Methodological challenges for music therapy controlled clinical trials in palliative care

Music Therapy in Palliative Care

“…No treatment-as-usual study arm was included in the design of the present study, as it was considered more ethical to use an active control (21). The selected design means that both study arms share factors that affect personal care and relaxation.…”

“…There is also preliminary evidence of efficacy in terms of a reduction in anxiety (12,20), improvement in emotional state (13) and communication (15), stress reduction (17), and enhanced spiritual wellbeing (19). However, systematic reviews reveal that many of these studies have a high risk of methodological bias (2,3,8,21). A recent retrospective data analysis shows that the use of music therapy is associated with increased readiness to discuss spiritual subjects and with a reduction in shortness of breath (22).…”

Music Therapy for Seniors at End-of-Life: Literature Review and a Preliminary Randomized Feasibility Study

“…Such duality creates a challenge in the development of a rigorous MT research protocol. 34 Some of the studies reviewed employed a standardized, passive MT intervention, consisting of a music-facilitated relaxation exercise using preselected live 12,20 or individualized recorded music. 35 Active MT interventions included song choice, song analysis, songwriting, singing, instrumental improvisation, composition and recording, and multimedia applications combined with music for life review.…”

“…Some studies used a supportive but non-music based control, such as a verbal relaxation exercise 12,20 or conversation, 23,38 while others contrasted the MT intervention with a passive music listening activity. 10 Other studies contrasted MT with standard care.…”

“…Additionally, experimental designs frequently lack the rigor necessary to support arguments for the effectiveness of MT. 9,12,13 Therefore, the objective of this study was to develop and test the feasibility of a clinical trial protocol that addressed the three components lacking in previous studies on MT at EOL, namely: (i) outcomes of MT beyond physical changes, (ii) bias reduction through randomization, inclusion of a control group and standardization, and (iii) active participation of patients, family members and staff at each stage of protocol development. As research has shown that seniors benefit from music interventions in a wide range of situations, 2,3,14 and addressing seniors' health is a priority in our region, this age contingent was targeted for the present study.…”