Stine Camilla Blichfeldt-Ærø: Music therapy as an adjunct in cardiac device lead extraction procedures.

Field of study: Music Therapy

Summary

This PhD study aims to evaluate music therapy as an adjunct for adult cardiac patients during a specific invasive procedure: the extraction of leads from pacemakers or implantable cardioverter defibrillators. The procedure is complex and lasts between two and six hours. It is performed in local anaesthesia and is often associated with some stress and pain for the patients, despite the analgesic and anxiolytic drugs given. A randomized controlled trial was conducted to investigate the impact of music therapy on pain, satisfaction with pain management and other stress responses during the procedure. Although previous research does indicate that both music medicine and music therapy are effective for patients’ stress regulation, its use as a resource at somatic hospitals tends to be relatively slight. More music therapy studies are called for, particularly within perioperative settings and for the detailed description of the clinical intervention.

For this particular study, a clinical music therapy protocol called Facilitated Music Listening was developed to support patients during the medical procedure, combining standardized and flexible intervention elements on a basis of biopsychosocial principles. The intervention was receptive, emphasizing feasibility on-site, individual guidance of coping strategies, and patient involvement.

The selected sample involved patients who were scheduled for a cardiac lead extraction procedure in local anaesthesia at Oslo University Hospital (OUS) Ullevål during the period 01.03.2018–30.09.2019. The 64 total patients were randomized either to the music therapy group (n=32) or the control group (n=32). Patients in the music therapy group received music therapy in addition to the standard treatment, while patients in the control group received the standard treatment without music therapy.

Results

The primary outcomes of the RCT involved the patients’ satisfaction with the pain management and the average level of pain felt during the procedure, as measured via self-reported levels on numeric scales. Secondary endpoints included average anxiety intensity, the need for analgesic/anxiolytic drugs, blood pressure, heart and respiration rate, and oxygen saturation during the procedure. As additional data, patients in the music therapy group were asked to rate their satisfaction with the music listening, and invited to provide written reflections of their experience with the same.

Music therapy during cardiac device lead extraction procedures was both feasible and safe. The patients were highly satisfied with the pain management and experienced very little pain both with and without music therapy as an adjunct during the procedure. No significant differences were found between groups with respect to the primary endpoints. Of secondary endpoints, patients who received music therapy did show reduced anxiety during the procedure, particularly in the postoperative phase. They also reported high satisfaction with the music listening. No differences were found in physiological parameters or the use of procedure medication.

The anxiety levels and supplementary analyses of additional data, including the qualitative written mate-rial, suggest that Facilitated music listening may be supportive for the patients in terms of experienced procedure coping and overall wellbeing.

The study is conducted in cooperation with Oslo University Hospital.

The dissertation

Full title: Music therapy as an adjunct in cardiac device lead extraction procedures. A randomized controlled trial.

The dissertation comprises three papers and an introduction. The dissertation is available in NMH 's digital archive.

The dissertation is written in English.