PARTECIPANTS
Over a 4-week period (from 15th April to 15th May 2021), all patients with SARS-COV2, hospitalized at Covid Hospital Bari, Italy were screend in the study.
Exclusion criteria were (a) age £18 years, (b) severe neurological or psychiatric conditions, (c) hearing impairment, (d) intubation.
Study protocol was approved by the Hospital Ethics Committee of Bari, (n° 6841-09/04/2021) and patients signed an informed consent form.
All methods were performed in accordance with the relevant guidelines and regulations
DESIGN AND PROCEDURE
A mixed-methods approach pre -post design was used to obtain and evaluate data in 2 areas: (1) the feasibility of delivering MT on site in the Codiv19 hospital and (2) the immediate effects of the intervention on patients’ HR, O2Sat, anxiety, receptivity, and satisfaction.
This study employed a patient-centered approach in which the music therapist (MTt) tailored interventions to patients’ individual needs in that moment (Bradt et al., 2016). An interactive relational approach of receptive MT (Bruscia, 1998a) (Grocke & Wigram, 2007), supplemented by adaptation of the Bonny Method Guided Imagery and Music in the medical setting (MED-GIM) was used (Bruscia & Grocke, 2002) 12.
Participants were assigned to control group (CG) or the music therapy group (MG) by computer simple randomization. Participants in MG received an individual bedside single session of receptive music therapy (RMT) by a certified MTt- GIM fellow in presence. Each session consisted of 4 parts:
(1) patient assessment and prelude to create a safe container in which the patient was able to disclose a concern, facilitating or encouraging a state of mind of wellbeing or enjoyment that is known to the patient 12;(2) induction by brief relaxation exercise to help patients find an image as the focus with a positive outcome; (3) music listening, prepared and selected by MTt on the basis of these steps, with dialogue between patient and MTt; (4) postlude to validate feelings and reinforce a positive experience 14.
Participants listened to the playlist with bone conduction headphones from Ipod® and volume was controlled by the MTt. The MTt tailored music for each participant was based on the results of patient assessment (Robb, Carpenter, & Burns, 2011). The MTt used music selected from classical music of the Western tradition, pop, rock, new age, soundtrack, light jazz
CG received standard care.
MEASURE
State Trait Anxiety Inventory Y-1(STAI-Y1) was used to measure how the subject felt in that moment. Subjects were asked to rate the intensity of their anxious feelings on 20 items on a four point scale: not at all, somewhat, moderately so, or very much so.
MG and CG were subjected to identical measurements of the parameters STAI-Y, HR and O2Sat.
STAI-Y values <40 defined absence of anxiety, between 40 and 50 mild anxiety, 51-60 moderate anxiety, and> 59 severe anxiety.
From the variables under study the parameter ΔSTAI-Y was derived, defined as the difference between the value of STAI-Y calculated at time T2 minus the value of STAI-Y calculated at time T0. Similarly, the parameters ΔO2Sat% and Δ H.R. were calculated. ΔO2Sat% was defined as the difference between the value of O2 Sat calculated at time T2 minus the value of O2Sat at time T0. ΔHR was defined as the difference between the value of O2Sat calculated at time T2 minus the value of O2Sat at time T0. STAI Y-1 was administered 5 min. before session (STAI Y-1 PRE) and 15 min. after session (STAI Y-1 POST) in paper form in MG and CG.
HR and O2Sat were recorded from the bedside monitor 3 times: start session (T0), 10 min. (T1), end session (T2). At the same time, STAI Y-1, O2Sat and HR were recorded in CG. Participants in MG were asked to fill in an optional open-ended question concerning their experience with RMT. Data collection was carried out by MTt and psychologist researcher.
STATISTICAL ANALYSIS
Continuous variables were expressed as Mean ± SD and median (IQ25, IQ 75) depending on whether they were with normal or non-normal distribution. The dichotomous or non-continuous variables were expressed as%. We verified the non-normal distribution of the continuous variables under study using the One Sample Kolmogorov-Smirnov test.
The dichotomous variables were compared with the Chi Square test.
Variables with normal distribution were compared with the Student's T-test for independent samples and variables with non-parametric distribution were compared with the Mann-Whitney U test. Non-parametric analysis was carried out by means of the Friedman test, and subsequently, if a significance emerged, the two-by-two comparison between the times was carried out with the Wilcoxon test.
To correctly classify the music therapy group with the control group, linear canonical discriminant analysis was used to create a model that optimizes the between sample classes and within-sample class distances. The cross validated accuracy percentage (CVA, %) was calculated.
All analyzes were conducted with the SPSS 23 software. Statistical significance was assumed for p value <0.050.