1. COCHRANE REVIEWS AND MUSIC THERAPY RESEARCH
Cheryl Dileo, PhD, MT-BC
Carnell Professor of Music Therapy
Director: Arts and Quality of Life Research Ctr.
Coordinator: PhD Program in Music Therapy

2. Basic issues to be addressed
How to understand Cochrane Reviews
Including important concepts such as bias
How to make use of this information in designing future research

3. Evidence-Based Practice
Strides being taken to accumulate high quality evidence in field of music therapy
Attempting to assure that procedures used in music therapy are:
Safe
Effective
Cost-Effective

4. Cochrane Collaboration
The Cochrane Collaboration
international network of individuals and institutions
review and analyze the best clinical trials
synthesize them into regularly updated systematic reviews and meta-analyses.
considered by many to be the Gold Standard, or the final word in the medical conversation on a topic.

5. Current Cochrane Reviews at Temple
Music for stress and anxiety reduction in coronary heart disease patients (Bradt, Dileo & Potvin) (2013)
Music therapy for end-of-life care (Bradt & Dileo) (2009)
Music therapy for acquired brain injury (2010) (Bradt, Magee, Dileo, Wheeler, McGilloway)
Music interventions for mechanically ventilated patients (Bradt & Dileo., 2010 update in press)

6. Music interventions for improving psychological and physical outcomes in cancer patients (Bradt, Dileo, Grocke & Magill) (2011) (being updated) Music for pre-operative anxiety (Bradt, Dileo & Shim) (2013)

7. Other Published Cochrane Reviews
Music during caesarean section under regional anaesthesia for improving maternal and infant outcomes (Laopaiboon, Lumbiganon, Martis, Vatanasapt, Somjaivong) (2009)
Music for pain relief (Cepeda,Carr, Lau, Alvare, 2013)
Music therapy for people with autism spectrum disorder Geretsegger , Elefant, Mössler Gold (2014)
Music therapy for Depression (Maratos, Gold, Wang, Crawford) (2008)
Music Therapy for People with Dementia (Vink,Bruinsma,Scholten) (2003)
Music therapy for people with schizophrenia and schizophrenia-like disorders (Mössler, Chen, Heldal, Gold, 2011)

8. Cochrane Reviews
Listening to music for improving sleep in adults with insomnia (Jespersen Koenig, Jennum and PetVuust, 2013
Music therapy for attention deficit hyperactivity disorder (ADHD) in children and adolescents (Zhang, Liu, An, You,Teng, Liu 2012)

9. Other Arts therapies
Art therapy for people with dementia Deshmukh, Holmes, Cardno, 2014)
Art therapy for schizophrenia or schizophrenia-like illnesses Ruddy, Milnes, 2005
Dance/movement therapy for improving psychological and physical outcomes in cancer patients (Bradt, Goodill, Dileo, 2011)
Dance therapy for schizophrenia (Ren, Xia, 2013)

10. Understanding Cochrane Reviews
Some Basics

11. Systematic Reviews
Systematic reviews seek to collate all evidence that fits pre-specified eligibility criteria in order to address a specific research question.
Systematic reviews aim to minimize bias by using explicit, systematic methods.
The Cochrane Collaboration prepares, maintains and promotes systematic reviews to inform healthcare decisions

12. Types of studies Cochrane reviews typically include
Randomized Controlled Trials
Controlled Clinical Trials

13. Library of Medicine definition
Randomized Controlled Trial
involves at least one test treatment and one control treatment,
concurrent enrolment and follow-up of the test- and control-treated groups,
in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table.

14. Library of Medicine Definition
Controlled Clinical Trial
Involves one or more test treatments
at least one control treatment,
specified outcome measures for evaluating the studied intervention,
and a bias-free method for assigning patients to the test treatment.

15. Reporting Results- Risk of Bias
In clinical trials, biases can be broadly categorized
selection bias,
performance bias,
detection bias,
attrition bias,
reporting bias and
other biases that do not fit into these categories.

