sleep disturbances and resumption of
normal life (Parvan et al., 2013). About 30% to 40% of the patients
undergoing heart surgery experience anxiety and depression
disorders. Anxiety is associated with increased heart rate and blood
pressure and can have a negative impact preoperatively and post-
operatively (Wakim et al., 2010). Pain after cardiac surgery is often
more intense and undertreated. Occurrences of chronic pain following
cardiac surgery vary from 21% to 55% (Cogan, 2010).
Major heart surgery may induce severe pain post-operatively
and the activation of a post-operative stress response. If the pain
is
not managed, patients may suffer a longer hospital stay, higher
costs and increased morbidity (Bigeleisen & Goehner, 2015). Uncon-
trolled post-operative pain is a long-term and important issue and
poorly treated pain after the surgery appears to be a risk factor
leading to chronic pain. Nurses and physicians treating post-
operative pain must recognize it as it emerges, and accordingly,
patients should be treated (Chapman et al., 2012). It is generally
hoped that complementary interventions may lessen the adverse
impact of anxiety and depression upon subsequent mortality and
morbidity (Tully & Baker, 2012).
Music has been utilized since ancient times to influence human
health. The musical intervention has been used in hospital settings to
decrease patient anxiety, pain and stress (Nilsson, 2008). Listening to
music reduces anxiety and promotes relaxation in patients after coro-
nary artery bypass graft (CABG) surgery (Barnason et al., 1995). Music
is used as an evidence-based intervention for treating anxiety and
depression in various conditions (Trappe, 2012). Music improves the
quality of life and decreases anxiety, and it is seen that cortisol levels
were significantly lower when listening to music (Trappe, 2010).
The use of music is cost-effective, safe and an independent nurs-
ing function that may be easily integrated into routine patient care by
nurses (Cole & LoBiondo-Wood, 2014). A systematic review reported
that music could be used as adjuvant therapy for the relief of post-
operative pain (Engwall & Duppils, 2009). Listening to music can have
a favourable effect on anxiety among patients on mechanical ventila-
tion and can decrease consumption of analgesics and sedatives. Music
may be a feasible management option of anxiety for patients who are
on mechanical ventilation (Bradt & Dileo, 2014).
Nurses and other healthcare providers need to deliver interven-
tions that will decrease anxiety and pain for the patient following car-
diac surgery. Before routine implementation, it is essential to provide
nurses and clinicians with strong evidence that the intervention of
music helps in decreasing patients’ anxiety and pain. There have been
some meta-analyses published reporting on the effect of music on
several clinical variables and among various populations. The effect of
listening to music has been shown generally in cardiovascular dis-
eases, but still, it is not yet clearly understood in patients following
cardiac surgery. Therefore, this meta-analysis evaluated the effect of
music therapy on anxiety, pain and relaxation among patients follow-
ing cardiac surgery. The findings of this meta-analysis will provide evi-
dence regarding musical interventions in healthcare and to the health
professionals in creating healthcare policies worldwide.
2 | REVIEW METHODS
2.1 | Aim
A systematic review and meta-analysis were performed to evaluate
the effectiveness of music on anxiety and pain among patients follow-
ing cardiac surgery.
2 of 12 CHANDRABABU ET AL.
2.2 | Design
The current systematic review with meta-analysis was performed using
the guidelines of the Cochrane Handbook (Higgins & Green, 2011) and
reported using the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) statement (Moher et al., 2009).
2.3 | Search methods
Trials were retrieved by systematically searching the Medical
Literature Analysis and Retrieval System Online (MEDLINE), Cochrane
Central Register of Controlled Trials (CENTRAL), Cumulative Index to
Nursing and Allied Health Literature (CINAHL), Excerpta Medica data-
base (EMBASE) and Web of Science. Based on PICO format (popula-
tion, intervention, control and outcomes), search strategy was formed
using relevant key terms, and two authors independently searched
the databases for randomized controlled trials (RCTs) from January
2000 to December 2017. Music, music therapy, anxiety, pain, cardiac
surgery, coronary artery bypass graft surgery and cardiac surgical pro-
cedures were the search terms used in combination to retrieve rele-
vant trials. We have listed the PubMed search strategies in Table 1.
The inclusion criteria were as follows:
2.3.1 | Participants
We focused on adult patients undergoing any form of cardiac surgical
procedures that included CABG or valve repair or replacement or a
combination of both.
2.3.2 | Intervention
Patients need to have received musical interventions. The studies
evaluated the effectiveness of music or music therapy or musical
interventions among cardiac surgery patients.
