[Impact of music therapy on anxiety and depression for patients with Alzheimer's disease and on the burden felt by the main caregiver (feasibility study)]. / Intérêts de la musicothérapie sur l'anxiété, la dépression des patients atteints de la maladie d'Alzheimer et sur la charge ressentie par l'accompagnant principal (étude de faisabilité).

INTRODUCTION: The impact of music therapy on dementia care for patients with Alzheimer's disease (AD) is well-recognized. Music alters the different components of the disease through sensory, cognitive, emotional, behavioral and social impacts. The academic aspect of music therapy in this area was based on the fact that music can alter the various components of the overall evolution of this disease. We found around 10 case studies presenting various results from receptive music therapy sessions on patients with Alzheimer's disease. The results of these studies point out the interest of music therapy in the multidisciplinary care of Alzheimer's disease and its related syndromes. It has been deemed useful for significantly reducing the medication given to AD patients. A music therapy protocol, specifically tailored to the patient's needs has been shown to significantly reduce anxiety, depression and aggressiveness in patients suffering from Alzheimer's disease. This technique has also demonstrated its impact on helping AD patients recall their previous life experience. OBJECTIVE: To demonstrate the feasibility and to evaluate the impact of music therapy on anxiety and depression at the early to moderate stage of Alzheimer's disease and on the main caregiver burden. METHOD: Five outpatients suffering from early stage of Alzheimer's disease (MMS: 18-26) were prospectively included. They were living in Montpellier with a reliable caregiver. A weekly receptive music therapy session was delivered to patients over a 10-week period, according to the U method standardized protocol. This technique was based on the recommendations made by Gardner and Good relating to the importance given to an individualized choice of music. Instrumental tracks were selected from various music styles (classic, jazz, world music...) and were tailored to the patient's requirements. This individual session was always followed by an interview with the music therapist in order to allow the patient to express the emotions felt during the session and to stimulate the patient's cognitive functions by recalling memories and images from his past life experience. The main evaluation criterion was regular session attendance at the hospital. Secondary criteria were: anxiety score (Hamilton scale), depression score (Cornell scale) and the burden score felt by the main caregiver (Zarit scale). Evaluations took place at W1, W4 and W10. The score evolution on the Hamilton, Cornell and Zarit scales were tested using the Wilcoxon test on paired data. The significance threshold has conventionally been set at 5% for all tests used. The statistical analysis was done using the SAS software (8th version) (SAS Institute, Cary, N.C.; proc npar1way, proc univariate, proc freq). Alzheimer's disease is a recognized indication for music therapy. A simple oral consent was collected prior to the study inclusion. RESULTS: Five patients were included for a total of 44 sessions. The patients' regular attendance at the music therapy sessions showed its feasibility. Thanks to oral feedback, we were able to see that music therapy was very well-accepted both by patients and caregivers. After the sessions, all patients expressed a sensation of well-being and pleasure, such as: "Music made me feel better, I feel more relaxed", "I feel better", "I didn't know that music could have such an impact on me"... Other verbal comments were collected regarding the patients' previous life experience: "This music reminds me of my childhood", "I imagined myself dancing just like I used to in the old days", "This reminds me of my trip to Italy with my children"... The level of anxiety (Hamilton scale) dropped significantly from 9.4 (+/-2.2) to 3.4 (+/-2.6) between the first session and the fourth session (P<0.004). The differences observed between W4-W10 and W1-W10 were close to the threshold of significance due to a major drop in the anxiety level starting at W4 (P=NS). On the Cornell scale, the depression level dropped significantly from 10.8 (+/-5.3) to 2.2 (+/-1.9) between the first session and the fourth session (P<0.01). The differences observed between W4-W10 and W1-W10 were not significant (P=NS). The weight of the physical and emotional burden experienced by the main caregiver (Zarit scale) fell significantly from 30.2 (+/-11.7) to 15.6 (+/-10.4) between W1-W4 (P<0.002). The differences observed between W4-W10 and W1-W10 were not significant (P=NS). DISCUSSION/CONCLUSION: This preliminary study demonstrates the feasibility as well as the initial efficacy of music therapy in terms of its impact on the overall care for patients suffering from Alzheimer's disease. This easily applicable technique can be useful in treating anxiety and depression in a patient with Alzheimer's disease and also in relieving the emotional and physical burden experienced by the main caregiver.

[Effect of music therapy among hospitalized patients with chronic low back pain: a controlled, randomized trial]. / Intérêt de la musicothérapie dans la prise en charge de la lombalgie chronique en milieu hospitalier (Etude contrôlée, randomisée sur 65 patients).

