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Art I Go Me Salir A Importante
Art I Go Me Salir A Importante
Art I Go Me Salir A Importante
A R T I C LE I N FO A B S T R A C T
Keywords: Objectives: So far, the effects of vibroacoustic music therapy in cancer patients are unknown. However, used in
Music therapy anthroposophic medicine, it could be an approach to enhance well-being.
Cancer The goal of this study was to evaluate the immediate effects of a sound-bed music intervention with respect to
Palliative care the subjective well-being as well as body warmth and pain.
Quality of life
Patients and methods: We treated 48 cancer patients with 10 min of sound-bed intervention in a cross-over de-
Well-being
sign. Primary outcome was the total sum of the Basler Mood Questionnaire (BMQ), secondary outcomes were
Anthroposophic medicine
subscales of the BMQ and questions addressing body warmth and pain. The EORTC-QLQ C30 was used as
baseline assessment for quality of life (QOL).
Results: Patients had lower QOL values than the EORTC reference samples (p < .001, d = 0.90). The primary
outcome increased after music (p < .001, d = 0.47), no changes were seen in the control condition (p = .73,
d = 0.04), the time by condition interaction was significant (p < .05). Secondary outcomes: Increase after
music for the BMQ subscales inner balance (p < .001, d = 0.73), vitality (p < .001, d = 0.51) and vigilance
(p < .001, d = 0.37) as well as for the additional questions satisfaction (p < .001, d = 0.43), current mood
(p < .001, d = 0.43), body warmth (p < .05, d = 0.44) and warmth distribution (p < .01, d = 0.49). No
significant changes were seen in pain levels and social extroversion.
Conclusion: Sound-bed intervention improved momentary well-being and caused self-perceived physiological
changes associated with relaxation beyond the benefits of simple resting time (control condition). Thus, it might
be a promising approach to improve well-being in cancer patients.
1. Introduction Music or music therapy as one of the art therapies is a powerful and
effective medium to reduce fatigue, depression, anxiety, pain and
In the oncology setting, quantity of life and quality of life (QOL) are stress6–8 and enhance positive emotions. The specific use of music
interdependent and yet often have to be weighed up against each other therapy to positively influence behaviour and mental status represents a
when making hard therapy decisions.1 Symptoms most affecting QOL in field of growing interest in music research. “Music therapy is an es-
cancer patients are fatigue, anxiety, pain, stress, nausea, vomiting2 and tablished healthcare profession that uses music to address physical,
altered taste perception. emotional, cognitive and social needs of individuals of all ages”.9 Ad-
Different definitions of the term QOL make it difficult to compare ditionally, music therapy promotes resilience, control, comfort and
research studies.3 For example, with respect to the functional perfor- peace for people affected by life-threatening illnesses.10–12 In cancer
mance, QOL can describe the ability to walk one block or climb stairs as patients, the main goal is to stimulate physical, emotional and cognitive
well as having sufficient social support.4 The World Health Organisa- processes to influence the patient’s stress physiology, alter individual
tion (WHO QOL group) defined QOL as an individuaĺs physical health, coping behaviours and evoke positive emotions13 to engage the in-
level of independence, psychological status and social relationships as dividual’s full coping capacity.
well as the relationship to salient features of their environment.5 Today, music therapy often consists of listening to or making music
⁎
Corresponding author at: ARCIM Institute (Academic Research in Complementary and Integrative Medicine), Im Haberschlai 7, 70794, Filderstadt, Germany.
E-mail address: j.vagedes@arcim-institute.de (J. Vagedes).
https://doi.org/10.1016/j.ctim.2018.03.002
Received 1 December 2017; Received in revised form 2 March 2018; Accepted 2 March 2018
Available online 03 March 2018
0965-2299/ © 2018 Published by Elsevier Ltd.
