NUR2300-Evidence Based Practice In Nursing

PICOT: 

Research question: 

In patients with depression, how does music therapy as compared to standard treatment affect the quality of life and symptom management within 1 to 6 months?

The population chosen for the Research question is the patient suffering from different symptoms of depression and the Research question development the systematic review was made using the PICOT format.  In this case the population is the patients with depression, the intervention is music therapy,  the comparison is the standard treatment for depression,  outcome is better quality of life and better symptomatic management,  and the time frame selected is six months to a year.

Evaluation of research: 

The first article chosen for this intervention study is the randomized control trial by Bidabadin and Mehryar, (2015) which evaluated the effectiveness of music therapy on symptoms of home of that anxiety and depression among the obsessive compulsive disorder patients.  The research in of this article was to evaluate the role of music in the treatment of search patients with depression symptoms and potential therapeutic benefits.  Research method selected for the study had been a single-center parallel-group randomized control trial which indicates that this is a primary source article.  The sampling was very small with only 30 patients of obsessive compulsive disorder that has also been suffering from depression symptoms and division of the patient groups was divided equally with 15% receiving music therapy and 15% being the control group.  The process of the study the evaluation measurement had been done using the Maudsley Obsessive–Compulsive Inventory, Beck Anxiety Inventory, and Beck Depression Inventory-Short Form which had been administered baseline along with one month after intervention. Considering the ethical considerations that have been upheld in the research article it has been mentioned that the protocol of the study was approved by the ethics committee of the faculty of psychology of the university.  However, no other information regarding ethical consideration for this being human subject study trial was evident in the article which can be considered a possible con (McCusker & Gunaydin, 2015).  The data findings indicated that the effect of the music therapy was significantly successful in the patient group selected (Bidabadin & Mehryar, 2015).

Research topic:

Depression is one of the most abundantly reported mental health disorders that is prevailing is a chronic disease all across the globe (Van, De & Vermote, 2015).  From the statistical reports that have been shared it can be mentioned that 3 million Australians are living with depression and every year 6% of Australians have been reported to acquire depression symptoms (Health.gov.au, 2018).  Furthermore data has also revealed that on an average around one among 6 women and one among 8 men have been predicted to experience some level of depression in the Australian population.  It has to be mentioned that depression associated co-morbidities affect well being personal relationships career and productivity of an individual which collectively impacts the quality of life and leads the individual towards self harming tendencies and suicidality. Only 35 % of the Australian depressed treatment access depression treatment and a very important contributing factor to the lack of health seeking behaviour is the exhaustive treatment procedures and extreme costs associated with it.  Hence, it is very important to discover treatment modalities that are cost effective and can also improve not just the symptoms of the risotto but also holistically improve the overall quality of life of these patients.  Music therapy has been identified as Earth excellent non pharmacological treatment that can provide long term symptomatic relief in not just mental disorders but also neurological aspects such as pain and sleep deprivation (Im & Lee, 2014). Hence, the research topic for this systematic review was decided to be music therapy intervention and its efficiency on improving the quality of life and other related symptoms of patients that are suffering from only depression or depression co-occurring with other mental illnesses (Zhao et al., 2016). 

Systematic review:

Considering the first research article selected,  Bidabadin and Mehryar, (2015) of selected the intervention of music therapy as a combined intervention technique with the standard treatment for the patients as compared to only standard treatment to perceive how the music therapy affected the living quality and provided symptomatic management of the co-occurring disorders of OCD with depression and anxiety.  The authors have mention the relevance of the research study with the fact that all the music therapy is a very common intervention that is used in community mental health centres but it has not been evaluated in patients with co-occurring disorders. The data findings indicated the post intervention score for music therapy with standard treatment being 10.8±3.8 vs standard treatment: 17.1±3.7, p<0.001, effect size=47.0% (Bidabadin & Mehryar, 2015).  Hence from this study it can be concluded that when music therapy is provided in combination with standard treatment to provide adequate symptomatic management and quality of life increases multiple falls in patients with co-occurring disorders involving depression.