OBJECTIVE: To evaluate the influence of music therapy in hospitalized patients with chronic low back pain. METHODS: A controlled, randomized study (N = 65). During a stationary rehabilitation stay of 12 days, 65 patients with low back pain were randomized to receive on alternate months standardized physical therapy plus 4 music therapy sessions between day 1 and day 5 (intervention group; N = 33) or standardized physical therapy alone (control group; N =32). Scores for pain (as measured on a visual analogue scale [VAS]), disability (Oswestry index) and anxiety and depression (as measured on the hospital anxiety and depression scale [HAD]) were collected on day 1, 5 and 12. Pain intensity was also evaluated on a VAS just before and after music therapy sessions. RESULTS: Introduced music therapy sessions during a stationary rehabilitation stay in patients with chronic low back pain reduce pain (-2.0+/-2.7 vs -1.8+/-2.6) but not significantly. However, music therapy significantly (p < 0.01) reduced disability as measured on the Owestry index between day 1 and day 5 (-11.8+/-17.8 vs -2.5+/-9.4), anxiety (-3.5+/-3.7 vs -0.9+/-2.7) and depression (-2.1+/-3.0 vs 0.6+/-2.4). The immediate effect on pain intensity (VAS score) was confirmed (p < 0.001). CONCLUSION: Our results confirmed the effectiveness of music therapy for hospitalized patients with chronic low back pain. Music therapy can be a useful complementary treatment in chronic pain and associated anxiety-depression and behavioural consequences.

The effect of music therapy on mood and anxiety-depression: an observational study in institutionalised patients with traumatic brain injury.

INTRODUCTION: A previous study (carried out in 2003-2004) had included 34 patients with traumatic brain injury in order to study the feasibility and usefulness of music therapy in patients with this type of injury. OBJECTIVE: To evaluate the effect of music therapy on mood, anxiety and depression in institutionalised patients with traumatic brain injury. STUDY METHODOLOGY: A prospective, observational study. MATERIALS AND METHODS: Thirteen patients with traumatic brain injury were included in the present study and took part in individual, weekly, 1-hour music therapy sessions over a period of 20 weeks. Each session was divided into two 30-minute periods - one devoted to listening to music (receptive music therapy) and the other to playing an instrument (active music therapy). The assessment criteria (measured at weeks 1, 5, 10, 15 and 20) were mood (on the face scale) and anxiety-depression (on the Hospital Anxiety and Depression [HAD] Scale). Mood was assessed immediately before and after the first music therapy session and every fifth session. RESULTS: Music therapy enabled a significant improvement in mood, from the first session onwards. This short-term effect was confirmed by the immediate changes in the scores after music therapy sessions (from 4.6+/-3.2 to 2.6+/-2; p<0.01). Music therapy also led to a significant reduction in anxiety-depression (p<0.05) from week 10 onwards and up until the end of the study (week 20). CONCLUSION: These results confirm the usefulness of music therapy in the treatment of anxiety-depression and mood in patients with traumatic brain injury. Music therapy could usefully form an integral part of the management programme for these patients.

[Effects of music therapy in intensive care unit without sedation in weaning patients versus non-ventilated patients]. / Effets de la musicothérapie en réanimation hors sédation chez des patients en cours de sevrage ventilatoire versus des patients non ventilés.

OBJECTIVES: Music has been found to be an effective nonpharmacologic adjunct for managing anxiety and promoting relaxation in limited trials of critically ill patients. However, its effects have not been compared in intubated patients during weaning from mechanical ventilation with non-intubated patients spontaneously breathing. STUDY DESIGN: A cross-over randomized experimental design. PATIENTS AND METHODS: Thirty patients were studied (intubated group n = 15, non-intubated group n = 15). Patients were randomized to receive either 20 minutes of uninterrupted rest or then 20 minutes of music therapy or the music therapy first and then the uninterrupted rest period. Patients selected a relaxing music of their choice from a selection including different types of music. Heart rate (HR), systolic blood pressure (SAP), respiratory rate (RR) and bispectral index (BIS score) were recorded each 5-min intervals throughout both periods (rest and music). Agitation/sedation state and pain were evaluated by the Richmond-Agitation-Sedation-Scale (RASS) and the Numerical-Rating-Scale (NRS) respectively, before and after each studied periods. Music have not been performed in five patients (5/35 = 14%). RESULTS: Music significantly decreased HR (88+/-15 vs 82+/-15, P<0.05), SAP (137+/-17 vs 128+/-14, P<0.05), RR (25+/-3 vs 22+/-4, P<0.05), BIS (94+/-5 vs 81+/-10, P<0.01), RASS (+0.1+/-0.7 vs -0.7+/-0.9, P<0.05) and NRS (4.4+/-1.7 vs 1.9+/-1.3, P<0.01) in both intubated and non-intubated groups whereas no significant change was observed during the rest period. The variations level studied parameters induced by music were comparable for the two groups. CONCLUSION: A single music therapy session was found to be effective for decreasing anxiety and promoting relaxation, as indicated by decreases in heart rate, blood pressure, BIS and respiratory rate over the intervention period in intubated patients during weaning phase.