Heart Rate Variability in Surgical Patients Experiencing Live Bedside Music; An Explorative Study.

It's known that surgery elicits a stress response involving the autonomic nervous system (ANS) which is important in general recovery but can also have detrimental effects in older patients. Music seems to positively effect postoperative recovery, although the mechanism requires further unravelling. Our objective was to explore the response of the ANS to live bedside music in older surgical patients, by using heart rate variability (HRV) as a proxy. This explorative prospective non-randomized controlled cohort study included 101 older non-cardiac surgical patients, with a median age of 70 (range 60-88 years). HRV was measured in a cohort receiving live bedside music provided by professional musicians and in a control group that did not receive music. HRV was measured pre-intervention, during the intervention, 30 min after the intervention, and again after three hours. Mixed linear modelling was used to assess the effect of the intervention compared to the control group over time. A significant change in both the low and high frequency bands (p = 0.041) and (p = 0.041) respectively, was found over time in the music group compared to the control group indicating relaxation and increased parasympathetic activity in the music group. Other measures revealed a trend but no significant effect was shown. These results provide a first glance and contribute to a better understanding of the effect of music on the recovery of older surgical patients.

Music and low-frequency vibrations for the treatment of chronic musculoskeletal pain in elderly: A pilot study.

BACKGROUND: Transcutaneous vagal nerve stimulation has analgesic potential and might be elicited by abdominally administered low-frequency vibrations. The objective was to study the safety and effect of a combination of music and abdominally administered low-frequency vibrations on pain intensity in elderly patients with chronic musculoskeletal pain. METHODS: This trial was an international multicenter, randomized controlled pilot study. Patients at age ≥ 65 years with musculoskeletal pain for ≥ 3 months and a daily pain score ≥ 4 out of 10 were recruited at three centers. They were randomized to receive either a combination of music and low-frequency (20-100 Hz) vibrations administered to the abdomen, or a combination with the same music but with higher frequency (200-300 Hz) vibrations administered to the abdomen. Low-frequency vibrations were expected to result in pain reduction measured with a numeric pain rating scale (NRS). Patients in both groups received eight treatments of the music combined with the vibrations in three weeks. Primary outcomes were safety (Serious Adverse Events) and pain intensity measured at baseline, after the last treatment and at six weeks follow-up. Multilevel linear model analyses were performed to study group and time effects. RESULTS: A total of 45 patients were analyzed according to intention-to-treat principle. After 344 treatments, 1 Adverse Event was found related to the intervention, while 13 Adverse Events were possibly related. A multilevel linear model showed that the interaction effect of group by time did not predict pain intensity (F[1, 45.93] = 0.002, p = 0.97) when comparing pain intensity at baseline, after the last treatment and at follow-up. CONCLUSIONS: The combination of music and abdominally administered vibrations was found to be safe and well tolerated by the elderly patients. However, over time, neither the low-frequency treatment group nor the high-frequency treatment group provided clinically meaningful pain relief. There is no evidence that the low-frequency treatment elicited vagal nerve stimulation. TRIAL REGISTRATION: The trial was prospectively registered in the Netherlands Trial Register (NTR: NL7606) on 21-03-2019.

Influence of respiration frequency on heart rate variability parameters: A randomized cross-sectional study.

BACKGROUND: Many patients visiting physiotherapists for musculoskeletal disorders face psychosocial challenges which may form a large barrier to recover. There are only a limited number of evidence based psychosocial therapies, but they are mainly based on breathing exercises. OBJECTIVE: to study which respiration frequency would lead to the highest relaxation, reflected in vagal tone derived from the heart rate variability (HRV) in healthy subjects. METHODS: A randomized controlled cross sectional study was performed. Respiration cycles of four, five, six, seven and eight breaths per minute (BPM) were delivered in randomized order for two minutes each. HRV metrics were measured during the sessions with electrocardiogram (ECG). Repeated Measures ANOVA's were performed to analyze differences between breathing frequencies. RESULTS: 100 healthy volunteers were included (40 male). Standard Deviation of inter beat intervals (SDNN) values were significantly highest at 5 BPM, whereas the Root Mean Square of Successive Differences (RMSSD) values appeared highest at 7 breaths per minute (p< 0.01). High Frequency (HF) power was lowest at 4 BPM, whereas Low Frequency (LF) power was not significantly influenced by respiration frequency. CONCLUSIONS: Breathing at a frequency of 5 to 7 breaths per minute leads to highest HRV values, but there is no single respiration ratio that maximizes all metrics. Physiotherapists may use five to seven BPM as guidance to determine ideal breathing frequencies.