The second research article chosen for this review study by Carr  et  al. (2017),  that focused on the feasibility and acceptability of group music therapy as compared to wait list control as a treatment for patients with long-term depression.  The starter design selected for this research article has been single centre randomized controlled feasibility trial.  It has to be mentioned in this context that the choice of single Centre randomized control is effective in this case because it is conducted in a single hospital which mix the entire study design very cost-effective and easy to successfully implement. Possible flaws of the research study design are the discrepancies associated with different data connection biases which can affect the authenticity of the data findings (Johnston, 2017).  Considering the process of intervention applied and the research conducted the authors chose a nested process evaluation for the study.  The sample size of the article was also very limited with only 30 participants randomly assigning with unbalanced allocation to the music therapy intervention group and wait list control group.  In this case the very small sample size has to be criticized about this research articles which can affect the general liability and transferability of the data findings.  The intervention was given 3 times per week in a community centre and the time frame for the research was said between three to six months after the intervention is completed. This study had also could significantly prove the effectiveness of the music therapy interventions in improving the symptoms of depression. Although, the very small sample size and the single centred study design are considerable limitations of this study which has to be taken into consideration for this study (Bialystok et al., 2015).

The third and last research article selected for this review is Lund, Heyman-Shlaczinska and Pederson, (2017), and this particular article emphasizes on a different aspect of patients with depressive symptoms which provides a different insight on the review study. On an elaborative note, this research article focuses on evaluating the effectiveness of music therapy to improve the sleep quality in depression patients which is a very important indicator of quality of life and symptomatic control in the depression patients.  Insomnia among the depression patient is one of the most contributed factors to reduced quality of life and deteriorating symptoms.  This randomized control trial address the use of Music as a treatment modality for patients in depression and the process of the research was exploratory mixed methods.  It has to be mentioned that mixed method designs are usually more details and authentic in the data findings and is also very easy to implement which has to be appreciated for this article (de la Rubia Ortí et al., 2018).  The data collection was from 3D accelerometer and using iPad called “the music star”, developed by Danish music therapist in psychiatry (Lund, Heyman-Shlaczinska & Pederson, 2017).  The follow-up was taken using semi structured interviews on the 11 participants that have been selected for this feasibility study.  The date of findings revealed positive results both in terms of participation and in sleep quality which further improved the quality of life and reduced the determination of the depression symptoms. Along with improving the quality of life and enhancing the effectiveness of the treatment music therapy in depression patients can also improve the sleep quality which can eradicate the issue of Insomnia and associated deterioration from the lives of patients suffering from depression completely (Chu et al., 2014).

Future research recommendation: 

From the research that has been conducted for this systematic review it was clearly identified that music therapy used in conjunction with standard treatment can improve the quality of life and reduce the time required for recovery in depression patients.  along with that from the article by Lund, Heyman-Shlaczinska and Pederson, (2017),  it was also identified that music intervention can also improve the sleep quality among these patients.  the data findings also supports the main idea of this review study it has to be acknowledged it is well that the sample population for all three studies selected have been very small and its limits the integration of this interventions in treatment procedures or National chronic disease management strategic framework without any large scale data points (Aihw.gov.au, 2018). Hence, in this case, the future research recommendations will be to conduct a more large scale study to evaluate the effectiveness of the intervention and the recommended study design is multi-centred double blinded randomized control trial which will ensure reliable data finds with utmost authenticity and minimum bias 

Bibliography: 

Bidabadi, S. S., & Mehryar, A. (2015). Music therapy as an adjunct to standard treatment for obsessive compulsive disorder and co-morbid anxiety and depression: A randomized clinical trial. Journal of affective disorders, 184, 13-17. Retrieved from https://doi.org/10.1016/j.jad.2015.04.011

This single-center, parallel-group, randomized clinical trial has attempted to understand and evaluate the effectiveness of the music therapy on the patients of obsessive compulsive disorder along with depression to judge the effectiveness on better symptomatic management and improving quality of life. The results indicated considerably better symptomatic management than standard treatment used alone.

Carr, C. E., O’Kelly, J., Sandford, S., & Priebe, S. (2017). Feasibility and acceptability of group music therapy vs wait-list control for treatment of patients with long-term depression (the SYNCHRONY trial): study protocol for a randomised controlled trial. Trials, 18(1), 149. Retrieved from https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-1893-8

This single-centre randomised controlled feasibility trial attempted to understand the effects of group music therapy to judge the positive outcome on patients with long term depression. The results indicated positive outcomes that aimed at better life quality and reduced deterioration of symptoms.

