Strategies for Recruiting People With Dementia to Music Therapy Studies: Systematic Review.

Positive effects of music therapy for people with dementia and their family carers are reported in a growing number of studies. However, small sample sizes or low recruitment rates often limit the success of these research studies. More adequately powered evidence-based studies are needed to impact policy and funding in dementia care. This systematic review examined recruitment strategies in music therapy clinical trials involving people living with dementia and/or their family carers. Eligible studies described enrolment, consent, accrual, or recruitment methods as well as recruitment or consent rates. Thirty studies with a total of 1,192 participants were included. Recruitment and conversion rates in residential aged care facilities (RACFs) (14 studies) were substantially higher than in community-based studies (16 studies). Whereas studies in RACFs most commonly recruited participants through staff approaching residents face-to-face or conversing with residents' legal guardians, community-based studies utilized a vast array of strategies, including staff referral, demonstrations/information sessions by researchers, advertisements, and direct contact with residents. Recruitment rates are likely to be higher when recruiters have an existing relationship with potential participants and when an independent third-party dementia organization is involved. Randomized controlled trials led to equally or greater recruitment conversion rates than other designs. Findings suggest that recruitment in dementia trials is complex, challenging, and needs thorough planning and consideration to be time- and cost-effective. Future studies should include reporting of recruitment strategies, enrolment rates, and related aspects so that researchers can better design recruitment strategies and estimate resources needed to reach the target sample size.

Treatment Fidelity in a Music Therapy Multi-site Cluster Randomized Controlled Trial for People Living With Dementia: The MIDDEL Project Intervention Fidelity Protocol.

High-quality clinical trials testing music therapy interventions have become more prevalent over the past decade. However, recent reviews of published music therapy trials reveal that reporting of strategies used to ensure treatment fidelity is lacking. Treatment fidelity refers to methodological strategies, put in place prior to clinical trial implementation, to strengthen the reliability and validity of intervention delivery and, therefore, safeguard research quality. This paper outlines strategies developed and implemented during the pilot phase of a randomized controlled trial involving the testing of music interventions for people living with dementia and presenting with symptoms of depression. We discuss the five recognized components of fidelity (study design, training intervention providers, treatment integrity, treatment differentiation, and treatment receipt) and describe our methods for training music intervention providers and testing interventionist competence prior to trial commencement, approaches to intervention delivery supervision, and methods for assessing intervention protocol adherence.

Participant-selected music and physical activity in older adults following cardiac rehabilitation: a randomized controlled trial.

OBJECTIVE: To evaluate effects of participant-selected music on older adults' achievement of activity levels recommended in the physical activity guidelines following cardiac rehabilitation. DESIGN: A parallel group randomized controlled trial with measurements at Weeks 0, 6 and 26. SETTING: A multisite outpatient rehabilitation programme of a publicly funded metropolitan health service. SUBJECTS: Adults aged 60 years and older who had completed a cardiac rehabilitation programme. INTERVENTIONS: Experimental participants selected music to support walking with guidance from a music therapist. Control participants received usual care only. MAIN MEASURES: The primary outcome was the proportion of participants achieving activity levels recommended in physical activity guidelines. Secondary outcomes compared amounts of physical activity, exercise capacity, cardiac risk factors, and exercise self-efficacy. RESULTS: A total of 56 participants, mean age 68.2 years (SD = 6.5), were randomized to the experimental ( n = 28) and control groups ( n = 28). There were no differences between groups in proportions of participants achieving activity recommended in physical activity guidelines at Week 6 or 26. Secondary outcomes demonstrated between-group differences in male waist circumference at both measurements (Week 6 difference -2.0 cm, 95% CI -4.0 to 0; Week 26 difference -2.8 cm, 95% CI -5.4 to -0.1), and observed effect sizes favoured the experimental group for amounts of physical activity (d = 0.30), exercise capacity (d = 0.48), and blood pressure (d = -0.32). CONCLUSIONS: Participant-selected music did not increase the proportion of participants achieving recommended amounts of physical activity, but may have contributed to exercise-related benefits.

Older Adults' Music Listening Preferences to Support Physical Activity Following Cardiac Rehabilitation.