2.3.3 | Control
The studies in which musical interventions in the experimental group
were compared with the control group with no music and routine care
of patients.
2.3.4 | Outcome
Anxiety and pain were specific measures that were considered for
inclusion.
We searched for RCTs that evaluated the effectiveness of
music as an intervention for the patient following cardiac surgery.
The duplicate studies were omitted by screening the title and
abstract. The eligibility criteria were assessed by screening the full-
text articles. We included heart rate, blood pressure, respiration
rate, oxygen saturation, relaxation and satisfaction as the secondary
outcomes. Initially, only primary outcomes were considered for this
systematic review, but during data extraction, the above-mentioned
secondary outcomes were identified and included in the narrative
synthesis. The trials that included paediatric samples (less than
18 years), are published in languages other than English, did not
include cardiac surgery patients and are non-RCTs were excluded
from this review.
2.4 | Data abstraction
Data were extracted by two reviewers using the Cochrane data
extraction form from included trials. Any discrepancies were
resolved by consensus and consultation with the third reviewer. The
data extraction form consisted of details regarding the author and
year of publication, study design, sample, musical intervention, the
outcome of the study, data collection tool, reliability and trial
findings.
2.5 | Quality appraisal
The methodological qualities of each included trial were judged using
the Cochrane risk of bias (ROB) assessment tool as recommended in
the Cochrane Handbook (Higgins & Green, 2011). The criteria
included sequence generation, allocation concealment, blinding of par-
ticipants and personnel, selective reporting of the outcome, incom-
plete data outcomes and other biases. Each domain was graded as
low ROB, unclear ROB or high ROB. The overall quality of evidence
for the outcome measures was evaluated using the Grading of Rec-
ommendations, Assessment, Development, and Evaluations (GRADE)
approach (Guyatt et al., 2013).
2.6 | Data analysis
RevMan software version 5.3 was used for data analysis (available
from the website at http://ims.cochrane.org/revman). The effect size
for music intervention on outcome measures was estimated with 95%
confidence interval (CI) pooling standardized mean difference (SMD).
Heterogeneity among included trials was analysed using the I2 value.
The random effects model was used to estimate SMDs to measure
the effects of interventions.
TABLE 1 PubMed search strategy
ID Search terms
#1 ‘cardiac surgical procedures’ (MeSH) OR (cardiac surgery) O
R
‘coronary artery bypass’ (MeSH) OR (coronary artery bypass
grafting) OR (open heart surgery)
#2 ‘music’ (MeSH) OR ‘music therapy’ (MeSH) OR
‘complementary therapies’ (MeSH)
#3 ‘anxiety’ (MeSH) OR (fear) OR ‘psychological distress’ (MeSH)
OR (emotional stress) OR ‘pain’ (MeSH) OR (discomfort)
#4 Search #1 AND #2 AND #3
CHANDRABABU ET AL. 3 of 12
http://ims.cochrane.org/revman
3 | RESULTS
3.1 | Search outcome
One thousand eight hundred and three studies were identified by
search strategy through online databases and other sources. Sixty
duplicate articles were removed. After screening the title and
abstract, 1725 records were excluded, as they did not fulfil review
criteria. After evaluating full text, another 11 articles were excluded
as they did not meet inclusion criteria. The reason for excluding tri-
als was that they did not involve cardiac surgery patients, did not
report outcome data, unavailability of full text, non-RCTs and the
study involved patients under 18 years. Fourteen trials
were included in the narrative synthesis and 13 in meta-
analysis. The flow chart of the study selection process is shown in
Figure 1.
3.2 | Descriptions of included studies
The reviewed trials comprised 1011 number of participants. In these
trials, sample sizes ranged from 40 to 156. The participants’ mean age
was 63, which ranged from 57 to 74 years. In all studies, both genders
were included. The majority of samples in the selected studies were
male participants (n = 738, 66.5%). In all the included studies, partici-
pants have undergone elective surgery. The type of surgery included
was CABG surgery and valve repair and valve replacement or a combi-
nation of both. In all trials, the intervention of music was given to the
experimental group alone and usual care was received by the control
group. The summary data of the included studies are shown in
Table 2.
3.3 | Summary of ROB
The Cochrane ROB assessment tool was used to assess the methodo-
logical qualities of the included studies. Ninety per cent of trials did
not demonstrate selection bias, and 25% of trials demonstrated an
unclear ROB in process of allocation concealment. Low ROB in
blinding personnel and patients was seen in 50% of trials, and 10%
showed a high ROB. Ninety per cent of trials demonstrated low ROB
in incomplete outcome data (attrition bias), and 100% of trials demon-
strated low ROB in selective reporting. The results of the ROB are
presented in Figure 2.