Lund, H. N., Heyman-Shlaczinska, A., & Pedersen, I. N. (2017). From pilot project to RCT–Music intervention to improve sleep quality in depressed patients: A mixed methods study. European Psychiatry, 41, S240. Retrieved from https://doi.org/10.1016/j.eurpsy.2017.02.009

This particular study attempted to understand the feasibility of music therapy on the sleep disorder encountered by the depression patients which is a very common adverse condition associated with depression. The data findings showed significant improvements in sleep quality and duration for the target patients which indicates at the multimodality of this intervention

Bialystok, E., Kroll, J. F., Green, D. W., MacWhinney, B., & Craik, F. I. (2015). Publication bias and the validity of evidence: What’s the connection?. Psychological science, 26(6), 944-946. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/0956797615573759?journalCode=pssa

Bidabadi, S. S., & Mehryar, A. (2015). Music therapy as an adjunct to standard treatment for obsessive compulsive disorder and co-morbid anxiety and depression: A randomized clinical trial. Journal of affective disorders, 184, 13-17. Retrieved from https://doi.org/10.1016/j.jad.2015.04.011

Carr, C. E., O’Kelly, J., Sandford, S., & Priebe, S. (2017). Feasibility and acceptability of group music therapy vs wait-list control for treatment of patients with long-term depression (the SYNCHRONY trial): study protocol for a randomised controlled trial. Trials, 18(1), 149. Retrieved from https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-1893-8

Chronic disease Overview – Australian Institute of Health and Welfare. (2018). Retrieved from https://www.aihw.gov.au/reports-statistics/health-conditions-disability-deaths/chronic-disease/overview

Chu, H., Yang, C. Y., Lin, Y., Ou, K. L., Lee, T. Y., O’Brien, A. P., & Chou, K. R. (2014). The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study. Biological research for Nursing, 16(2), 209-217. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/1099800413485410 

de la Rubia Ortí, J. E., García-Pardo, M. P., Iranzo, C. C., Madrigal, J. J. C., Castillo, S. S., Rochina, M. J., & Gascó, V. J. P. (2018). Does Music Therapy Improve Anxiety and Depression in Alzheimer’s Patients?. The Journal of Alternative and Complementary Medicine, 24(1), 33-36. Retrieved from https://www.liebertpub.com/doi/abs/10.1089/acm.2016.0346

Health.gov.au. (2018). Department of Health | National Strategic Framework for Chronic Conditions. [online] Available at: https://www.health.gov.au/internet/main/publishing.nsf/content/nsfcc [Accessed 28 Sep. 2018].

Im, M. L., & Lee, J. I. (2014). Effects of art and music therapy on depression and cognitive function of the elderly. Technology and Health Care, 22(3), 453-458. Retrieved from https://content.iospress.com/articles/technology-and-health-care/thc00803 

Johnston, M. P. (2017). Secondary data analysis: A method of which the time has come. Qualitative and Quantitative Methods in Libraries, 3(3), 619-626. Retrieved from https://www.qqml-journal.net/index.php/qqml/article/view/169 

Lund, H. N., Heyman-Shlaczinska, A., & Pedersen, I. N. (2017). From pilot project to RCT–Music intervention to improve sleep quality in depressed patients: A mixed methods study. European Psychiatry, 41, S240. Retrieved from https://doi.org/10.1016/j.eurpsy.2017.02.009

McCusker, K., & Gunaydin, S. (2015). Research using qualitative, quantitative or mixed methods and choice based on the research. Perfusion, 30(7), 537-542. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/0267659114559116 

Van, E. A., De, J. B., & Vermote, R. (2015). Music therapy and depression. Tijdschrift voor psychiatrie, 57(11), 823-829. Retrieved from https://europepmc.org/abstract/med/26552929 

Zhao, K., Bai, Z. G., Bo, A., & Chi, I. (2016). A systematic review and meta?analysis of music therapy for the older adults with depression. International journal of geriatric psychiatry, 31(11), 1188-1198. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.4494