S. Bieligmeyer et al. Complementary Therapies in Medicine 40 (2018) 171–178
Fig. 1. Exemplary scene. The therapist plays the sound-bed with the fingers while sitting beside the instrument ©Edwin Wall, studios delĺarte.
with different kinds of instruments. This kind of music therapy mostly the BMQ total sum and subscales inner balance, vitality, vigilance, so-
acts via the auditory experience. In contrast, the potential of vi- cial extroversion), body warmth, current mood and pain when com-
broacoustic or tactile effects of music has hardly been studied system- pared to a control group.
atically. The idea is that the beneficial effects of musical as well as
emotional experiences could be amplified if a person not only listens to
music, but actually senses the tactile vibration.14 2.1. Patients and methods
In clinics with an integrative approach, sound-beds are frequently
used for vibroacoustic music therapy, striving to enhance well-being 2.1.1. Design
and improve the body awareness of patients. Mainly used in an an- We did a randomized controlled clinical trial with a two-group
throposophical setting, these are made with a set of 48 strings strung cross-over design to compare the effect of a sound-bed intervention on
horizontally across the underside of the bed frame which is constructed current well-being of patients with advanced cancer to a control con-
as a wooden resonance body (Fig. 1). The strings are tuned in a special dition (lying on the sound-bed without music). The study was con-
fifth tuning called TAO (tones D, E, A, B) over four octaves. During ducted from November 2013 to May 2014. Based on a priori-G*power
treatment, the patient lies on the sound-bed while the therapist sits calculations for optimal sample size with a 20% drop-out rate included
beside the instrument and strokes evenly across the strings with the (significance α = 0.05. 1-β = 0.80; estimated effect size of the primary
fingers of both hands, producing a sound carpet. The patient hears the outcome d = 0.45 was based on an uncontrolled pilot study we had
sound and perceives the vibration of the strings through the full body conducted in advance with 16 cancer patients using the same music
contact with the wooden bed. intervention and questionnaires [unpublished]), a minimum of 48
In the last decades monochords are also increasingly used for vi- participants was required. The primary outcome was the sum score of
broacoustic music therapy, especially in German speaking countries, the Basler Mood-Questionnaire (BMQ)20 indicating mental well-being.
and have been the subject of a limited set of studies. The monochord is The study protocol was reviewed and approved by the ethics committee
a sound-bed version with approximately 30 strings tuned to one base of the University of Tuebingen and was recorded at the German Clinical
tone while nevertheless producing a variety of overtones. It has mainly Trials Register (DRKS00005411). Fig. 2 presents the flow diagram for
been explored by a research group of the Heidelberg School of participant identification, temporal evolvement and compliance
Therapeutic Sciences. In the last years, they focused on the therapeutic throughout the trial.
effects of the monochord with respect to psychological and physiolo-
gical benefits.14–18 Sandler et al.19 examined for example whether the
spontaneous EEG activity during a relaxation state induced by mono- 2.1.2. Patients
chord vibroacoustic stimulation differs from a state of relaxation in- Study participants were recruited from the Filderklinik oncology
duced by listening to audio CD relaxation music. The authors found that inpatient department by the author (S.B., psychologist), regardless of
vibroacoustic stimulation with a monochord appears to induce states of the oncological diagnosis. Patients had to be aged between 25 and 65
relaxation which are experienced as pleasant by a subset of patients and years and able to read, write and speak German. Exclusion criteria were
is associated with focused attention and a simultaneous release of extreme immobility, severe pain symptoms or previous experience with
control.19 the sound-bed. Eligible patients who agreed to participate gave written
So far, the TAO-tuned sound-bed has often been used as a ther- informed consent prior to completing the baseline assessment forms
apeutic instrument in the clinical context but to the best of our (demographic data and case history, EORTC-QLQ C30). Using opaque
knowledge the effects of this approach have not been systematically envelopes for the randomization procedure, participants were ran-
studied yet. We therefore did a randomized controlled trial to evaluate domly assigned to either music intervention followed by control in-
the immediate effects on the general well-being of oncology patients tervention or control intervention followed by music intervention. For
after 10 min of TAO-tuned sound-bed intervention. every block of four participants, two envelopes were allocated to each
arm of the trial to ensure groups of approximately the same size. Block
2. Objectives size was unknown to the participants so that the schedule was not
predictable. The participants opened the envelopes immediately before
We hypothesized that oncological patients who receive the TAO- the first intervention so that at this moment the author was informed
tuned sound-bed intervention show a significantly greater short-term about the actual sequence for the respective participant. Randomization
improvement in self-reported parameters of well-being (as assessed by was carried out by the author.