FIGURE 1 Flow diagram of study selection.
RCTs, randomized controlled trials
4 of 12 CHANDRABABU ET AL.
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G
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al
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ai
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<
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so
n
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an
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rg
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3
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at
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ch
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la
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xi
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lo
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T
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0
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=
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o
ss
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.(
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0
0
4
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C
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1
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G
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b
b
re
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ti
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s:
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M
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b
b
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v
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lT
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al
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ic
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ar
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se
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to
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lo
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u
re
;
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xp
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ta
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ro
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A
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ac
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n
xi
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ty
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;
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R
,h
e
ar
t
ra
te
;
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A
P
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e
an
ar
te
ri
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p
re
ss
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re
;
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o
t
re
p
o
rt
e
d
;
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R
S
,
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u
m
e
ri
ca
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at
in
g
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ca
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;
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la
ce
b
o
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ro
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p
;
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M
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ro
fi
le
o
f
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o
o
d
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ta
te
s;
R
C
T
,r
an
d
o
m
iz
e
d
co
n
tr
o
lle
d
tr
ia
l;
R
R
,r
e
sp
ir
at
io
n
ra
te
;
S
A
I,
S
ta
te
A
n
xi
e
ty
In
v
e
n
to
ry
;
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B
P
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y
st
o
lic
b
lo
o
d
p
re
ss
u
re
;
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p
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2
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xy
g
e
n
sa
tu
ra
ti
o
n
;
S
T
A
I,
S
ta
te
–
T
ra
it
A
n
xi
e
ty
In
v
e
n
to
ry
;
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A
S
-A
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is
u
al
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n
al
o
g
u
e
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ca
le
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n
xi
e
ty
;
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A
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is
u
al
A
n
al
o
g
u
e
S
ca
le
-P
ai
n
.
6 of 12 CHANDRABABU ET AL.
3.4 | Effect of music on outcomes
Details regarding primary outcomes, the magnitude of the effect and
quality of evidence are shown in the summary of findings (Table 3),
and secondary outcomes are shown in Table 4.
3.5 | Pooled analysis
3.5.1 | Anxiety
Eight RCTs including 619 participants revealed the effect of music on
anxiety after cardiac surgery (Aghaie et al., 2014; Ci�gerci &
Özbayir, 2016; Cutshall et al., 2011; Heidari et al., 2015;
Nilsson, 2009b; Sendelbach et al., 2006; Twiss et al., 2006; Voss
et al., 2004). An analysis of random effects model showed that musical
intervention decreased anxiety significantly (SMD = −0.68, 95% CI:
−0.88 to −0.47, I2 = 36%) and there was a significant statistical differ-
ence between groups (Z = 6.40, P < 0.0001) (Figure 3). There was a
moderate quality of evidence due to an unclear ROB and medium effect
size on the effect of an intervention in the anxiety level (Table 3).
3.5.2 | Pain
Nine RCTs including 559 participants revealed the effect of music on
pain after cardiac surgery (Ahmadabad et al., 2016; Ci�gerci &
Özbayir, 2016; Cutshall et al., 2011; Jafari et al., 2012; Kyavar
et al., 2016; Nilsson, 2009b; Selle & Silverman, 2017; Sendelbach
et al., 2006; Voss et al., 2004). An analysis of random effects model
showed that musical intervention reduced pain significantly
(SMD = −0.74, 95% CI: −0.99 to −0.49, I2 = 52%) and there was a sig-
nificant statistical difference between the groups (Z = 5.73,
P < 0.0001) (Figure 4). There was a low quality of evidence due to
inconsistency, unclear ROB and medium effect size on the effect of
an intervention in the pain scores (Table 3).
3.6 | Secondary outcomes
Heart rate, respiration rate, blood pressure, mean arterial pressure, oxy-
gen saturation, relaxation and satisfaction were the secondary outcomes
included in this review. A narrative analysis was performed to assess the
effect of music on secondary outcomes, as there were not enough stud-
ies to see combined effects. Nine RCTs evaluated the effect of music
on secondary outcomes (Aghaie et al., 2014; Ahmadabad et al., 2016;
Ci�gerci & Özbayir, 2016; Cutshall et al., 2011; Heidari et al., 2015; Iblher
et al., 2011; Jafari et al., 2012; Nilsson, 2009a, 2009b; Sendelbach
et al., 2006). Out of nine, five trials revealed a favourable effect of the
musical intervention on secondary outcomes (Aghaie et al., 2014;
Ahmadabad et al., 2016; Heidari et al., 2015; Jafari et al., 2012). The
details of secondary outcome data are presented in Table 4.
