Question: In children having a cast-room procedure, does music therapy reduce anxiety?
Design: Randomized (unclear allocation concealment), unblinded controlled trial with follow-up immediately after the procedure.
Setting: Cast room of a hospital in Cleveland, Ohio.
Patients: 69 patients =10 years of age (mean age, 6 y) who were scheduled for cast application, cast removal, pin removal, or suture removal. All patients completed the study.
Intervention: At the start of every clinic, the cast room was allocated to have soft lullaby background music (n = 28) or no music (n = 41). The volume was set so that patients could be interviewed at normal voice level.
Main outcome measures: Pulse oximeter probes were placed on the patients in the waiting room. Heart rates were recorded in the waiting room and then in the cast room before the procedure, during the procedure, and immediately after the procedure. Heart rates were recorded at 15-second intervals for 1 minute except during the procedure, when they were recorded for 2 minutes.
Main results: The mean heart-rate measurements were lower for the no-music group in the waiting room (102 vs 91 beats/min, p = 0.001); the measurements were not significantly different between groups before, during, and after the procedure. Between the time when the heart rate was measured in the waiting room and when it was measured again in the cast room before the procedure, the rate had decreased in the music group and increased in the no-music group (Table). A borderline difference existed between groups for change in heart rate between the waiting room and during the procedure (Table). No significant difference in heart rate between the two groups was noted between the time during the procedure compared with the time before the procedure or between the time during the procedure compared with the time after the procedure (Table). 17% of children in the no-music group had heart rate increases in excess of 40 beats/min, whereas no child in the music group had an increase of >40 beats/min (p = 0.04).
Conclusion: Children entering a cast room in which soft music was playing had lower heart rate increases than children entering a cast room with no music.
The study by Liu et al. is the first, to our knowledge, to evaluate music therapy for the reduction of anxiety in children during cast-room procedures. The authors present their results in support of this inexpensive and readily applicable intervention.
The study design raises two principal concerns: similarity of patient groups and method of randomization. The authors randomized the cast room to the playing of music or to no music at the start of each 4-hour session. Therefore, randomization was for groups rather than individual patients. This randomization method may lead to dissimilar groups due to intra-diem and inter-diem differences. The initial heart-rate measurements in the waiting room were found to be significantly different, suggesting that these were not similar groups. Thus, subsequent comparisons were made based on the difference in heart rate between the waiting room and other time points (before procedure, during procedure, and after procedure). We cannot draw definitive conclusions because of the significantly lower baseline heart-rate measurements in the no-music group. In fact, if we add the difference noted between waiting and cast room to the baseline heart rate, the no-music group had a lower ultimate rate of 95.7 beats/min (91 + 4.7), while the music group had an ultimate heart rate of 99.3 beats/min (102 — 2.7). The authors noted that the method of randomization may have affected their results. However, given the low cost and negligible risk, it would seem appropriate that music should be played in cast rooms.