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Table 1
Baseline characteristics of study participants by group.
Total Group 1 Group 2
Music-Control Control-Music
n = 44 n = 21 n = 23
across groups via t-tests. The additional questions were treated as ex- Table 3
ploratory testing. EORTC QLQ C-30 results were compared with the Distribution of tumour diagnosis of participants.
reference samples of the questionnaire (a general population sample25 primary diagnosis number of patients %
and an oncology reference sample [EORTC Manual, p. 15 ff., “All
cancer patients: all stages”26]) calculating t-tests. Effect sizes were Mamma CA 12 27.3
calculated for each parameter using Cohen’s d. The statistical sig- Colorectal CA 6 13.6
Bronchial CA 4 9.1
nificance was set at p < .05; all reported p values are two-tailed.
Lymphoma 4 9.1
Others 18 40.9
3. Results
3.1. Demographic data Carboplatin, three with Doxorubicin, three were treated according to
the Folfox scheme. The remaining patients received other chemother-
Baseline characteristics were balanced across treatment arms. There apeutics such as Bortezomib, Capecitabin and the PCV and PEB
were no statistically significant differences between the groups in the schemes. Antibiotics were administered to 18% of all patients (n = 8),
baseline demographic and medical parameters (Tables 1 and 2). Data Cortisone to 23% (n = 10). Eight patients underwent full-body hy-
were obtained from 31 female and 13 male patients (aged 29.3–65.6 perthermia, five had local applications and two received full-body as
yrs, mean age: 54.4 yrs, SD = 7.7). Twelve patients (27%) had breast well as local hyperthermia. Bisphosphonates were administered to three
cancer, the others had different cancer diagnoses (Table 3). Almost 30% patients. Almost two thirds (n = 28) of all patients received mistletoe
(29.5%) reported previous experience with relaxation techniques and therapy with Abnoba viscum fraxini (68% of all mistletoe treatments),
34% often listen consciously to music. During the study, twenty-three Iscador Q (11%), Helixor M (7%), Iscador M (7%), Iscador U or Helixor
patients (52%) underwent chemotherapy, four of these with P (7%).
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Table 4
Descriptive statistics (M (SD)) of behavioural parameters at t1 and t2 for music and control condition.
music control
t1 t2 t1 vs. t2 t1 t2 t1 vs. t2
BMQ
Total sum 71.80 (19.67) 81.00 (16.26) t(43) = −3.98. p < .001 73.52 (20.62) 72.75 (20.63) t(43) = 0.35. p = .73
Inner balance 19.70 (5.18) 23.47 (4.40) t(43) = −5.72. p < .001 20.50 (5.28) 20.84 (5.39) t(43) = −0.49. p = .63
Vitality 16.50 (6.31) 19.75 (5.33) t(43) = −4.12. p < .001 16.41 (6.17) 16.73 (5.85) t(43) = −0.54. p = .59
Vigilance 18.52 (5.39) 20.50 (4.95) t(43) = −2.60. p = .01 18.95 (.84) 18.55 (5.56) t(43)=0.58. p = .57
Social extroversion 17.07 (5.58) 17.27 (4.95) t(43) = −0.25. p = .81 17.66 (5.55) 16.64 (5.86) t(43) = 1.74. p = .09
Additional questions
Satisfaction 4.53 (1.93) 5.36 (1.78) t(43) = −3.83. p < .001 4.45 (2.12) 4.61 (1.94) t(43) = −0.62. p = .54
Current mood 5.02 (1.73) 5.36 (1.78) t(43) = −5.69. p < .001 5.27 (1.56) 5.18 (1.54) t(43) = 0.45. p = .66
Pain intensity 12.88 (19.59) 10.00 (16.3) t(43) = 1.28. p = .21 12.75 (18.62) 15.36 (21.56) t(43) = −1.86. p = .07
Body warmth 5.14 (1.46) 5.77 (1.38) t(43) = −2.50. p = .02 4.68 (1.60) 4.70 (1.79) t(43) = −0.104. p = .92
Warmth distribution 4.80 (1.94) 5.75 (1.30) t(43) = −2.84. p = .007 4.57 (1.86) 4.86 (1.75) t(43) = −1.29. p = .2
marginally significantly in the control group (Table 4). No other ad- the total sum of the BMQ scored higher after the sound-bed intervention
verse effects were reported. indicating greater well-being. The BMQ subscales (secondary outcomes)
