Cochrane Stroke is one of the oldest Cochrane groups and has produced nearly 200 reviews of various interventions for stroke and other types of brain injury. An update to one of these, in January 2017, examines the evidence on music interventions and lead author Wendy Magee from the Boyer College of Music and Dance at Temple University in Philadelphia, USA, tells us more in this podcast.
John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. Cochrane Stroke is one of the oldest Cochrane groups and has produced nearly 200 reviews of various interventions for stroke and other types of brain injury. An update to one of these, in January 2017, examines the evidence on music interventions and lead author Wendy Magee from the Boyer College of Music and Dance at Temple University in Philadelphia, USA, tells us more in this podcast.
Wendy: The team of us who worked on this Cochrane review are based in the USA and Australia and, between us, we’ve worked with people with acquired brain injuries for a total of nearly 60 years, and have seen dramatic benefits from music interventions for these people. However, it’s important to examine the effects formally and bringing the relevant research evidence together in this review allowed us to do so.
Previously, our review was limited to interventions delivered by trained music therapists alone but, for this update, we’ve added trials that used music interventions delivered by any health professional.
We now include 29 controlled trials, with a total of nearly 800 participants. This is 22 more trials than our previous review.
Sixteen studies tested rhythm-based methods to address gait or arm function in stroke patients. These studies used rhythmic auditory stimulation or cueing, or a modification of these, in which an external metronome beat is used to facilitate movements. Nine of the studies did this without music, while six embedded the external metronome beat in live or recorded music. The other thirteen trials in the review tested various other interventions, including listening to live or pre-recorded music, music-based voice training methods, songwriting, and active music-making on instruments and electronic devices.
We were able to pool the results of ten of the studies of rhythmic auditory stimulation, showing that this can improve gait in stroke patients and that the effect may be enhanced when a trained music therapist delivers the intervention and the metronome beat is embedded in music rather than being played without music. Based on two studies, we found that music interventions may be beneficial for improving the timing of arm function after stroke.
The existing evidence also suggests that music interventions may be beneficial for communication outcomes in people with aphasia following stroke, improving quality of life following stroke and improving mood states. But, we found no strong evidence for effects on memory and attention; and the data were insufficient to examine the effect of music interventions on other outcomes for people with other types of acquired brain injury.
Although the findings are promising and confirm our experiences with patients, further research is needed to strengthen the evidence base and resolve remaining uncertainties. For example, we’d like to see more randomized trials with people with acquired brain injuries. These studies should be large enough to detect the moderate differences that would matter to patients and should include outcomes such as cognitive functioning, mood and emotions, social skills and interactions, activities of daily living, and behavioural outcomes such as agitation, in addition to the outcomes we examined in this review.
John: If you’d like to find out more about the evidence that is already available, you can find Wendy’s review online at Cochrane Library dot com, with a simple search for ‘music and ABI’. That’s also the place to look out for future updates should these new studies be done.