3.7 | Publication bias
No distinct asymmetry was observed in the funnel plot for both out-
comes, but funnel plots showed that there is mild publication bias
(Figures 5 and 6).
3.8 | Psychometrics
The validity and reliability of instruments used to measure outcomes
in the included trials were adequate. Details of the data collection tool
and respective reliability values are shown in Table 2.
3.9 | Quality of evidence
There was a low to moderate quality of evidence for the outcome
measures due to the imprecision, inconsistency and unclear ROBs.
The GRADE guidelines were adopted to rate the quality of evidence
on outcomes measures and shown in the summary of findings table
(Guyatt et al., 2013). The effect of magnitude was classified into the
following grades: large (effect size of 0.8 or higher), medium (effect
size around 0.5) and small (effect size around 0.2). There was no
higher quality of evidence on selected outcome measures (Table 3).
4 | DISCUSSION
Musical interventions were given to the patients to divert their mind
from unnecessary fear or anxiety about surgery and its outcome.
FIGURE 2 Risk of bias graph
CHANDRABABU ET AL. 7 of 12
T
A
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8 of 12 CHANDRABABU ET AL.
Generally, there is evidence that musical intervention will result in
beneficial health outcomes in cardiovascular conditions but not much
is known about effectiveness in patients following cardiac surgery.
This systematic review used the meta-analysis of RCTs to evaluate
the effect of musical interventions for patients undergoing cardiac
surgery.
The main objective of this meta-analysis was to assess whether
the musical intervention can decrease anxiety and pain or not. This
systematic review included the RCTs published between the years
2000 and 2017. This review aimed to appraise the current evidence
concerning the effect of musical intervention among patients under-
going cardiac surgery. RCTs included in this meta-analysis were from
both the developing and developed countries.
Fourteen trials were included in the systematic review and
13 RCTs in the meta-analysis. This meta-analysis produced positive
TABLE 4 Effect of music on secondary outcomes
Secondary outcomes HR RR SBP DBP MAP SpO2 Satisfaction Relaxation
Aghaie et al. (2014), RCT # # # # # ”
Ahmadabad et al. (2016), RCT # # # # ”
Ci�gerci and Özbayir (2016), RCT = = = =
Cutshall et al. (2011), RCT = = = ”
Heidari et al. (2015), RCT = # = =
Iblher (2011), RCT = = = = ”
Nilsson, 2009a, RCT = = = ”
Nilsson, 2009b, RCT = =
Sendelbach et al. (2006), RCT = = =
Note: =, no statistical significant difference with the music and control groups; #, significant decrease with the music group; “, significant increase with the music group.
Abbreviations: DBP, diastolic blood pressure; HR, heart rate; MAP, mean arterial pressure; RCT, randomized controlled trial; RR, respiration rate; SBP,
systolic blood pressure; SpO2, oxygen saturation.
FIGURE 3 Effect of music intervention on anxiety. CI, confidence interval
FIGURE 4 Effect of music intervention on pain. CI, confidence interval
FIGURE 5 Funnel plot of selected studies for anxiety. SMD,
standardized mean difference
CHANDRABABU ET AL. 9 of 12
results. An analysis of the random effects model revealed that musical
intervention decreased anxiety and pain significantly in cardiac surgi-
cal patients. In the narrative synthesis out of 15 trials, 13 (86.6%) con-
cluded that music had positive results and two trials (14.4%) without
positive findings. None of the included studies reported any harmful
effects of the musical intervention.
The results of this meta-analysis are in agreement with the con-
clusions of previously published systematic reviews, which reported
that music has positive effects; however, strong evidence in cardiac
surgery remains unanswerable. This is the first systematic review that
has evaluated the benefits of music therapy for patients following car-
diac surgery. The previous systematic reviews on the effects of music
therapy have reported on general cardiovascular health and not focus-
ing on the patients following cardiac surgery (Bradt et al., 2013;
Hanser & Mandel, 2005).