inner balance, vitality and vigilance enhanced only in the music inter-
3.3. Quality of life (EORTC QLQ C-30) vention group. Furthermore, significant improvements in body warmth,
warmth distribution, present mood and overall satisfaction were observed
At baseline, we found a significantly lower QOL global score for our in the music intervention group (additional questions, secondary out-
participants compared to a general population reference sample [25](t comes). However, no changes were found with respect to social ex-
(3062) = −6.37, p < .001, d = −0.90). With respect to the subscales, troversion which is in line with the results of Baumann and Schüle who
all values of the functional dimension were significantly lower (Fig. 3), used the BMQ to evaluate effects of physical activity in cancer pa-
whereas symptom dimension values (Fig. 4) were higher than those of tients.23 A marginally significant increase in pain intensity (additional
the reference sample, indicating lower quality of life. For pain, the questions) was reported in the control group. During the interventions,
difference between our study population and the general population patients had to lie on the wooden sound-bed for 20 min with only a
sample was only a trend (t(3062) = 1.91, p ≤ .10 (*)) which can be woollen blanket as padding underneath. If no music was played this
explained by the fact that our patients received pain medication if re- might have been more consciously experienced as slightly un-
quired. comfortable which might have resulted in a stronger perception of pain.
Compared to the reference samplesof EORTC QLQ C-30, our study
4. Discussion population reported lower QOL values.
Focusing on the vibroacoustic stimulation during sound-bed inter-
To the best of our knowledge, this is the first randomized controlled vention, a research group of the Department of Psychosomatic Medicine
study to compare the immediate effects of a TAO-tuned sound-bed in- at the Charité in Berlin/Germany recently examined the spontaneous
tervention on cancer patients with a control condition. We determined EEG activity during vibroacoustic stimulation compared to the relaxa-
overall well-being measured by the Basler Mood Questionnaire as our tion state induced by listening to audio CD relaxation music in patients
primary outcome (BMQ total sum). Compared to the control condition, with a psychosomatic disorder. The authors found changes in EEG
Fig. 3. EORTC QLQ-C30 functional scales of study participants compared with a general population25 and an oncology reference sample of the EORTC manual
(means and standard deviation with ***p ≤ .001).
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Fig. 4. EORTC QLQ-C30 symptom scales of study participants compared with a general population25 and an oncology reference sample of the EORTC manual (means
and standard deviation with ***p ≤ .001).
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S. Bieligmeyer et al. Complementary Therapies in Medicine 40 (2018) 171–178
6.0
(***)
5.5 (*)
body warmth
(**)
4.5
Fig. 6. Mean ( ± SE) changes in the additional questions over each condition. Each item scored from 1 to 7; higher numbers indicate greater values for body warmth,
warmth distribution, actual mood and overall satisfaction.
Chemotherapy might in some patients have caused peripheral neuro- to Dr Katrin Vagedes, Tido von Schön-Angerer and Prof David Martin
pathy which could result in an impaired sensitivity for the vibroacoustic for help with the translation. The study was financed by the ARCIM
stimulation whose possible impact could not be quantified and thus Institute.
might be another source of bias. Moreover, only few of the oncological
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