The effects of singing on lung function and quality of life in children and adults with cystic fibrosis

Review question

We reviewed the evidence of the effects of using singing as an add-on treatment in children and adults with cystic fibrosis.

Background

People with cystic fibrosis are at risk of chest infections due to abnormally thick mucus in their airways. Airway clearance is therefore an important part of managing the condition. Increasing anecdotal reports suggest that singing may support lung function and enhance quality of life in people with cystic fibrosis. We searched for trials using the standard search methods of the Cochrane Cystic Fibrosis and Genetic Disorders Group, and conducted extensive searches in other relevant databases and publications. This is an update of a previously published review.

Search date

The evidence is current to: 18 February 2016.

Study characteristics

The review includes one study with 40 children with cystic fibrosis aged between seven and 17 years of age. This study compared a specially designed singing intervention with other non-physical leisure activities (recreation) and children were selected for the singing or the recreation program randomly. The study lasted two weeks and children were followed up for between six and eight weeks. The study assessed the impact of singing on respiratory muscle strength, quality of life and lung function tests.

Key results

Participants from both the singing and recreation groups reported some improvement in quality of life measurements. Participants in the singing group demonstrated a greater increase in maximal expiratory pressure (a substitute measure of respiratory muscle strength test), while participants in the recreation group did not show improvement. No adverse events were reported. There is currently not enough evidence to assess the effect of singing on clinical outcomes in people with cystic fibrosis. Future studies using robust methods are needed to assess the possible effects of singing for people with cystic fibrosis

Quality of the evidence

The included study was limited by the small number of participants (only 51 participants enrolled and only 40 analysed) and a high drop-out rate (21%). We also think the fact that young people who were keen to sing were enrolled in the study, could have affected the study results.

Authors' conclusions: 

There is insufficient evidence to determine the effects of singing on quality of life or on the respiratory parameters in people with cystic fibrosis. However, there is growing interest in non-medical treatments for cystic fibrosis and researchers may wish to investigate the impact of this inexpensive therapy on respiratory function and psychosocial well-being further in the future.

Read the full abstract...
Background: 

Cystic fibrosis is a genetically inherited, life-threatening condition that affects major organs. The management of cystic fibrosis involves a multi-faceted daily treatment regimen that includes airway clearance techniques, pancreatic enzymes and other medications. Previous studies have found that compliance with this intensive treatment is poor, especially among adolescents. Because of both the nature and consequences of the illness and the relentless demands of the treatment, many individuals with cystic fibrosis have a poor quality of life. Anecdotal reports suggest that singing may provide both appropriate exercise for the whole respiratory system and a means of emotional expression which may enhance quality of life. This is an update of a previously published review.

Objectives: 

To evaluate the effects of singing as an adjunct therapy to standard treatment on the quality of life, morbidity, respiratory muscle strength and pulmonary function of children and adults with cystic fibrosis.

Search strategy: 

We searched the Group's Cystic Fibrosis Trials Register and the Cochrane Central Register of Controlled Trials. Date of latest search: 18 February 2016.

We also searched major allied complementary data bases, and clinical trial registers. Additionally, we handsearched relevant conference proceedings and journals. Date of latest search: 18 February 2016.

Selection criteria: 

Randomised controlled trials in which singing (as an adjunct intervention) is compared with either a control intervention (for example, playing computer games or doing craft activities) or no singing in people with cystic fibrosis.

Data collection and analysis: 

Results of searches were reviewed against pre-determined criteria for inclusion. Only one eligible trial was available for analysis.

Main results: 

Since only one small study (n = 40) was included, no meta-analysis could be performed. The included randomised controlled study was of parallel design and undertaken at two paediatric hospitals in Australia. The study evaluated the effects of a singing program on the quality of life and respiratory muscle strength of hospitalised children with cystic fibrosis (mean age 11.6 years, 35% male). While the singing group received eight individual singing sessions, the control group participated in preferred recreational activities, such as playing computer games or watching movies. This study was limited by a small sample size (51 participants) and a high drop-out rate (21%). 

There were no significant differences between the groups at either post-intervention or follow up; although by the end of treatment there were some within-group statistically significant increases for both singing and control groups in some of the domains of the quality of life questionnaire Cystic Fibrosis Questionnaire-Revised (e.g. emotional, social and vitality domains). For the respiratory muscle strength indices, maximal expiratory pressure at follow up (six to eight weeks post-intervention) was higher in the singing group, mean difference 25.80 (95% confidence interval 5.94 to 45.66). There was no significant difference between groups for any of the other respiratory function parameters (maximal inspiratory pressure, spirometry) at either post-intervention or follow up.

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