This systematic review and meta-analysis revealed that there is
some evidence that patients benefit from music and provides initial
support for nurses and other healthcare providers to deliver music as
interventions for patients following cardiac surgery. Yet these findings
must be interpreted with caution, as there was mild to moderate qual-
ity of evidence in the analysed outcome measures. There is a need for
high-quality RCTs to build strong evidence of musical interventions in
patients following cardiac surgery.
4.1 | Directions for future research
Only a few RCTs evaluated the effectiveness of music in cardiac surgi-
cal patients. Hence, rigorous research is required to demonstrate the
effectiveness of musical interventions. High methodological qualities
of RCTs specifically done for cardiac surgery patients are required to
create strong evidence. Future research also must emphasize the sci-
entific rationale behind musical intervention by evaluating relevant
biomarkers, as mechanisms of the effect of music on the physiology
of humans are not yet understood clearly.
4.2 | Implications for clinical practice
The use of musical intervention after cardiac surgery might be a
positive complementary intervention that decreases anxiety and
pain. Although musical intervention alone may be inadequate to
increase recovery, this meta-analysis is considerable support to the
scope of investigation on music in cardiac surgical procedures.
Nurses can use music as a complementary therapy for patients
undergoing cardiac surgery. Nurses and clinicians can expect
improvements when implementing adjuvant music therapy for anxi-
ety, pain and relaxation. Music therapy can be more widely used in
post-operative cardiac surgery healthcare considering the outcome
of this meta-analysis.
4.3 | Limitations
Some limitations should be addressed in this meta-analysis. As the
RCTs published only in English were included, this could have pro-
duced a language bias. Articles included in meta-analysis contained
a variety of musical interventions, not just music, the studies
tested nature sounds, a combination of sounds and so forth. Other
databases in health sciences that have studies in Spanish or
Portuguese of interest on the subject were not included; this
should be considered as one of the limitations. There was a low to
moderate quality of evidence due to inconsistency, imprecision and
unclear ROB.
5 | CONCLUSION
Music has positive benefits in decreasing anxiety and pain among
patients undergoing cardiac surgery. Due to low quality of evidence,
it is difficult to conclude the effect of music interventions in
patients following cardiac surgery or implications for clinical prac-
tice. However, considering the importance of this safe, low-cost,
valuable intervention, it is recommended that higher quality, well-
designed and rigorous RCTs are necessary to generate higher quality
of evidence.
ACKNOWLEDGEMENTS
We greatly acknowledge all the authors of the original research arti-
cles that were found useful to write this review. We also extend our
thanks to the Manipal University Health Sciences Library for providing
facilities to retrieve relevant studies from various online databases.
CONFLICT OF INTEREST
There were no conflicts of interest to report.
AUTHORSHIP STATEMENT
RC and JR designed the study. RC, JR and ESD collected the data. RC
and BSN analysed the data. RC, BSN, ESD and AG prepared the man-
uscript. All authors approved the final version for submission.
FIGURE 6 Funnel plot of selected studies for pain. SMD,
standardized mean difference
10 of 12 CHANDRABABU ET AL.
ORCID
Ramesh Chandrababu https://orcid.org/0000-0001-9481-6489
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Devi E, Nayak BS, George A. Effectiveness of music on anxiety
and pain among cardiac surgery patients: A quantitative
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https://doi.org/10.1111/j.1478-5153.2006.00174.x
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https://doi.org/10.1016/j.pain.2004.08.020
https://doi.org/10.1016/j.jopan.2010.05.009
https://doi.org/10.1016/j.jopan.2010.05.009
https://doi.org/10.1111/ijn.12928
https://doi.org/10.1111/ijn.12928
- Effectiveness of music on anxiety and pain among cardiac surgery patients: A quantitative systematic review and meta-analys…
1 INTRODUCTION
2 REVIEW METHODS
2.1 Aim
2.2 Design
2.3 Search methods
2.3.1 Participants
2.3.2 Intervention
2.3.3 Control
2.3.4 Outcome
2.4 Data abstraction
2.5 Quality appraisal
2.6 Data analysis
3 RESULTS
3.1 Search outcome
3.2 Descriptions of included studies
3.3 Summary of ROB
3.4 Effect of music on outcomes
3.5 Pooled analysis
3.5.1 Anxiety
3.5.2 Pain
3.6 Secondary outcomes
3.7 Publication bias
3.8 Psychometrics
3.9 Quality of evidence
4 DISCUSSION
4.1 Directions for future research
4.2 Implications for clinical practice
4.3 Limitations
5 CONCLUSION
ACKNOWLEDGEMENTS
CONFLICT OF INTEREST
AUTHORSHIP STATEMENT
REFERENCES