BACKGROUND: Music listening during exercise is thought to increase physiological arousal and enhance subjective experience, and may support physical activity participation among older adults with cardiac disease. However, little is known about how music preferences, or perceptions of music during exercise, inform clinical practice with this population. OBJECTIVE: Identify predominant musical characteristics of preferred music selected by older adults, and explore participants' music listening experiences during walking-based exercise following cardiac rehabilitation. METHODS: Twenty-seven participants aged 60 years and older (21 men, 6 women; mean age = 67.3 years) selected music to support walking over a 6-month intervention period, and participated in post-intervention interviews. In this two-phase study, we first identified predominant characteristics of participant-selected music using the Structural Model of Music Analysis. Second, we used inductive thematic analysis to explore participant experiences. RESULTS: Predominant characteristics of participant-selected music included duple meter, consistent rhythm, major key, rounded melodic shape, legato articulation, predictable harmonies, variable volume, and episodes of tension with delayed resolution. There was no predominant tempo, with music selections ranging from slow through to medium and fast. Four themes emerged from thematic analysis of participant interviews: psycho-emotional responses, physical responses, influence on exercise behavior, and negative experiences. CONCLUSIONS: Findings are consistent with theory and research explaining influences from music listening on physiological arousal and subjective experience during exercise. Additionally, for older adults with cardiac disease, a holistic approach to music selection considering general well-being and adjustment issues, rather than just exercise performance, may improve long-term lifestyle changes and compliance with physical activity guidelines.

Music interventions and physical activity in older adults: a systematic literature review and meta-analysis.

OBJECTIVE: To determine the effectiveness of music interventions in increasing physical activity in older adults. METHODS: Searches until March 2011 were conducted through CINAHL, MEDLINE, EMBASE, PubMED, AMED, PsychINFO, AUSPORT, PEDro, OTseeker, Expanded Academic ASAP, SPORTDiscus, and The Cochrane Library. Selection criteria included older adults, music interventions, physical activity outcomes, and quantitative designs. Two reviewers independently screened records. Study details included objectives, designs, participants, music interventions, physical activity outcomes, and results. Risk of bias was assessed using the PEDro scale. RESULTS: The review included 12 low to moderate quality studies with 309 participants. Three meta-analyses conducted for the review (4 trials and 99 participants) did not demonstrate any within-session differences in comparisons between music and no-music interventions. Two individual trials of moderate quality demonstrated increased capacity to perform physical activity following exercise programs with music over 4 and 8 weeks compared with no-music. There was no evidence that any particular music intervention was superior to another. CONCLUSION: Evidence from a small number of low to moderate quality trials did not demonstrate within-session improvements for older adults who listen to music during exercise. However, there may be cumulative benefits following programs with music over several weeks.

The Effects of Live Patterned Sensory Enhancement on Group Exercise Participation and Mood in Older Adults in Rehabilitation.

BACKGROUND: Older adults in rehabilitation often experience barriers to exercise, which may impede recovery. Patterned sensory enhancement (PSE) is a neurologic music therapy intervention for sensorimotor rehabilitation. The use of live music during patterned sensory enhancement (live-PSE) may be particularly beneficial in meeting patient needs and improving older adults' exercise participation and mood during therapy. OBJECTIVE: To examine the effects of live-PSE on exercise output, exercise adherence, ratings of perceived exertion, and mood for 24 older adult inpatients in a rehabilitation facility attending a group exercise program. METHODS: Using a within-subjects design, results from sessions involving exercise instruction and live-PSE (experimental condition) were compared with sessions of exercise instruction alone (control condition). A logbook documenting participant comments and behaviors was also maintained. RESULTS: There were no significant between condition differences for the exercise outcome measures. Between condition session outcome measures for mood were non-significant for all profiles except confusion, which suggested that some participants might have become more confused during sessions with live-PSE. Unsolicited participant comments and behaviors recorded in the logbook indicated that 21 participants perceived experimental sessions positively, 2 reacted negatively, and 1 did not express any preferences. CONCLUSIONS: Live-PSE did not significantly improve exercise outcomes and there were indications of increased confusion during experimental sessions for some participants. However, participant comments and behaviors also suggested positive experiences during sessions with live-PSE Further research to investigate these discrepant results is warranted, and might best be explored using a mixed methods approach.