Does Mindfulness Improve After Heart Coherence Training in Patients With Chronic Musculoskeletal Pain and Healthy Subjects? A Pilot Study.

BACKGROUND: Mindfulness and heart coherence training (HCT) training are applied increasingly in the treatment of patients with chronic musculoskeletal pain (CMP). Questionnaires have been developed to assess changes in mindfulness but no gold standard is available. OBJECTIVE: Explore the relationship between changes in mindfulness scores and changes in heart coherence after 3 sessions of HCT in patients with CMP and in healthy subjects. RESEARCH METHOD/DESIGN: Ten patients with CMP and 15 healthy subjects were trained in self-regulation with the use of HCT following a standardized stress relief program developed by the HeartMath Institute. A heart coherence-score (HC-score) was constructed with scores ranging from 0-100 with higher scores reflecting more heart rate variability (HRV) coherency. Change scores, Spearman correlation coefficients, and Wilcoxon Signed Rank test were calculated to test relationships and differences between HC-score, the Mindfulness Attention and Awareness Scale (MAAS) and Five Facet Mindfulness Questionnaire (FFMQ). A new questionnaire was constructed to explore on which mindfulness-related domains patients with CMP report changes after HCT. RESULTS: Increases were present on HC-score in healthy subjects (P<.01) and in patients (P<.01) between baseline and follow-up. Effect sizes on change on the MAAS and FFMQ were low. Weak (r<0.25) and non-significant correlations were observed in change scores between HC-score and MAAS or FFMQ. Patients reported significant favorable differences on 6 mindfulness related domains in the new questionnaire: breathing rhythm, physical awareness, positive or negative emotions, recognition of stressful situations, thoughts, and tendency to actively self-regulate. CONCLUSIONS: In this pilot study, mindfulness as assessed by the MAAS and FFMQ does not appear to improve after HCT. HRV coherency, MAAS, and FFMQ measure different constructs and are weakly related. It is of great importance to choose and develop valid measures that reflect patients' states of mindfulness. Content and face validity of measures of mindfulness may be considered in the light of performance-based measures.

Heart coherence training combined with back school in patients with chronic non-specific low back pain: first pragmatic clinical results.

The aim of this study was to explore on which variables a stress reduction program based on heart coherence can enhance the effects of a back school (BS) in patients with chronic non-specific low back pain and to explore possible moderators for treatment success. A retrospective explorative design was carried out with 170 patients with chronic non-specific low back pain. 89 Patients were admitted to BS and 81 patients were selected for BS and heart coherence training (BS-HCT). Six sessions of heart coherence were provided. At T0 (baseline) and T1 (discharge), the Numeric Rating Scale for pain (NRS pain), Roland Morris Disability Questionnaire (RMDQ), Pain Disability Index (PDI) and Rand-36 were administered in both groups. Both groups improved significantly on NRS pain, RMDQ, PDI and most of the Rand-36 subscales. On physical functioning, the BS-HCT group improved significantly more than the BS group (p = 0.02) but not after Bonferroni correction. Significant moderate correlations (r = 0.39 and r = 0.48) were found between the change of heart coherence and change of PDI and RMDQ respectively, but not with other variables. Baseline characteristics were not related to change on heart coherence. Providing HCT was more effective on physical functioning compared to a BS program. Change in heart coherence was related significantly to 2 out of 12 analyses. Placebo controlled and blinded studies are needed to confirm this. Characteristics of individuals who might benefit remain unknown. Evidence of this study is considered a level C, because of its pragmatic clinical character.