16. A Common Classification Scheme for Bias
Type of bias
Description
Relevant domains in the Collaboration’s ‘Risk of bias’ tool
Selection bias.
Systematic differences between baseline characteristics of the groups that are compared.
Sequence generation.
Allocation concealment.
Performance bias.
Systematic differences between groups in the care that is provided, or in exposure to factors other than the interventions of interest.
Blinding of participants and personnel.
Other potential threats to validity.
Detection bias.
Systematic differences between groups in how outcomes are determined.
Blinding of outcome assessment.
Attrition bias.
Systematic differences between groups in withdrawals from a study.
Incomplete outcome data
Reporting bias.
Systematic differences between reported and unreported findings.
Selective outcome reporting (see also Chapter 10).

17. Understanding Results
Effect size
Confidence Intervals
Heterogeneity

18. Music for stress and anxiety reduction in coronary heart disease patients
Bradt, Dileo, Potvin, 2013

19. Music…CHD In Purpose: to assess the effects of On
music interventions with standard care
vs. standard care alone On
psychological responses
physiological responses In
people with heart disease.

20. Studies Included 26 trials- 1369 Ss 3 trials - music therapy
Representing US, Australia, Denmark, Hong Kong, S, Korea, Sweden, Iran
3 trials - music therapy
23 trials - music medicine

21. Music Medicine vs. Music Therapy
Use of music by medical professionals
No therapeutic process
No relationship established through the music
Primarily pre-recorded music listening
Trained/ Credentialed music therapist
Therapeutic process (assessment, treatment, evaluation
Relationship with pt through music
Range of music experiences

22. Data Analysis
Were there significant differences between patients who had music vs. no music/standard care?
What was size of difference? Small? Moderate? Large?
Did the studies differ significantly in their results? Homogenous or heterogenous?

23. Bradt, Dileo & Grocke, 2010) (Bradt & Dileo, in press)
Music Interventions for Mechanically Ventilated Patients
Bradt, Dileo & Grocke, 2010) (Bradt & Dileo, in press)

24. Music…Mechanically Ventilated Patients
PURPOSE
Compare the effects of standard care + music therapy or music medicine interventions
with standard care alone
on anxiety in mechanically ventilated patients.

25. Music…Mechanically Ventilated Patients
14 studies
USA (5) China (3) and 1 each from Taiwan, Canada, Germany, Netherlands, Turkey & France
805 participants
13 studies- music medicine
1 study-music therapy

26. Bradt, Magee, Dileo, Wheeler, McGilloway , 2010
Music Therapy for Acquired Brain Injury
Bradt, Magee, Dileo, Wheeler, McGilloway , 2010

27. MT/ABI Seven studies (184 participants, 54% male) All Music Therapy
3 US, 1 South Korea, 1 Germany, 1 Australia, 1 US and Germany

28. Bradt, Dileo, Grocke, Magill, 2011 BRADT, DILEO, MAGILL (IN PROGRESS)
Music Interventions for Improving Psychological and Physical Outcomes in Cancer Patients
Bradt, Dileo, Grocke, Magill, 2011 BRADT, DILEO, MAGILL (IN PROGRESS)

29. Music….Cancer Patients
29 studies (1880 participants; 33% male)
17 US, 6 China, 2 Italy, 1 Iran, 1 Spain, 1 Taiwan, 1 Vietnam
12 music therapy
17 music medicine
9 chemotherapy or radiation
8 surgery or procedure
12 general
4 pediatric

30. Music for Preoperative Anxiety
Bradt, Dileo, Shim (2013)

31. Music….Preoperative Anxiety
26 Trials (2051 Participants)
Inpatients, outpatients, emergency, non-emergency
Patients undergoing major as well as minor surgical procedures
General, endoscopic, gynecological, urogenital, orthopedic,cosmetic, caesarean, cardiac, opthalmic, septorhinoplastic, gastric

32. Music….Preoperative Anxiety
54% female; 46% male participants (Average 48.7 years)
Studies included
USA (9); Taiwan (5); Hong Kong (3); China (3); Turkey (2); Poland (2); Malaysia (1); Israel (1)
All studies classified as Music Medicine
Most with one minute listening session
2 with multiple listening sessions

33. Music Therapy for End-of-Life Care
Bradt & Dileo, 2010

34. Music Therapy…..EOL PURPOSE
To compare the effects of music therapy combined with standard care with
standard care alone, or
standard care and other therapies.

35. Music Therapy….EOL Studies Included
5 studies (175 participants, 49% male)
All Music Therapy
4 US, 1 Australia

36. Contact cdileo@temple.edu www.temple.edu/musictherapy