Music Therapy in Post-Operative Orthopedic Patient
Clinical Question:
Does the use of pharmacological interventions with music therapy lower pain level more than the solo use of pharmacological interventions in post-operative orthopedics patients?
Literature Review:
A systematic review with a total of 10 RCTs and quasi-experimental studies looked at the pain, anxiety, and delirium levels using validated tools in post-operative patients in hospital (Sibanda et al., 2018). Level I.
A RCT compared the levels of pain, anxiety, nausea, and mood using validated tools in 163 post-operative orthopedic patients in hospital with 84 in the intervention group who received music therapy and 79 subjects in the control group (Gallagher et al., 2018). Level II.
A single-blinded RCT compared the pain and satisfaction using validated tools in 30 orthopedic patients in hospital with the intervention group receiving music intervention intraoperatively (Simcock et al, 2008). Level II.
A quasi-experimental study with 42 post-operative orthopedic patients in an acute hospital rating their pain levels on a 0-10 pain scale before and after music intervention (Schneider, 2018). Level III.
Methods:
Database: PubMed, Joanna Briggs Institute EBP Database
Keywords: music therapy, pain, postoperative, orthopedic
MeSH terms: ("Music Therapy"[Mesh]) AND "Pain, Postoperative"[Mesh]
Synthesis of findings:
There is growing evidence to show that music intervention reduces the perception of pain in orthopedic post surgical patients when coupled with pharmacologic interventions.
Across three days postoperative, patient’s pain improved on average 1.25 points in the group listening to music versus the 0.25 point increase in the control group (Gallagher, 2018).
Based on a 0-10 pain scale, average pain scores went from 5.43 before listening, to 3.97 after listening. Listening time had no effect on pain reduction (Schneider, 2018).
Less pain was reported in patient’s listening to music at 3 hr and 24 hr postoperatively in total knee arthroplasty (Simcock, 2008).
One study did not find statistical significance, however there was a significant drop in pain scores suggesting clinical significance.
Studies agree that the use of music is inexpensive, easy to use, and can aid in managing pain symptoms.
Decision about practice:
The inclusion of music therapy, in addition to standard pharmacological interventions, is effective in reducing pain.
Based on clinical findings, it is recommended that music therapy is implemented in the patient’s care plan to reduce post-operative pain.
Implementation:
Since each individual has a different perception on what type of music is considered relaxing to them, patients should be given the option between different music selections. However, these music selections should share characteristics of being harmonious, relaxing, easy to listen to, and should be around 60-80 beats per minute.
Music therapy is applied to patients as an adjuvant to the administration of medication for every dose. Patient will determine how long the music is on, but recommendation should state that music should be on at least an hour or two while medicating.
Educating the patients about music therapy should be done in preoperative preparation to allow the patients to choose their music and will be made available to them at recovery.
Nurses will have to educate patients that music therapy is not limited to be only utilized in the hospital setting. We have to make sure that the patients take this knowledge and use it for their own benefit at home.
Evaluation:
Patient will complete preferred pain scale an hour after pain medications are given. With the implementation of music therapy, the expected outcome is a decreased pain rating.
Upon discharge, patients will complete “Patient Satisfaction Survey” with likert-scale type questions. The expected outcome is an increase in satisfaction during hospitalization.
During routine assessments, the nurse will directly ask the patient if they find the addition of music therapy to be helpful. The expected outcome is that the patient verbalizes positive feelings towards the music and verbalizes its help in reducing pain.
Discussion:
Studies show that music therapy is an effective adjuvant to pharmacological interventions.
The studies shows that postoperative patients’ pain levels decreased when listening to music as part of recovery.
It was agreed upon that music therapy is not only an effective intervention for pain management in postoperative patients in an orthopedic setting, but it is also inexpensive, accessible, and easy to use.
Music therapy can be used in hospital setting or at home. Nurses must educated patients on the effectiveness of continued utilization of this intervention after discharge.
References:
Chiodo, C. P., Keyser, C., Palms, D., Malone, C., Bluman, E. M., & Smith, J. T. (2019). The impact of music therapy in the postoperative setting on overall patient satisfaction using validated outcome scores. Journal of PeriAnesthesia Nursing, 34(2), 354-358.
Evans, D. (2002). The effectiveness of music as an intervention for hospital patients: a systematic review. Journal of advanced nursing, 37(1), 8-18.
Gallagher, L. M., Gardner, V., Bates, D., Mason, S., Nemecek, J., DiFiore, J. B., ... & Bethoux, F. (2018). Impact of Music Therapy on Hospitalized Patients Post-Elective Orthopaedic Surgery. Orthopaedic Nursing, 37(2), 124-133.
Hsu, C. C., Chen, S. R., Lee, P. H., & Lin, P. C. (2019). The effect of music listening on pain, heart rate variability, and range of motion in older adults after total knee replacement. Clinical nursing research, 28(5), 529-547.
Joanna Briggs Institute. (2011). The Joanna Briggs Institute best practice information sheet: Music as an intervention in hospitals. Nursing & health sciences, 13(1), 99-102.
Kenny, M. H. (2018). Music Therapy's Impact on Pain after Elective Knee or Hip Replacement Surgery (Doctoral dissertation, Shepherd University).
Kühlmann, A. Y. R., De Rooij, A., Kroese, L. F., van Dijk, M., Hunink, M. G. M., & Jeekel, J. (2018). Meta‐analysis evaluating music interventions for anxiety and pain in surgery. British Journal of Surgery, 105(7), 773-783.
Leonard, H. (2019). Live Music Therapy During Rehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial. Journal of music therapy, 56(1), 61-89.
Lin, P. C., Lin, M. L., Huang, L. C., Hsu, H. C., & Lin, C. C. (2011). Music therapy for patients receiving spine surgery. Journal of clinical nursing, 20(7‐8), 960-968.
Lukas, L. K. (2004). Orthopedic outpatients' perception of perioperative music listening as therapy. Journal of Theory Construction & Testing, 8(1), 7.
Nelson, K., Adamek, M., & Kleiber, C. (2017). Relaxation training and postoperative music therapy for adolescents undergoing spinal fusion surgery. Pain management nursing, 18(1), 16-23.
Poulsen, M. J., & Coto, J. (2018). Nursing music protocol and postoperative pain. Pain Management Nursing, 19(2), 172-176.
Radcliffe, J. A., & Porterfield, S. (2018). Music Therapy and Post-Operative Pain. Florida State University Libraries.
Schneider, M. A. (2018). The effect of listening to music on postoperative pain in adult orthopedic patients. Journal of Holistic Nursing, 36(1), 23-32.
Sibanda, A., Carnes, D., Visentin, D., & Cleary, M. (2019). A systematic review of the use of music interventions to improve outcomes for patients undergoing hip or knee surgery. Journal of advanced nursing, 75(3), 502-516.
Simcock, X. C., Yoon, R. S., Chalmers, P., Geller, J. A., Kiernan, H. A., & Macaulay, W. (2008). Intraoperative Music Reduces Perceived Pain After Total Knee Arthroplasty–A Blinded, Prospective, Randomized, Placebo-Controlled Clinical Trial. The journal of knee surgery, 21(04), 275-278.
Studies show that music therapy is an effective adjuvant to pharmacological interventions.